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Balakrishnan P, Swain TA, McGwin G, Owsley C, Girkin CA, Rhodes LA. Comparison of Glaucoma Diagnosis by Telemedicine, In-Person Ophthalmologist, and Optometrist. J Glaucoma 2024; 33:619-623. [PMID: 38976298 PMCID: PMC11365792 DOI: 10.1097/ijg.0000000000002456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 06/15/2024] [Indexed: 07/09/2024]
Abstract
PRCIS Diagnosis of glaucoma through telemedicine demonstrates moderate agreement with in-person ophthalmologist (MD) and in-person optometrist (OD) diagnosis, providing evidence that telemedicine is a timely, accurate screening method in settings where an in-person visit may not be feasible. OBJECTIVE To compare diagnostic agreement of glaucoma between in-person MD, in-person OD, and a simulated telemedicine program. PATIENTS AND METHODS A cross-sectional study of patients with normal optic nerve structural and functional imaging and new patients referred for glaucoma evaluation examined in-person by an MD for glaucoma with a dilated examination and structural and functional optic nerve testing (optical coherence tomography, photos, and visual field); examined in person by an OD with a dilated examination and optic nerve testing; and structural and functional optic nerve testing reviewed separately by 2 ophthalmologists [telemedicine ophthalmologist reviewer 1 (TMD1), telemedicine ophthalmologist reviewer 2 (TMD2)] with masking of prior MD and OD diagnoses. Interrater agreement between each diagnostic method (MD, OD, TMD1, and TMD2) of normal versus disease (open angle glaucoma, normal tension glaucoma, other types of glaucoma, other optic nerve disorders, ocular hypertension, and glaucoma suspect) for each eye was calculated (Cohen unweighted kappa). RESULTS A total of 100 patients with a median age of 66 years (interquartile range: 59-72), male (40%) and white (62%) were analyzed. There was moderate agreement between MD and telemedicine [TMD1 kappa 0.49 (95% CI: 0.37-0.61), TMD2 kappa 0.44 (95% CI: 0.32-0.56)] and between MD and OD diagnosis [0.41 (95% CI: 0.28-0.54)] and fair-moderate agreement between OD and telemedicine [TMD1: 0.46 (95% CI: 0.34-0.58), TMD2: 0.61 (95% CI: 0.50-0.72)]. CONCLUSIONS The simulated telemedicine approach had comparable levels of agreement in glaucoma diagnosis with in-person fellowship-trained ophthalmologists, presenting a crucial complementary role in screening and increasing access to care, particularly in rural or underserved settings.
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Affiliation(s)
- Poojitha Balakrishnan
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Thomas A. Swain
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gerald McGwin
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Cynthia Owsley
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Christopher A. Girkin
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lindsay A. Rhodes
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Lim AWY, Leong CT, Salowi MA, Lim YMF, Wong WJ, Hwong WY. Trends in cataract surgery and healthcare system response during the COVID-19 lockdown in Malaysia: Lessons to be learned. PUBLIC HEALTH IN PRACTICE 2024; 7:100469. [PMID: 38323125 PMCID: PMC10844644 DOI: 10.1016/j.puhip.2024.100469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 12/20/2023] [Accepted: 01/09/2024] [Indexed: 02/08/2024] Open
Abstract
Background Elective surgeries were suspended during the national lockdown in March 2020 to curb the spread of the COVID-19 pandemic in Malaysia. We sought to evaluate the impact of the lockdown on cataract surgeries and suggest lessons for future outbreaks. Study design We conducted an interrupted time series analysis to examine rates of cataract surgery before and during the lockdown. Methods We used national cataract surgical data between 2015 and 2021 from the Malaysian Cataract Surgery Registry. Segmented regression with a seasonally adjusted Poisson model was used for the analysis. Stratified analyses were performed to establish whether the effect of the lockdown on cataract surgeries varied by hospital designation, type of cataract service, sex, and age groups. Results Cataract surgeries began falling in March 2020 at the onset of the lockdown, reached a trough in April 2020, and subsequently increased but never recovered to pre-lockdown levels. Cataract surgical rates in December 2021 were still 43 % below the expected surgical volume, equivalent to 2513 lost cataract surgeries. There was no evidence of a differential effect of the lockdown between COVID-19 designated and non-COVID-19 designated hospitals. The relative decrease in cataract surgical rates appears to have been greatest in outreach services and in people 40 years and older. Conclusions The lockdown caused an immediate reduction in cataract surgical rates to nearly half of its baseline rate. Despite its gradual recovery, further delays remain to be expected should there be no redistribution or increase in resources to support backlogs and incoming new cases.
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Affiliation(s)
- Amanda Wei-Yin Lim
- Centre for Clinical Epidemiology, Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
| | - Chin Tho Leong
- Centre for Clinical Epidemiology, Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
| | - Mohamad Aziz Salowi
- Department of Ophthalmology, Selayang Hospital, Ministry of Health Malaysia, Batu Caves, Selangor, Malaysia
- Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu, Malaysia
| | - Yvonne Mei Fong Lim
- Centre for Clinical Care and Outcomes Research, Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Wen Jun Wong
- Centre for Clinical Epidemiology, Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
| | - Wen Yea Hwong
- Centre for Clinical Epidemiology, Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Yu G, Michalak S, Mishra K, Yu M, Pan C. Trends of Ophthalmic Surgery Cancellations at a County Hospital Before and During COVID-19: A 10-Year Retrospective Study. Semin Ophthalmol 2024; 39:305-311. [PMID: 38073109 DOI: 10.1080/08820538.2023.2293032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/23/2023] [Indexed: 03/28/2024]
Abstract
PURPOSE Despite several publications on ophthalmic surgical cancellations discussing preventative causes in academic institutions, there remains a paucity of similar studies for safety-net hospitals. This study analyzed cancellation rates at a county hospital over a 10-year period. METHODS This retrospective, open cohort study investigated a total of 11,350 surgeries scheduled at a tertiary-level county hospital between January 1, 2012 and December 31, 2021. Surgical cancellation reasons were collected from chart review and categorized into eight groups to allow for analyses. Cancellation rates were then calculated per year and per subspecialty. The primary statistical analyses were paired, 2-tailed t test and χ2 test. RESULTS The most common reason for cancellation overall was institution-related (1065 surgeries), which was also the most common reason per year from 2012 to 2019 (range: 37.4% - 60.6%). In 2020, during COVID-19 stay-at-home mandates, the most common reason became COVID-related rescheduling, and in 2021, it was patient-driven. The cancellation rate in 2020 was significantly higher than 2019 (+9.27%,95% CI:4.96%-13.6%,p = .05), and significantly lower from 2021 to 2020 (-22.8%,95% CI:-26.8%-(-)18.7%,p = .001). Pediatric surgery had the highest cancellation rate overall (36.4%), but oculoplastics had the highest cancellation rate in 2020 (48.9%). CONCLUSION The most common reason for cancellation over the 10-year period was institution-related, in contrast to other publications based in academic centers. The study also had a higher cancellation rate than previously reported, again suggesting the difference between county and academic centers. The COVID-19 pandemic had a significant impact on cancellations, even after the COVID-19 stay-at-home orders were eased.
