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COVID-19 study examines true eye protection benefit

Eye protection could lead to a large reduction in coronavirus infection, according to a new study that found the protective measure dropped the chance of transmission by 10%.

The World Health Organization-commissioned comprehensive review was published in The Lancet this month, and sought to investigate the effects of physical distance, face masks, and eye protection on virus transmission in healthcare and non-healthcare settings.

The international research team conducted a systematic review of 172 observational studies across 16 countries and six continents, along with 44 comparative studies that were included in a meta-analysis, including 25,697 patients with COVID-19, SARS, or MERS.

The findings are said to be the first to rapidly synthesise all direct information on COVID-19 and provide the best available evidence to inform optimum use of three interventions to reduce the rate of infection.

The study compared the ‘absolute risk’ of viral infection or transmission for people with eye protection – such as a face shield or goggles – compared to those without.

It found those with no eye protection faced a 16% likelihood of contracting the virus, while those adopting the protective measure reduced their chances to 5.5%, equating to a 10.5% difference.

Overall, the study found the existing evidence supports physical distancing of two metres or more to prevent person-to-person transmission of COVID-19, while face masks also reduced the infection risk.

“Eye protection might result in a large reduction in virus infection”, the study noted, adding “a physical distance of more than one metre probably results in a large reduction in virus infection; for every one metre further away in distancing, the relative effect might increase 2·02 times.”

The study’s scientific lead was Mr Derek Chu, a clinician scientist in the departments of health research methods, evidence, and impact, and medicine at McMaster University and an affiliate of the Research Institute of St Joe’s Hamilton.

“There is an urgent need for all caregivers in healthcare settings and non-healthcare settings to have equitable access to these simple personal protective measures, which means scaling up production and consideration about repurposing manufacturing,” he said.

“However, although distancing, face masks, and eye protection were each highly protective, none made individuals totally impervious from infection and so, basic measures such as hand hygiene are also essential to curtail the current COVID-19 pandemic and future waves.”

Optometry Australia’s Infection control and COVID-19 factsheet June 2020 advises that optometrists should be prepared to use appropriate PPE, such as surgical masks, P2/N95 masks, gloves, eye protection and breath shields for the slit-lamp.

In its advice, RANZCO states there is strong evidence from other respiratory viral epidemics that wearing PPE, including mask and eye protection, minimises the risk of infection. It says ophthalmologists are likely to be at higher infection risk compared with the general population.

For theatre staff, the college says eye protection is recommended but at the surgeon’s discretion due to a compromised view through the operating microscope.

On 15 May, the Australian and New Zealand Society of Ophthalmic Plastic Surgeons advised that lacrimal surgery may be cautiously resumed in patients who are low-risk for COVID-19 infection using standard universal precautions including gloves, gown, eye protection and mask.