Effect of COVID-19 pandemic on glaucoma surgical practices in the UK

Mendelian randomization supports causality between COVID-19 and glaucoma

To determine whether there is a causal relationship between Corona Virus Disease 2019 (COVID-19) and glaucoma, a 2-sample Mendelian Randomization (MR) design was applied with the main analysis method of inverse-variance-weighted. The reliability of the results was checked using the heterogeneity test, pleiotropy test, and leave-one-out method. Four sets of instrumental variables (IVs) were used to investigate the causality between COVID-19 and glaucoma risk according to data from the IEU Genome Wide Association Study (GWAS). The results showed that 2 sets of COVID-19(RELEASE) were significantly associated with the risk of glaucoma [ID: ebi-a-GCST011071, OR (95% CI) = 1.227 (1.076-1.400), P = .002259; ID: ebi-a-GCST011073: OR (95% CI) = 1.164 (1.022-1.327), P = .022450; 2 sets of COVID-19 hospitalizations were significantly associated with the risk of glaucoma (ID: ebi-a-GCST011081, OR (95% CI) = 1.156 (1.033-1.292), P = .011342; ID: ebi-a-GCST011082: OR (95% CI) = 1.097 (1.007-1.196), P = .034908)]. The sensitivity of the results was acceptable (P > .05) for the 3 test methods. In conclusion, this MR analysis provides preliminary evidence of a potential causal relationship between COVID-19 and glaucoma.

Cyclodiode vs micropulse transscleral laser treatment

BACKGROUND

Continuous-wave transscleral cyclophotocoagulation (CW-TSCP) is usually reserved for advanced/refractory glaucoma. Micropulse transscleral laser therapy (MPTLT) utilises short energy pulses separated by 'off'-periods. MPTLT is postulated to have fewer complications, but its relative efficacy is not known. The National Institute for Health and Care Excellence (NICE) has deemed the evidence supporting MPTLT use of inadequate quality, limiting its use to research. This study aims to evaluate MPTLT efficacy and safety compared to CW-TSCP.

METHODS

This 24-month follow-up retrospective audit included 85 CW-TSCP and 173 MPTLT eyes at a London tertiary referral centre. Primary outcome was success rate at the last follow-up; defined as at least 20% intraocular pressure (IOP) reduction with the same/fewer medications, and IOP between 6 and 18 mmHg. Secondary outcomes were acetazolamide use and success rates per glaucoma type. Safety outcomes were reported as complication rates.

RESULTS

By 24-months, mean IOP reduced from 34.6[±1.4]mmHg to 19.0[ ± 3.0]mmHg post-CW-TSCP (p < 0.0001); and from 26.1[±0.8]mmHg to 19.1[±2.2]mmHg post-MPTLT (p < 0.0001). Average IOP decreased by 45.1% post-CW-TSCP, and 26.8% post-MPTLT. Both interventions reduced medication requirements (p ≤ 0.05). More CW-TSCP patients discontinued acetazolamide (p = 0.047). Overall success rate was 26.6% for CW-TSCP and 30.6% for MPTLT (p = 0.83). Only primary closed-angle glaucoma saw a significantly higher success rate following CW-TSCP (p = 0.014). CW-TSCP complication rate was significantly higher than MPTLT (p = 0.0048).

CONCLUSION

Both treatments significantly reduced IOP and medication load. CW-TSCP had a greater absolute/proportionate IOP-lowering effect, but it carried a significantly greater risk of sight-threatening complications. Further prospective studies are required to evaluate MPTLT compared to CW-TSCP.

Preserflo TM MicroShunt implantation combined with Ologen TM in primary and secondary glaucoma patients in a clinical setting

PURPOSE

This study aims to assess the effectiveness and safety of combining the Preserflo™ MicroShunt implant (MicroShunt) with a simultaneous Ologen™ implant in patients with glaucoma.

METHODS

We conducted a retrospective study on consecutive patients with medically uncontrolled glaucoma who underwent MicroShunt + Ologen implantation as a standalone procedure or in combination with phacoemulsification (combined procedure). Success was defined as achieving an intraocular pressure (IOP) of 6-15 mmHg at 18 months post surgery, with a preoperative IOP reduction of at least 20%, and without (complete success) or with (qualified success) the need for antiglaucoma medications. The primary endpoint was the success rate.