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Affiliation(s)
- Gina Yu
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA USA
- Division of Ophthalmology, Department of Surgery, Santa Clara Valley Medical Center, San Jose, CA USA
| | - Suzanne Michalak
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA USA
- Division of Ophthalmology, Department of Surgery, Santa Clara Valley Medical Center, San Jose, CA USA
| | - Kapil Mishra
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA USA
- Division of Ophthalmology, Department of Surgery, Santa Clara Valley Medical Center, San Jose, CA USA
| | - Michael Yu
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA USA
- Division of Ophthalmology, Department of Surgery, Santa Clara Valley Medical Center, San Jose, CA USA
| | - Carolyn Pan
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA USA
- Division of Ophthalmology, Department of Surgery, Santa Clara Valley Medical Center, San Jose, CA USA
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Zhou S, Chen CM, Shen C, Liu H, Liang J, Zhou L, Qu H, Chen X. Impact of COVID-19 pandemic on a world-wide private ophthalmic practice. Heliyon 2024; 10:e25841. [PMID: 38370169 PMCID: PMC10869871 DOI: 10.1016/j.heliyon.2024.e25841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 01/29/2024] [Accepted: 02/02/2024] [Indexed: 02/20/2024] Open
Abstract
Purpose To assess the impact of the COVID-19 pandemic on a worldwide private ophthalmic practice. Design In this retrospective study, we reviewed the 2020 monthly outpatient and surgical volume of refractive, cataract, and retinal disease in Aier Eye clinics/hospitals of different regions, including the United States, Germany, Spain, Italy, and six major cities in China (Wuhan, Beijing, Shanghai, Shenyang, Urumqi and Yili). All of these data were compared to those of the same period of 2019. Results Overall, during the early stage (2020 January to 2020 April) of COVID-19 outbreak, the outpatient and surgical volume of three main type ocular diseases (refractive, cataract and retinal surgery) showed an obvious reduction and reached the bottom in February in China. The data from the United States, Germany, Spain and Italy revealed the same trend, but the visit count nadir occurred until April, which is consistent with the spread trend of COVID-19 disease around the world. The average change rates of surgery volume (refractive, cataract and retinal surgery) in Chinese centers are 5.59%, -26.38%, 11.76%. The change rates of refractive (REF) and cataract volumes (CAT) in the United States are -8.62% and -10.58%, in Germany are -13.71% and -20.49%, in Spain are 15.35% and 27.97%, in Italy are 30.43% and -22.64%. In addition, the optometry outpatient volumes keep going up since May, with an average increasing rate of 21.18%, ranging from 7.43% to 49.51%. Conclusion In conclusion, in this global chain of eye care units, the visit volumes of cataract, retinal and refractive changed significantly with the spread of COVID-19 pandemic. Among them, cataract surgery was the most affected sub-specialty, and refractive surgery and optometry volumes showed a potential growth in the near future. Therefore, medical institutions should make corresponding adjustments to the disease diagnosis and treatment strategies.
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Affiliation(s)
- Suowang Zhou
- Aier Eye Hospital, Jinan University, No.601, Huangpu Road West, Guangzhou, China
| | - Chloe Mengdi Chen
- Aier Eye Hospital Group, Aier Global Vision Care Management Co, China
| | - Chong Shen
- Aier Eye Hospital Group, Aier Global Vision Care Management Co, China
| | - Hui Liu
- Department of Opthalmology, Changsha Aier Eye Hospital, Changsha, China
| | - Jianheng Liang
- Department of Opthalmology, Guangzhou Aier Eye Hospital, Guangzhou, China
| | - Lijing Zhou
- Aier School of Ophthalmology, Central South University, Changsha, Hunan Province, China
| | - Haokun Qu
- Aier Eye Hospital, Jinan University, No.601, Huangpu Road West, Guangzhou, China
| | - Xu Chen
- Department of Ophthalmology, Shanghai Aier Eye Hospital, Shanghai, China
- Aier School of Ophthalmology, Central South University, Changsha, Hunan Province, China
- New Bund Medical and Surgical Center, Sino United Health Clinics, Shanghai, China
- Department of Ophthalmology, Shanghai Aier Qingliang Eye Hospital, Qingpu, Shanghai, China
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Angermann R, Franchi A, Frede K, Rettenwander J, Rettenwander T, Neyer J, Stattin M, Kralinger M, Zehetner C. The Impact of the COVID-19 Pandemic on the Quality of Care of Treatment-Naïve Patients with Neovascular Age-Related Macular Degeneration Receiving Intravitreal Aflibercept. Klin Monbl Augenheilkd 2023; 240:1246-1254. [PMID: 35445380 DOI: 10.1055/a-1830-0505] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim of this study was to compare the quality of care received by treatment-naïve patients with neovascular age-related macular degeneration (nAMD) who received intravitreal aflibercept therapy before the coronavirus disease 2019 (COVID-19) pandemic with patients who received the same therapy during the pandemic. METHODS Data, including best corrected visual acuity (BCVA) as the logarithm of the minimum angle of resolution (logMAR) and anatomical outcomes at diagnosis and at each follow-up, was collected on 297 treatment-naïve patients who received intravitreal aflibercept. Therapy-naïve patients who started therapy at least 24 months prior to the first pandemic-related lockdown and were thus treated exclusively prior to the pandemic (n = 123) were compared with patients who started therapy within 12 months prior to the first lockdown and were thus treated during the pandemic (n = 174). Both groups were followed over a two-year period. RESULTS In patients treated before the COVID-19 pandemic, VA remained stable (0.58 ± 0.41 logMAR) compared to baseline (0.54 ± 0.34 logMAR; p = 0.228) until the end of the observation period. In patients treated during the COVID-19 pandemic, BCVA dropped below the baseline (0.56 ± 0.35 logMAR) within 24-month of follow-up (0.79 ± 0.43 logMAR; p = 0.010). Compared to the patients treated prior to the COVID-19 pandemic, the latter group showed a significantly worse VA at the 6-month (p = 0.041), 12-month (p = 0.040), 18-month (p = 0.024), 21-month (p = 0.035), and 24-month (p = 0.004) follow-up. Additionally, the group treated during the COVID-19 pandemic received significantly fewer aflibercept injections (3,94 ± 1,9 vs. 3,30 ± 1,6; p = 0,007) and fewer follow-up examinations (2,71 ± 1,2 vs. 2,16 ± 0,9; p < 0,001) in the second year compared to the group that was treated before the COVID-19 pandemic. CONCLUSION We confirmed significantly worse VA outcomes in the group of nAMD patients treated during the COVID-19 pandemic. Impeded access to care could be attributed to the restrictions imposed owing to the COVID-19 pandemic.
