Aerosol generation and potential COVID-19 pandemic during ophthalmic procedures

Team Lead: Saptarshi Basu

The chance of aerosol generation during various surgical and routine out-patient procedures in addition to those generated ubiquitously by patients and visitors pose a real threat for doctors and medical attendants.

In this regard, ophthalmologists from the Narayana Nethralaya collaborated with the Department of Mechanical Engineering at the Indian Instiute of Science to investigate suspected aerosol generation in several procedures such as phacoemulsification (cataract surgery), microkeratome (LASIK surgery), non-contact tonometry (glaucoma screening), oculoplastic procedures and vitreoretinal surgeries.

The Narayana team was headed by Dr. Abhijit Sinha Roy and involved Drs. Rohit Shetty, Naren Shetty, Luci Kaweri, Pooja Khamar, Nikhil Balakrishnan, Roshmi Gupta, Thirumalesh Mochi and Chaitra Jayadev. The IISc team was led by Prof. Saptarshi Basu and involved Dr. Prasenjit Kabi, Dr. Khusboo Pandey, Mr. Durbar Roy, Ms. Sophia M. and Mr. Abdur Rasheed. 

Clinical trials were emulated on optical benchtops and imaged using state-of-the-art high speed imaging. Droplet ejection was observed during these procedures. Using in-house image processing and standard models of aerodynamics, the final distance travelled by the distance was calculated which indicated the safety protocols to be followed for each procedure. Some of the findings have been published in the prestigious Journal of Cataract and Refractive Surgery while the rest are at various stages of submission.

The findings have also been well articulated in a series of videos produced and directed by Narayana Nethralaya team. The videos have been circulated amongst professionals as well as the general public to spread awareness regarding the safety of visiting ophthalmic centres during times of pandemic.

These investigations clearly showed that a majority of the ophthalmic surgeries, particularly phacoemulsification and cataract surgery, are highly safe procedures to conduct amidst the pandemic with minimum to no risk to patients and healthcare staff. Based on the findings of these studies, Narayana Nethralaya has further improved their safety protocols to give first priority to the safety of their patients and staff.

Rohit Shetty, Nikhil Balakrishnan, Naren Shetty, Prasenjit Kabi, Durbar Roy, Sophia Marie Joseph, Pooja Khamar, Saptarshi Basu, Abhijit Sinha RoyQuantitative high-speed assessment of droplet and aerosol from an eye after impact with an air-puff amid COVID-19 scenarioJournal of Glaucoma (2020) doi: 10.1097/IJG.0000000000001672 November 2020 – Volume 29 – Issue 11 – p 1006-1016  
Highlighted in the November-2020 issue of Journal of Glaucoma
Pooja Khamar, Rohit Shetty, Nikhil Balakrishnan, Prasenjit Kabi, Durbar Roy, Saptarshi Basu, Abhijit Sinha RoyAerosol and droplet creation during oscillatory motion of the microkeratome: a high-speed shadowgraphy assessment amidst COVID-19 pandemicJournal of Cataract and Refractive Surgery (2020)  DOI: 10.1097/j.jcrs.0000000000000326
Naren Shetty, Luci Kaweri, Pooja Khamar, Nikhil Balakrishnan, Abdur Rasheed#, Prasenjit Kabi#, Saptarshi Basu, Rohit Shetty, Rudy M.M.A. Nuijts and Abhijit Sinha RoyPropensity of aerosol creation during phacoemulsification: A risk assessment with high speed shadowgraphy amidst COVID-19 pandemic Journal of Cataract and Refractive Surgery (2020)  DOI: 10.1097/j.jcrs.0000000000000289

Youtube links:

High speed imaging setup
Non-contact tonometry
Droplet generation in syringing
Droplet generation in vitreoretinal surgery

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