Globally, 71% of the educators reported that their institutions were currently closed to students to attend in person (Fig. 1), but most (92%) expected their institution to be open to students to attend before the end of 2020 (Fig. 2).

Fig. 1.

Institution currently closed.

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Fig. 2.

Expected to open in 2020.

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However, there were wide differences between countries depending on the progress of the pandemic at that time. In Americas and in the Europe / Middle East – Africa (EMEA) region, a high proportion of institutions (93%) were closed when the survey was conducted. In the Asia-Pacific (APAC) region, the proportion was similar to globally in India (92%), but only 41% in China were closed to students at that time.

Almost all institutions in EMEA (97%) expected to open by the end of 2020, compared to 76% in APAC countries other than China (93%) and India (94%), such as Korea, Malaysia and Indonesia. One institution in China had not been open at all in 2020, and the latest opening date anticipated at that time was February 2021 for a university in Colombia.

A majority of educators responding (58%) were already delivering more online education than they would normally provide and only a small proportion (7%) were providing no online education at all (Fig. 3).

Fig. 3.

How much online education is your institution currenty providing?

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When questioned about lecture formats, most were using live lectures to deliver online education, especially when combined with discussion (Fig. 4). PowerPoint and recorded lectures were used by about one in three educators. Very few were not delivering any online lectures (3%).

Fig. 4.

How is your institution currently delivering contact lens lectures to students online?

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Just over half of educators (54%) said their institutions were running online exams or assessments (Fig. 5). Only about one in four were holding these for students to attend in person (24%) or conducting practical sessions (27%).

Fig. 5.

Is your institution currently running any of the following?

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All EMEA respondents were providing some form of online education and these educators were likely to be teaching more online already (79%). In this region online student exams and assessments were also more commonly running (79%). Practical sessions and clinics were less likely to be taking place (both 17%), reflecting the high proportion of institutions in the region that were closed to students at that time.

More than three in four respondents (77%) were currently using video conferencing technology such as Zoom, WebEx or others in their teaching, and nearly half (43%) were using an online teaching platform (virtual learning environment) such as Canvas or Blackboard (Fig. 6). Only 9% were not using any of this form of technology.

Fig. 6.

Are you currently using the following types of technology in your contact lens teaching?

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When asked about specific platforms, the most popular was Zoom – used by more than half of educators (56%), followed by WeChat, which is a Chinese platform similar to WhatsApp (Fig. 7). Google Classroom, Microsoft Teams and WebEx were the next most commonly used. One in five employed a variety of other platforms, principally GoToMeeting, QQ (a Chinese version of Facebook) and WhatsApp.

Fig. 7.

What video conferencing or online teaching technology are you currently using to deliver contact lens education to students?

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Nearly half of respondents (48%) were using the social media platform WhatsApp to communicate with students, followed by 36% using WeChat (Fig. 8), and 13% used no social media for this purpose.

Fig. 8.

Which of the following social media do you currently use to communicate with your students?

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When educators were questioned about their social media preferences for personal rather than professional use, WhatsApp (56%) and Facebook (48%) were most popular, followed by YouTube (42%) and WeChat (36%). While preferences overall were similar to those for communicating with students, LinkedIn, Instagram and Twitter were more widely accessed for personal use.

Online teaching technology and social media platforms differ around the world and are influenced by availability in individual countries. In China, WeChat was by far the most used for professional and personal purposes, at 68% and 84% of respondents respectively, since some platforms are not accessible.

Asked about their contact lens teaching prior to COVID-19 restrictions, the largest proportion of educators (36%) estimated that online education had made up 10% or less of their total teaching (Fig. 9). One in five responding said that none of their teaching was conducted online prior to the pandemic.

Fig. 9.

What percentage of your total contact lens teaching would you estimate was conducted online prior to COVID-19 restrictions?

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When questioned on how much of their teaching would be online by the end of 2020, 68% of respondents estimated they would be conducting more than half of their total teaching online and 12% expected that 90% or more of their teaching would be online (Fig. 10).

Fig. 10.

What percentage of your total contact lens teaching would you estimate will be conducted online by the end of 2020?

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While the move towards more teaching online was general across all regions, some were starting from a higher base. In the Americas, 44% were already conducting around 75% of their teaching online.

Among the resources that educators were currently employing to teach their students online were the IACLE contact lens course (77%), case reports (46%) and image galleries (44%). COVID-19 resources and updates (29%) and monthly research updates (26%) were also used.

Some educators were collaborating across institutions and with colleagues (Fig. 11). About one in three were sharing live sessions (34%) and a similar proportion (32%) were discussing clinical cases together. Only 10% were donating presentations to other institutions or colleagues, and 43% were not collaborating in any of these ways.

Fig. 11.

Are you currently collaborating with other institutions or colleagues in any of the following ways?

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Teaching and assessing contact lens clinical skills is challenging in the absence of clinic facilities and practical sessions. One in four of the educators were not providing contact lens practical training in any form, and a similar proportion (22%) were not conducting student assessments at the time of the survey.

More encouragingly, 49% were using an online teaching platform or virtual learning environment for assessing their students.

The survey also reveals a variety of challenges to online provision of contact lens education, from the difficulty in measuring learning outcomes and monitoring students, to limited interaction and feedback (Fig. 12). Unstable or limited internet connectivity was also an issue for a substantial proportion of educators (41%).

Fig. 12.

What are the challenges you currently face in providing online education?

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Most respondents expected to have to change their teaching in the post-COVID situation and in varying ways (Fig. 13). The most common – cited by 76% of educators – was to provide more online lectures, followed by new methods to deliver practical education (63%). More than half of educators were also looking at introducing new teaching platforms and more online assessment methods.

Fig. 13.

How do you plan to adapt your contact lens teaching in future in light of the COVID-19 pandemic?

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Asked about specific resources for future use, there was support for a range of online resources. Notably, 74% of the educators would be interested in using an online platform delivering educational resources.

More webinars, discussions and debates, videos, case reports and images were popular choices to aid future teaching, along with methods for delivering and assessing practical/ clinical concepts remotely. There was also support for more collaboration between institutions in different regions and countries.

Re-opening institutions will require education providers to introduce new measures to minimize the spread of the virus. Questioned on precautions needed for students to attend in person, 90% of respondents expected to be using personal protective equipment (Fig. 14).

Fig. 14.

What precautions do you expect to take when students attend your institution in person?

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Hand sanitization and disinfection of contact lens trial sets and equipment were widely anticipated. Social distancing and use of slit-lamp shields were also envisaged. Reduced patient contact, anticipated by 65% of the educators, will challenge the teaching of practical skills and assessment.

Almost all the educators expected to change their advice to students in light of the pandemic (Fig. 15); 93% said they would place greater emphasis on hand hygiene and lens care procedures. There was support for additional hygiene measures that COVID-19 had highlighted – keeping unwashed hands away from the face and temporarily ceasing lens wear when unwell – and a move towards recommending daily disposable lenses.

Fig. 15.

Do you expect to change your advice to students towards any of the following in light of the COVID-19 pandemic?

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Overall, 18% of the educators would anticipate a change towards recommending spectacles rather than contact lenses. But this figure masks some substantial regional differences: only 4% in Americas would change their advice to students in this direction, but in China 29% expected their recommendation to change in favour of spectacles.