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Affiliation(s)
- Reinhard Angermann
- Augenheilkunde und Optometrie, Medizinische Universität Innsbruck, Österreich
- Augenheilkunde und Optometrie, Landesklinikum Mistelbach-Ganserndorf, Mistelbach, Österreich
| | - Alexander Franchi
- Augenheilkunde und Optometrie, Medizinische Universität Innsbruck, Österreich
| | - Katharina Frede
- Augenheilkunde und Optometrie, Medizinische Universität Innsbruck, Österreich
| | - Julia Rettenwander
- Augenheilkunde und Optometrie, Medizinische Universität Innsbruck, Österreich
| | - Tanja Rettenwander
- Augenheilkunde und Optometrie, Medizinische Universität Innsbruck, Österreich
| | - Julia Neyer
- Augenheilkunde und Optometrie, Medizinische Universität Innsbruck, Österreich
| | - Martin Stattin
- Augenheilkunde und Optometrie, Wiener Gesundheitsverbund Klinik Landstraße, Wien, Österreich
| | - Martina Kralinger
- Augenheilkunde und Optometrie, Medizinische Universität Innsbruck, Österreich
| | - Claus Zehetner
- Augenheilkunde und Optometrie, Medizinische Universität Innsbruck, Österreich
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Mousavi M, Kahuam-López N, Iovieno A, Yeung SN. Global impact of COVID-19 on corneal donor tissue harvesting and corneal transplantation. Front Med (Lausanne) 2023; 10:1210293. [PMID: 37608828 PMCID: PMC10440952 DOI: 10.3389/fmed.2023.1210293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 07/24/2023] [Indexed: 08/24/2023] Open
Abstract
Introduction The purpose of this review is to consolidate and examine the available literature on the coronavirus disease 2019 pandemic and its effect on corneal transplantation and eye banking. Methods A primary literature search was conducted using the PubMed (Medline) database with keywords and MeSH terms such as "corneal transplantation," "eye banks," "keratoplasty" and then were combined with COVID-19. Relevant articles through September 2022 were assessed and 25 articles were included in this review. Results Donor tissue volumes declined globally during lockdown periods due to a lower number of referrals and tighter tissue screening guidelines. Rates of elective surgeries decreased in the lockdown period compared to respective periods in previous years. However, changes in rates of emergency procedures were not uniform across different regions. Moreover, rates of different elective corneal grafts [i.e., penetrating keratoplasty (PK), endothelial keratoplasty (EK), or anterior lamellar keratoplasty (ALK)] were affected differently with the pattern of change being dependent on region-specific factors. Conclusion Both donor tissue volumes and rates of corneal transplant procedures were affected by lockdown restrictions. The underlying etiology of these changes differed by region. Examining the range of impact across many countries as well as the contributing factors involved will provide guidance for future global pandemics.
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Affiliation(s)
| | | | | | - Sonia N. Yeung
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, BC, Canada
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Sidhu JK, Yaakub A, Ahmad Tajudin LS. Lockdown: The Impact on Management of Glaucoma in a Suburban Tertiary Centre in Malaysia. Cureus 2023; 15:e34412. [PMID: 36874736 PMCID: PMC9980875 DOI: 10.7759/cureus.34412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2023] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic brought the world to a standstill in 2020. Many countries have imposed lockdowns, known as the movement-control order (MCO) in Malaysia, to prevent transmission of the disease. AIM The objective of this study is to evaluate the impact of the MCO on the management of glaucoma patients in a suburban tertiary hospital. METHODOLOGY We conducted a cross-sectional study of 194 glaucoma patients between June 2020 and August 2020 in the glaucoma clinic at Hospital Universiti Sains Malaysia. We evaluated the patients' treatment, visual acuity, intraocular pressure (IOP) measurements, and potential signs of progression. We compared the results with those of their last clinic visits prior to the MCO. RESULTS We studied 94 (48.5%) male and 100 (51.5%) female glaucoma patients with a mean age of 65 ± 13.7. The mean duration between pre-MCO and post-MCO follow-up was 26.4 ± 6.7 weeks. There was a significant increase in the number of patients with deterioration of visual acuity, and one patient lost his vision after the MCO. There was also a significant elevation of the mean IOP of the right eye: pre-MCO, 16.7 ± 7.8 mmHg, compared to post-MCO, 17.7 ± 8.8 mmHg (p = 0.027). The cup-to-disc ratio (CDR) for the right eye increased significantly from pre-MCO, 0.72 ± 0.18, to 0.74 ± 0.19 post-MCO (p < 0.001). However, there were no significant changes in IOP or CDR in the left eye. Twenty-four patients (12.4%) missed medications during the MCO period, and 35 patients (18%) required additional topical medications due to the progression of the disease. Only one patient (0.5%) required admission due to uncontrolled IOP. CONCLUSION Lockdown, as a preventive step in the COVID-19 pandemic, indirectly caused the progression of glaucoma and uncontrolled IOP.
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Affiliation(s)
- Jasvinjeet K Sidhu
- Department of Ophthalmology and Visual Science, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, MYS.,Ophthalmology Clinic, Hospital Universiti Sains Malaysia, Kubang Kerian, MYS
| | - Azhany Yaakub
- Department of Ophthalmology and Visual Science, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, MYS.,Ophthalmology Clinic, Hospital Universiti Sains Malaysia, Kubang Kerian, MYS
| | - Liza Sharmini Ahmad Tajudin
- Department of Ophthalmology and Visual Science, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, MYS.,Ophthalmology Clinic, Hospital Universiti Sains Malaysia, Kubang Kerian, MYS
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The COVID-19 Pandemic and Ophthalmic Care: A Qualitative Study of Patients with Neovascular Age-Related Macular Degeneration (nAMD). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159488. [PMID: 35954844 PMCID: PMC9368447 DOI: 10.3390/ijerph19159488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/28/2022] [Accepted: 07/30/2022] [Indexed: 02/05/2023]
Abstract
Concerns have been expressed about the relationship between reduced levels of health care utilisation and the COVID-19 pandemic. This study aimed to elicit and explore the views of patients with neovascular age-related macular degeneration (nAMD) regarding the COVID-19 pandemic and their ophthalmic care. Semi-structured telephone interviews were conducted with thirty-five patients with nAMD taking part in a larger diagnostic accuracy study of home-monitoring tests. Participants were recruited using maximum variation sampling to capture a range of key characteristics including age, gender and time since initial treatment. Transcribed interview data were analysed using a deductive and inductive thematic approach. Three themes emerged from the analysis: i. access to eye clinic care. ii. COVID-19-mitigating factors and care delivery and iii. social and personal circumstances. Participants reported anxieties about cancelled or delayed appointments, limited communication from clinic-based services about appointments, and the impact of this on their ongoing care. Despite these concerns, there was apprehension about attending appointments due to infection risk and a perception that nAMD patients are a ‘high risk’ group. Views of those who attended clinics during the study period were, however, positive, with social distancing and infection control measures providing reassurance. These findings contribute to our understanding about experiences of patients with nAMD during the COVID-19 pandemic and may have potential implications for future planning of care services in similar circumstances. Innovative approaches may be required to address issues related to access to care, including concerns about delayed or cancelled appointments.
