A lot of ups and downs

Thomas Kohnen MD, PhD, FEBO spoke with EuroTimes editor Sean Henahan, giving us an update on the coronavirus situation in Germany. Prof Kohnen is professor and chairman, Department of Ophthalmology, Goethe University, Frankfurt, He is editor of the Journal of Cataract & Refractive Surgery and former president of the German Ophthalmological Society (DOG) and former president the DGII [German-speaking Society for Intraocular Implantation, Intervention and Refractive Surgery. First of all, how are you doing? I’m fine, but there are lot of ups and downs. We have prepared as much as we can. Germany is basically shut down, nobody should go out of the house. German guidelines now say you can’t have more than two people together. We have stopped short of the last step, where everyone is forced to stay home and not go anywhere. From our perspective, most of the German people understand this, but not everyone, which is a problem. The police can’t do, it is the responsibility of every citizen of Germany. What is your day-to-day situation now and how have things changed in recent days? We have a very special situation, I am at a university clinic in the middle of Frankfurt. We have seen a big change in the last two weeks as we prepare for the COVID patients, those who have to be in intensive care. We as ophthalmologists don’t have much to do with this effort at the moment. We have cancelled all of our elective surgeries. We have gone from seeing 50-60 cases a day in our clinic to seeing only emergency cases. This includes retinal detachments, perforated globes, cases that need treatment because of pain. We are still doing some cases requiring intravitreal injections. At this point, we are conserving our resources such as masks for emergencies. We also want to keep the older people at home. However, some of these older patients made decisions on their own that they do want to be treated to preserve vision. We also see emergency cases in the ambulatory clinic. We have to titrate care in the ambulatory clinic. We find out why they came in, and a senior ophthalmologist decides if they need immediate care, or can go home. For example even if a patient comes in with really bad dry eye we would send him home with some drops and ask him to come back when the circumstances allow this. The current situation also requires logistical changes for my staff. Some have to stay home, or take over hours. It is very difficult just to keep everything running. When you do have an emergency, what is the protocol? We have a protocol for COVID and non-COVID patients. We take the temperature and ask questions. If we don't have signs, we treat them. If it is a COVID patient with the recognised signs, we would not treat him in the eye clinic, we would transfer directly to our COVID clinic, which was just constructed over the last seven days. This is where we have the emergency cases, as well as those under treatment. We have not had an emergency eye COVID case so far. Are ophthalmologists being asked to work in clinical areas beyond their specialty skills? Not yet, but I have already prepared some steps for this. As physicians, when the time comes we will do whatever we can. I’ve spoken to local hospitals and to the heads of other departments and I feel that we are all prepared (at least what we currently know). But number one is to protect our staff, and have protocols for this. Do you have enough personal protection equipment? At the moment we do. We had a donation from a company of 800 FFP3 masks. Looking ahead, this will be a big logistical problem. You are at one of the busiest teaching hospitals in Germany. What is the impact of the crisis on training the next generation of ophthalmologists? There is a big impact. We have had to cancel conferences including the AAD, an annual teaching meeting in March in Düsseldorf with 7000 attendees. We try to do the best for our residents. They know there is a problem. We are not allowed to do teaching, as we have been preparing for COVID. We have few cases. The residents are not complaining. In our system, in contrast to the US, most residents are doing less surgery in the beginning of their education and are doing more in the clinic. We can do other things, learning by studying texts and watching videos. Once we are past the peak of the crisis we will come up with ideas and may even be able to improve on what we were doing before. Your department is noted for research. What has been the effect of the crisis on ongoing research? This is a problem. We want to keep patients in the trials under way, but some of them don’t come in, but we do what we can. We prepare but can not really start any new trials at the moment. But because we have more time, there is the opportunity to catch up on the documentation side of research. Do you have any COVID research under way? Yes, just this month in the ophthalmology department we have started some research. We are working with virologists and those in intensive care. People are so busy preparing for the catastrophe that they have little time to think about this. Once we are over this we can start. Now we might collect some samples and store them for later. We are also working with Prof Rudy Nuijts (President of the ESCRS) in the Netherlands to do some multinational projects. You are also the editor of JCRS. What is status of the journal? The journal is ongoing. My secretary works from home and we continue to review and edit manuscripts online. We have a system working with our ESCRS and ASCRS offices to keep the flow of manuscripts going. Indeed, we have a little more time to do what we need to do because of what is going on. It is running very smoothly. What are your thoughts for colleagues in other areas? This is a very tough time. Everybody is afraid, I’m afraid as well, for my family, for my peers, for everybody around me. We will get through it. Many things will change and we will see things differently. We need to stay positive, do our jobs and keep going. We will need to find ways to come back. I hope that laboratories all over the world will soon develop treatments and vaccines. Let’s hope we can all get together in Amsterdam in October for the ESCRS Congress and in Las Vegas for the AAO. My hope is that we can all restart ophthalmology, doing research, sharing our friendships together, and bringing this field forward.

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