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New mask guidance for ophthalmologists

RANZCO is now recommending that Australian ophthalmologists and their asymptomatic patients wear surgical masks during face-to-face consultations, in response to the emergence of evidence surrounding universal masking.

Until now, the use of personal protective equipment (PPE) by ophthalmologists seeing asymptomatic or non-COVID-19 patients has remained contentious, with the Australian Department of Health only recommending its use for healthcare professionals caring for suspect or confirmed cases.

RANZCO has previously advised that ophthalmologists use their own judgement for PPE use in asymptomatic, routine patients.

Last week, it stepped up its advice to recommend ophthalmologists in metropolitan Melbourne and the Mitchell Shire wear masks during all routine care and procedures, and eye protection during all procedures. Updated mask advice was extended to the whole of Australia on Monday 20 July after further review of the literature.

“When face-to-face consultations are required, both ophthalmologists and asymptomatic patients are advised to wear a surgical mask,” the college stated this week.

“Ophthalmologists should avoid touching patients directly and, if they need to, should wear disposable gloves or practise hand washing after each contact. Eye protection is preferable.”

However, it noted: “These general recommendations need to be determined on a case-by-case basis, taking into account the local prevalence of disease, local policies and importance of preserving supplies of PPE in Australia and New Zealand. If supplies are limited in a public health setting, ophthalmologists should be permitted to wear their own PPE, if they feel this is clinically justified.”

Sydney retinal surgeon Associate Professor Adrian Fung, who is on the RANZCO COVID-19 Taskforce and vice chair of the Clinical Standards Committee, told Insight the sector was now guided by stronger evidence in respect to masks.

He highlighted a review of healthcare workers from Mass General Brigham, the largest healthcare system within Massachusetts with more than 75,000 employees. It demonstrated a linear reduction in SARS-CoV-2 positivity rates from 14.65% to 11.46% after the implementation of universal masking for healthcare workers and patients.

This was despite a state-wide increase in COVID-19 cases during the same period, according to the study which was published in the Journal of the American Medical Association (JAMA).

Surgical masks are currently recommended for ophthalmologists seeing asymptomatic routine patients in the US, UK, China, Italy, South Korea and Singapore. They are recommended in some, but not all local health districts in Australia for healthcare workers caring for patients in a vicinity closer than 1.5 metres.

RANZCO states that it is likely ophthalmologists are at higher risk of infection compared with the general population.

An American Academy of Ophthalmology article from April highlighted a total of 28 eyecare professionals from 10 hospitals in Wuhan, China, who contracted COVID-19. This included 14 ophthalmologists, 12 ophthalmic nurses, and two ophthalmic technicians. Eight patients (28.5%) demonstrated severe disease, including 3 deaths.

There is currently no reporting system of COVID-19 infections in healthcare workers in Australia.