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Panos GD, Poyser O, Sarwar H, Kumudhan D, Orr G, Zaman A, Wilde C. The Impact of the COVID-19 Pandemic and Lockdown on Macular Hole Surgery Provision and Surgical Outcomes: A Single-Centre Experience. J Clin Med 2022; 11:jcm11133678. [PMID: 35806963 PMCID: PMC9267484 DOI: 10.3390/jcm11133678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose: We aimed to report the impact of the COVID-19 pandemic and related health policies and restrictions on the provision and efficacy of macular hole (MH) surgery. Methods: We carried out a retrospective cohort study. Two MH patient cohorts, those treated during the COVID-19 pandemic (12 months) and the pre-COVID-19 period (12 months before the lockdown) were reviewed and compared. Patient characteristics, time to consultation and surgery, MH size, baseline and postoperative visual acuity (VA) and failure rate were recorded and analysed. Results: A reduction of 43% in MH surgery occurred during the COVID-19 period (93 eyes vs. 53 eyes). Mean time to consultation and time to surgery increased significantly (52.7 days vs. 86.3 days, p < 0.01 and 51.3 days vs. 83.6 days, p = 0.01, respectively), while mean baseline and postoperative vision was significantly lower in the COVID-19 group (0.75 LogMAR vs. 0.63 LogMAR, p < 0.01 and 0.61 LogMAR vs. 0.44 LogMAR, p < 0.01, respectively). The median MH size was significantly larger in the COVID-19 group (296 μm vs. 365 μm, p = 0.016), and the failure rate increased from 7.6% to 15.4% (odds ratio 2.2 (95% CI: 0.72−6.8)). Conclusions: Our findings suggest the COVID-19 pandemic caused a significant reduction in MH surgery, increased waiting times and led to poorer surgical outcomes. For future pandemics, better strategies are required that allow semi-elective and elective surgery to continue in a timely fashion. Health providers should preserve the delivery of ophthalmological care, with enhanced encouragement to seek medical help for acute symptoms.
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Sanak F, Faes L, Eppenberger L, Baenninger P, Kaufmann C, Golla K, Bachmann L, Buhl D, Schmid MK, Thiel M. Effect of Protective Measures on the Risk of SARS-CoV-2 Infection among Eye Clinic Staff Members. Klin Monbl Augenheilkd 2022; 239:605-609. [PMID: 35472816 DOI: 10.1055/a-1785-5226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Switzerland was strongly affected by the pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that resulted in a nationwide lockdown in March 2020. Ophthalmologists were at most risk of contracting a SARS-CoV-2 infection due to their close working distance from patients. The aim of the study is to evaluate the overall effectiveness of protective measures on the risk of SARS-CoV-2 infection among employees in a large public eye hospital. MATERIAL AND METHODS After lifting the lockdown in April 2020, standard precaution measures were taken, such as no handshaking and the use of operating face masks and a protective plastic shield on slit lamps and diagnostic devices. Only patients with no signs of SARS-CoV-2 disease were seen during the study period. Specific anti-SARS-CoV-2 IgG antibody titers were measured in eye clinic employees at the end of April 2020 (1st test phase) and in January 2021 (2nd test phase). The prevalence of SARS-CoV-2 IgG antibody titers among employees with daily patient contact was compared to staff members with no patient contact. RESULTS The SARS-CoV-2 prevalence in employees with daily patient contact, with 0% in the 1st phase and 7.4% in the 2nd phase, was not significantly higher than the prevalence in the control group with no patient contact (0.9% in the 1st phase, p = 0.4; and 8.6% in the 2nd phase, p = 0.8). Furthermore, physicians were not at a significantly higher risk of SARS-CoV-2 infection compared to technicians, nurses, or office staff. CONCLUSIONS This study shows that the abovementioned precaution measurements are effective in preventing transmission of SARS-CoV-2 infection in eye hospitals and enable us to resume practicing ophthalmology in a safe manner.
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Affiliation(s)
- Frantisek Sanak
- Ophthalmology, Lucerne Cantonal Hospital, Lucerne, Switzerland.,Medical Faculty, University of Zürich, Zürich, Switzerland
| | - Livia Faes
- Ophthalmology, Lucerne Cantonal Hospital, Lucerne, Switzerland.,Medical Retina and Uveitis, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | | | | | - Claude Kaufmann
- Ophthalmology, Lucerne Cantonal Hospital, Lucerne, Switzerland.,Medical Faculty, University of Zürich, Zürich, Switzerland
| | - Kathrin Golla
- Ophthalmology, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Lucas Bachmann
- Medical Faculty, University of Zürich, Zürich, Switzerland.,Research Consultancy, Medignition INC, Zürich, Switzerland
| | - Daniela Buhl
- Laboratory Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Martin K Schmid
- Ophthalmology, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Michael Thiel
- Ophthalmology, Lucerne Cantonal Hospital, Lucerne, Switzerland.,Medical Faculty, University of Zürich, Zürich, Switzerland
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Troisi M, Zannella C, Troisi S, De Bernardo M, Galdiero M, Franci G, Rosa N. Ocular Surface Infection by SARS-CoV-2 in COVID-19 Pneumonia Patients Admitted to Sub-Intensive Unit: Preliminary Results. Microorganisms 2022; 10:microorganisms10020347. [PMID: 35208803 PMCID: PMC8878281 DOI: 10.3390/microorganisms10020347] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/23/2022] [Accepted: 01/28/2022] [Indexed: 01/08/2023] Open
Abstract
The aim of the present study is to check the relationship between virus detection on the conjunctival swabs by RT-PCR and the systemic and ocular clinical data, treatments, and to the modalities of administration of supplemental oxygen. The SARS-CoV-2 RNA reverse-transcriptase PCR assay of conjunctival brushing samples and the corneal/conjunctival clinical findings were evaluated in 18 eyes of 9 consecutive patients admitted to the COVID-19 Sub-intensive Unit of Salerno Hospital University, Italy. Conjunctival swabs were positive for SARS-CoV-2 in 13 eyes of 7 patients; corneal epithelial defects were detected in 9 eyes. The seven patients with ocular involvement from SARS-CoV-2 had undergone treatment with a full-face mask or oxygen helmet in the last week, while the two subjects with negative conjunctival swabs had been treated with high flow nasal cannula. The positivity to the conjunctival test for SARS-CoV-2 was higher (72%) than that reported in the literature (10–15%) and related in all cases to the use of facial respiratory devices. These results suggest that exposure of unprotected eyes to aerosols containing high concentrations of SARS-CoV-2 could cause a keratoconjunctival viral infection. Further studies are needed to verify the causal link with the use of respiratory facial devices in patients suffering from COVID-19 pneumonia.
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Affiliation(s)
- Mario Troisi
- Department of Medicine, Surgery and Dentistry Scuola Medica Salernitana, University of Salerno, 84081 Baronissi, Italy; (M.D.B.); (G.F.); (N.R.)
- Correspondence:
| | - Carla Zannella
- Department of Experimental Medicine, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (C.Z.); (M.G.)
| | - Salvatore Troisi
- Ophtalmologic Unit AOU San Giovanni di Dio e Ruggi D’Aragona Scuola Medica Salernitana, 84125 Salerno, Italy;
| | - Maddalena De Bernardo
- Department of Medicine, Surgery and Dentistry Scuola Medica Salernitana, University of Salerno, 84081 Baronissi, Italy; (M.D.B.); (G.F.); (N.R.)
| | - Massimiliano Galdiero
- Department of Experimental Medicine, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (C.Z.); (M.G.)
| | - Gianluigi Franci
- Department of Medicine, Surgery and Dentistry Scuola Medica Salernitana, University of Salerno, 84081 Baronissi, Italy; (M.D.B.); (G.F.); (N.R.)
| | - Nicola Rosa
- Department of Medicine, Surgery and Dentistry Scuola Medica Salernitana, University of Salerno, 84081 Baronissi, Italy; (M.D.B.); (G.F.); (N.R.)
