Bret C. Crumpton, M.D.
Eye Protection and COVID-19
Our planet, country, state, county and city should be laser focused on the pandemic of Coronavirus disease (COVID -19), the pathogen of which is severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
As an ophthalmologist, I feel compelled to discuss the September 16, 2020 JAMA Ophthalmology article, “Association of Daily Wear of Eyeglasses With Susceptibility to Coronavirus Disease 2019 Infection” and the concurrent editorial of invited commentary, “Eye Protection and the Risk of Coronavirus Disease 2019, Does Wearing Eye Protection Mitigate Risk in Public, Non-Health Care Settings?”
This cohort study attempts to answer the question, what is the association between the daily wear of eyeglasses (eight hours or longer a day) and susceptibility to coronavirus disease 2019 (COVID-19)? In the findings of this study of 276 patients hospitalized with COVID-19 in Suizhou, China, the proportion of daily wearers of eyeglasses was lower than that of the local population (5.8% vs 31.5 %). These findings suggest that daily wearers of eyeglasses may be less likely to be infected with COVID-19. This virus has been proven to be transmitted mainly through droplets and contact. The eye is also considered an important route of infection.
The hypothesis of this study is that eyeglasses prevent or discourage wearers from touching their eyes, thus avoiding transferring the virus from the hands to the eyes. Studies have shown that normal people will involuntarily touch their eyes about 10 times per hour. Eyes usually lack protection, and an abundance of the SARS-CoV-2 receptor angiotensin-converting enzyme 2 has been found on the ocular surface, through which this pathogen can enter the human body. SARS-CoV-2 may also be transported to the nasal and nasopharyngeal mucosa through continuous tear irrigation of the lacrimal duct, causing respiratory infection. According to available statistics, 1% to 12% of patients with this virus have ocular manifestations. SARS-CoV-2 was detected in tears or the conjunctival sacs of patients with COVID-19, and some ophthalmologists were reported to be infected during routine treatment. Therefore, eyes are considered an important channel for SARS-CoV-2 to enter the human body. For daily wearers of eyeglasses, who usually wear eyeglasses on social occasions, wearing eyeglasses may become a protective factor, reducing the risk of virus transfer to the eyes and leading to long-term daily wearers of eyeglasses being rarely infected with COVID-19.
The concurrent invited commentary by Lisa L. Maragakis, MD, MPH, epidemiologist, and Infectious Disease Specialist from Johns Hopkins University, raise poignant issues regarding this landmark study. Although it is tempting to conclude from this study that everyone should wear eyeglasses, goggles, or a face shield in public to protect their eyes and themselves from COVID-19, from an epidemiological perspective, Dr. Maragakis reminds us that we must be careful to avoid inferring a causal relationship from a single observational study. The study authors acknowledge several limitations to the study design and call for further studies to replicate and possibility validate or refute their findings. The data suggest that the observed difference in wearing eyeglasses between the group of patients with the virus vs the general population is unlikely to have occurred by chance alone, but it does not indicate a causal relationship between wearing eyeglasses and preventing the disease.
The study by Zeng et al is provocative and raises the possibility that use of eye protection by the general public might offer some degree of protection from COVID-19. More retrospective and prospective studies are needed to confirm the association that was observed in this study and to determine whether there is any incremental benefit to wearing eyeglasses or other forms of eye protection in pubic settings, in addition to wearing a mask and physical distancing, to reduce the risk of acquiring SARS-CoV-2.
Considering the on-going pandemic, the MCMS is delaying our scheduled in person Fall Social gathering at the Columbus Botanical Gardens in November. We will regroup and offer a virtual CME meeting, possibly an update on COVID-19 or another relevant and interesting topic.
Stay safe and vigilant so that we can better serve our patients, staff and community as we continue to provide the best medical care to our Chattahoochee Valley.