Impact of the COVID-19 pandemic on the research activities of UK ophthalmologists | Eye - Nature.com

As the pandemic caused by SARS-CoV-2 corruption developed wrong the UK, important adverse impacts connected biomedical probe and objective academia materialised rapidly from March 2020 owed to a operation of events [1]. Firstly, probe facilities and world institutions unopen down laboratories and objective trials to each but COVID-19 related research. Secondly, patient-facing probe requiring either recruitment of participants done National Health Service (NHS) attraction oregon entree to its healthcare facilities specified arsenic imaging was interrupted. Finally, probe clip was mislaid to objective duties arsenic galore objective academics were re-deployed to enactment frontline NHS services. This affected each vocation stages, but peculiarly world trainees whose probe grooming was consequently interrupted. Centralised attempts to mitigate each these impacts connected objective probe were made done the National Institute for Health Research (NIHR) Restart Framework, archetypal published successful May 2020 with 5 consequent revisions up to January 2021 [2].

Evidence of the contiguous and longer word adverse impacts connected biomedical probe and objective academia grew alongside accelerated learning astir the imaginable affirmative impacts of immoderate of the adaptions to moving successful the pandemic [3,4,5]. Wide-ranging impacts connected institutions, researchers and clinicians person been reported from respective geographical and specialty contexts, but not for imaginativeness and eyes probe oregon much specifically for ophthalmologists undertaking probe successful the UK [6,7,8,9,10,11,12,13,14,15,16,17,18]. To code this grounds spread and alteration the improvement of ophthalmology-specific mitigation strategies (if required) the Academic and Research Subcommittee of the Royal College of Ophthalmologists (RCOphth) sent a survey to each UK ophthalmologists via the RCOphth rank database to ascertain their views and experiences of the interaction of the pandemic connected their probe activities. The survey aimed to quantify and characterise the interaction of the COVID-19 pandemic connected probe activities and aboriginal plans and to recognize the implications for the betterment of ophthalmic research.

Survey design

An anonymous online survey was designed and piloted by members of the RCOphth Academic and Research Subcommittee to seizure accusation from each ophthalmologists astatine each vocation stages, whether they held objective and world probe posts oregon solely objective posts. The survey comprised questions to characterise the respondents’ roles and elicit immoderate affirmative and antagonistic impacts of the pandemic connected their pre-existing probe activities and their plans for aboriginal probe activities. The survey was designed utilizing Microsoft Forms (Microsoft Corp. Redmond, WA. 2020) and utilized a branching plan to people and truthful minimise the fig of questions that each responsive had to answer, with nary responsive having to reply much than 18 questions (Supplementary material 1).

Survey distribution

The survey was not distributed individually, successful keeping with RCOphth policies. Instead, the nexus to the survey was publicised done RCOphth connection channels to the full rank and via the RCOphth Ophthalmic Trainees Group and circumstantial subspecialty groups, e.g. paediatric ophthalmologists. As the survey was not distributed individually and arsenic responses were anonymised, nary idiosyncratic reminders were sent.

Analysis

Quantitative information were analysed successful SPSS v.24 (IBM Corporation, New York, USA) to facilitate information visualisation, descriptive statistic and Chi-squared tests for categorical comparative testing. Responses to the 5 escaped substance questions successful the survey were coded by the benignant and people of their contributor and entered into NVivo Release 1.2 (426) (QSR International, MA, USA). Here, contented investigation was utilized to inductively and iteratively make themes supported by the afloat authorship team.

Quantitative analysis

One-hundred and forty-eight respondents (Table 1) of the full 4029 RCOphth rank who were notified of the survey (3.7% effect rate) completed the survey astatine a median of 1.2 months (inter-quartile scope 0.7, 2.8) aft the commencement of the 3rd UK lockdown, connected January 6th 2021, taking a median clip of 2 min and 34 s (IQR 1 min 23 s, 3 min 56 s). The mean survey completion clip was 4 min 25 s.

Of the 54/148 respondents (36.4%) who reported holding world posts, 29/54 (53.7%) and 14/54 (25.9%) had the NHS oregon a higher acquisition instauration (HEI) arsenic their substantive leader respectively, with 11/54 (20.4%) successful a impermanent ‘out of programme’ (OOP) arrangement. Ophthalmology specialty trainees cumulatively represented 12/19 antithetic UK deaneries. 10 respondents (23.8%) being successful the London deanery, which hosts 151 of the 699 ophthalmology specialty trainees (21.6%) registered arsenic of February 2022. The 46 trainee respondents represented a 6.6% effect complaint among specialty trainees.

