News & Thoughts

Thoughts from RetinaCare

Retinacare’s quarterly newsletter keeps you up-to-date with the latest in retinal care developments. The most recent issue is below, you can browse the archive by clicking the links to the right or subscribe by emailing info@retinacare.org.uk.

Newsletter January 2021

How the covid-19 pandemic has changed the way we work

I hope you are all keeping well and that your loved ones are safe and have not been affected directly by the pandemic. These are truly unprecedented times, and particularly challenging to all of us.

So what are we doing differently at Retinacare?

For a start we have seen an increase in the number of patients with retinal disease in particular retinal detachment, macular hole and epiretinal membrane. There is also some suggestion that non-attendance to scheduled appointments after the implementation of national lockdowns might have resulted in a disproportionately higher number of patients with macular haemorrhages secondary to macular degeneration. Fortunately, the local NHS trusts have kept going the local injection services for age-related macular degeneration and diabetic macular oedema which is so important to prevent vision loss from the most common but treatable macular diseases. In the NHS however, we have seen a number of advanced retinal detachments with proliferative vitreoretinopathy, either because of non-attendance (patients were shieling) or because the early signs of PVD and retinal break had not been spotted.

For patients who are shielding, I have been able to do video consultations in the private sector using a link though the “top doctors” website which works very well https://www.topdoctors.co.uk/doctor/hadi-zambarakji. For some patients, a telephone consultation is sufficient of course, but most have adapted to using face time or zoom so one way or another it is always possible to communicate with the patients reasonably well.

Most of you have provided a primary care service, which is so important and for which I know patients are extremely grateful. I have been very impressed with the quality of referrals of new patients with anterior segment images and OCT images, which is indeed so helpful so as to identify those that need to be seen promptly from the less urgent referrals.

In the private sector, at one point we had to prioritise patients who needed cataract surgery as the private hospitals had been providing some NHS services and would only allow surgery for patients who met certain priority levels. Everything changes daily of course, and at the moment this does not seem to be an issue. However, we are unable to do surgery under general anaesthesia at The Holly or The Spire London East Hospitals because of the concern for the possible need to recover a patient in intensive care. For 99% of patients who need cataract surgery however, surgery is done under local anaesthesia with or without mild sedation so this is not really a concern. I have however done any surgery that requires general anaesthesia for more complex procedures at the Hospital of St. John’s and St. Elizabeth in St John’s Wood which is a very useful back up.

Ophthalmic manifestations of Covid-19

A small number of articles have addressed the association between covid-19 and conjunctivitis but the true association remains unclear. Viral particles however, have been detected in conjunctival secretions of SARS-CoV-2 patients who present with conjunctivitis, which is likely to be another mode of transmission. To prevent ocular transmission, the importance of eye protection cannot be emphasized enough for all of us that manage eye disease and to the healthcare workforce in general.

In terms of the posterior segment findings, retinal vascular changes (mainly dot blot haemorrhages) have been reported in severely ill patients with covid-19 and are thought to be secondary to clinical comorbidities instead of a direct damage by SARS-CoV-2.

On this note, I would like to wish you all a safe and healthy New Year and I hope that by the time I write another newsletter, we would have all been vaccinated. Unfortunately, covid-19 is here to stay for a while and will change the way we do things long-term. For one we will most probably be wearing masks for some considerable time, but this is only a minor consequence if the dangers of covid-19 can be controlled with the current vaccination program.

With very best wishes to all

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