April 2020


COVID-19 News you can use
Thoughts from members of the ASCRS Executive Committee

Nick Mamalis, MD
Outgoing President

EyeWorld reached out to members of the ASCRS Executive Committee for their thoughts amid the COVID-19 pandemic. Members of the Executive Committee come from different areas of the country and here provide their personal experiences with the crisis as well as messages of advice, hope, solidarity, and encouragement.
It’s difficult to talk about the accomplishments of the past year given the circumstances of the pandemic and the extremely difficult time people are going through now. It has affected everyone. It has affected all people everywhere in the world right now, so it’s difficult to sit back and consider some of the good things that happened within the society over the last year.
If we go back to a more positive time, that starts with the 2019 ASCRS Annual Meeting. I think that meeting a year ago was particularly exciting because we launched the new initiatives of the society. We had a new slogan at that point: “For surgeons. For you.” It wasn’t just a rebrand, but it reflects what ASCRS does.
This brings us to the point that ASCRS is the society for all anterior segment surgeons, and that includes not only cataract and refractive but also cornea and glaucoma surgeons. I think we made it clear exactly what the society represents and who we represent.
Over the course of the year, we put forward what ASCRS is about. The first mission of ASCRS is education. ASCRS is where anterior segment surgeons of all kinds can get content regarding surgical techniques, complications, new medications, and new IOLs. I think that education is a huge part of the mission.
Over the course of the year, we have been presenting our educational content, especially online, with things like webinars and online content that members and even non-members can receive.
Even in this terrible time that we’re in right now, ASCRS is still pushing to fulfill our mission to give education to surgeons. It may be in a different way because of the cancellation of the ASCRS Annul Meeting this year, but we still have a large amount of educational content that we’re going to get out to surgeons.
Another part of ASCRS is philanthropy. Through our ASCRS Foundation, ASCRS has continued to push philanthropic efforts and put resources behind these efforts. This includes things like Operation Sight and helping doctors who want to help the patients who don’t have the resources necessary to get surgery. I think this has been a nice way for ASCRS to help because surgeons don’t have to fly across the world; there are underserved areas in our own communities. The efforts of the Foundation, both international and domestic, allow surgeons to have the mechanisms in place and the resources to allow them to perform surgery on needy patients, sometimes within their own surgical centers and their own hospitals.
In the past year, we’ve launched the ASCRS Research Council. It will be very important in the future because we want to put a mechanism in place that will allow us to do major studies in areas that need huge numbers of patients and a large amount of participating doctors. Our first initiative is the TIME (topical vs. intracameral moxifloxacin for endophthalmitis) study. This is a huge effort that has been spearheaded by Doug Rhee, MD, who is putting together a large multicenter study across the U.S. The problem is that in the U.S., there is no intracameral antibiotic approved for single use to prevent endophthalmitis, so a lot of U.S. surgeons are not using this. This study is going to be very large, around 75,000 patients, and it’s a huge undertaking. We’re going to be using members’ surgical centers, academic centers, and partnering with the Veterans Affairs. This is going to be a very important study because this will allow us to prove that intracameral antibiotics can prevent endophthalmitis and allow U.S. doctors to get an FDA-approved medication that they can then use in their patients. This will hopefully be just the first of many potential studies that the ASCRS Research Council will put together.
In terms of the Journal of Cataract & Refractive Surgery, we just went through a major transition to a new publisher. Everyone at the journal has worked very hard over the past 6 months to make this happen and to make it happen seamlessly.
The fact that we’ve canceled the ASCRS Annual Meeting has been a huge hit to the society. But I’d like to end on a positive note and say that even in this hard time, ASCRS is going to be committed to our educational mission, and we’re going to do everything that we can to get content out to our members online without face-to-face interaction.
This pandemic is unprecedented. We’ve never faced a challenge like this. We’ve shut down all elective surgeries and shut down our clinics to all but urgent and emergent cases. How our membership is going to get through this is a huge challenge, and they need to know that ASCRS is there to help them. ASCRS is going to be there for members as we go through this incredibly challenging time.