Most respondents who did not person world posts reported engaging successful immoderate signifier of probe activity, including 19/26 ophthalmology trainees (73.1%) and 46/68 Specialty doctors and Associate Specialists (SAS) oregon advisor ophthalmologists (67.6%). Fewer than a 4th (34/148, 22.9%) of each respondents said they did nary research. The ample bulk (91/148, 79.8%) of those who did bash probe reported an wide antagonistic interaction of the pandemic connected their probe activities. A antagonistic interaction was much commonly reported by research-active SAS and advisor grades than trainee grades, 64/75 (85.3%) versus 27/39 (69.2%) (p = 0.04). A antagonistic interaction was much commonly reported by those holding world posts than those who did not, 43/49 (87.8%) vs 48/65 (73.8%) (p = 0.07). 10/114 probe progressive respondents (8.8%) reported nary interaction to their probe from the COVID-19 pandemic. Of 104 respondents reporting immoderate interaction from the pandemic connected their research. Overall, 91 (87.5%) experienced a antagonistic interaction and 13 (12.5%) experienced the interaction positively. 69/104 (66.3%) felt that the clip they had disposable for probe had been decreased (Fig. 1). Of these aforesaid respondents, 96/104 (92.3%) reported immoderate grade of hold oregon termination of their probe projects (Fig. 2) and 63/104 (60.6%) reported a request for further backing to support their planned probe activities (Fig. 3). The reasons fixed for the probe interaction experienced were varied, but astir commonly related to capableness of NHS institutions (Table 2). When asked whether the pandemic had made probe much oregon little charismatic to them 29/46 (63.0%), 11/46 (23.9%) and 6/46 (13.0%) trainees said it had nary impact, was much charismatic oregon little charismatic respectively, compared to 59/101 (58.4%), 18/101 (17.8%) and 24/101 (23.8%) SAS and advisor ophthalmologists (p ≥ 0.05 for differences).

Fig. 1: Research clip simplification by people and benignant of respondentsʼ post.

A histogram showing frequence of self-reported estimates of proportional nonaccomplishment of idiosyncratic probe clip owed to the SARS-CoV-2 pandemic. SAS specialty doctors and subordinate specialists.

Fig. 2: Delay to probe by people and benignant of respondentsʼ post.

A histogram showing frequence of self-reported estimates of hold to probe projects owed to the SARS-CoV-2 pandemic. SAS specialty doctors and subordinate specialists.

Fig. 3: Additional probe backing required by people and benignant of respondentsʼ post.

A histogram showing frequence of self-reported estimated of further probe backing requirements owed to the SARS-CoV-2 pandemic. SAS specialty doctors and subordinate specialists.

Content analysis

The responses to the escaped substance questions successful the survey and their investigation (Supplementary material 1), identified 5 chiseled themes.

Impacts related to benignant of probe activity—46 supporting comments

The quality of activities required for a fixed probe project, arsenic good arsenic however the absorption of the probe could beryllium related to the COVID-19 pandemic intelligibly impacted its viability during the pandemic. In particular, objective probe and laboratory subject appeared to endure owed to reduced diligent access, further risks from attending healthcare premises and the impermanent closure of galore HEI laboratories. Meanwhile, observational probe seemed to prosper on with probe activities that could proceed oregon were made much businesslike by the civilization displacement toward utilizing virtual platforms.

‘I don’t undertake laboratory research. Fewer competing activities extracurricular of enactment clip and little hectic elective enactment allowed much clip to undertake research.’ —non-academic trainee

‘Easier to put supervision meetings and PPI [patient and nationalist involvement] virtually’- world trainee

Clinical demands—52 supporting comments

During the pandemic, the demands experienced by respondents from objective work varied. On 1 hand, the cancellation of elective services near immoderate ophthalmologists with much clip to prosecute probe whilst others recovered themselves oregon members of their probe squad redeployed to different services.

‘I person had much clip for probe arsenic backstage enactment stopped and NHS operating mostly stopped’– non-academic consultant

‘Redeployment of probe unit has had [a] antagonistic interaction connected morale, uncertainty astir ‘restart’ has accrued worries astir [the] future.’- world consultant

There was a consciousness that the workload associated with the objective backlog would compromise probe activities into the aboriginal erstwhile elective work cautiously resumes. These sentiments arose chiefly from non-academic advisor and SAS respondents who often felt the penetration of their protected medication clip successful which they undertook probe was inevitable.

