According to the American Academy of Ophthalmology (AAO), the virus that causes COVID-19 may be found in the tears and conjunctival secretions of patients with the infection. In addition, the fact that conjunctivitis is common in the general population increases the likelihood that ophthalmologists may be the first providers to evaluate patients infected with the new coronavirus. To learn more about the potential risks, we contacted Irene Kuo, chief of infection control at the Wilmer Eye Institute, Johns Hopkins Medicine and an expert in infectious diseases of the eye.

Can you comment on the risk factors that the AAO identified?

While there has been some viral RNA isolated from conjunctival secretions in patients with conjunctivitis and COVID-19, it’s questionable how transmissible it is. Respiratory droplets are still the primary mode of transmission, so there is some increased risk in that we’re sitting in such close proximity to our patients. I think it’s important to note that the doctor who sounded the alarm about this virus was an ophthalmologist.

What steps is Wilmer taking to help minimize the risk to faculty and staff?

Many of our patients are older and may not hear well, so they often have a tendency to get close to you when they talk. That’s one reason that advance screening can be helpful — screening patients before they arrive in our clinics. A lot of this screening activity falls to our call center to ask patients questions about things like upper respiratory symptoms and fever.

In our exam rooms, we’re wiping and disinfecting surfaces, including countertops, armrests, slit lamps and testing equipment between patients as before, but we’re also disinfecting surfaces in waiting rooms and ensuring there is adequate distance between seats in the waiting area. We’re taking measures to protect our mouths, noses and eyes by wearing masks and goggles or shields during patient care activities. In addition, slit-lamp breath shields help reduce exposure of employees and patients to aerosol-borne virus.

We’re also cutting back on the number of patients we’re seeing until transmission of the novel coronavirus becomes less of a threat. All of Wilmer’s ambulatory surgery centers are now closed, and Bendann Surgical Center is only performing urgent procedures such as retinal detachment repair. Telemedicine is offered in some cases, and doctors are able to screen patients over the phone to determine as best they can the nature of a patient’s needs — for example, whether telemedicine is appropriate, whether something can wait or whether a patient needs to be seen more urgently. Someone with glaucoma that’s somewhat tenuously controlled might be considered urgent, because that’s potentially vision threatening, whereas someone wanting cataract surgery is not considered urgent and will be asked to wait until a later time to schedule the procedure.

What would you say to employees who may be feeling especially anxious?

I think Wilmer employees should know that the doctors, managers and employees are on the same page. As satellite managers and division chiefs, we have almost daily conference calls. Since we’ve cut down on the number of patients we’re seeing for the time being, we’re able to limit the number of personnel that come to work. That includes doctors, too. We consolidate the patient rosters and have one doctor see patients rather than three different doctors. We’re also beginning to take temperatures as a screening precaution before patients enter the clinics. All of these precautions help minimize the risk to patients and staff. Johns Hopkins employees also benefit from the only red eye medical center policy in the nation, which I had previously developed for screening for another virus known to attack the eyes and lungs, just as this new virus does. We’re very invested in keeping our faculty, staff and patients healthy.