RESULTS

Forty-eight eyes from 47 patients were included, with 28 eyes (58.3%) undergoing the standalone procedure and 20 eyes (41.7%) undergoing the combined procedure. Overall, there was a significant reduction in preoperative IOP from 19.7 ± 5.8 mmHg to 11.4 ± 2.6 mmHg at 18 months ( P < 0.0001). In the standalone procedure group, preoperative IOP decreased from 21.5 ± 5.2 mmHg to 11.7 ± 2.5 mmHg ( P < 0.0001), and in the combined procedure group, preoperative IOP decreased from 17.1 ± 5.8 mmHg to 10.9 ± 2.7 mmHg ( P = 0.0002), with no significant difference between the two groups regarding final IOP. The mean number of antiglaucoma medications significantly decreased from 3.2 ± 1.1 to 0.3 ± 0.7 in the overall study population ( P < 0.0001). At 18 months, 40 eyes (83.3%) were classified as successful. Regarding safety, out of the total number of eyes, two (4.2%) experienced choroidal detachment without visual impairment, two (4.2%) had transient hyphema, one (2.1%) showed reactivation of a corneal herpetic ulcer, one (2.1%) had diplopia, and one (2.1%) exhibited a shallow anterior chamber during the first week.

CONCLUSION

The combination of Ologen™ and Preserflo™ MicroShunt, either alone or in conjunction with phacoemulsification, demonstrated a favorable profile in terms of IOP reduction and safety.

Changes to glaucoma surgery patterns during the coronavirus disease 2019 pandemic: a shift towards less invasive procedures

PURPOSE

The aim of the study was to compare the quantity, type of glaucoma surgeries, and the disease stage before and during the coronavirus disease 2019 (COVID-19) pandemic.

METHODS

This was a retrospective, single-centre consecutive case series that included medical records of patients who underwent glaucoma surgery at the University Hospital in Białystok between 4 September, 2018, and 3 March, 2020 (pre-pandemic group) and compared it with patients treated between 4 March, 2020, and 4 September, 2021 (pandemic group). Adult patients with primary or secondary open-angle or closed-angle glaucoma who underwent surgery were included in this study. Finally, 534 operated eyes (362 and 172 eyes operated on before and during the pandemic, respectively) were examined.

RESULTS

The number of glaucoma surgeries dropped by 50% during the pandemic compared to a similar pre-pandemic period, with a significant difference in the kind of procedure between the two groups (p < 0.001). The most common procedures in the pre-pandemic group were Ex-Press implantation (33.7%) and trabeculectomy (31.5%). Within the pandemic group, half of the eyes underwent trabeculectomy (50.0%), followed by Preserflo microshunt (11.6%), iStent (8.7%), and transscleral cyclophotocoagulation (TSCP) (8.7%). A significant difference in the average intraocular pressure was revealed among patients who qualified for surgery.

CONCLUSION

The COVID-19 pandemic is associated with a decrease in the number of extended antiglaucoma procedures and an increase in the number of short procedures performed, such as TSCP and minimally invasive glaucoma surgery.Key MessagesOur study has shown the negative impact of the COVID-19 pandemic in reducing the number of antiglaucoma procedures.The number of glaucoma surgeries dropped by 50% during the pandemic compared to those in a similar pre-pandemic period, and the type of performed procedures has changed.The COVID-19 pandemic is associated with a decrease in the number of combined antiglaucoma procedures, in opposite: the number of minimally invasive glaucoma surgeries increased due to safety reasons.

Ophthalmology procedure trends in the United States during the COVID-19 pandemic

PURPOSE

To evaluate the relationship between the COVID-19 pandemic and ophthalmic procedural volume.

METHODS

A retrospective cohort study using TriNetX, a federated electronic health record's research network was done. Monthly Current Procedural Terminology-specific volumes per healthcare organization were clustered chronologically to calculate average volumes into 3-month seasons to calculate average procedural volumes. An aggregate of the total pandemic period (March 2020-August 2021) was compared to corresponding figures in pre-pandemic timeframes.

RESULTS

Intravitreal injections were the most prevalent procedure in this time period with 320,106 occurrences. Phacoemulsification cataract surgery was the second most prevalent (N = 176,095) procedure. From March 2020 to August 2021, a mean pandemic volume of 266.7 (SD = 15) was observed, a 5% decrease (p < 0.05) in procedures compared to the pre-pandemic mean of 280.8 (SD = 26.1). Spring 2020 exhibited the sharpest seasonal decrease in procedural volume (- 88%). The largest count of statistically significant increases in procedure volume was in Spring 2021 (+ 18%). The aggregate mean volume per HCO showed significant decreases for 11 out of 17 procedures in the 12 month March 2020-February 2021 timeframe and significant decreases for 10 out of 17 procedures over the 18-month March 2020-August 2021 pandemic period.

CONCLUSIONS

This study highlights the relative inverse relationship between COVID-19 cases and ophthalmic procedure volume in America. Quantifying ophthalmic procedure trends is important in retrospectively assessing surgical disruptions and prospectively accommodating delayed surgeries. Furthermore, awareness of these trends could help ophthalmologists prepare should similar disruptions occur in the setting of future pandemics or national disasters.

Glaucoma Characteristics and Influencing Factors during the COVID-19 Pandemic in the Huizhou Region

Objective

Glaucoma in individuals who tested positive for the coronavirus disease 2019 (COVID-19) during the pandemic outbreak has not been comprehensively studied. Therefore, this study aimed to analyze the characteristics and risk factors of glaucoma during the COVID-19 pandemic in Huizhou.

