2 Impact of COVID-19 on a national serum eyedrops programme in the UK

NHSBT run a Serum Eyedrops programme for the UK, providing Autologous (AutoSE) and Allogenic (AlloSE) eyedrops for patients affected by severe dry eyes. The service is based within the Eye & Tissue Bank in Liverpool.In February 2020 (pre-pandemic within the UK) there were 1052 patients on the programme. 34% received AutoSE and 66% AlloSE. Due to a recent change in central funding, referrals for AlloSE had increased, creating a waiting list; in March 2020 the list had 72 patients.In March 2020 government guidelines were introduced to reduce the spread of COVID-19. These measures presented a number of challenges for NHSBT and our ability to maintain the supply of Serum Eyedrops: i) Many AutoSE patients could not attend donation appointments, as they were clinically vulnerable and needed to shield. This issue was addressed by temporarily providing them with AlloSE. This was done with agreement between patients and consultants. As a result, the proportion of patients receiving AlloSE increased to 82%.ii) There was a reduced supply of AlloSE donations due to a general reduced attendance at blood donation centres. To deal with this, additional donor centres were recruited to collect AlloSE. In addition, the postponing of much elective surgery during the pandemic meant the demand for blood for transfusion reduced, enabling us to build up stock in anticipation of blood stocks reducing as the pandemic developed.iii) Our service was also impacted by reduced staffing levels, due to staff needing to shield or self-isolate, and the need to implement workplace safety measures. To address these problems, a new laboratory was created, allowing staff to dispense eyedrops and adhere to social distancing. It was also possible to re-allocate staff from other areas within the Eye Bank due to a reduction in demand for other grafts during the pandemic.iv) There were initial concerns over the safety of blood and blood products as to whether the transmission of COVID-19 was possible through blood. Following a stringent risk assessment by NHSBT clinicians, and implementation of additional safeguards around blood donation, it was agreed that provision of AlloSE was safe and could continue.Despite all the challenges created by the pandemic, the measures we implemented enabled us to maintain our SE service for existing patients, provide treatment for new referrals and accommodate a significant increase (25% in the 12 months following the beginning of the pandemic) in the number of patients requiring treatment.