key: cord-0714702-1ovko7ua authors: Tiosano, Alon; Hindi, Isaac; Bahar, Irit; Nahum, Yoav title: Continuity of ophthalmology education during a pandemic by combining video conferencing application with a slit-lamp camera date: 2020-11-18 journal: Can J Ophthalmol DOI: 10.1016/j.jcjo.2020.10.008 sha: 29f1c8da8b61e04e56cde2beec841b790320708c doc_id: 714702 cord_uid: 1ovko7ua nan the pandemic, owing to reduction in surgical exposure caused by shutdowns in elective surgery, the travel restrictions for international fellowships, job stress, and the postponed Royal College examinations. Importantly, most residents stated that they did not have adequate availability of surgical simulation or access to a wet lab to maintain their surgical skills. We recommend that this should be rapidly explored further by individual programs and rectified given the indeterminate timeline of the pandemic. Thankfully, despite the added stressors and changes brought by the pandemic, there was guarded optimism among residents, with the feeling that they would have adequate training and be competent ophthalmologists by the end of their residency. The 47.0% response rate, although high for national resident surveys, 3, 4 represents half of all residents, which limits generalizability of the results. As with most survey studies, information is subject to recall bias. There was more representation from larger programs in cities that had a larger prevalence of COVID-19. Andrei-Alexandru Szigiato,* Mathew Palakkamanil, y Marie-Josee Aubin,* ,z Setareh Ziai § We thank Dr. Majd Mustafa and Dr. Irfan Kherani for their help with survey review and distribution. The authors have no proprietary or commercial interest in any materials discussed in this article. Continuity of ophthalmology education during a pandemic by combining video conferencing application with a slit-lamp camera The on-going coronavirus disease 2019 (COVID-19) outbreak has dramatically changed the way of work and communication in health care. As of March 22, 2020, public hospitals in Israel have ceased to provide nonurgent office-based visits and surgeries, and the presence of faculty and residents is kept to a minimum. Clinical departments' staff is commonly divided into separate teams, to diminish their vulnerability in case of exposure to COVID-19 carriers. Worldwide, quarantine and social distancing regulations have now put new barriers between ophthalmologists, their patients, and their colleagues. 1,2 e44 As a result of COVID-19 epidemic, video conferencing tools have become crucial for remote worker collaboration, as well as for social and family communication. In Israel, physicians are currently using video conferencing applications for the purpose of conducting country-level professional tele-conferences and department-and hospital-level staff meetings. We report a technique that allows sharing high-resolution real-time slit-lamp video with multiple viewers simultaneously, by combining a slit-lamp camera with a video conferencing application. The free version of Zoom cloud meeting application 3 (Zoom Video Communications, Inc, San Jos e, CA), which allows meetings of up to 100 attendees, was installed in 2 different ophthalmology departments in university hospitals in Israel, onto standalone computers with WiFi capability, connected to Righton MW50D LED slit-lamp (Right group, Tokyo, Japan) and to the Elite SL9900 slit-lamp (CSO, Florence, Italy) cameras. The screen sharing option in the application allowed remote viewers to see a real-time highresolution video feed using a desktop computer or a smartphone, which displays the slit-lamp ophthalmic examination. Importantly, it enables the remote viewers to guide the examiner in adjusting slit-lamp properties (focus, magnification, location, slit aperture, etc.) to produce a desired image of the area of interest ( Fig. 1 and Video 1) . The technique is currently used by residents in 2 different university hospitals in Israel for the purpose of conducting consultations with one or more remote-based specialists. In our experience, this technique allows a much more reliable presentation of the clinical status than verbal description or static compressed smartphone pictures sent via WhatsApp application (Facebook, Inc, Menlo Park, CA). This technique can also allow the presentation of special and difficult cases by senior ophthalmologists to their peers, in lieu of specialist clinical meetings and grand rounds that are now impossible to perform. Additionally, video conferencing applications can be combined with smartphone-based examination using smartphone directly or with an adapter, for the basic examination of patients in corona-dedicated wards. 4 Naturally, the acquired video is limited by the optical properties of the imaging device, and although this technique allowed us to produce superb video images of the anterior segment, images of the posterior segment were of lower quality, contained reflections even with dilated pupil, and demonstrated a relatively small area of the ocular fundus. We believe that the same technique can be applied to fundus cameras better suited for this purpose, as well as to optical coherence tomography or other imaging devices. That being said, with clear media, and a small slit aperture, the optic nerve and the posterior pole could reliably be seen even through a nonmydriatic pupil (Video 2). Although many video conferencing applications are available, notably the Zoom software offers HIPPA (Health Insurance Portability and Accountability Act)/PIPEDA (Personal Information Protection and Electronic Documents Act) compliant plans (priced at $200 a month), 5 and use end-to-end encryption. In conclusion, although escalating isolation and quarantine measures are implemented worldwide, and the end is nowhere to be seen, it is our hope that our initial experience with this simple and affordable technique can help ophthalmologists to communicate reliably and efficiently, while minimizing the exposure of patients and medical personnel to COVID-19. The authors have no proprietary or commercial interest in any materials discussed in this article. Telemedicine for postoperative consultations following vitrectomy for retinal detachment repair during the COVID-19 crisis: a patient satisfaction survey The most recent World Health Organization (WHO) report on the coronavirus disease 2019 (COVID-19) pandemic confirms a total of 4 013 728 cases, with a death toll of 278 993. 1 The staggering number of deaths has thrust us into embracing telemedicine within ophthalmology, with the increased use of video and telephone consultations, to reduce the risk of virus transmission. 2 At our tertiary eye unit, we continue to provide a 7-day-a-week emergency retinal surgical service; however, our postoperative review has been modified to include telephone consultations, rather than face-to-face patient contact. As part of an ongoing plan to transform the vitreoretinal emergency service, we conducted a survey of patient perspective on the use of telephone consultations to replace routine postoperative review as a possible long-term plan. We conducted a retrospective patient satisfaction survey of 53 consecutive patients who presented with a retinal detachment over a 6-week period since the beginning of the lockdown in United Kingdom on 23rd March 2020. All patients received a postoperative telephone consultation 2 weeks after COVID-19: A timeline of Canada's first-wave response Resident wellness in US ophthalmic graduate medical education the resident perspective Assessment of phonomicrosurgical training in otolaryngology residencies: a resident survey References 1. World Health Organization. Coronavirus disease 2019 (COVID-19): situation report Stepping up infection control measures in ophthalmology during the novel coronavirus outbreak: an experience from Hong Kong Zoom Video Communications website High-resolution direct ophthalmoscopy with an unmodified iPhone X Zoom Video Communications website Supplementary material associated with this article can be found in the online version at doi:10.1016/j.jcjo.2020.10.008.Alon Tiosano,* ,y Isaac Hindi, z, § Irit Bahar,* ,y Yoav Nahum* ,y *Rabin Medical Center, Petach Tikva, Israel; y Tel Aviv University, Tel Aviv, Israel; z Hillel Yaffe Medical Center, Hadera, Israel;x Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel.Originally received Sep. 15, 2020. Final revision Oct. 10, 2020. Accepted Oct. 16, 2020.Correspondence to: Alon Tiosano, MD; alon.tiosano@gmail.com.