Methods

Retrospective data from outpatients with glaucoma at the Huizhou Hospital Affiliated with Guangzhou Medical University and Longmen County People's Hospital were collected during two periods: the COVID-19 pandemic period (Phase A: December 1, 2022, to January 19, 2023) and the prevention and control period (Phase B: December 1, 2021, to January 19, 2022). The demographic characteristics of the outpatients during both phases were compared. The characteristics of glaucoma in patients with COVID-19 during Phase A were examined. Multivariate logistic regression analysis was used to identify factors influencing the development of acute angle-closure glaucoma (AACG) in Phase A patients.

Results

The proportion of patients with glaucoma was significantly higher during Phase A than during Phase B at both hospitals. No statistically significant differences were observed between patients with glaucoma during Phases A and B for age, sex, and region. A high COVID-19-positive rate was associated with old age, females, AACG, newly diagnosed glaucoma, and binocular involvement during phase A. Females testing positive for COVID-19, glaucoma that started after testing positive for COVID-19, and a history of medication use were associated with a higher proportion of AACG in phase A. Multivariable logistic regression analysis identified testing positive for COVID-19 as an independent potential risk factor for developing AACG.

Conclusion

In summary, during the COVID-19 pandemic in Huizhou, patients with COVID-19 were primarily affected by AACG, especially females, older individuals, and those with binocular involvement. Testing positive for COVID-19 increases the risk of developing AACG.

PRESERFLO ™ MicroShunt versus trabeculectomy: 1-year results on efficacy and safety

PURPOSE

To compare the efficacy and safety of the PRESERFLO™ MicroShunt versus trabeculectomy in patients with primary open-angle glaucoma (POAG) after one year.

PATIENTS AND METHODS

Institutional prospective interventional cohort study comparing eyes with POAG, which had received the PRESERFLO™ MicroShunt versus trabeculectomy. The MicroShunt group was matched with the trabeculectomy group for age, known duration of disease, and number and classes of intraocular pressure (IOP) lowering medications to have similar conjunctival conditions. The study is part of the Dresden Glaucoma and Treatment Study, using a uniform study design, with the same inclusion and exclusion criteria, follow-ups and standardized definitions of success and failure for both procedures.

PRIMARY OUTCOME MEASURES

mean diurnal IOP (mdIOP, mean of 6 measurements), peak IOP, and IOP fluctuations.

SECONDARY OUTCOME MEASURES

success rates, number of IOP lowering medications, visual acuity, visual fields, complications, surgical interventions, and adverse events.

RESULTS

Sixty eyes of 60 patients, 30 in each group, were analyzed after 1-year follow-ups. Median [Q25, Q75] mdIOP (mmHg) dropped from 16.2 [13.8-21.5] to 10.5 [8.9-13.5] in the MicroShunt and from 17.6 [15.6-24.0] to 11.1 [9.5-12.3] in the trabeculectomy group, both without glaucoma medications. Reduction of mdIOP (P = .596), peak IOP (P = .702), and IOP fluctuations (P = .528) was not statistically significantly different between groups. The rate of interventions was statistically significantly higher in the trabeculectomy group, especially in the early postoperative period (P = .018). None of the patients experienced severe adverse events.

CONCLUSION

Both procedures are equally effective and safe in lowering mdIOP, peak IOP and IOP fluctuations in patients with POAG, one year after surgery.

CLINICAL TRIAL REGISTRATION

NCT02959242.

Will the PRESERFLO™ MicroShunt impact the future of trabeculectomy practice? A UK and Éire Glaucoma Society National Survey

BACKGROUND/OBJECTIVES

To explore the attitudes of UK glaucoma specialists regarding the current and future practice of trabeculectomy and the novel PRESERFLO™ MicroShunt (PF-MS) device, and intentions to adopt the PF-MS into routine glaucoma surgical practice.

METHODS

Online survey of UK and Éire Glaucoma Society members.

RESULTS

43 glaucoma consultants completed the survey. All surgeons performed trabeculectomies (median of 40 annually) and 51% undertook PF-MS procedures (median of 22.5 annually). The mean duration of surgery was reported as 48.9 (SD 13.3) and 31.2 (SD 9.9) min for trabeculectomy and PF-MS respectively (p < 0.0001). For surgeons not currently using the PF-MS, 65% planned to do so. Respondents judged completion of 35 trabeculectomies and 10 PF-MS were required to achieve basic competence. 91% of participants predicted their trabeculectomy volume would decrease and 73% expected PF-MS usage to increase. Respondents reported a median of six and four follow-ups within 3 months post surgery for trabeculectomy and PF-MS respectively (p < 0.0001). Respondents reported trabeculectomy required more post-operative interventions than the PF-MS and 81.8% judged the patient experience to be better with the PF-MS. The PF-MS was deemed suitable for early visual field loss by 72% of respondents, severe visual field loss by 35% and normal tension glaucoma by 21%.

