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That’s the question being asked by the Australian Society of Ophthalmologists for World Sight Day. The ASO argues that 2020 has been the year when we’ve lost sight of the importance of everybody’s eyes, and they want to do something about it.

‘2020 is the Year of Vision and on World Sight Day we are supposed to be urging people to be aware of eye health,’ said Associate Professor Ashish Agar, Vice President of the Australian Society of Ophthalmologists (ASO).

‘The irony is that while we are telling the public to protect their eyes via an eye test today, our healthcare workers are putting their lives at risk every day because their eyes aren’t being adequately protected’, he said.

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World Sight Day

The second Thursday of October is an annual day of awareness to focus attention on blindness and vision impairment, established by the World Health Organisation in 2000.

in 2020, 253 million people are blind or visually impaired, with 90% being preventable or treatable if detected early.

The ASO want people to remember that our eyes are one of the largest exposed mucosal surfaces of the body, covered by membranes which form a barrier between our bodies and the environment.

Unfortunately, this barrier isn’t foolproof and can actually be a point of vulnerability for infection. In a pandemic, protecting the eyes should be just as important as protecting mouths via face-masks or encouraging hand-washing.

‘The eyes are one of the most susceptible but also one of the most manageable routes of coronavirus infection,’ said Associate Professor Agar.

He’s dismayed that healthcare workers are still being expected to work without adequate personal protective equipment (PPE), which includes eye protection such as visors, face-shields and goggles, despite numerous studies which support the use of eye protection as a vital component of adequate PPE.

Exposure Prevention Information Network Data found that 79% of all mucotaneous-related infections in hospitals were via the eyes.

The Lancet published a study in June this year which showed significantly higher rates of infection without eye protection in recent pandemics, stating that, ‘Eye protection might result in a large reduction in virus infection.’

White House advisor Dr Anthony Fauci has recommended using goggles or eye shields for complete protection against COVID-19, and a recent study has even found that wearing spectacles in a public, non-health care setting, conferred some protection.

In Australia, ophthalmologist Professor Minas Coroneo AO, a colleague of Associate Professor Ashish Agar at the Prince of Wales Hospital, has published a landmark paper detailing the science and history behind this concept.

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The eyes have it?

The idea that respiratory viruses likely bind to the tear film, pass through the tear duct and invade the throat was worked out in 1919 during the influenza epidemic.

This is quite sneaky, since only a small proportion of patients develop eye symptoms, as the tears are doing their job, protecting the surface of the eye. After exposure, because of rapid tear turnover, there’s little evidence that an individual has been exposed.

Professor Cornoneo believes that, as this is where we think the virus enters the human body, this could provide the opportunity for drug treatment in the early phase of infection, potentially preventing the viral spread from the nasopharynx to other parts of the body.

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Eye care health providers at risk

Ophthalmologists and other eye care health providers are at a much higher occupational risk for COVID-19 than other health care workers because of the close proximity in which they work, but Associate Professor Agar insists that this says more about the neglect of all healthcare workers that is currently happening worldwide.

‘When we become doctors, we swear the Hippocratic oath to prevent disease whenever we can because prevention is preferable to cure. We also swear to attend to our own health and well being in order that we can provide the highest standard of care to others.

‘This simply isn’t happening today,’ he said.

Medical groups including the AMA have been unanimous in their call for proper PPE to protect healthcare workers.

‘From an anthropological perspective, the adoption of adequate PPE during times of need has marked our transformation as a society: from ignorant and superstitious to educated and enlightened,’ said Associate Professor Agar.

‘How we have survived the Age of Reason, the Age of Progress, Modernism and even Post-Modernism only to have our approach to medical management flung back centuries into the past is something scholars of the future will have to decipher, but practitioners of today will have to live – or die – with,’ he concluded.