Forced to transition from in-person to virtual, we’ve been here before, many times since February 2020. But this time it wasn’t due to COVID-19. As the Caldor Fire in California exploded toward Lake Tahoe, air quality plummeted beyond the Very Unhealthy zone into Hazardous, and evacuations began. Five days before the inaugural  Clinical Trials at the Summit conference, aimed at bringing together physicians and industry leaders focused on the clinical trial ecosystem, the meeting went virtual. 

We’ve become fairly good at pivoting, likely due to so many opportunities to practice. As parents we pivoted to the virtual classroom with our kids and continue to adapt within our nation’s fragmented education system. As international travelers, we learned about NAVICA, the digital platform for rapid COVID-19 testing; attestation forms; polymerase chain reaction test turnaround times (with exorbitant fees); and each destination’s unique testing and quarantine requirements. As physicians, we learned to minimize risk of exposure while cautiously starting to reengage pre-pandemic routines. 

Within the last month two friends, a retina specialist and a general practitioner, contracted COVID-19 despite being double vaccinated. One was quite ill but didn’t need hospitalization. In response, I pivoted and got my Pfizer booster at the end of August, earlier than I had planned. 

Despite a full Food and Drug Administration approval, with others anticipated to follow, and an overwhelmingly positive benefit-to-risk ratio, many are still resistant to vaccination. The proportion of anti-vaxxers in my clinic is not trivial, even among high-risk populations. The inpatient COVID-19 census at my hospital, Houston Methodist, is near its peak. The large majority of these patients, many dying, are unvaccinated. 

I’m embarrassed to admit that only about 70 percent of my clinic staff are vaccinated. As medical systems and prominent companies embrace vaccine mandates, I’m encouraging my employees to get vaccinated; if not, we will likely pivot to a mandate. 

On the medical side, what will it take for you to pivot to a new therapy for your exudative AMD patients? Presumably the risk of intraocular inflammation with brolucizumab, as detailed by Drs. Huy Nguyen and Michael Singer on page 26, is too high to recommend it for most patients. When the Port Delivery System (PDS) with ranibizumab is commercially available, what safety profile will be tolerable for the benefit of fewer intravitreal injections longitudinally? With faricimab, will you pivot first with your incomplete responders? 

On page 38, Dr. Sunir Garg details key ergonomic considerations to maximize your health, and I think he would recommend not pivoting too much!

Will the upcoming annual Retina Society, American Society of Retina Specialists and American Academy of Ophthalmology conferences really happen in person? I hope so. But, we will be ready to pivot if we need to. RS