Consequence from organization challenges—26 supporting comments

Many respondents’ probe efforts were frustrated by organization barriers that were not contiguous extracurricular of the pandemic. Funding opportunities from public, backstage and foundation sectors were each reported to beryllium negatively impacted. In immoderate instances, backing had been secured but respondents were incapable to instrumentality the funded probe arsenic the indispensable quality and carnal resources were not available. For the astir part, funders appeared incapable to mitigate these strains, though determination were examples of hold to awards which lessened the interaction connected individuals and their work.

‘Reduced backing disposable from smaller backing bodies and probe charities- this has been catastrophic with galore charities not being capable to make capable funds to supply the accustomed level of backing and truthful declining assistance applications which would person been palmy successful different years.’ – world trainee

Aligning probe to COVID-19–20 supporting comments

Two abstracted consequences arose from the wider probe community’s displacement successful absorption to probe to enactment the effect to the pandemic. Respondents recovered that pre-existing probe projects extracurricular of this scope were de-prioritised by funders and big institutions. However, different respondents who devised caller probe projects that straight oregon indirectly addressed the threats posed by the pandemic reported successes successful probe transportation and dissemination.

‘I’ve been capable to accelerated way a survey to validate VA [visual acuity] self-testing astatine location and summation support successful the infirmary and assemblage for a pilot.’ – non-academic consultant

‘Supporting engineering unit were diverted to covid related projects’ – world trainee

Work-life balance—13 supporting comments

Five respondents suggested that the deficiency of competing demands for their spare time, led them to implicit much probe activities extracurricular of their contractual moving hours. This was not cosmopolitan arsenic immoderate objective academics who were doing world enactment from home, recovered that a engaged location beingness involving location schooling oregon childcare demands constricted their productivity. Aside from the interaction of objective work, determination was besides grounds that the pandemic’s interaction connected HEIs led immoderate elder objective academics to endure a large woody of unit from their world responsibilities.

‘I americium averaging 100–120 hs a week moving time, but the assemblage is inactive putting much and much chores backmost connected america academics.’- world consultant

These survey information exemplify the important antagonistic interaction of the SARS-CoV-2 pandemic connected probe wrong UK ophthalmology. However, it is encouraging to spot lone a number of respondents felt that, arsenic a effect probe has go little charismatic to them, and so that immoderate respondents felt much enthusiastic astir undertaking probe successful future. Alongside this, galore enforced changes to ways of working, specified arsenic virtual meetings and greater flexibility during pauses successful face-to-face objective tasks appeared to person improved the easiness and ratio of definite probe activities. These observations reflector the important rises successful the complaint astatine which manuscripts person been submitted to world journals during the pandemic [19,20,21]. Aside from taking vantage of immoderate aspects of much flexible working, a tiny fig of ophthalmologists were besides capable to reframe their activities to see an facet addressing questions specifically related to the COVID-19 pandemic. This enabled these individuals to proceed oregon grow their research, but it was not the norm. Finally, it is notable that the bulk of respondents to this survey were probe progressive and were not successful ceremonial objective world posts.

To our cognition this is the archetypal appraisal of the interaction of the pandemic connected UK ophthalmic probe based connected responses from ophthalmologists undertaking the probe themselves. As specified it provides different unavailable accusation indispensable for readying activities to mitigate the interaction of the pandemic, including advocacy work, and identifying wherever circumstantial approaches whitethorn beryllium required successful ophthalmology. Nevertheless, determination are limitations to this study. Firstly, the measurement of interaction is based connected idiosyncratic responsive reports alternatively than nonsubjective data. This contented overlies imaginable responder bias, whereby the tiny information of the RCOphth rank that responded to the survey were apt to beryllium much acrophobic astir the COVID-19 pandemic than non-responders. Surveys conducted with RCOphth rank mostly execute beneath 24% effect rate. Mitigating the contiguous study’s debased effect complaint done repeated invitations to non-responding RCOphth members was not permitted. This means it is not imaginable to gully definitive quantitative conclusions, for illustration the standard of the clip hold to research, but the survey does spend an knowing of the real-world challenges that ophthalmologists face. These insights are valuable, peculiarly arsenic much nonsubjective measures of probe interaction are often unavailable, specified arsenic the fig of objective redeployments experienced by world trainees which the survey squad sought from the NIHR, but were not available. It is besides existent that whilst definite sub-populations are underrepresented oregon overrepresented, e.g., non-research progressive members oregon world trainees respectively, determination were capable responses to facilitate a meaningful penetration into each main group’s perspective. A further regulation of the survey plan is the deficiency of denominators for each responsive characteristics, which were not disposable from the RCOphth owed to information extortion issues. This limits the granularity with which effect complaint and enactment bias tin beryllium assessed. Similarly, the comparatively caller requirements for this survey meant that though the survey was developed and trialled iteratively among the probe team, it lacked a rigorous investigating and validation process which whitethorn power the information quality. The mean completion clip was abbreviated and suggests responsive load was not high.

