Eyes are the window to the soul; it is important we look after them
Patients critically ill with Covid-19 on The Queen Elizabeth Unit are receiving first-class eye care thanks to the ophthalmology team from The Royal London Hospital.
The eyes are our most developed organs and without them life would be more of a challenge. Even when patients are admitted to critical care with serious health complications, it is important their eyes are looked after, so they can continue to enjoy the world around them, if they get better.
During the Covid-19 pandemic the ophthalmology team used their expertise to ensure severely ill patients were able to do just that. In this interview we spoke to Mr Andrew Coombes, consultant eye surgeon, Caroline Severs, specialist optometrist and Leah Bogues, specialist orthoptist about how they have continued to care for eyes amongst the challenges of Covid-19.
How did the ophthalmology team respond to the call for help during the Covid-19 pandemic?
Mr Coombes: “During the pandemic, a lot of our routine eye care work was put on hold, and we were prioritising emergency care. Most of our junior doctors were formally redeployed across The Royal London, however our team of consultants, optometrists and orthoptists all wanted to help with the response as best as we could.
“The consultants and I were acutely aware of the risks to eye health for patients in critical care. Rather than assist as healthcare support workers, we could use our specialist skills to routinely check a patient’s eyes and prescribe any antibiotics if needed.
“When you are in a high pressured Covid-19 environment and you are doing all that you can to save someone’s life, eye care isn’t always at the forefront of a doctor or nurses mind. We wanted to help bridge that care gap with our knowledge.”
Caroline: “Our orthoptists and optometrists worked closely with Mr Coombes and our eye consultants by implementing eye care rounds once a day. We ensured that the eyes were lubricated and flagged any persisting issues to the consultants.
“Things can change very quickly, so our daily monitoring of a patients eye health helped to prevent further complications. A patient’s eyes may be OK one day, but exposure can get worse, in which case we would ensure that a consultant review was upcoming and recommend a prescription of antibiotics.
Leah: “We were teamed up with dental team and upskilled in mouth care too. The combination of dental and eye care rounds really helped the intensive care nurses, who already had a huge daily list of jobs to do. Having the skills to do both and help in a small way was very fulfilling.”
Andrew: “At one point there were around 150 patients in critical care, if we visited each of them, that would be around 10 hours of time we would save the intensive care nurses – it all mounts up!”
What are the risks to eye health for patients being treated in intensive care?
Mr Coombes: “There is a relentless need to protect the eyes of critical care patients as over exposure to air can cause exposure keratitis; patients aren’t able to voluntarily blink when sedated. In the past, critical care patients who have recovered, have become visually impaired due to poor eye health. Thankfully, this is rare at The Royal London, as we conducted research into this very topic 10-15 years ago.
“Every patient on intensive care is prescribed lubricant; this is applied every day and debris and discharge is cleaned out regularly. This is a big undertaking for critical care nurses, who during the pandemic, were looking after up to 4 patients at a time.
“Looking after a patients eyes means nurses can focus on other priorities that need their attention. They were extremely appreciative of our help, but also our knowledge of the eyes too. As well as treating eye health complications, the consultants and I rewrote guidelines and helped to educate redeployed staff on looking after the eyes of sedated patients.
“Compared to life and death, eye ointment doesn’t seem critical at the time, but it is for a patient’s quality of life after they leave intensive care.”
Caroline, Leah; how did you feel before your first shift on the intensive care unit?
Leah: “My first concern was whether my PPE was on correctly. We had all been fit-tested but this was the first time I had worn protection like this.
“The intensive care unit was a new situation for me, so in the beginning I did feel overwhelmed; you see the pictures on the TV, but nothing quite prepares you. However, it is comforting to know that you are helping; I returned from a week off and one of the patients I was looking after was awake and blinking – that was great to see.”
Caroline: “I’ll be honest, I did find my first few shifts tough. However, I would agree with Leah after the initial shock, you do become familiar with what is going on around you. We have seen patients improve, and that is why we do the job we do.
“Huge credit goes to the intensive care team, who despite working under extremely high pressure, and longs hours, are so calm and professional. The responsibility the nurses have is phenomenal, I was amazed by what they do day in and out.”
And finally, what are your reflections on the past year?
Mr Coombes: “Working during the pandemic has been a big learning experience and taught me to take nothing for granted; we all knew there would be a second wave, but none of us imagined it would be as bad as it was. It has shown that we can be flexible, adaptable and resilient, and we have worked more as one than ever before, which is encouraging for the future.
Caroline: “The pandemic has taken us to different territories and enabled us to grow as a team. During the first wave we planned for the second wave, so we could further assist on critical care if we needed to. I am glad we did that as we were able to contribute to the Covid-19 response so much more using our expertise – I feel very proud of what we have done to help our patients.”
Leah: “During the first wave of the pandemic I was redeployed to other areas of the hospital, aside from critical care, and I was also part of the second wave planning work, so I have seen The Royal London is lots of different lights.
“This experience will change how ophthalmology works not just with intensive care but the whole hospital; we’ve almost extended our role as staff from across the hospital understand how we can help.”
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