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12
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Invernizzi A. The impact of COVID-19 on the retina: clinical features and management considerations. EXPERT REVIEW OF OPHTHALMOLOGY 2022. [DOI: 10.1080/17469899.2022.2021877] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Sciences L. Sacco, Luigi Sacco Hospital, University of Milan, Milan, Italy
- The Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, Save Sight Institute, Sydney Eye Hospital, The University of Sydney, Sydney, Australia
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13
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The impact of COVID-19 pandemic and national lockdown on the surgical care of ophthalmic patients in a tertiary health care institution. SRP ARK CELOK LEK 2022. [DOI: 10.2298/sarh220211068v] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction/Objective. World Health Organization in January 2020 declared a pandemic of the coronavirus disease named COVID-19. The state of emergency in the Republic of Serbia began on March 15 2020, which greatly influenced the treatment of those patients who were not affected by COVID-19. The aim of this paper is to compare the most common ophthalmic surgeries during quarantine with those performed in 2019 in the same period. Methods. This is a retrospective study. We collected data from the operating protocol of the main ophthalmic operating room. We have followed the changes related to surgical procedures during these two years. Results. During the state of emergency, significantly more operations were performed on male patients than on female patients compared to the same period in 2019 (p = 0.043). In the observed period, in 2019 significantly more patients older than 65 were surgically treated (p < 0.001). During 2019, there were 397 (64.3%) elective and 220 (35.7%) urgent procedures, while for the same period next year there were 9 (9.1%) elective and 90 (90.9%) urgent procedures. Significantly more urgent interventions were performed during 2020 compared to 2019 (p < 0.001). Conclusion. The coronavirus pandemic has led to numerous changes in the treatment of ophthalmic patients. Many patients did not have access to adequate treatment, which certainly led to the impairment of many ophthalmic diseases.
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14
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Toro MD, Bremond-Gignac D, Brézin AP, Cummings AB, Kemer OE, Kermani O, Malyugin BE, Prieto I, Teus MA, Tognetto D, Zweifel S, Rejdak R. COVID-19 outbreak and increased risk of amblyopia and epidemic myopia: Insights from EUROCOVCAT group. Eur J Ophthalmol 2021; 32:17-22. [PMID: 34751045 DOI: 10.1177/11206721211053175] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The most common cause of vision impairment in children is amblyopia. It is defined as impaired visual acuity in one or both eyes that is present with no demonstrable abnormality of the visual pathway and is not immediately resolved by wearing glasses. After the World Health Organization (WHO) recognized COVID-19 as a global pandemic on March 11, 2020, widespread changes and restrictions to social and sanitary practices have presented significant issues in access to eye care during the COVID-19 pandemic. A reduction of more than 80% in pediatric eye care volume up to its total cessation has been observed in different departments. In this scenario, reduced or absent eyesight, due to delay in timely treatment of amblyopic conditions, could create major, long-lasting effects on all aspects of life, including daily personal activities, interacting with the community, school and work opportunities and the ability to access public services. Processes coming out of lockdown should be gradually easing restrictions giving priority to ophthalmology and eye care facilities so that amblyopia does not remain unattended and irreversible as in adults due to lack of timely treatments. If not reversible, this process could lead to a dramatic increase in disability and unsustainable social costs for many governments.
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Affiliation(s)
- Mario Damiano Toro
- Department of General and Pediatric Ophthalmology, 49554Medical University of Lublin, Lublin, Poland.,Department of Ophthalmology, University Hospital of Zurich, Zurich, Switzerland
| | - Dominique Bremond-Gignac
- 246596University Hospital Necker Enfants Malades, APHP, Paris, France.,INSERM 1138, Team 17, Paris Sorbonne University, Cordeliers, Paris, France
| | | | | | | | - Omid Kermani
- Augenklinik am Neumarkt Schildergasse 107 - 109, Köln, Germany
| | - Boris Edvard Malyugin
- 96710Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russian Federation.,A. Yevdokimov Moscow State University of Medicine and Dentistry, Russian Federation
| | | | | | | | - Sandrine Zweifel
- Department of Ophthalmology, University Hospital of Zurich, Zurich, Switzerland
| | - Robert Rejdak
- Department of General and Pediatric Ophthalmology, 49554Medical University of Lublin, Lublin, Poland
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15
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The effect of COVID-19 pandemic on the attendance and clinical outcomes of patients with ophthalmic disease: A mini-review. Metabol Open 2021; 12:100131. [PMID: 34604730 PMCID: PMC8474871 DOI: 10.1016/j.metop.2021.100131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/26/2021] [Accepted: 09/26/2021] [Indexed: 01/15/2023] Open
Abstract
The outbreak of COVID-19 was followed by a rapid spread leading to its declaration as a pandemic in a short time. The transmission through aerosols and direct contact with infected individuals forced the application of strict safety protocols and rearrangements in the activities of different healthcare systems around the world. Ophthalmology healthcare workers are highly exposed to viral infection and therefore adjustments were made to ensure the safety of patients and health providers by performing only urgent treatments. The suspension and delay in regular follow-up visits and the lower number of patients recorded during the lockdown period due to restrictions and patient anxiety led to severe consequences in the clinical and anatomical outcome affecting the overall prognosis. The current review aims to summarize the effect of the lockdown policies in the number and profile of patients that attended the ophthalmology clinics from different countries and analyze the effect of the pandemic in terms of vision and patient functionality. The effects of the pandemic included a reduction in the number of appointments, cancellations of non-emergency conditions and delays of surgical interventions. These had a negative effect in terms of visual outcomes.
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16
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Felfeli T, Ximenes R, Naimark DMJ, Hooper PL, Campbell RJ, El-Defrawy SR, Sander B. The ophthalmic surgical backlog associated with the COVID-19 pandemic: a population-based and microsimulation modelling study. CMAJ Open 2021; 9:E1063-E1072. [PMID: 34815262 PMCID: PMC8612655 DOI: 10.9778/cmajo.20210145] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Jurisdictions worldwide ramped down ophthalmic surgeries to mitigate the effects of COVID-19, creating a global surgical backlog. We sought to predict the long-term impact of COVID-19 on the timely delivery of non-emergent ophthalmology sub-specialty surgical care in Ontario. METHODS This is a microsimulation modelling study. We used provincial population-based administrative data from the Wait Time Information System database in Ontario for January 2019 to May 2021 and facility-level data for March 2018 to May 2021 to estimate the backlog size and wait times associated with the COVID-19 pandemic. For the postpandemic recovery phase, we estimated the resources required to clear the backlog of patients accumulated on the wait-list during the pandemic. Outcomes were accrued over a time horizon of 3 years. RESULTS A total of 56 923 patients were on the wait-list in the province of Ontario awaiting non-emergency ophthalmic surgery as of Mar. 15, 2020. The number of non-emergency surgeries performed in the province decreased by 97% in May 2020 and by 80% in May 2021 compared with the same months in 2019. By 2 years and 3 years since the start of the pandemic, the overall estimated number of patients awaiting surgery grew by 129% and 150%, respectively. The estimated mean wait time for patients for all subspecialty surgeries increased to 282 (standard deviation [SD] 91) days in March 2023 compared with 94 (SD 97) days in 2019. The provincial monthly additional resources required to clear the backlog by March 2023 was estimated to be a 34% escalation from the prepandemic volumes (4626 additional surgeries). INTERPRETATION The estimates from this microsimulation modelling study suggest that the magnitude of the ophthalmic surgical backlog from the COVID-19 pandemic has important implications for the recovery phase. This model can be adapted to other jurisdictions to assist with recovery planning for vision-saving surgeries.
