Care of ophthalmological patients during the COVID-19 pandemic: A rapid scoping review

Medwave. 2020 May 13;20(4):e7902. doi: 10.5867/medwave.2020.04.7902.
[Article in Spanish, English]

Abstract

Introduction: A new type of coronavirus (SARS-CoV-2) causes a respiratory distress syndrome that has been called COVID-19 and has generated an unprecedented pandemic. Serious complications include pneumonia, and mortality ranges from 2 to 5%. Until March 26, the World Health Organization reports 462 684 confirmed cases and 20 834 deaths worldwide. Dissemination occurs from aerosols or respiratory droplets. Different scientific societies have published clinical practice guidelines regarding ophthalmic care in the COVID-19 pandemic, but the information is presented inconsistently, which makes decision-making difficult.

Methods: We conducted a sensitive bibliographic search in EMBASE and ophthalmic society webpages, of the clinical practice guidelines of ophthalmic care in pandemic COVID-19. We extracted the recommendations, organizing them into three categories: "Which patients to attend", "How should the clinic work", and "What interventions should be avoided". For each guideline, we assessed whether the search was systematic and whether the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was followed.

Results: Fourteen relevant articles were found. Fifty-one recommendations were extracted and are shown in a summary table. None are based on a systematic search for evidence, nor do any use GRADE to develop the recommendations.

Conclusions: The clinical practice guidelines that we reviewed all recommend rescheduling all non-urgent consultations and surgeries, reinforcing contact precautions, the use of personal protection elements, and the disinfection of surfaces and instruments. The guidelines should be improved by incorporating systematic searches for evidence, using GRADE for recommendations, and Appraisal of Guidelines for Research and Evaluation (AGREE II) for reporting.

Introducción: Un nuevo tipo de coronavirus, denominado SARS‐CoV-2, puede provocar patología respiratoria, denominada COVID-19, y ha generado una pandemia sin precedentes. Las complicaciones graves incluyen neumonía y la mortalidad oscila entre un 2 a un 5%. Hasta el 26 de marzo de 2020 la OMS informó 462 684 casos confirmados, y 20 834 muertes en todo el mundo. Se transmite por aerosoles o gotitas respiratorias. Distintas sociedades científicas han publicado guías de práctica clínica respecto a la atención oftalmológica en pandemia COVID-19. Cada una expone la información de manera diferente, lo que dificulta la toma de decisiones.

Métodos: Realizamos una búsqueda bibliográfica sensible en EMBASE y dirigida en sociedades oftalmológicas de guías de práctica clínica de atención oftalmológica en pandemia COVID-19. Extrajimos las recomendaciones, organizándolas en tres categorías: "qué pacientes tratar", "funcionamiento del policlínico y consulta" y "qué intervenciones evitar". En cada una se evaluó la búsqueda sistemática de evidencia y el uso en las recomendaciones de metodología Appraisal of Guidelines for Research and Evaluation, GRADE.

Resultados: Se encontraron 14 artículos relevantes. Se extrajeron 51 recomendaciones, elaborando una tabla resumen. Ninguna efectuó búsqueda sistemática de evidencia, ni incorporó GRADE en las recomendaciones.

Conclusiones: Las guías de práctica clínica revisadas comparten los principios generales de reprogramar toda consulta y cirugía no urgente, reforzando las precauciones de contacto, el uso de elementos de protección personal y desinfección de superficies e instrumentos. Se deben mejorar las guías de práctica clínica incorporando búsquedas sistemáticas de evidencia, usando metodología GRADE para las recomendaciones y Appraisal of Guidelines for Research and Evaluation (AGREE II) para el reporte.

Keywords: COVID-19; Coronavirus; Pandemics; Practice Guideline; Ophthalmology.

Publication types

  • Systematic Review

MeSH terms

  • Betacoronavirus*
  • COVID-19
  • Coronavirus Infections / complications
  • Coronavirus Infections / epidemiology*
  • Coronavirus Infections / prevention & control
  • Diagnostic Techniques, Ophthalmological / standards
  • Equipment Contamination
  • Humans
  • Ophthalmology / methods
  • Ophthalmology / standards*
  • Pandemics* / prevention & control
  • Pneumonia, Viral / complications
  • Pneumonia, Viral / epidemiology*
  • Pneumonia, Viral / prevention & control
  • Practice Guidelines as Topic*
  • SARS-CoV-2
  • Sterilization / methods