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Up Front: Chief Medical Editor's Page | Sept 2020

What Have We Learned?

In the relatively recent past, our understanding of the COVID-19 pandemic was frighteningly incomplete, making planning of any sort difficult or impossible. Looking back over the past half-year with the benefit of hindsight, it's easy to forget that the prevailing wisdom regarding the pandemic shifted daily, and opinions regarding the seriousness of its threat ranged from a mild flu outbreak to a zombie apocalypse. Even today, there is still a broad spectrum of views regarding the best course of action for the next several months, the impact of potential vaccines and new treatments, and the pandemic’s overall course.

As partial and near-complete shutdowns followed the virus's geographic spread, we physicians reacted to the immediate ongoing needs of our patients while contemplating what an eventual return to normal practice would look like. Each time we formulated a plan, the ground shifted and a new reality emerged. We truly had no idea what awaited us only a few weeks into the future, and long-term planning felt like folly.

It seems so long ago, but in the spring of 2020, we did not know if the routine clinical and surgical practice of ophthalmology would subject many of us and our staff members to extreme infection hazards. Without a doubt, members of our profession have been affected by SARS-CoV-2, in some cases severely so. Still, it now seems clear that, with proper safety protocols, it is possible to examine and operate on patients safely without contracting the virus. Although I have no evidence to support this, it seems that the risk of contracting the virus is lower in a highly controlled clinical setting than elsewhere. I feel safest in the surgical environment, where our control of barrier protection, masking, and sterility is at its highest.

Another unknown early in the year was the future demand for cataract surgery in general and with premium lenses in particular. Many predicted a major collapse in premium lens demand due to economic turmoil and business closures. As is the case in all economic upheavals, some of our cataract patients are experiencing severe economic difficulties while others are doing quite well. Certainly, too, there are regional variations in demand.

In my own experience, however, and among a reasonably large sample of practices across the country, demand for premium lenses is now at record levels. Some of this may represent a backlog as a result of the shutdown, but it now seems clear that our patients view the value proposition of these lenses favorably, and the pandemic has created an ideal window of downtime in which to have surgery. A new generation of presbyopia-correcting IOLs is also boosting the market to new levels, as improved outcomes translate into patient-to-patient referrals.

Similarly, refractive surgery is doing reasonably well, especially considering that it is truly elective surgery. While many young patients are struggling financially, and many are out of work, others are busily working remotely. Perhaps the reduction or elimination of travel, dining out, and clothes shopping has made room in the monthly budget for laser vision correction.

I profess no special predictive powers for the next several months, but I’m sure they will be interesting. At the time of this writing, two SARS-CoV-2 vaccines have been approved internationally, and several are in phase 3 trials in the United States and elsewhere.1 It seems likely that we will see expedited approval of at least one vaccine by the end of this year.2 A safe and effective vaccine could change everything, but it is premature to declare victory. Thus far, ophthalmology has weathered this storm reasonably well.

Let's hope that our future challenges pale in comparison to those we have faced this year.


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