CONCLUSION

The PF-MS has seen rapid adoption in the UK. Respondents predict its usage will significantly increase whilst trabeculectomies will decrease. They report the PF-MS is quicker to learn and perform, and requires less post-operative follow-ups and interventions which may facilitate a more efficient service delivery for patients requiring glaucoma surgery.

Lifestyle Measures for Glaucoma Patients: An Objective Social Media Content Analysis

Aim

In this study, we analyze the content quality and characteristics of the most viewed search results on various internet platforms related to lifestyle measures for patients with glaucoma.

Materials and methods

In this internet-based cross-sectional study, we used search keywords "glaucoma," "lifestyle," "glaucoma," and "exercise" on the most popular internet platforms-Google, Facebook, YouTube, and Reddit. The top 30 Google searches about each of the keyword combinations were identified. We also assessed the first 30 videos on YouTube and Facebook Watch, the first 30 Reddit posts and the first 30 Google images about each of the keyword combinations. The quality of content from the platforms was evaluated by three independent reviewers using the well-established Sandvik score, Health on Net (HON) code, and risk score for different uploaders. The quality of content regarding lifestyle measures in glaucoma uploaded by healthcare professionals (HCPs) was further evaluated.

Results

The established criteria resulted in 48 websites from the Google search engine, 22 videos from YouTube, 37 posts from Reddit, and 28 videos from Facebook Watch, which were included in the final analysis. The mean Sandvik scores were 11.14 ± 1.8 (Google webpages), 10.4 ± 2.19 (YouTube videos), 10.54 ± 2.21 (Facebook Watch), and 4.24 ± 1.18 (Reddit). The mean risk scores were 0.22 ± 0.68 (YouTube videos), 0.18 ± 0.47 (Facebook Watch), and 0.11 ± 0.31 (Reddit). The mean HON code scores were 5.45 ± 1.62 (YouTube), 6.55 ± 1.44 (Google webpages), 5.29 ± 1.04 (Facebook Watch), and 8.27 ± 3.05 (Reddit). The content uploaded by HCPs was primarily from ophthalmologists and had significantly (p < 0.05) higher content quality scores. The majority of the content recommended aerobic exercise as a lifestyle measure in patients with glaucoma as an adjuvant to medical and surgical management.

Conclusion

The majority of the content regarding lifestyle measures in glaucoma was uploaded by HCPs and had medically accurate and well-referenced information, especially on Google and YouTube.

Clinical significance

Primary care physicians and ophthalmologists can reliably use social media content to guide recently diagnosed patients about the requisite lifestyle measures.

How to cite this article

Chahal R, Jindal A, Parmar UPS, et al. Lifestyle Measures for Glaucoma Patients: An Objective Social Media Content Analysis. J Curr Glaucoma Pract 2023;17(3):141-148.

Short-term safety and efficacy of Preserflo™ Microshunt in glaucoma patients: a multicentre retrospective cohort study

BACKGROUND/AIMS

To evaluate 1-year success rates and safety profile of Preserflo™ Microshunt in glaucoma patients.

METHODS

Retrospective multicentre cohort study of 100 consecutive eyes (91 patients) from four tertiary-referral glaucoma centres. Four intraocular pressure (IOP) criteria were defined: A: IOP ≤ 21 mmHg+IOP reduction ≥20% from baseline; B: IOP ≤ 18 mmHg+IOP reduction ≥20%; C: IOP ≤ 15 mmHg+IOP reduction ≥25%; D: IOP≤12 mmHg+IOP reduction ≥30%. Success was defined as qualified or complete based on whether reached with or without medication. Primary outcome was success according to the above criteria. Secondary outcomes included: IOP, best-corrected visual acuity (BCVA), medication use, complications, postoperative interventions, and failure-associated factors.

RESULTS

Qualified and complete success rates (95% CI) at 12 months were 74%(66-83%) and 58%(49-69%) for criterion A, 72%(63-82%) and 57%(48-68%) for B, 52%(43-63%) and 47%(38-58%) for C, 29%(21-40%) and 26%(19-36%) for D. Overall median (interquartile range (IQR)) preoperative IOP decreased from 21.5(19-28) mmHg to 13(11-16) mmHg at 12 months. BCVA was not significantly different up to 12 months (p = 0.79). Preoperative median (IQR) number of medications decreased from 3 (2-3) to 0 (0-1) at 12 months. Twelve eyes underwent needling, five surgical revision and one device removal due to corneal oedema. There were no hypotony-related complications. Non-Caucasian ethnicity was the only risk factor consistently associated with increased failure.