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Affiliation(s)
- Tina Felfeli
- Department of Ophthalmology and Vision Sciences (Felfeli), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Ximenes), University Health Network; Sunnybrook Health Sciences Centre (Naimark), Toronto, Ont.; Ivey Eye Institute (Hooper), Western University, London, Ont.; Department of Ophthalmology (Campbell), Queen's University, Kingston, Ont.; Kensington Vision and Research Centre (El-Defrawy), Kensington Eye Institute, and Institute of Health Policy, Management and Evaluation (Sander), University of Toronto, Toronto, Ont.
| | - Raphael Ximenes
- Department of Ophthalmology and Vision Sciences (Felfeli), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Ximenes), University Health Network; Sunnybrook Health Sciences Centre (Naimark), Toronto, Ont.; Ivey Eye Institute (Hooper), Western University, London, Ont.; Department of Ophthalmology (Campbell), Queen's University, Kingston, Ont.; Kensington Vision and Research Centre (El-Defrawy), Kensington Eye Institute, and Institute of Health Policy, Management and Evaluation (Sander), University of Toronto, Toronto, Ont
| | - David M J Naimark
- Department of Ophthalmology and Vision Sciences (Felfeli), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Ximenes), University Health Network; Sunnybrook Health Sciences Centre (Naimark), Toronto, Ont.; Ivey Eye Institute (Hooper), Western University, London, Ont.; Department of Ophthalmology (Campbell), Queen's University, Kingston, Ont.; Kensington Vision and Research Centre (El-Defrawy), Kensington Eye Institute, and Institute of Health Policy, Management and Evaluation (Sander), University of Toronto, Toronto, Ont
| | - Philip L Hooper
- Department of Ophthalmology and Vision Sciences (Felfeli), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Ximenes), University Health Network; Sunnybrook Health Sciences Centre (Naimark), Toronto, Ont.; Ivey Eye Institute (Hooper), Western University, London, Ont.; Department of Ophthalmology (Campbell), Queen's University, Kingston, Ont.; Kensington Vision and Research Centre (El-Defrawy), Kensington Eye Institute, and Institute of Health Policy, Management and Evaluation (Sander), University of Toronto, Toronto, Ont
| | - Robert J Campbell
- Department of Ophthalmology and Vision Sciences (Felfeli), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Ximenes), University Health Network; Sunnybrook Health Sciences Centre (Naimark), Toronto, Ont.; Ivey Eye Institute (Hooper), Western University, London, Ont.; Department of Ophthalmology (Campbell), Queen's University, Kingston, Ont.; Kensington Vision and Research Centre (El-Defrawy), Kensington Eye Institute, and Institute of Health Policy, Management and Evaluation (Sander), University of Toronto, Toronto, Ont
| | - Sherif R El-Defrawy
- Department of Ophthalmology and Vision Sciences (Felfeli), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Ximenes), University Health Network; Sunnybrook Health Sciences Centre (Naimark), Toronto, Ont.; Ivey Eye Institute (Hooper), Western University, London, Ont.; Department of Ophthalmology (Campbell), Queen's University, Kingston, Ont.; Kensington Vision and Research Centre (El-Defrawy), Kensington Eye Institute, and Institute of Health Policy, Management and Evaluation (Sander), University of Toronto, Toronto, Ont
| | - Beate Sander
- Department of Ophthalmology and Vision Sciences (Felfeli), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Ximenes), University Health Network; Sunnybrook Health Sciences Centre (Naimark), Toronto, Ont.; Ivey Eye Institute (Hooper), Western University, London, Ont.; Department of Ophthalmology (Campbell), Queen's University, Kingston, Ont.; Kensington Vision and Research Centre (El-Defrawy), Kensington Eye Institute, and Institute of Health Policy, Management and Evaluation (Sander), University of Toronto, Toronto, Ont
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17
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Ashrafzadeh S, Gundlach BS, Tsui I. The Impact of Non-Ophthalmic Factors on Intravitreal Injections During the COVID-19 Lockdown. Clin Ophthalmol 2021; 15:3661-3668. [PMID: 34483654 PMCID: PMC8409597 DOI: 10.2147/opth.s314840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 06/09/2021] [Indexed: 12/21/2022] Open
Abstract
Purpose Early on in the COVID-19 pandemic, it was difficult to know what factors would affect patient and physician decision-making regarding ophthalmic care utilization. The purpose of this study is to investigate the effect of non-ophthalmic factors on patient decision-making to receive intravitreal injections during the COVID-19 lockdown. Patients and Methods Data on patients who had intravitreal injection appointments at a tertiary care Veterans Health Administration clinic during a seven-week period (March 19, 2020-May 8, 2020) of the COVID-19 outbreak in Los Angeles County were collected and compared to patients who had intravitreal injection appointments during the same time period in 2019. Demographic characteristics, injection diagnoses, visual acuities, body mass indices, co-morbidities, and psychiatric conditions of patients and clinic volumes were tabulated and compared between the two time periods. Results There were 86 patients in the injection clinic in 2020 compared to 176 patients in 2019. The mean age and gender of patients in the injection clinic did not differ between 2019 and 2020. Compared to 2019, the number of patients who identified as Hispanic or Latino remained nearly the same, but the number of patients who identified as White, Black, or Asian or Pacific Islander decreased by nearly half. In 2020, a greater proportion of patients came to the injection clinic for neovascular age-related macular degeneration (56.5% vs 39.3%, p=0.017), but a decreased proportion of patients diagnosed with a heart condition (OR 0.57, 95% CI 0.33, 0.96), chronic obstructive pulmonary disease (OR 0.43, 95% CI 0.21, 0.91), or asthma (OR 0.09, 95% CI 0.01, 0.70) came to the injection clinic. Conclusion The COVID-19 pandemic was associated with behavioral changes in eyecare utilization influenced by race and systemic co-morbidities. These data can be used to design and implement strategies to address disparities in essential ophthalmic care among vulnerable populations.