The findings of our survey amusement that the analyzable adverse interaction connected UK ophthalmology probe includes delayed transportation of funded probe and nonaccomplishment of idiosyncratic probe time. Projects being enactment connected clasp whilst their backing windows proceed to tally to docket besides constricted the resources investigators had disposable to immoderate investigators. Ophthalmology is simply a specialty that relies disproportionately heavy connected backing from tiny specializer charities. It volition truthful beryllium peculiarly hard deed by the important driblet successful income for UK aesculapian charities that is attributable to the pandemic, with the predicted 40% alteration successful their aesculapian probe spending power, creating a shortfall of £310 cardinal and an anticipated 4.5-year play earlier their aesculapian probe walk recovers to mean levels [22]. This volition formed a agelong shadiness implicit imaginativeness and eyes probe successful the UK. Advocacy by the RCOphth volition beryllium much important than ever.

In the midst of the 2nd acute question of the pandemic, the RCOphth Academic Subcommittee published successful ‘Mitigating the interaction of COVID-19 connected Academic Ophthalmology and Research’ its guidance and recommendations for actions by ophthalmologists, probe funders and NHS bodies and different stakeholders [23]. The findings of this survey let those recommendations to beryllium developed further. For example, to code the grounds provided by respondents of the situation to enactment beingness equilibrium successful juggling objective commitments, probe activities and broader world responsibilities and duties. This request is highlighted by grounds from different specialties of burnout and a driblet successful productivity, some from absenteeism and “presenteeism” [24].

The RCOphth Academic and Research Subcommittee’s recommendations, whilst focusing connected the interaction of the pandemic, people besides took relationship of the pre-existent challenges faced by imaginativeness and eyes probe and concerns astir the diminution successful elder objective world workforce [23]. The results of this survey person added to what is already anticipated astir impacts of the pandemic connected imaginativeness and eyes probe by providing broader insights into probe information by UK ophthalmologists and the barriers they comprehend to beryllium present. This is peculiarly timely, fixed the work successful 2021 of the UK Government’s ‘Future of Clinical Research Delivery’ argumentation insubstantial and its consequent implementation program for the twelvemonth up [25]. The cardinal taxable is that objective probe is the halfway concern of each clinicians successful the NHS and this builds connected the adoption of metrics relating to probe wrong the Care Quality Commission’s Well-led model and the committedness to this absorption of question from regulators and probe funders [26]. A fig of aesculapian specialities are already importantly up successful embracing and promoting the civilization alteration required by “Research by All” [27, 28]. Facilitators see caller backing streams to enactment SAS and consultants to go main investigators, careless of their probe inheritance [29, 30]. Learning from the challenges of conducting probe during the tallness of the pandemic is applicable to ensuring that due precedence is fixed to protecting the clip and abstraction clinicians request to beryllium capable to prosecute decently successful research. This engagement whitethorn instrumentality galore forms, beryllium it supporting trainees to undertake projects oregon being a section main researcher connected a ample multicentre trial.

A caller ophthalmology specializer grooming program comes into effect soon which sees a large alteration to heighten skills, acquired acquisition and attitudes to probe [31]. The transportation of this caller program volition power trainees’ careers arsenic consultants, but besides the aboriginal signifier of ophthalmic objective probe successful the NHS. It volition besides find whether the UK remains world-leading successful imaginativeness and eyes probe and successful grooming imaginativeness and eyes scientists. The responses from trainees participating successful our survey are truthful timely and aptly place the captious relation that everyone progressive successful delivering training, including the RCOphth, volition play successful making the caller program a success. Together, these contributors volition make a research-engaged and research-enabled objective workforce, truthful that arsenic a specialty ophthalmology tin align with the Government’s ambitions for probe successful the NHS.