CONCLUSIONS

Preserflo™ Microshunt is a viable surgical option in glaucoma patients, with reasonable short-term success rates, decreased medications use, excellent safety profile, smooth postoperative care, and rapid learning curve. Success rates for the most stringent IOP cutoffs were modest, indicating that it may not be the optimal surgery when very low target IOP is required.

Mental health and social support among glaucoma patients enrolled in the NIH All of Us COVID-19 Participant Experience (COPE) survey

BACKGROUND

The COVID-19 pandemic created many challenges for our society. In this study, we explore how measures of mental health, coping strategies, and social support during the pandemic varied by glaucoma status.

METHODS

A cohort of patients aged 40 and over enrolled in the NIH All of Us Research Program, a nationwide longitudinal cohort, who answered the COVID-19 Participant Experience (COPE) survey was obtained. We analyzed several measures of mental health, coping strategies, and social support used during the early stages of the COVID-19 pandemic. Surveys were recurring and answered from May 2020 to February 2021. Demographics and the most recently answered survey responses were obtained and stratified by glaucoma status. Pearson's Chi-squared tests and multivariable logistic regressions adjusting for age, gender, race, ethnicity, and income were used to generate p-values, odds ratios (ORs) and 95% confidence intervals (CIs) between outcome measures and glaucoma status.

RESULTS

Of 42,484 patients who responded to All of Us COPE survey items, 2912 (6.9%) had a diagnosis of glaucoma. On Pearson's Chi-squared tests glaucoma patients were less likely to report drinking alcohol (P = 0.003), eating more food than usual (P = 0.004), and using marijuana (P = 0.006) to cope with social distancing than those without a diagnosis of glaucoma. Further, glaucoma patients had lower rates of probable mild, moderate, or severe depression as calculated by Patient Health Questionnaire-9 (PHQ-9) scores (P < 0.001) and had lower rates of reporting some or a lot of stress from social distancing (P < 0.001). However, glaucoma patients were less likely to report having someone to help prepare meals (P = 0.005) or help with daily chores (P = 0.003) if they became sick with COVID-19. In multivariable logistic regression analyses adjusting for confounding factors, no differences were found for measures of mental health or social support.

CONCLUSIONS

Glaucoma patients did not fare worse on many measures of mental health and coping strategies during the early stages of the COVID-19 pandemic compared those without glaucoma. However, a substantial proportion of glaucoma patients still endorsed stress, social isolation, and probable depression, representing challenges for disease management.

Laser in Glaucoma and Ocular Hypertension (LiGHT) Trial: Six-Year Results of Primary Selective Laser Trabeculoplasty versus Eye Drops for the Treatment of Glaucoma and Ocular Hypertension

PURPOSE

The Laser in Glaucoma and Ocular Hypertension (LiGHT) Trial has shown selective laser trabeculoplasty (SLT) to be clinically and cost-effective as a primary treatment of open-angle glaucoma (OAG) and ocular hypertension (OHT) at 3 years. This article reports health-related quality of life (HRQoL) and clinical effectiveness of initial treatment with SLT compared with intraocular pressure (IOP)-lowering eye drops after 6 years of treatment.

DESIGN

Prospective, multicenter randomized controlled trial.

PARTICIPANTS

Treatment-naive eyes with OAG or OHT initially treated with SLT or IOP-lowering drops.

METHODS

Patients were allocated randomly to initial SLT or eye drops. After the initial 3 years of the trial, patients in the SLT arm were permitted a third SLT if necessary; patients in the drops arm were allowed SLT as a treatment switch or escalation. This study is registered at controlled-trials.com (identifier, ISRCTN32038223).

MAIN OUTCOME MEASURES

The primary outcome was HRQoL at 6 years; secondary outcomes were clinical effectiveness and adverse events.

RESULTS

Of the 692 patients completing 3 years in the LiGHT Trial, 633 patients (91.5%) entered the extension, and 524 patients completed 6 years in the trial (82.8% of those entering the extension phase). At 6 years, no significant differences were found for the EuroQol EQ-5D 5 Levels, Glaucoma Utility Index, and Glaucoma Quality of Life-15 (P > 0.05 for all). The SLT arm showed better Glaucoma Symptom Scale scores than the drops arm (83.6 ± 18.1 vs. 81.3 ± 17.3, respectively). Of eyes in the SLT arm, 69.8% remained at or less than the target IOP without the need for medical or surgical treatment. More eyes in the drops arm exhibited disease progression (26.8% vs. 19.6%, respectively; P = 0.006). Trabeculectomy was required in 32 eyes in the drops arm compared with 13 eyes in the SLT arm (P < 0.001); more cataract surgeries occurred in the drops arm (95 compared with 57 eyes; P = 0.03). No serious laser-related adverse events occurred.

CONCLUSIONS

Selective laser trabeculoplasty is a safe treatment for OAG and OHT, providing better long-term disease control than initial drop therapy, with reduced need for incisional glaucoma and cataract surgery over 6 years.