Terry Kim, MD
Incoming President

This year certainly has not started out as any one of us would have expected. While I am deflated at not having the chance to open the 2020 ASCRS Annual Meeting in Boston as your incoming president, I also feel extremely fortunate to be hunkering down in my home headquarters in North Carolina together with my family, who are all healthy and safe. Like many of you reading this, I have witnessed a major downscaling of my ophthalmology practice and, of course, have concerns about when this will all start to turn around. We are certainly living in crazy times in this new era of pandemia that is affecting the daily life of every single individual in the world. As a people person, I have had a tough time adjusting from the handshaking, hugging, and mingling to the new norm of everyday communicating via “eye fives,” foot taps, and conference calls.
All of us have been inundated with new and evolving information regarding statistics, precautions, recommendations, etc., some of which have been changing on a daily and weekly basis. By the time this is published, I’m sincerely hoping we have more clarity on when we will get out of this crisis to some sense of normalcy. When I had to inform Duke men’s basketball head coach Mike Krzyzewski (a.k.a., Coach K), the winningest college basketball coach of all time and our special guest speaker for the Opening General Session, that we had to cancel our annual meeting for the first time in its history, he said something to me that made me smile and gave me hope: “Thanks, Terry. Great decision. Let me know if I can help you in any way as you navigate this new landscape. Please stay safe. Terry, it’s GREAT BEING ON THE SAME TEAM! Coach K.” We are indeed so lucky that all of us are on the same team, fighting the same battles against this novel virus. With the help of ASCRS and other organizations, we will get through this professionally and personally and move on to a brighter future ahead. Best wishes and stay safe, ASCRS Nation.

P.S. I thought I’d share the timeline that I’ve kept on my iPhone highlighting some of the activities related to COVID-19 and how it affected me and my family in such a short period of time. I encourage you to do the same, as I’m sure you’ll look back at this someday and say “Wow, it is amazing how things have progressed so quickly.”
12/31/19: China notifies WHO of a cluster of pneumonia cases and closes seafood market in Wuhan, the presumed epicenter
1/7: Novel coronavirus identified
1/20: First U.S. case identified in the state of Washington
2/7: Ophthalmologist and coronavirus whistleblower Dr. Li Wenliang from China dies
2/11: WHO labels coronavirus disease COVID-19
2/12: Coronavirus cases spike in South Korea 
2/21: Coronavirus cases spike in Italy
3/6: We cancel our spring break trip to Madrid to visit our daughter Ashley, who is doing her Duke semester away program there
3/8: Last-minute spring break ski trip to Utah
3/10: Duke decides to pull its students out of Madrid; we scramble to get a flight home for Ashley
3/11: WHO declares COVID-19 a pandemic
• President Trump bans all travel from European countries into U.S.
• ACC and NCAA cancel tournaments after Utah Jazz players test positive 
3/12: Ashley arrives home safely and in self-quarantine
3/13: We return home and all ski resorts close
3/14: Abrahmson Center, where my father is currently in hospice care, imposes major restrictions on visitors, causing me to cancel my biweekly trips to Philadelphia to visit him
3/15: Duke and local schools close and move to distance learning
3/16: Coronavirus cases spike in Spain
• Back to clinic at Duke Eye Center (a third of patients cancel)
3/17: Back to surgery at Duke Eye Center (half of patients cancel)
• ASCRS cancels its 2020 Annual Meeting
• Governor Roy Cooper closes restaurants and bars in North Carolina
3/18: The American Academy of Ophthalmology issues advisory with ASCRS endorsement to all ophthalmologists to cease providing any treatment other than urgent or emergent care immediately as a result of COVID-19
• Duke Medical Center cancels all elective clinic visits and OR cases
3/21: Coronavirus cases spike in New York City

