The COVID-19 pandemic is truly “pan,” in that it’s everywhere. We’ve spoken with doctors from all around the world to get their perspective on ophthalmology in this confounding time, and have gleaned considerable wisdom from them.
In this article, we’re crossing continents and sharing views from Russia’s Dr. Boris Malyugin, India’s Dr. Reena Sethi and Canada’s Dr. George Beiko. Despite the geographical distance between them, they share similar views on many topics — though of course they differ on some.
The Global Ophthalmic Industry
The global ophthalmic industry is made up of its component parts in individual countries. How each fares contributes to the overall health of the industry. So, how is the industry faring in each of the countries our contributing doctors live in?
Moscow’s Dr. Malyugin (MD, PhD), president of the Russian Ophthalmology Society — among many other positions — noted that Russia has not imposed stiff restrictions on procedures like many other countries have done. “There was a general recommendation by the Prime Minister which was seconded by the Russian Ministry of Health and it involved reconsideration of our planning activities. Every clinic has its own internal rules,” he said.
He continued: “In our clinic, we agreed to address the primary emergency situations like retinal detachment, closed angle glaucoma, inflammation, coronal perforation, among others. We have a list of primary and second line emergency procedures in place. The second line includes intravitreal injections, which sometimes demand consistency to the current treatment protocol.”
As for ophthalmic companies in Russia? Dr. Malyugin sees substantial effects. “Their business will be quite significantly affected,” he said. “For instance, there are companies which are providing IOLs and there is no big demand for IOLs during this phase. As we are still in the early phase of lockdown and cannot comment on how long this will last, so we cannot say to what extent these companies will be affected.”
He further pointed out the gap in education that is taking place in Russia at the moment. “A lot of these companies are involved in the educational part of ophthalmology so that is also getting affected. With our clinics being almost closed and lack of work flow, this is also affecting the education of new ophthalmologists.”
India, of course, is also being affected by the coronavirus. With a massive and dense population, there’s a deep concern about the virus taking hold in densely populated areas. This will affect all parts of the medical sector, including ophthalmology.
Dr. Sethi (medical director, Arunodaya Deseret Eye Hospital, Gurugram, India) shared her views on how the ophthalmic industry in India would be affected. “I believe our bread and butter is routine cataract surgery, refractive surgery and other procedures that we do,” she said. “Now all that is going to come to a stop for a while and we do not know when we are going to begin our comeback with all these procedures.”
She continued: “There will also be trouble getting into intraocular lenses. If there is a patient who got lenses implanted from abroad and is facing issues with the other eye, there could be a problem getting the same lens as the supply chain is also affected. It is going to take a while, even after lifting the lockdown, for things to get back to normal. Economically, we are all going to be affected.”
What kinds of procedures are still available in India? Only those that are critically necessary:“Emergencies like sudden loss of vision, severe redness in the eye, sudden floaters, pain, acute conjunctivitis, or trauma to the eyeball,” she said.
Dr. Beiko (BM, BCh, FRCS(C)) of St. Catherine’s, Ontario and a lecturer at the University of Toronto, was perhaps more sanguine in his outlook — but still firmly cautious. Regarding business in Canada, he said: “I think most of the people are pushing to get back to the office. They are looking at ways they can protect themselves and the patients by means of wearing PPE and pre-screening patients.
“However, the reality is until we know the treatment or we know that the patients are immune, we are not going to get back to normal.”
When compared to the United States, however, he urged caution and likened re-opening to risky gambling. “I know that some of my American colleagues are pushing and they want to start doing refractive and cataract surgery at private centers,” he said. “However, I ask myself a question: ‘Why do you want to play Russian Roulette?’ You may not get it, your staff may not get it, but the next person who comes to your office and is 80-years-old may get it. So, unless there is a really good reason to see patients or until we have a vaccine or an effective treatment, I do not think we will go back to normal.”
A Return to Ophthalmic Conferences?
Speaking of normal, when will ophthalmic conferences come back? Will they come back?
Each doctor spoke on the topic.
Russia, like other countries, has been forced to cancel conferences and meetings. “The Russian Society of Ophthalmology meeting that was scheduled for June stands cancelled and we are now finding ways to substitute the meeting,” said Dr. Malyugin. “It’s not possible to substitute all the activities of the meeting, so we are thinking about rescheduling some of the activities and those will be placed online.”
Regarding the future of meetings, Dr. Malyugin expressed pessimism for in-person conferences but optimism for virtual conferences. “There will be a loss of attendees as most of the attendees attend these events in order to interact, meet friends and have lively conversations. With most of the meetings going virtual, it might fill up for that but maybe to a certain extent. It is a great way to continue interacting with these meetings online,” he said.
Dr. Sethi was straight to the point about conferences: She likes things being digital. “I think having webinars is a good platform. It is time effective and they are better managed. I feel we have to change the way we are practicing post-COVID,” she said.
Even if webinars are imperfect, they’re only going to get better. “I think we will get solutions that will make us feel that we’re in the conference hall and as close as we could be in real time. We will improve a lot of our digital efforts.”
Dr. Beiko is less sold on the idea of webinars replacing in-person conferences, as they lack the same level of intimacy. Face-to-face interaction is hard to replace.
“I do not think that webinars will take over completely from conferences,” he said. “We have had webinars before. We are relying on them now because we have no choice. I think the appeal of conferences is the human contact, meeting with your colleagues, meeting with your friends, talking to them, having coffee or drink, and interacting. Webinars certainly don’t allow that. A webinar is more of information being given to you and less of interaction. I am not sure if it will ever supersede a meeting/conference.”
When asked when he would feel comfortable attending conferences again, Dr. Beiko was uncertain. “I think once we have a treatment or a vaccine. I do not think this is going to finish and things will get back to normal all that quickly. First of all, we will see when we will start doing surgeries,” he said.
He continued: “Meetings are going to be down the line. It is going to be hard as a lot of societies rely on meetings to raise funds. The meetings that rely on industry support will certainly suffer in the short term.”
Perspective Is Key
It’s crucial to hear voices from all regions of the ophthalmic world to gain a full appreciation of the scope of the changes the industry faces. Here we’ve covered countries that span a huge portion of the globe and a huge percentage of the world’s population — and that’s just a start. Extrapolate the effects discussed here to the whole world and the picture comes more into focus.
We’re not out of the woods yet, but it’s possible we’re seeing the light at the end of the tunnel. The panic phase seems to be over and as “new normal” sets in, physicians readjust their expectations and practices to match. Here’s to hoping we all make it through okay and look back on this as a massive learning opportunity.
Editor’s Note: This story is part of the continuing “Q&A from Quarantine” series of CAKE Talks, where Matt Young (CEO of Media MICE and Publisher of PIE and CAKE magazines), during the time of COVID-19 lockdown reached out to KOLs and industry friends to evaluate and discuss the impact of this pandemic to the ophthalmic world.