The effect of COVID-19 pandemic and wearing face masks on ophthalmology practice: What is known so far? A narrative review

Face masks, along with other preventive measures, can help slow the spread of COVID-19. Despite the positive effect of the mask in combating the virus, it has some negative effects on the human body that must be followed up on and reduced. In this study, we discuss the impact of wearing face masks on the eye and the common issues associated with using them. The literature search was conducted using electronic databases such as PubMed and Google Scholar. Only articles published in English were included. A total of 39 relevant articles were deemed eligible. After the duplicate articles were removed, the titles and abstracts of 20 papers underwent full-text screening. The review comprised both prospective and retrospective investigations, case reports, and a series of reporting ocular symptoms following the use of face masks. The COVID-19 pandemic affected ophthalmology practices in managing patients. New factors must be considered, especially when dealing with anti-VEGF injections, such as the risk of endophthalmitis, tests and symptoms of patients with glaucoma, and the emerging symptoms associated with the COVID-19 vaccination. The use of face masks and breathing aids seemed to influence the tear film.

Impact of COVID-19 on glaucoma management: A review

Glaucoma is the leading cause of irreversible vision loss and the second leading cause of blindness worldwide. The rapid transmission of SARS-CoV-2virus compelled governments to concentrate their efforts on emergency units to treat the large number of cases that arose due to the Covid-19 outbreak. As a result, many chronically ill patients were left without access to medical care. The progression of glaucoma in previously diagnosed cases has been accelerated; due to this, some have lost their vision. Evaluation of Covid-19's effect on glaucoma treatment was one goal of this study. We used search phrases like "COVID-19," "telemedicine," and "glaucoma" to find published papers on COVID-19 and glaucoma. Artificial Intelligence (AI) may be the answer to the unanswered questions that arose due to this pandemic crisis. The benefits and drawbacks of AI in the context of teliglaucoma have been thoroughly examined. These AI-related ideas have been floating around for some time. We hope that Covid-19's enormous revisions will provide them with the motivation to move forward and significantly improve services. Despite the devastation the pandemic has caused, we are hopeful that eye care services will be better prepared and better equipped to avoid the loss of sight due to glaucoma in future.

MicroShunt versus Trabeculectomy for Surgical Management of Glaucoma: A Retrospective Analysis

This case-control study aims to compare the efficacy, safety, and postoperative burden of MicroShunt versus trabeculectomy. The first consecutive cohort of MicroShunt procedures (n = 101) was matched to recent historical trabeculectomy procedures (n = 101) at two London hospital trusts. Primary endpoints included changes in intraocular pressure (IOP) and glaucoma medications. Secondary outcome measures included changes in retinal nerve fibre layer (RNFL) thickness, rates of complications, further theatre interventions, and the number of postoperative visits. From the baseline to Month-18, the median [interquartile range] IOP decreased from 22 [17–29] mmHg (on 4 [3–4] medications) to 15 [10–17] mmHg (on 0 [0–2] medications) and from 20 [16–28] mmHg (on 4 [3–4] medications) to 11 [10–13] mmHg (on 0 [0–0] medications) in the MicroShunt and trabeculectomy groups, respectively. IOP from Month-3 was significantly higher in the MicroShunt group (p = 0.006), with an increased number of medications from Month-12 (p = 0.024). There were greater RNFL thicknesses from Month-6 in the MicroShunt group (p = 0.005). The rates of complications were similar (p = 0.060) but with fewer interventions (p = 0.031) and postoperative visits (p = 0.001) in the MicroShunt group. Therefore, MicroShunt has inferior efficacy to trabeculectomy in lowering IOP and medications but provides a better safety profile and postoperative burden and may delay RNFL loss.

Evaluation of the perception of physical and emotional health of ophthalmologists in Spain and the influence of the COVID-19 pandemic

Objective

The main objective was to study the perception of physical and emotional health of Spanish ophthalmologists and their health habits, as well as the possible influence of the COVID-19 pandemic.

Methods

An observational, cross-sectional, non-randomized and uncontrolled study was carried out among at Spanish ophthalmologists through an online survey of 47 questions on eating habits, tobacco, alcohol, physical exercise, workload, and perception of physical and emotional state.

Results

Of a total of 2,179 ophthalmologists, 260 (11.9%) of whom 55% were men responded to the survey, with a mean age of 52.9 ± 11.4 years. 5.8% were smokers. In total, 51.5% reported good physical health, with a mean Body Mass Index of 24.4 kg/m². Overall, 53.5% reported depression, 66.9% tiredness, 34.6% difficulty sleeping, and 57.3% considered their work hard. Up to 28.5% of those surveyed had thought about leaving their job and 60.8% about reorganizing their workload. In total, 91.9% would continue to choose Ophthalmology as a specialty. In total, 36.2% reported an increase in workload, 42.3% worsening of physical state and 63.8% worsening of emotional state as a consequence of the COVID-19 pandemic.

