Dear MSO Members,
 
This pandemic will probably have a greater and longer-lasting impact on the profession of Ophthalmology - yes, perhaps even more than for the respiratory physicians, contrary to what many people would think. As many sigh a relief with their new-found freedom in the recovery movement control order (RMCO), it is evident that there is still a healthy fear of catching SARS-COV-2 and rightly so as it is the fear of the unknown that is most worrying.

Parents and children rush in complaining of digital eye strain - all bearing the internal conflict of loving and loathing their gadgets all at once. Well, it seems the children are just loving it - steadily fuelling the myopia pandemic. Never before has there been a greater international catalyst to literally widen our bandwidth. Network providers can hardly cope with the global move towards being a more digitally social people - Air, food water & WiFi indeed. Augmented reality has already started rearing its head - adoption is inevitable.

Closer to home, most of us already have webinar fatigue - but on a positive note, never before have we been able to collect CPD points so easily - it only counts from next month though. Our own MSO AGM has to be held online as well and we hope that this level of convenience would attract more people to join with many important points which we need to address with the members.

ARTICLES

THE EFFECTS OF COVID-19 ON OPHTHALMOLOGY PRACTICE IN MALAYSIA

The novel coronavirus disease (COVID-19), as its name suggests, is a new virus that has never been isolated from humans, which affects the lungs and airway with high rates of infection and fatality. What was initially a mysterious virus causing severe pneumonia has now become a pandemic as declared by the World Health Organization (WHO) on 11 March 2020. Locally, we were not spared the brunt of this highly contagious virus with Malaysia initiating the Movement Control Order (MCO) on 18 March 2020.

How has this pandemic affected our field of ophthalmology? Profoundly and painfully. Dr Li Wenliang was a Chinese ophthalmologist who was initially vilified when he warned the public about the outbreak of a mysterious viral pneumonia. Dr Li sadly contracted the virus as well, and succumbed to COVID-19 after being hospitalized for 3 weeks.

The provision of eye services was greatly affected. Ophthalmologists are at high risk of infection as our consultations are usually done at close proximity to patients, thus potentially exposing ourselves to droplet transmission from an infected individual. We also usually face a high volume of patients during our outpatient clinics. There are reports that show conjunctivitis (one of the manifestations of COVID-19) may be indistinguishable from other viral causes and possibly be transmitted by aerosol. Eye surgeries such as phacoemulsification and vitrectomy are considered aerosol-generating procedures; thus, most eye practices saw a drastic decrease in surgeries. As a high percentage of infected individuals remain asymptomatic, and local transmission has steadily climbed, any patient walking in to see an ophthalmologist is a potential risk of infection to staff and doctors.

THE IMPACT OF COVID-19 ON OPHTHALMOLOGY TRAINING IN MALAYSIA

If there is one word that can describe Ophthalmology training in Malaysia during this period of Covid-19 pandemic, the word is PAUSED. Not only has it affected the post graduate training (both Master and FRCOphth) but also the MOH post-basic and subspecialty training.

In this article, I would like to describe the impact of Covid-19 pandemic at key areas of Post Graduate training.

I. Clinical and Surgical Exposure

Most of the designated Covid-19 hospitals are major teaching hospitals which had to temporarily shift their focus from teaching trainees to caring for Covid-19 patients. Training in hybrid and non Covid-19 hospitals too have been affected as the movement control order (MCO) significantly reduced the numbers of patients attending clinics and follow-ups.

At the same time, all elective surgery had to be postponed. Semi-emergency and emergency cases had to be done only by specialists to reduce complications and to avoid the need for additional follow-ups. Even as elective cataract surgeries are beginning to resume, the trend to limit the number of patients listed for surgery is being continued and is predicted to remain so until the end of the year.

Some of our trainees had to be redeployed to manage the surge of Covid-19 cases. They have been involved in screening activities in ED and in helping out in the COVID-19/SARI wards. Some of them have even volunteered to help out with the production of personal protective equipment.

All these changes significantly reduced our trainees’ contact hours with patients and the number of procedures and surgeries performed by them.

SUB-SPECIALITY FOCUS - Part 3: The BATTLE WITH REALITY: FROM MENTEE TO FUTURE MENTOR

Finally, everything is coming together, and all the years of pain and struggle seem like a distant memory; the exciting yet daunting prospect of being initiated into the world of sub-specialty awaits. But is the reality of practise as we have imagined? In this final part, we will get some advice and viewpoints from junior sub-specialists who will share their experiences in managing the leap in expectations and the challenges they have to face.

What is the biggest unexpected challenge you encountered after being posted to your new place and how did you manage it?

Ch’ng Tun Wang, MD: The biggest challenge I faced is the inability to fully apply the latest technology and innovations available. During our training, we had the opportunity to learn and be exposed to the latest treatment modalities in the field. Most of the new, fascinating and innovative ophthalmic technologies originate from developed countries and are often deemed not cost effective in the local setting which can be frustrating at times when treating patients.

Ling Kiet Phang, MBBS: The most significant obstacle for me is having to make important decisions for patients with an expected poor outcome. This is not easy. The patient pool in my center is larger than I thought and I have to ensure the quickest and best treatment options for my patients. With long waiting times for surgery, I have to decide when and whether to operate on poor outcome patients. With time and experience, I have learnt to identify my post-operative outcomes and it helps me to decide on the timing of surgery for the good and the poor outcome patients. Sometimes, I ask my mentors for advice on complex retinal cases. Learning never stops even after you are a sub-specialist.

Siti Norzalehawati Sapian, MD: For me, the most demanding and unexpected challenge was to find out that the place I was posted to wasn’t expecting my presence. There was lack of proper instruments, working space and lack of supporting staff members which are all vital to run the Paediatric Ophthalmology services. To add to my struggles, I had to deal with making crucial decisions in complex cases on my own. Nevertheless, nothing is impossible. With time, proper paperwork, and collaboration with a supporting team, I was fortunate to secure instruments and personnel that is crucial to the service. As what Ling mentioned earlier, learning never stops. I always have open discussions with my mentors when managing difficult cases.