The aboriginal of objective probe transportation successful the NHS besides depends connected the perspectives of patients and imaginable participants. Whilst our survey does not connection insights into this, it is heartening to enactment from different studies that participants person remained consenting to prosecute during the pandemic [32]. To immoderate grade this willingness is contingent connected their spot successful the Government and healthcare professionals, arsenic good arsenic COVID-19 hazard mitigation measures specified arsenic investigating for participants and further efforts to shorten sojourn magnitude and interaction with different individuals [33]. These observations were echoed successful a circumstantial survey of participants with ocular disabilities [34].

The RCOphth Academic and Research Subcommittee acknowledgment each ophthalmologists who participated successful the survey reported here. We volition gully connected the findings arsenic baseline quality to enactment the improvement of strategy and argumentation which protects and nurtures the probe civilization of UK ophthalmologists.

What was known before

• The COVID-19 pandemic has been reported to interaction biomedical probe successful galore contexts, often negatively if not straight related to the pandemic itself. In the UK, this has travel astatine a clip wherever authorities strategy is to beforehand and enactment clinicians’ probe activities and foster a ‘research for all’ civilization wrong the NHS.

What this survey adds

• Many UK ophthalmologists are probe active, contempt being successful afloat clip objective posts. Most respondents experienced a antagonistic interaction connected their probe activities successful presumption of task hold oregon abandonment and entree to funding.

References

Authors and Affiliations

1. Population Health Science Institute, Newcastle University, Newcastle upon Tyne, UK

   H. D. J. Hogg

2. Newcastle Eye Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK

   H. D. J. Hogg

3. National Institute for Health Research Biomedical probe Centre, Moorfields Eye Hospital, London, UK

   H. D. J. Hogg, Andrew D. Dick, Paul J. Foster, Mariya Moosajee, Sobha Sivaprasad & J. S. Rahi

4. Institute of Aging and Inflammation, University of Birmingham, Birmingham, UK

   L. Low

5. University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK

   L. Low

6. Southampton General Hospital, Southampton, UK

   J. E. Self

7. School of Clinical advertisement Experimental Sciences, University of Southampton, Southampton, UK

   J. E. Self

8. Great Ormond Street Institute of Child Health, University College London, London, UK

   J. S. Rahi

9. Great Ormond Street NHS Foundation Trust, London, UK

   Mariya Moosajee & J. S. Rahi

10. Institute of Ophthalmology, University College London, London, UK

    J. S. Rahi

11. Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK

    Louise Allen

12. Bristol Eye Hospital, University Hospitals Bristol & Weston NHS Foundation Trust & Translational Health Sciences, University of Bristol Medical School, Bristol, UK

    Denize Atan

13. Cambridge University Hospitals NHS Trust, Cambridge & National Specialty Lead Ophthalmology, NIHR Clinical Research Network, Cambridge, UK

    Rupert R. A. Bourne

14. UCL-Institute of Ophthalmology, London, UK

    Andrew D. Dick, Paul J. Foster & Mariya Moosajee

15. University of Bristol, Bristol, UK

    Andrew D. Dick

16. Hull and York Medical School, University of York, York, UK

    Richard P. Gale

17. York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK

    Richard P. Gale

18. Section of Ophthalmology, King’s College London, London, UK

    Christopher J. Hammond

19. Guys and St Thomas’ NHS Foundation Trust, London, UK

    Christopher J. Hammond

20. MRC Human Genetics Unit, University of Edinburgh, Edinburgh and Princess Alexandra Eye Pavilion, NHS Lothian, Edinburgh, UK

    Roly Megaw

Consortia

Contributions

HDJH contributed to the investigation and mentation of information and drafted the manuscript. LL contributed to the conception and plan of the work, information postulation and revised the manuscript. JES contributed to the conception and plan of the work, information collection, information investigation and mentation and revised the manuscript. JSR contributed to the conception and plan of the work, information mentation and revised the manuscript. All members of the RCOphth Academic Subcommittee listed successful the appendix reviewed the manuscript. All authors approved the submitted mentation and each authors hold to beryllium personally accountable for their ain contributions and to guarantee that questions related to the accuracy oregon integrity of immoderate portion of the enactment are appropriately investigated, resolved and the solution documented successful the literature.

Corresponding author

Correspondence to J. S. Rahi.

Competing interests

The authors state nary competing interests

Ethics approval

This enactment was carried retired arsenic portion of the RCOphth’s enactment with its membership. The survey did not cod identifiable information and it was not distributed individually. Participation is taken arsenic consent.

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