Edward Holland, MD
Chair, Program Committee

Every one of us has been affected by the coronavirus pandemic. Our lives have been upended and changed, possibly forever. Unfortunately, we had to cancel the 2020 ASCRS Annual Meeting in Boston, as almost all non-essential meetings have been canceled worldwide.
I would like to thank the ASCRS Program Committee who put a tremendous amount of time, effort, and creativity into what was going to be an outstanding educational and social event. I would also like to thank the ASCRS Clinical Committee members and physicians who were part of the major symposia, paper sessions, and instructional courses who submitted their ideas and academic work that makes up our meeting. I also need to thank our industry partners for their continued support for this meeting. We will need great support from industry to help us recover as a profession and as an academic organization.
The ASCRS Annual Meeting is about innovation and reporting the progress we make in our great field of ophthalmology. Innovation is what drives our improved outcomes and efficient care for our patients. I am confident that our colleagues in internal medicine, infectious disease, pulmonary medicine, as well as the corporate world, will innovate to resolve this pandemic. We will see innovation for new and faster diagnostics, new and effective treatments, more efficient logistics, as well as a successful vaccine. The intelligence, drive, creativity, and cooperation of all of us will defeat this pandemic.
We must support our physicians, nurses, and technicians who are on the frontline and are at a significant health risk. We also need to support our employees and local community that face financial hardships.
Stay positive, be safe, and be well. Together we will defeat COVID-19 and get our lives back. We will also put on great educational events once again. I look forward to seeing everyone at the 2021 ASCRS Annual Meeting, April 9–13, in San Francisco.

Eric Donnenfeld, MD
EyeWorld Chief
Medical Editor

The world of ophthalmology has changed dramatically over the past several weeks with the COVID-19 pandemic. We closed 80% of our offices in mid-March, and we are only doing emergency surgery. A couple of second eyes in patients with significant anisometropia had cataract surgery and that was the end of cataract surgery. Our OR is open only for emergent cases such as retina, corneal perforations, and glaucoma.
We have opened four regional emergent offices that are staffed by a skeleton crew of office staff, a retina doctor, and a glaucoma doctor. We have a cornea person on call but not seeing routine cases. All of our offices are being cleaned several times a day, family members stay outside in their cars, and only the patient is allowed in the waiting or examining room. We have outfitted many of our slit lamps with homemade splashguards.
We are still following up with some postops from the last few weeks, but the busiest part of the practice is anti-VEGF retina injections. Our main OR does around 100 cases a day. But on a day in late March, there were two cases.
We have taken any physician over the age of 70 and are not allowing them to see patients for any reason. There are six people affected. We have about 100 ophthalmologists in the practice, and on any given day, only 10 are seeing patients. We have seven ODs in the practice, and they are not working at all.
Our biggest problem is we have had to close three offices because a staff member was exposed to someone at home with COVID-19, and we were forced to move to another office. The only offices that are open have retina capability.
We have had to furlough many of the staff. Partners are not taking a paycheck, and associates are continuing to be paid based on productivity (which is not a lot). We are continuing health insurance for all.
Our management is doing an exceptional job, and they could write a book about how to respond to a crisis.
I have an update twice a day with our management leadership, and we keep our lines of communication open with physicians and staff through frequent emails and personal calls when needed.
New York is exploding with new cases, and there is a sense of dread as hospitals are being overrun with new cases. Keeping the subways, theaters, and schools open so long was, in my opinion, a bad decision that is now affecting the entire population.
We are taking Draconian steps, but I think they are necessary, and we are confident we will come out the other side stronger than ever, but there is a good deal of pain right now. Most importantly, none of our staff or physicians has tested positive yet.
In summary, this is a time of concern in ophthalmic practices, and the key to our success is to limit exposure and continue our vigilant action plan to stay abreast of the Centers for Disease Control and Prevention and local department of health guidelines as they are released. The American Academy of Ophthalmology and ASCRS are sending out updates that very effectively detail the steps that should be taken in an ophthalmic office. My best advice to my colleagues is to stay home as much as you can with your family.