Conclusions

Spanish ophthalmologists have a positive perception of their physical and emotional health, despite having life habits that are not always healthy and feeling mostly down. The COVID-19 pandemic has had a negative influence on the physical and emotional health of ophthalmologists.

Patient and clinician perspectives of ophthalmology emergency attendances during the COVID 19 pandemic

Introduction

To explore patient and clinician perspectives on acute ophthalmology presentations during the COVID pandemic. To ascertain whether the pandemic had differentially impacted access to care based on patient demographics and postcodes.

Methods

A single-centre, cross-sectional prospective study in a busy metropolitan eye casualty between April-June 2020 recording patient demographics, distance travelled to access healthcare, diagnosis and outcome compared to the equivalent period in 2019. A further two-part survey was conducted to explore patient and clinician's perceptions around delays in attendances, views on remote consultation and severity of the condition.

Results

There was a 68% decrease in April 2020 compared to previous year's ED attendance. The diagnosis tended towards more visually significant pathology. From 2019 to 2020, there was a significant decrease in average distance travelled to the eye emergency department (eye ED). working-age adults (18-59) and white patients travelling from very far pre-pandemic contributed most to this change. 513 Patient responses (12%) out of 4433 attendances during the study period were received, 89% (456/513) of the completed surveys also had matching clinician surveys. 29% (149/513) patients felt COVID-19 stopped them from attending earlier. Clinicians thought a video consultation would have been suitable for 40% (182/456) of patients compared to only 13% (58/456) of patients preferring a video consultation.

Discussion

Although our findings were limited by low response rates, COVID-19 may have caused a delay in presentation for emergency eye care. Demographic changes and attitudes towards video consultations have implications for planning of emergency eye care in future pandemics.

How glaucoma care changed for the better after the pandemic

PURPOSE OF REVIEW

The current article reviews enhancements to the delivery of glaucoma care that developed in response to the coronavirus disease 19 (COVID-19) pandemic and are likely to persist beyond its resolution.

RECENT FINDINGS

Literature from the review period (2020-2021) includes reports highlighting contributions of the ophthalmology community to global health during the pandemic. Glaucoma practices worldwide have instituted more robust infection control measures to mitigate severe acute respiratory syndrome coronavirus 2 transmission in the outpatient setting, and many of these modifications will endure in the post-COVID era. Operational adjustments have led to the provision of more efficient glaucoma care. A hybrid care model involving technician-based diagnostic testing and subsequent virtual consultation with a glaucoma specialist has evolved as a useful adjunct to traditional face-to-face encounters with patients.

SUMMARY

Glaucoma specialists, patients, and staff have adapted to a 'new normal' of glaucoma care delivery during the COVID-19 pandemic. Although innovation has propelled several improvements to glaucoma care during this global health crisis, significant barriers to more widespread implementation of teleglaucoma still exist. Whether, and in what capacity, the pandemic has permanently altered glaucoma practice patterns remains to be seen.

Audit of outcomes following attendance at the City West drive-through IOP glaucoma clinic during the COVID-19 pandemic

BACKGROUND

Glaucoma is the leading cause of irreversible blindness globally. During the COVID-19 pandemic, an enforced reduction in capacity resulted in the deferral of routine outpatient appointments for glaucoma patients.

AIM

This study analyses patient outcomes following the establishment of a drive-through intra-ocular pressure (IOP) clinic during the COVID-19 pandemic to alleviate increased pressure on the tertiary glaucoma services at Royal Victoria Eye and Ear Hospital (RVEEH) and Mater Misericordiae University Hospital (MMUH) between August 2020 and June 2021.

METHODS

A 1-lane driveway system was established in a marquee on the grounds of City West hotel. IOPs were measured in patients' cars using a hand held iCare100 tonometer. Results were reviewed by a consultant ophthalmologist. At hospital follow-up clinic visits, IOP was measured using the Goldmann applanation tonometer (GAT).

RESULTS

Three hundred one patients of a total of 672 who attended the drive-through clinic have subsequently attended a designated hospital follow-up appointment. In this cohort, the mean drive-through iCare IOP of 19.4 mmHg ± 6.0 was significantly higher (< 0.005) than the mean GAT IOP at the pre-drive through clinic visit (16.3 mmHg ± 3.7) and the post drive-through hospital follow-up visit (17.2 mmHg ± 4.1). Two hundred twenty-six (75%) patients did not need any treatment change, 53 (18%) required eye drop medication changes, 10 (3%) underwent a laser procedure, 4(1%) required surgical intervention, and 8 (3%) were discharged. When patient outcomes were analysed according to IOP grade assigned at the drive-through clinic, those with an iCare IOP < 21 were significantly less likely to require a treatment change. The cohort with iCare IOP ≥ 30 were significantly more likely to have a laser or surgical intervention.

