key: cord-0683223-696b6mny
authors: Moussa, George; Mandal, Priyanka; Mathews, Namita; Lee, Rynn
title: Quantifying examination distance in ophthalmic assessments
date: 2020-05-20
journal: Eye (Lond)
DOI: 10.1038/s41433-020-0978-x
sha: 1ca52794eaa0cb0291c594c20a8caaa861c33d38
doc_id: 683223
cord_uid: 696b6mny

nan

In response to 'Controversies regarding mask usage in ophthalmic units in the United Kingdom during the COVID-19 pandemic' [1] .

We read the above comment with interest. As of 2nd May 2020, COVID-19 has claimed 229,971 lives and there are over 3 million confirmed cases [2] . The World Health Organisation notes that transmission of the virus can occur via droplet spread within 1 m. As Ophthalmologists, examination and treatment at close proximity is our daily practice. Ophthalmic clinical reviews are currently classified in the same category as other specialties with minimal levels of personal protective equipment (PPE) advised. These recommendations also apply to prolonged procedures, such as slit-lamp laser treatment [3] .

Using a range of routinely employed ophthalmic equipment, we measured the nose-to-nose distance between the clinician and patient during these encounters. The measurements were repeated three times and a mean was taken (Table 1 ). Figure 1 is illustrative of common ophthalmic on-call referrals. An 81-year-old gentleman was admitted out-ofhours with suspected orbital cellulitis secondary to facial cellulitis. This necessitated bedside review by the on-call Ophthalmology registrar using a portable slit-lamp and indirect ophthalmoscope at a distance of 13 and 71 cm, respectively. The examination took several minutes to complete due to extensive oedema and patient discomfort. The patient also coughed at several points during the examination. This patient had not been deemed a COVID-19 suspect, nor was he in a high-risk area. At the time of his assessment, guidelines recommended that only a surgical mask and slit-lamp guard for COVID-19 suspected or confirmed cases was required. Public Health England (PHE) and the Royal College of Ophthalmology (RCOphth) now recommend the use of a fluid-resistant type IIR surgical mask, eye protection, disposable gloves, and plastic apron when assessing all patients, regardless of COVID-19 status. However, a recent survey of Ophthalmologist's reflected anxiety and a lack of confidence concerning COVID-19 exposure risk in an ophthalmic setting [4] . Consequently, standalone eye hospitals introduced PPE standards beyond recommendations from PHE and RCOphth, such as FFP3 respirators for all clinical staff in A&E [4] .

Ophthalmologists continue to provide emergency services during the COVID-19 outbreak. Bedside reviews lend to small distances, far less than 2 m, perhaps more often than appreciated. Measurements dependent on anatomical variance between clinicians and patients, and the nature of the examination. 

Controversies regarding mask usage in ophthalmic units in the United Kingdom during the COVID-19 pandemic

World Health Organization

Ophthalmologists RC of PPE requirements for ophthalmology

Survey of ophthalmology practitioners in A&E on current COVID-19 guidance at three Major UK Eye Hospitals