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Affiliation(s)
- Sahar Ashrafzadeh
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Bradley S Gundlach
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Irena Tsui
- Ophthalmology Department, West Los Angeles Veterans Health Administration, Los Angeles, CA, USA.,Retina Division, Stein Eye Institute, University of California, Los Angeles, CA, USA.,Doheny Eye Institute, University of California, Los Angeles, CA, USA
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18
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Salvetat ML, Salati C, Busatto P, Zeppieri M. The impact of COVID-19 related national lockdown on ophthalmic emergency in Italy: A multicenter study. Eur J Ophthalmol 2021; 32:1782-1794. [PMID: 34219482 PMCID: PMC9111919 DOI: 10.1177/11206721211028046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Purpose: To assess ocular pathologies admitted to Italian Emergency Eye Departments
(EEDs) during the COVID-19 pandemic national lockdown in 2020 in comparison
with the same period in 2019. Methods: Electronic records of all patients presenting at EEDs of two tertiary-care
Eye Centers during the COVID-19 national lockdown in Italy (March 10–May 3,
2020) were compared with the equivalent period in 2019. Main outcomes were
patient age, gender, and diagnoses. Statistical analysis included unpaired
Student t-tests, Poisson regression, and chi-square
test. Results: Overall EED visits significantly decreased by 54.1% during the 2020 lockdown
compared to 2019 (851 vs 1854, p < 0.001). During
lockdown, patients showed comparable mean age (52.8 years in 2020 vs
53.3 years in 2019, p = 0.52) and significant male gender
bias (61.1% in 2020 vs 55.8% in 2019, p < 0.0001). The
most frequent pathologies were eye inflammations, trauma-related incidents,
and spontaneous acute vitreous detachment. Patients with inflammation,
headache/hemicrania, and spontaneous subconjunctival hemorrhages were
significantly less, whereas those with trauma-related diagnoses were
significantly higher during the lockdown as compared with 2019
(p < 0.05). The proportion of non-urgent visits
decreased from 17% in 2019 to 8% in 2020
(p < 0.001). Conclusions: During the 2020 lockdown, there was a significant reduction of accesses to
EED, especially for non-urgent pathologies. Potentially visual function
threatening conditions, such as trauma-related pathologies, retinal
detachment or ruptures, and wet AMD, showed lower number of cases but higher
or stable proportion relative to the total caseload, suggesting a correct
and efficient access to ophthalmic health care during the pandemic
period.
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Affiliation(s)
- Maria L Salvetat
- Department of Ophthalmology, Azienda Sanitaria "Friuli Occidentale", Pordenone, Italy
| | - Carlo Salati
- Department of Ophthalmology, University Hospital of Udine, Udine, Italy
| | - Patrizia Busatto
- Department of Ophthalmology, Azienda Sanitaria "Friuli Occidentale", Pordenone, Italy
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, Udine, Italy
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19
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Chatziralli I, Dimitriou E, Kazantzis D, Machairoudia G, Theodossiadis G, Theodossiadis P. Effect of COVID-19-Associated Lockdown on Patients With Diabetic Retinopathy. Cureus 2021; 13:e14831. [PMID: 34094782 PMCID: PMC8173491 DOI: 10.7759/cureus.14831] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2021] [Indexed: 01/20/2023] Open
Abstract
Purpose To evaluate the effect of the coronavirus disease 2019 (COVID-19)-related lockdown in the management of patients with diabetic retinopathy (DR), including diabetic macular edema (DME), in a tertiary reference center in Greece. Methods In this retrospective study, we first compared the number of patients who were diagnosed with DR or DME in our clinic during the period of the lockdown and during the same period of the previous year. In addition, we included consecutive patients with DR or DME, who were followed up and treated regularly in our clinic and their appointments deferred due to lockdown, so as to compare the visual acuity, fundoscopy, and optical coherence tomography (OCT) findings prior to and post lockdown. Results During the lockdown period, there was a statistically significant decrease in patients with DR and DME as compared to the same period in the previous year. Regarding patients with previously diagnosed DME, there was a statistically significant worsening in their visual acuity and central retinal thickness after lockdown as compared to the last visit before lockdown (p<0.001 for both comparisons). Concerning patients diagnosed with DR and without DME before lockdown, 30% of patients with severe non-proliferative diabetic retinopathy (NDPR) and 8.3% of patients with quiescent proliferative DR (PDR) progressed to active PDR while four out of 107 patients (3.7%) developed DME during the lockdown. Multivariate regression analysis revealed that only the time interval between the last visit before lockdown and the first visit after the lockdown was associated with the best-corrected visual acuity (BCVA) change (p=0.017). Conclusions The COVID-19-related lockdown was related to the postponement in patient care, which resulted in significantly worse visual acuity outcomes in patients with DR.
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Affiliation(s)
- Irini Chatziralli
- 2nd Department of Ophthalmology, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Eleni Dimitriou
- 2nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, GRC
| | - Dimitrios Kazantzis
- 2nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, GRC
| | - Genovefa Machairoudia
- 2nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, GRC
| | - Georgios Theodossiadis
- 2nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, GRC
| | - Panagiotis Theodossiadis
- 2nd Department of Ophthalmology, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
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20
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dell'Omo R, Filippelli M, Virgili G, Bandello F, Querques G, Lanzetta P, Avitabile T, Viola F, Reibaldi M, Semeraro F, Quaranta L, Rizzo S, Midena E, Campagna G, Costagliola C. Effect of COVID-19-related lockdown on ophthalmic practice in Italy: A report from 39 institutional centers. Eur J Ophthalmol 2021; 32:695-703. [PMID: 33724078 DOI: 10.1177/11206721211002442] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND/OBJECTIVES To compare the number of eye surgical procedures performed in Italy in the 2 months following the beginning of lockdown (study period) because of COVID-19 epidemic with those performed in the two earlier months of the same year (intra-year control) and in the period of 2019 corresponding to the lockdown (inter-year control). METHODS Retrospective analysis of surgical procedures carried out at 39 Academic hospitals. A distinction was made between elective and urgent procedures. Intravitreal injections were also considered. Percentages for all surgical procedures and incidence rate ratios (IRR) for rhegmatogenous retinal detachment (RRD) events were calculated. A p value <0.05 was considered significant. RESULTS A total of 20,886 versus 55,259 and 56,640 patients underwent surgery during the lockdown versus intra-and inter-year control periods, respectively. During the lockdown, only 70% of patients for whom an operation/intravitreal injection was recommended, finally underwent surgery; the remaining patients did not attend because afraid of getting infected at the hospital (23%), taking public transportation (6.5%), or unavailable swabs (0.5%). Elective surgeries were reduced by 96.2% and 96.4%, urgent surgeries by 49.7% and 50.2%, and intravitreal injections by 48.5% and 48.6% in the lockdown period in comparison to intra-year and inter-year control periods, respectively. IRRs for RRDs during lockdown dropped significantly in comparison with intra- and inter-year control periods (CI: 0.65-0.80 and 0.61-0.75, respectively, p < 0.001 for both). CONCLUSION This study provides a quantitative analysis of the reduction of eye surgical procedures performed in Italy because of the COVID-19 epidemic.