CONCLUSION

The implementation of a drive-through IOP clinic was a safe and effective way to monitor glaucoma patients during COVID-19, and identify those at high risk of poor IOP control or requiring a change in treatment.

Micropulse Transscleral Cyclophotocoagulation as Primary Surgical Treatment for Primary Open Angle Glaucoma in Taiwan during the COVID-19 Pandemic

Glaucoma is the leading cause of irreversible blindness worldwide, with primary open angle glaucoma (POAG) accounting for the greatest number of total glaucoma cases. This study aimed to evaluate the efficacy and safety of micropulse transscleral cyclophotocoagulation (MP-TSCPC) as a primary procedure in POAG during the COVID-19 pandemic. We retrospectively analyzed 60 eyes of 52 patients, who were diagnosed with mild-to-end-stage POAG without previous glaucoma surgery and received MP-TSCPC between 1 January 2020 and 31 August 2020. The mean preoperative intraocular pressure (IOP) significantly decreased from 27.8 mm Hg to 19.8, 20.1, 20.3, 20.4, and 20.2 mm Hg at 1, 3, 6, 9, and 12 months, respectively (all p < 0.05). The mean number of IOP-lowering medications used significantly decreased from 3.3 at the baseline to 1.6, 1.8, 1.8, 1.9, and 1.9 at 1, 3, 6, 9, and 12 months, respectively (all p < 0.001). Total withdrawal of antiglaucoma medications was fulfilled in five patients. The main outcome was achieved in 81.7% at postoperative month 12. The most common adverse effect was transient mydriasis (28.3%). No major complications were encountered. MP-TSCPC seems to be an effective and safe treatment to reduce IOP and the medication burden with minimal vision-threatening complications in mild-to-end-stage POAG patients without previous glaucoma surgery.

The Impact of Covid-19 in the Follow-Up of Glaucoma Patients in a Tertiary Center: A Comparison Between Pre-Pandemic and Pandemic Periods

Purpose

To evaluate the impact of Covid-19 on the treatment and follow-up of glaucoma patients in a tertiary center.

Materials and Methods

We compared the total number of outpatient clinical visits, visual field exams, surgical procedures and medications released in the pre-pandemic period (March 2019–February 2020) and pandemic period (March 2020–February 2021). We also performed a paired analysis, which included patients who were examined in both periods, comparing the number of visits and medications.

Results

The total number of outpatients clinical visits, visual field exams, surgical procedures and medications released decreased 92.52% (7117 vs 532), 93.84% (1525 vs 94), 72.74% (682 vs 145) and 19.63% (23,259 vs 18,692), respectively, when the pre-pandemic and pandemic periods were compared. The mean number of annual clinical visits per patient (1.8 ± 0.79 vs 1.04 ± 0.18, p<0.0001) and surgical procedures per patient (1.46 ± 0.92 vs 1.13 ± 0.41, p<0.0001) decreased significantly, whereas the mean number of medications released per patient did not change significantly (28.62 ± 19.11 vs 30.34 ± 20.15, p=0.97). In the paired analysis, the mean number of visits (n=423 patients) decreased from 1.86 ± 0.76 to 1.04 ± 0.19 (p<0.0001) and the mean number of medications (n=561 patients) decreased from 33.44 ± 18.61 to 31.97 ± 19.86 in the pre-pandemic and pandemic periods, respectively (p=0.393).

Conclusion

The Covid-19 pandemic dramatically decreased the number of outpatient visits and surgical procedures, impacting the follow-up of glaucoma patients in our service. We encourage other health care units to verify the impact of the pandemic in their own population to better prepare for a possible overload of uncontrolled glaucoma patients in the future.

Do University Students Adhere to WHO Guidelines on Proper Use of Face Masks during the COVID-19 Pandemic?—Analysis and Comparison of Medical and Non-Medical Students

Covering the mouth and nose has become the common standard for protection from human-to-human virus transmission during the COVID-19 pandemic. The aim of the study was to investigate whether students at universities (medical and non-medical students) do adhere to WHO recommendations on the proper use of face protection. The study was based on the survey created with Google® Forms regarding data on demographics and self-reported skin conditions. The main questions addressed the WHO guideline on the correct use of face masks. Responses were obtained from 1173 students. Compliance with all WHO criteria among the whole group of respondents was very low at less than 1% with no significant difference between medical and non-medical students. Covering of the nose and mouth with the face mask was the criterion most commonly complied with (81.2%); contact avoidance of touching the mask with hands appeared to be the most difficult criterion to comply with (2.8%). Medical students were significantly more compliant with three out of seven criteria. In general, compliance with the WHO guidelines on the proper use of face masks was dramatically low among all the students. Education campaigns should be introduced to increase the awareness of the correct use of face coverings during the viral pandemic.