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SARS warning sign outside Toronto General Hospital.

OPHTHALMIC surgery has been severely curtailed in Toronto, Ontario as Canadian health authorities attempt to deal with the worst outbreak of Severe Acute Respiratory Syndrome (SARS) so far reported outside Asia.

Near the end of March, all hospitals in the greater Toronto area were ordered to suspend non-essential services, including non-urgent ophthalmic procedures.
Shortly afterwards, the World Health Organisation (WHO) took the unprecedented step of advising the public against travelling to Toronto because of the SARS outbreak, but a week later lifted the travel advisory because the situation there has improved.

The WHO also issued travel advisories for Guangdong Province, Hong Kong Special Administrative Region, Beijing and Shanxi Province- all in China.

The hospital suspensions, among other directives, came from the Canadian province's Ministry of Health in an effort to contain the SARS outbreak. A ‘code orange’ alert cancelled all elective surgeries and outpatient procedures.

“Ophthalmologists are worried about their practices and not being able to see patients. Those who have their offices inside the hospitals are scrambling to be able to work in some of the community offices. Physicians in general are all pretty stressed about this,” said Jeffrey Hurwitz MD, Ophthalmologist-in-Chief, Mt Sinai Hospital, Toronto.

Overall, delayed surgeries and the postponement of other procedures are putting a huge strain on an already overburdened health care system, he added.
The move by the province came after three SARS -related deaths and numerous suspect cases occurred as a result of the infection spreading through the Scarborough Grace Hospital in one of Toronto's suburbs. The index case was a patient there who had recently returned from a visit to Hong Kong.

The hospital was temporarily closed to new patients on March 23 by the Ministry of Health after two SARS patients died. People who had contact with the patients including hospital staff, other patients and visitors have been put into voluntary home quarantine.
In some ways, ophthalmology hasn’t been hit as hard as other medical specialties like cardiology, where the rates of urgent cases needing hospital care have been much higher, Dr Hurwitz noted.

PATIENTS suffering from dry eye disorders now have more treatment options as new long-acting products come on stream.

Among the most notable of the new products is Restasis (cyclos porine 0.05% ophthalmic emulsion, Allergan), which recently gained FDA approval as the first prescription medication for dry eye.

The approval followed years of research demonstrating that in many patients, dry eye is a manifestation of an underlying inflammatory ocular surface disorder affecting the lacrimal glands and subconjunctival tissues.

Indeed, cyclosporine is distinguished as the only available drug for treating dry eye which targets the etiology of the disease rather than just its symptoms, US ophthalmologist Steven E Wilson MD said.

The pivotal clinical trials evaluating Restasis enrolled patients with moderate to severe keratoconjunctivitis sicca. The studies found that treated patients showed statistically significant improvements compared with those receiving placebo.

According to the FDA, 15% of patients had an increase of 10mm, which is clinically significant, while 59% may have experienced an improvement of 7.0mm.

“This is remarkable since all of these patients had Schirmer’s levels less than 5.0mm of wetting prior to inclusion in the study,” Dr Wilson said.

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