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Affiliation(s)
- Roberto dell'Omo
- Department of Medicine and Health Sciences "Vincenzo Tiberio," University of Molise, Campobasso, Italy
| | - Mariaelena Filippelli
- Department of Medicine and Health Sciences "Vincenzo Tiberio," University of Molise, Campobasso, Italy
| | - Gianni Virgili
- Department of Ophthalmology, University of Florence, Florence, Italy
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giuseppe Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Paolo Lanzetta
- Department of Medicine - Ophthalmology, University of Udine, Udine, Italy
| | - Teresio Avitabile
- Department of Ophthalmology, University Hospital "Policlinico-Vittorio Emanuele," Catania, Italy
| | - Francesco Viola
- IRCCS Ca' Granda Ospedale Maggiore Policlinico Foundation, University of Milan, Milan, Italy
| | | | - Francesco Semeraro
- Eye Clinic, Department of Neurological and Vision Sciences, University of Brescia, Brescia, Italy
| | - Luciano Quaranta
- Department of Surgical, Clinical, Diagnostic and Pediatric Sciences, Section of Ophthalmology, University of Pavia, Pavia, Italy
| | - Stanislao Rizzo
- Department of Ophthalmology, Catholic University of Sacred Hearth-Foundation "Policlinico Universitario A. Gemelli"-IRCCS, Rome, Italy
| | - Edoardo Midena
- Department of Ophthalmology, University of Padua, Padua, Italy
| | - Giuseppe Campagna
- Department of Clinical and Molecular Medicine, "Sapienza" University, Rome, Italy
| | - Ciro Costagliola
- Department of Medicine and Health Sciences "Vincenzo Tiberio," University of Molise, Campobasso, Italy
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21
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Al-Sharif E, Strianese D, AlMadhi NH, D'Aponte A, dell'Omo R, Di Benedetto R, Costagliola C. Ocular tropism of coronavirus (CoVs): a comparison of the interaction between the animal-to-human transmitted coronaviruses (SARS-CoV-1, SARS-CoV-2, MERS-CoV, CoV-229E, NL63, OC43, HKU1) and the eye. Int Ophthalmol 2021; 41:349-362. [PMID: 32880786 PMCID: PMC7471531 DOI: 10.1007/s10792-020-01575-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/29/2020] [Indexed: 01/15/2023]
Abstract
PURPOSE Several studies have reported conflicting results on ocular manifestations and transmission of coronavirus disease 2019 (COVID-19) whose causative virus, SARS-CoV-2, belongs to the coronavirus family, the seventh recognized as a human pathogen and the third causing a severe clinical syndrome. COVID-19 primarily affects the lungs, similar to the other human coronaviruses. Comparing the relation between the animal-to-human transmitted coronaviruses (SARS-CoV-1, SARS-Cov-2, MERS-CoV, CoV-229E, NL63, OC43, HKU1) and the eye may contribute to determining their actual eye-tissue tropism and risk of ocular transmission. METHODS Literature review was conducted via Pubmed.gov, Google Scholar and medRixv using the following keywords: COVID-19, SARS-CoV-2, SARS-CoV-1, MERS-CoV, CoV-229E, NL63, OC43, HKU1, conjunctivitis, tear swab, ocular expression, ocular symptoms and human angiotensin converting enzyme-2 expression. Studies with lack in methodology were excluded. RESULTS Sixteen observational studies were selected. The range for detection of viral RNA in tears was 0-8% for SARS-CoV-1 and 0-5.3% for SARS-CoV-2, while no reports were found for other coronaviruses. Ocular manifestations have been reported for NL63 and SARS-CoV-2. Ocular symptoms in the form of conjunctivitis/conjunctival congestion predominantly were detected in 65 (3.17%) out of 2048 reported patients with COVID-19 (range of 0.8-32%). Eye symptoms were not reported for the other coronaviruses. CONCLUSIONS Data aggregation for coronaviruses shows a relatively low eye-tissue tropism. Conjunctival congestion is an uncommon manifestation of COVID-19 similar to all human coronaviruses' infections. In a low percentage of patients, the virus can be excreted in ocular fluids at different stages of the infection, regardless of positive SARS-Cov-2 throat swab. Albeit high viral loads in ocular tissue seem to have relatively low prevalence, the eye should be regarded as a potential source of infection dissemination for COVID-19.
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Affiliation(s)
- Eman Al-Sharif
- King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
- Department of Ophthalmology, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
| | - Diego Strianese
- King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia.
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, 80121, Naples, Italy.
| | - Nada H AlMadhi
- King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | | | - Roberto dell'Omo
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
| | - Rita Di Benedetto
- Department of Preventive Medicine, ASL Napoli 1 Centro, Naples, Italy
| | - Ciro Costagliola
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
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22
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Tognetto D, Brézin AP, Cummings AB, Malyugin BE, Evren Kemer O, Prieto I, Rejdak R, Teus MA, Törnblom R, Toro MD, Vinciguerra AL, Giglio R, De Giacinto C. Rethinking Elective Cataract Surgery Diagnostics, Assessments, and Tools after the COVID-19 Pandemic Experience and Beyond: Insights from the EUROCOVCAT Group. Diagnostics (Basel) 2020; 10:E1035. [PMID: 33276612 PMCID: PMC7761628 DOI: 10.3390/diagnostics10121035] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/21/2020] [Accepted: 12/01/2020] [Indexed: 01/08/2023] Open
Abstract
The progressive deterioration of the visual function in patients on waiting lists for cataract surgery has a negative impact on their quality of life, especially in the elderly population. Patient waiting times for cataract surgeries in many healthcare settings have increased recently due to the prolonged stop or slowdown of elective cataract surgery as a result of coronavirus disease 19 (COVID-19). The aim of this review is to highlight the impact of such a "de-prioritization" of cataract surgery and to summarize some critical issues and useful hints on how to reorganize cataract pathways, with a special focus on perioperative diagnostic tools during the recovery phase and beyond. The experiences of a group of surgeons originating from nine different countries, named the European COVID-19 Cataract Group (EUROCOVCAT), have been combined with the literature and recommendations from scientific ophthalmic societies and healthcare institutions. Key considerations for elective cataract surgery should include the reduction of the number of unnecessary visits and examinations, adoption of precautionary measures, and implementation of telemedicine instruments. New strategies should be adopted to provide an adequate level of assistance and to guarantee safety conditions. Flexibility will be the watchword and regular updates would be necessary following scientific insights and the development of the pandemic.
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Affiliation(s)
- Daniele Tognetto
- Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34134 Trieste, Italy; (A.L.V.); (R.G.); (C.D.G.)
| | | | | | - Boris E. Malyugin
- S. Fyodorov Eye Microsurgery Federal State Institution, Russian Federation, 127486 Moscow, Russia;
| | - Ozlem Evren Kemer
- University of Health Sciences, Ankara City Hospital, 06800 Ankara, Turkey;
| | - Isabel Prieto
- Department of Ophthalmology, Fernando Fonseca Hospital, 2720-276 Amadora, Portugal;
| | - Robert Rejdak
- Department of General Ophthalmology, Medical University of Lublin, 20-079 Lublin, Poland;
| | - Miguel A. Teus
- Department of Ophthalmology, University of Alcalá, 28802 Madrid, Spain;
| | - Riikka Törnblom
- Department of Ophthalmology, TYKS Hospital, 20521 Turku, Finland;
| | - Mario D. Toro
- Department of General Ophthalmology, Medical University of Lublin, 20-079 Lublin, Poland;
- Faculty of Medical Sciences, Collegium Medicum, Cardinal Stefan Wyszyński University, 01-815 Warsaw, Poland
- Department of Ophthalmology, University Hospital of Zürich, University of Zürich, 8091 Zürich, Switzerland
| | - Alex L. Vinciguerra
- Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34134 Trieste, Italy; (A.L.V.); (R.G.); (C.D.G.)
| | - Rosa Giglio
- Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34134 Trieste, Italy; (A.L.V.); (R.G.); (C.D.G.)
| | - Chiara De Giacinto
- Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34134 Trieste, Italy; (A.L.V.); (R.G.); (C.D.G.)
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