How 2020 has been the year when we’ve lost sight of the importance of everybody’s eyes… and what we can do to fix it
The Australian Society of Ophthalmologists has declared that everyone has the right to sight – and adequate eye protection – this World Sight Day, Thursday 8th October.
“2020 is the Year of Vision and on World Sight Day we are supposed to be urging people to be aware of eye health. 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” – Associate Professor Ashish Agar, Vice President of the Australian Society of Ophthalmologists (ASO).
World Sight Day is an annual day of awareness to focus attention on blindness and vision impairment, established by the World Health Organisation in 2000. 253 million people are blind or visually impaired with 90% being preventable or treatable if detected early.
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. Hence, in a pandemic, protecting the eyes should be just as important as protecting our mouths via face-masks or encouraging us to wash our hands.
“The eyes are one of the most susceptible but also one of the most manageable routes of coronavirus infection,” Associate Professor Agar said. But he is 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.
There have been 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 eyes1. The respected medical journal, 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”2. Even White House advisor Dr Anthony Fauci has recommended using goggles or eye shields if you want complete protection against COVID-193. A recent study has even found that wearing spectacles in a public, non-health care setting, conferred some protection4.
In Australia, distinguished 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. 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 is little evidence that an individual has been exposed5. Professor Cornoneo believes that, as this is where we think the virus enters the human body, that this could provide the opportunity for drug treatment in the early phase of infection. This would prevent the viral spread from the nasopharynx to other parts of the body.
Whilst 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, Associate Professor Agar insists that this more about the neglect of the entirety of 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 wellbeing 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 been unanimous in their call for proper PPE to protect healthcare workers.
It may be that the eye is key to understanding how we are infected by this virus and also to provide a portal for treatment. That we have been slow to react to principles from a century ago may help to explain why humanity has been held to ransom by a pesky piece of RNA.
“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. 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,” Associate Professor Agar said.
The History of Protective Eye Equipment
- The use of semi-transparent masks to cover and protect the eyes dates back to 1200 BC.
- The use of goggles for eye protection is thought to have begun in Persia in the 15th century when polished tortoise shells were used.
- The 17th century outbreak of the bubonic plague saw the emergence of doctors wearing beaked mask suits (a pre-cursor to today’s hazmat suit). Importantly, these suits also contained in-built spectacles to cover the eyes.
- The 1910 – 1911 Manchurian pneumonic plague also saw healthcare workers’ eyes concealed by goggles.
About World Sight Day
- 253 million around the world are blind or visually impaired and approximately 90% of visual impairment is preventable or treatable if detected early.
- The leading causes of blindness and vision impairment are:
- Refractive error 48%
- Cataracts 26%
- Macular Degeneration 4%
- Glaucoma 3%
- Corneal Opacity 2%
- Diabetic Retinopathy 1%
- All of these conditions can be detected and treated by your local ophthalmologist.
Associate Professor Ashish Agar is available for interview
For further information, please contact Sally Symonds, National Manager, Media & Communications ASO – 0417 727 625