Commentary: Care for retinopathy of prematurity in the COVID-19 era: When the going gets tough, the tough get going.

On 11 March 2020, the World Health Organization (WHO) declared the coronavirus disease 2019 (COVID-19) a pandemic. This ongoing pandemic has had a significant impact on the health care industry, where clinical care was restricted to emergency conditions.[1] Sudden and unprecedented lockdown measures were taken to curb the spread of the disease, especially in the absence of vaccinations in the early stage of the pandemic. This resulted in the disruption of normal services by eye care providers as well. Retinopathy of prematurity (ROP) is one such disease that requires mandatory timely screening, multiple visits to the hospital, and close follow up to prevent blindness in premature babies. There was a lack of information on when to plan the visit, how to reach the hospital owing to travel restrictions, and what measures to be taken to prevent the spread of infection while delivering health care.[23]

To rise to the emergent situation, many preferred practice patterns were established and revised as new information improved the knowledge of the spread and nature of this virus. The All-India Ophthalmological Society made a joint consensus statement on preferred practices during the COVID-19 pandemic.[4] Medical and surgical conditions necessitating emergency treatment were enumerated. Due to its potentially blinding nature, ROP screening and its treatment with laser and anti-vascular growth factor (anti-VEGF) was one of the medical emergencies which needed to be treated even during the peak of the pandemic.[45] The Indian ROP society (iROP) also suggested detailed guidelines for ROP screening as well as follow up and treatment.[6] Some other modifications used by ophthalmologists for safe and effective treatment of ROP included daycare treatment, use of social distancing, prioritizing clinical care, family counseling via teleconference, use of aerosol containment box during laser treatment[7] and increased use of anti-VEGF for treatment of threshold ROP.[8]

The authors have discussed the impact of one such revised plan for the treatment of ROP.[9] Their plan included selective referral, longer follow-up intervals, use of the locally available workforce, and use of teleconsultation as and when available. More targeted screening and streamlined screening plans are the need of the hour to reduce the treatment burden of ROP. It is heartening to know that there was no incidence of transmission of SARS- CoV-2 between those cared for and the caregiver related to ROP care in this study. Thus, the treatment of the needy could be provided without any health hazards to the health providers, by following a carefully modified strategy.

The development of teleconsultation services in health care received an impetus during the COVID-19 pandemic. Development of teleconsultation facilities, if taken by the government of India and implemented through the network of government hospitals and primary health centers, would ensure that basic services reach the grassroots level, thereby avoiding needless blindness due to ROP. COVID-19 opened the doors to innovation and brought in a digital boom. Let us not lose momentum, and try to maximize the use of technology in health care.