Changes in Retina Practice Patterns During the COVID-19 Pandemic in the Philippines

Early-Phase Perceptions of COVID-19's Impact on Ophthalmology Practice Patterns: A Survey from the Pan-American Association of Ophthalmology

Purpose

The COVID-19 pandemic affected medical practice worldwide due to interventions to prevent spreading. Its effect on ophthalmology practices in Latin America has not yet been explored. We aimed to assess the perceptions about the pandemic from countries' ophthalmological national and subspecialty retina societies affiliated to the Pan-American Association of Ophthalmology (PAAO).

Patients and Methods

A survey-based study of leaders of national ophthalmological and retinal societies was conducted. The survey was sent by email to 30 societies, from which 20 responded (12 countries, 66.6% response rate). It included closed- and open-ended questions about (1) operational capacity and precautions, (2) telemedicine and virtual care, (3) procedures, and (4) post-pandemic considerations.

Results

There was a marked decline in ophthalmology patient visits (80-95%) and elective surgeries (90%) during 2020 compared to before the pandemic. Precautions like temperature checks, mask usage, and social distancing were widely implemented while personal protective equipment (PPE) availability varied. Telemedicine use was limited due to lack of experience with it. Reopening plans focused on maintaining precautions and gradually resuming activities. Economic and security concerns were raised, and adherence to guidelines was emphasized. Respondents acknowledged the need to adapt to a "new normal". Long duration drugs, fewer imaging studies, and shorter wait times were preferred; however, availability of long duration drugs was limited.

Conclusion

The pandemic impacted ophthalmology in Latin America, with reduced patient visits, procedures, and surgeries. Delayed treatment and complications were likely the result of the pandemic.

Online Questionnaire-Based Study on the Knowledge, Attitude, and Practices of Non-Ophthalmic Physicians-in-Training Regarding Exposure Keratopathy Among Patients Admitted in a Tertiary Referral Hospital

Objective

This study aimed to determine the knowledge, attitude, and practices of non-ophthalmic physicians-in-training regarding recognition and prevention of exposure keratopathy among patients admitted in a tertiary referral hospital.

Methods

This study was a single-center cross-sectional study. An anonymous self-administered online questionnaire was distributed among non-ophthalmic physicians-in-training at the Philippine General Hospital (PGH) using convenience and snowball sampling.

Results

A total of 77 responses were recorded with a response rate of 37%. The majority of the respondents uniformly reported the absence of an established eye care protocol or policy being implemented for different subsets of patients at risk for developing exposure keratopathy. Ninety-six percent (96%) was aware of exposure keratopathy. The most urgent reason for referral to the ophthalmology service was the presence of whitish of opacity at 46.8%, while the least urgent reason was the presence of eye redness at 36.4%. Only 43% of the patients with incomplete eyelid closure was referred to the ophthalmology service. The most frequently used modality of prophylactic eye protection treatment was eyelid taping (84.4%) followed by lubricants (drops and gels, 79.1%). The most common reason for not referring was the absence of an established protocol on the appropriate indication for referral to the ophthalmology service.

Conclusion

This study showed that the majority of non-ophthalmic physicians-in-training had adequate knowledge and favorable attitude regarding recognition and prevention of exposure keratopathy among patient admitted at the PGH; however, the absence or the unavailability of an eye care protocol among patients with inadequate eyelid closure in our institution on the prevention of exposure keratopathy and its early treatment and appropriate indications for ophthalmology referral resulted in non-uniformity and varied practice patterns on its management.

Exploring Ophthalmologists' Adoption of Telemedicine during the COVID-19 Pandemic: A Mixed Methods Study

INTRODUCTION

The COVID-19 pandemic promoted hitherto unseen uptake of telemedicine by ophthalmologists. We performed a mixed methods study to explore patters of utilization during the pandemic and perceived future utility.

METHODS

Ophthalmologists practicing in Canada between March and July 2020 were invited to complete an online questionnaire assessing demographics, clinical practice characteristics and telemedicine utilization prior to and during the pandemic. Descriptive and bivariate statistics were used to analyze the data. Agglomerative hierarchical cluster analysis was used to identify groups who varied on the types of visits offered using telemedicine. Ten one-on-one interviews were conducted and analyzed using thematic content analysis to explain trends observed in the survey data.

RESULTS

Seventy-three ophthalmologists completed the survey. Six percent reported using telemedicine prior to the pandemic compared to 80% during the pandemic. A significant majority (81%) primarily used the telephone for telemedicine visits. Overall, visit volumes during the pandemic declined to 40% of pre-pandemic levels, with a smaller decline for ophthalmologists who used telemedicine than those who did not. Those who used telemedicine for all visit types were more likely to use telemedicine software and to anticipate a modest-to-large role for telemedicine in their future practice.

DISCUSSION

For many ophthalmologists, integrating telemedicine into clinical practice may have partially offset the disruption to normal clinical activities during the pandemic. While the majority saw telemedicine as a temporary solution, a sizeable minority appear to have made considerable use of the technology and see an ongoing role for it once regular clinical activities resume.