Richard Lindstrom, MD
Member at Large

The worldwide coronavirus (COVID-19) pandemic is unprecedented in my lifetime. No one who lived through the influenza pandemic of 1918–1919 is alive today, but it was even worse, with an estimated 40 million deaths.
Early outcomes, as far as mitigation and medical management, are in from several counties including China, South Korea, and Taiwan. In other countries, including the U.S., we are just entering the exponential phase of increasing cases, both in deaths and, fortunately, recoveries each day. There is much to learn by studying the course of this pandemic in countries ahead of us in onset and resolution.
The rise in cases appears to last 4–6 weeks and the recovery another 4–6 weeks. In total, it is about a 3-month process. So in regard to practice management, we can expect to have reduced schedules in our clinics and ASCs for March, April, and much of May, gear up in June, and be very busy July–December.
We at Minnesota Eye Consultants, open today only for emergency and sight-threatening disease management, are planning to stay home and work hard through the summer. The goal right now is to prevent the acute care hospitals from being overwhelmed by so many patients in respiratory distress that there are not enough beds, personnel, and respirators to care for them. We must attempt to flatten the curve of increasing citizens infected and also reduce the number of highly vulnerable individuals infected.
The most powerful tool is “social distancing.” In a nutshell: Stay home and stay well. If you become ill, you still stay home until you are ill enough to require hospitalization. In most cases, COVID-19 is no different than a mild case of the flu and can be managed at home. We can infect others for 3–6 days before we are symptomatic and for 6–12 days during the illness until our immune system locks it down. If while at home an individual develops pneumonitis with respiratory distress and persistent fever, it is time for a trip to the emergency room, with probable hospitalization. Otherwise, everyone, including the infected individual, is best just staying home and quarantining themselves for 14 days.
The skill of “social distancing” is foreign to most cultures and hard to enforce in a democracy, but some U.S. states and communities are managing well and others poorly. This will be a topic of intense study over the next few years, and we have much to learn.
Frequent hand washing, mask wearing in public, getting the routine influenza vaccine, and perhaps nutritional supplementation with vitamins C, D, and zinc, which appear capable of enhancing the immune system, are available to all. Other prescription medications are being investigated, but at this time, I for one am saving precious masks, hydroxychloroquine, and respirators for those truly sick, as we are not prepared for this pandemic, and there is a shortage of all three.
In the future, it will likely be wise for us all to have some N95 masks at home for our family, and if proven in prospective studies, a bottle of hydroxychloroquine on the shelf. It is hoped we will soon have a vaccine, but just like adenovirus-induced influenza, coronavirus will do its best to mutate every year and could be a challenge again as early as the winter/spring season of 2020–21.
For the ophthalmologist in the office seeing a patient with acute conjunctivitis, coronavirus can be considered much like adenovirus-induced pharyngoconjunctival fever (PCF), but with an RNA virus rather than the DNA adenovirus 8, 19, and 37. Read up on the diagnosis and management of PCF, and remember it is extremely contagious, so protect yourself like you would when seeing a case of epidemic keratoconjunctivitis (EKC).
ASCRS, while itself significantly stressed, will be working overtime to help the ophthalmic surgeon survive and recover from this pandemic personally, professionally, and financially. Let’s all pull together and remember this as one of our finer moments.

Elizabeth Yeu, MD
Incoming Secretary

Watching COVID-19 devastate lives across the globe has been beyond shocking. Under the most restricted quarantines in China, the disease spread required 3 months to control. In contrast, before our eyes, we are witness to more than 600 people dying daily in Italy due to the heightened peak in the disease spread curve from delayed quarantining. We can learn so much from these dichotomous disease spread curves. We are living and learning from all that continues to unfold. It is so important for each of us to individually and collectively self-quarantine as much as possible for all non-essential needs. It is a very ambiguous time for us as medical professionals and business owners. We are dynamically figuring out how to best care for our more acute patients within our four walls and from the community. Each medical practice has tens to hundreds of employees who we are also responsible for taking care of. The burden of those mouths we have to feed is a heavy one in this reality, and there is no easy answer on how to handle this conundrum. I continue to struggle with the realities of our foreseeable future. As a pragmatist, I think we need our national and state executive leaders to enforce stringent quarantines in order to flatten the curve of and control the duration of the disease spread. We are living in unprecedented times. I’m anxiously look forward to getting back to the normal swing of things, although it will undoubtedly reset to a different daily norm.

Thoughts from members of the ASCRS Executive Committee Thoughts from members of the ASCRS Executive Committee
Ophthalmology News - EyeWorld Magazine
283 110
283 110
True, 4