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      New digital models of care in ophthalmology, during and beyond the COVID-19 pandemic

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          Abstract

          COVID-19 has led to massive disruptions in societal, economic and healthcare systems globally. While COVID-19 has sparked a surge and expansion of new digital business models in different industries, healthcare has been slower to adapt to digital solutions. The majority of ophthalmology clinical practices are still operating through a traditional model of ‘brick-and-mortar’ facilities and ‘face-to-face’ patient–physician interaction. In the current climate of COVID-19, there is a need to fuel implementation of digital health models for ophthalmology. In this article, we highlight the current limitations in traditional clinical models as we confront COVID-19, review the current lack of digital initiatives in ophthalmology sphere despite the presence of COVID-19, propose new digital models of care for ophthalmology and discuss potential barriers that need to be considered for sustainable transformation to take place.

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          Most cited references23

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          Presumed Asymptomatic Carrier Transmission of COVID-19

          This study describes possible transmission of novel coronavirus disease 2019 (COVID-19) from an asymptomatic Wuhan resident to 5 family members in Anyang, a Chinese city in the neighboring province of Hubei.
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            Virtually Perfect? Telemedicine for Covid-19

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              Presymptomatic SARS-CoV-2 Infections and Transmission in a Skilled Nursing Facility

              Abstract Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can spread rapidly within skilled nursing facilities. After identification of a case of Covid-19 in a skilled nursing facility, we assessed transmission and evaluated the adequacy of symptom-based screening to identify infections in residents. Methods We conducted two serial point-prevalence surveys, 1 week apart, in which assenting residents of the facility underwent nasopharyngeal and oropharyngeal testing for SARS-CoV-2, including real-time reverse-transcriptase polymerase chain reaction (rRT-PCR), viral culture, and sequencing. Symptoms that had been present during the preceding 14 days were recorded. Asymptomatic residents who tested positive were reassessed 7 days later. Residents with SARS-CoV-2 infection were categorized as symptomatic with typical symptoms (fever, cough, or shortness of breath), symptomatic with only atypical symptoms, presymptomatic, or asymptomatic. Results Twenty-three days after the first positive test result in a resident at this skilled nursing facility, 57 of 89 residents (64%) tested positive for SARS-CoV-2. Among 76 residents who participated in point-prevalence surveys, 48 (63%) tested positive. Of these 48 residents, 27 (56%) were asymptomatic at the time of testing; 24 subsequently developed symptoms (median time to onset, 4 days). Samples from these 24 presymptomatic residents had a median rRT-PCR cycle threshold value of 23.1, and viable virus was recovered from 17 residents. As of April 3, of the 57 residents with SARS-CoV-2 infection, 11 had been hospitalized (3 in the intensive care unit) and 15 had died (mortality, 26%). Of the 34 residents whose specimens were sequenced, 27 (79%) had sequences that fit into two clusters with a difference of one nucleotide. Conclusions Rapid and widespread transmission of SARS-CoV-2 was demonstrated in this skilled nursing facility. More than half of residents with positive test results were asymptomatic at the time of testing and most likely contributed to transmission. Infection-control strategies focused solely on symptomatic residents were not sufficient to prevent transmission after SARS-CoV-2 introduction into this facility.
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                Author and article information

                Journal
                Br J Ophthalmol
                Br J Ophthalmol
                bjophthalmol
                bjo
                The British Journal of Ophthalmology
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                0007-1161
                1468-2079
                April 2022
                22 March 2021
                22 March 2021
                : 106
                : 4
                : 452-457
                Affiliations
                [1 ] departmentSingapore Eye Research Institute , Singapore National Eye Centre , Singapore
                [2 ] departmentOphthalmology and Visual Sciences Academic Clinical Program , Duke-NUS Medical School , Singapore
                Author notes
                [Correspondence to ] Professor Tien Yin Wong, Singapore Eye Research Institute, Singapore 168751, Singapore; wong.tien.yin@ 123456singhealth.com.sg

                Y-CT and RH are joint first authors.

                GSWT and TYW are joint senior authors.

                Author information
                http://orcid.org/0000-0002-6752-797X
                http://orcid.org/0000-0003-2264-7174
                http://orcid.org/0000-0002-4916-6074
                http://orcid.org/0000-0002-8448-1264
                Article
                bjophthalmol-2020-317683
                10.1136/bjophthalmol-2020-317683
                8961770
                33753407
                029647df-b7ff-44a7-a19c-e9e47598719a
                © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 13 August 2020
                : 05 March 2021
                : 06 March 2021
                Categories
                Review
                1506
                2474
                Custom metadata
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                Ophthalmology & Optometry
                telemedicine,public health,vision,covid-19,diagnostic tests/investigation

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