Italian ophthalmologists must show courage

Italian ophthalmologists say the situation in their country is a disaster but they must show courage. Colin Kerr and Sean Henahan report

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Dr Roberto Bellucci
Distinguished Italian ophthalmologist and former ESCRS President Dr Roberto Bellucci says in the north of Italy, where he practices, ophthalmology is closed. “All the people are staying at home and there is little sign that the infection will subside. "The problem is particularly bad for patients with macular degeneration who cannot receive their monthly injections," said Dr Belucci. "My message to my colleagues in ophthalmology is that everyone of us will have to decide what type of care should be carried out and we should find the courage to do surgery for patients with retinal detachment, trauma and other emergencies,” he said. The outbreak of COVID-19 in Europe began in northern Italy where Prof Bellucci, MD, practices in the city of Verona. The first cases in Italy were reported in mid-February, and as the number began to rise quickly. The government soon imposed a lockdown that brought ophthalmology care to a standstill. “Ophthalmology in hospital settings in northern Italy is completely locked down as all hospital departments were converted to the care of COVID-19 patients. The lockdown is affecting both private and public hospitals, and the very operating theatres in these facilities are being used as intensive care units to save the life of the most seriously ill virus patients,” said Dr Bellucci. Ophthalmology trainees in Italy, who include Dr Bellucci’s son, are now working as general practitioners taking care of infected patients. “Teaching is suspended, and we do not know when it will begin again,” Dr Bellucci said, adding that the entire year 2020 may be lost for ophthalmology training. Patients with ophthalmic emergencies or who require a small invasive procedure, such as for removal of a corneal foreign body, can still be seen in hospital emergency departments. Fear of contracting the coronavirus infection, however, keeps patients from coming, Dr Bellucci observed. Ophthalmologists in private practice are seeing patients for emergencies and relying on each other to provide the necessary service. “We continue to phone colleagues until we find someone who can schedule a surgical appointment. The opening may require that the patient travel to another city, and with such limited availability, a wait time of at least 1 week is common for a patient needing repair of a retinal detachment,” Dr Bellucci said. To protect themselves and patients, practices are following proper disinfection methods, using personal protection equipment, and following a strict scheduling limit. Despite those precautions, patients are staying away. “We allow just one patient per waiting room per hour in our clinic,” Dr Bellucci said. “The request for appointments, however, has been very low. In total, we see just 10 to 12 patients a week.” Future impact The inability to provide care could have devastating consequences for some patients, Dr Bellucci said. In particular, he expressed concern about the prognosis for patients who had been receiving intravitreal injections to control exudative age-related macular degeneration. “This treatment, which was 100% public, is no longer available to patients,” Dr Bellucci said. “Depending on how long the lack of access continues, some patients will probably suffer permanent damage and loss of vision.” Dr Bellucci said he is also worried about how the ophthalmology workforce will be able to address the need for services once the crisis is over. “Each public facility has cancelled thousands of appointments for visits, intravitreal therapy, and cataract surgery. We do not know how we will meet this accumulating demand considering that the wait time for future appointments was already extending for months,” he explained. “We can expect that our dedicated doctors and nurses will step up as much as they can to take care of this situation. There is a limit to what can be done, however, and we cannot ask our providers to double their work hours for months to come.” Research was already suffering in Italy because of the country’s incredible bureaucracy, and Dr Bellucci said he expects nothing will change in that regard after the crisis is over. Ophthalmology practice itself, however, may be changed forever. “Nothing will be as it was,” Dr Bellucci predicted. “Because of COVID-19, we will see practices restructuring their waiting rooms to avoid crowding, and we will probably see requirements issued by the government authorities. Maintaining proper distancing between patients will translate into a decrease in the number of patients we will be able to see.”
Tags: covid-19, covid-19 italy