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The AAO – AAOOP & Covid-19

The AAO

The American Academy of Ophthalmology is the world’s largest association of eye physicians and surgeons, a global community of 32,000 medical doctors, protecting sight and empowering lives by setting the standards for ophthalmic education and advocating for patients and the public.

The Academy evolved as part of the American Academy of Ophthalmology and Otolaryngology, which was founded in 1896 primarily to provide continuing education to eye, ear, nose and throat doctors.

The American Academy of Ophthalmology was incorporated as an independent organization in 1979 when the AAOO was divided into separate academies for each specialty.

The AAOOP

The American Association of Ophthalmic Oncologists and Pathologists is a professional association of medical doctors who practice, teach and or engage in research in ocular oncology and/or ophthalmic pathology.

What is Ocular Oncology?

Ocular oncology is a highly specialized branch of ophthalmology that provides medical and surgical care to patients with ocular cancers.

These include intraocular tumors, most commonly uveal melanoma in adults and retinoblastoma in children, intraocular lymphoma, metastastic cancers to the eye, other intraocular tumors and tumors on the surface of the eye, most commonly involving the conjunctiva.

What is Ophthalmic Pathology?

Ophthalmic pathology (also known as eye pathology or ocular pathology) is a highly specialized branch of the medical laboratory specialty pathology.

Clinical ophthalmic pathology involves gross and microscopic examination and diagnosis of eyes and ocular adnexal tissues that are removed surgically (biopsies) or post-mortem.

The ocular adnexae include the eyelids and periocular skin, the contents of the orbit, and the lacrimal (tear) system comprising the lacrimal gland and the nasolacrimal drainage system.

The AAO – AAOOP & Covid-19

The coronavirus disease 2019 (COVID-19) pandemic has been a challenge worldwide, not only in attempts to minimize the spread of the virus and to treat desperately ill patients, but, according to physicians abroad, also by limitations placed on patient care.

European colleagues have warned their international counterparts about the transfer of ventilators from ocular oncology centers to other services and reduced access to chemotherapy for globe-salvaging techniques for retinoblastoma.

After hearing of these warnings, the American Association of Ophthalmic Oncologists and Pathologists (AAOOP) moved to the forefront to deal with the hurdles. “It was apparent to many of us in the US that we had to prepare for the possibility of governmentimposed restrictions on clinical care,” said Dan S. Gombos, MD, FACS, who is president of AAOOP.

Gombos is a professor and chief of ophthalmology at The University of Texas MD Anderson Cancer Center in Houston, clinical codirector of the Retinoblastoma Center of Houston, and vice president of the International Society of Ocular Oncology.

At the onset of the pandemic, AAOOP initiated early advocacy with the American Academy of Ophthalmology (AAO) to work to ensure clinical care and access for patients with ophthalmic tumors and the related ophthalmic pathology needs, Gombos said.

Gombos underscored the need for continuity of care for these patients because delayed care carried with it risk to life, such as in the case of screening examinations for high-risk children with retinoblastoma or the need for urgent enucleation for some intraocular malignancies.

The AAO advised AAOOP to create recommendations. Similar approaches were used with other professional ophthalmic subspecialties, surgical societies, and the American College of Surgeons, he said.

AAOOP’s goal was to identify a cohort of ophthalmic oncology and pathology experts and individuals from other subspecialties such as retina, oculoplastics, and pediatrics. This would allow creation of parallel recommendations with colleagues in retina, the American Society of Ophthalmic Plastic and Reconstructive Surgery, and the United States and Canadian Academy of Pathology.

AAOOP also wanted to create a source document to facilitate care during the pandemic that would justify the use of certain resources when operating room resources and access were limited, Gombos explained.

This guide was published in Ocular Oncology and Pathology. The information then was forwarded to the AAO and sister ophthalmic societies and posted on AAOOP and AAO websites. Additional guidelines were formulated for the American College of Surgeons.

Gombos explained that AAOOP used its website to communicate ongoing practice patterns early in the pandemic and collaborated with the Collaborative Ocular Oncology Group Uveal Melanoma Validation Study Number 2 (COOG2), a group of ocular oncologists that maintained a database of members who managed ocular neoplasms.

The COOG2 surveyed its member practitioners, and interval practice patterns were posted on AAOOP’s website. AAOOP also created a survey and offered a way to perform ophthalmic telepathology for centers that did not have access to ophthalmic pathologists.

“Throughout the pandemic, AAOOP continued to advocate strongly for our patients and their practitioners,” Gombos said. “Our source documents have been referenced worldwide and were endorsed by the International Society of Ocular Oncology.

Despite the challenges of the pandemic, we continue to see innovations and advances in our field, and we will continue to support our colleagues and patients during the pandemic.”

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