Letter to the Editor—We read the article “COVID-19 and ophthalmology: an underappreciated occupational hazard” by Kuo and O’Brien^{Reference Kuo and O’Brien1} with great interest. They have described the challenges faced by eye care personnel during this pandemic very well in a systematic manner. We would like to add few of our own experiences.

Personal protective equipment (PPE) has become the gold standard during the COVID-19 pandemic for prevention of infection. Although it has its advantages, many problems may arise in terms of comfort and ease in certain circumstances. Currently, with much of the primary focus on infection prevention, these may often be overlooked. In the long term, these difficulties may hamper the performance of healthcare workers like ophthalmologists, whose work demands high precision. As lockdowns are easing and services are resuming, we present our report from a pilot study we conducted in Nepal among ophthalmologists on this matter. We conducted a small survey among 24 ophthalmologists who had recently (<1 week) returned to work using PPE. They were asked to describe issues related to discomfort or difficulty in performing regular tasks when using PPE. They were also asked to grade on a Likert scale of 1 to 5 (1 least likely to 5 most likely) the issues they considered were most troubling (Table 1).

Table 1. Problems Related to Discomfort and Difficulty in Performing Regular Examination for Ophthalmologists With Use of Personal Protective Equipment^a

^a Total participants = 24.

^b 14 of the 24 participants were spectacle users; all complained of fogging.

Returning to work after weeks of furlough only to suddenly and be enshrouded in PPE is a new challenge for many of us. Although it has become a norm, the evidence is already clear that many ophthalmologists and eye care professionals are having difficulties related to PPE use.^{Reference Minocha, Sim, Than and Vakros2} Although the evidence is concrete on infection prevention with its use,^{Reference Ortega, Gonzalez, Nozari and Canelli3} our results suggest that PPE may need to be redesigned and customized to best fit the activity or the demands of individual workers. Problems like fogging, sweating, and difficulty focusing are unacceptable not only in ophthalmological but many other faculties related to high-precision procedures. With more evidence that COVID-19 is here to stay,^{Reference Barnes and Sax4} these problems will continue to hinder efforts to restart or continue services.

Physical distancing often tops the list and is the most prioritized advise during this pandemic. However, due to the nature of examination, it is practically impossible for eye care professionals to adopt it.^{Reference Kuo and O’Brien1,Reference Sadhu, Agrawal and Pyare5} In addition to PPE, improvised, low-tech, “Do it yourself” (DIY) protective devices are also being widely used.^{Reference Greig, Carvalho, El-Boghdadly and Ramessur6} Although this may be an advantage because much of the “design for the greatest ease of use” would have already been already improvised, many such DIY efforts remain unproven in terms of the actual protection they provide. Until tested for its “quantifiable” protection value, physicians may fall into the trap of “pseudo” protection and confidence in their use.

Collaboration of physicians with the manufacturers, laboratories, and testing facilities are of utmost importance to devise such protective devices. Efforts focused on extensive testing of these materials and designs to make them more protective and comfortable are necessary immediately if we are to continue serving with confidence in this era of “the new normal.”