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

Impact of COVID-19 pandemic on the dynamic of patients with oral and maxillofacial trauma: interrupted time-series analysis

Oral and maxillofacial trauma is influenced by various factors, including regional characteristics and social background. Due to the coronavirus disease 2019 (COVID-19) pandemic, a state of emergency was declared in Japan in March 2020. In this study, we aimed to examine the dynamics of patients with oral and maxillofacial trauma over a 12-years period using interrupted time-series (ITS) analysis. Patients were examined at the Shimane University Hospital, Maxillofacial Trauma Center from April 2012 to April 2023. In addition to general patient characteristics, data regarding the type of trauma and its treatment were obtained from 1203 patients (770 men and 433 women). Group comparisons showed significant differences in age, trauma status, method of treatment, referral source, route, and injury occasion. ITS analysis indicated significant changes in combined nasal fractures, non-invasive reduction, and sports injuries (P < 0.05), suggesting COVID-19 significantly impacted oral and maxillofacial trauma dynamics. A pandemic of an infectious disease may decrease the number of minor trauma cases but increase the number of injuries from outdoor activities, resulting in no overall change in the dynamics of the number of trauma patients. Medical systems for oral and maxillofacial trauma should be in place at all times, independent of infectious disease pandemics.

Glaucoma progression due to refraining examination amid the pandemic of COVID-19

PURPOSE

Some patients refrained from seeking an ophthalmologist due to the anxiety and morbidity associated with the coronavirus disease (COVID-19) pandemic. We investigated progressive visual field defects in patients with glaucoma who refrained from ophthalmological examinations.

METHODS

This was a retrospective study. We analyzed data from 886 patients with glaucoma who visited Inouye Eye Hospital in June 2022 and were followed-up prior to January 2020. We examined the number of times patients canceled visits between January 2020 and May 2022 due to coronavirus concerns. We assessed the mean deviation (MD) values of the Humphrey Visual Field Assessment (HFA) program 30-2 SITA Standard values after visit interruptions for worsening beyond the MD values predicted by the MD slope. Factors influencing this difference were analyzed using logistic regression analysis.

RESULTS

The study included 374 men and 512 women. The mean age was 68.7 ± 12.0 years. Visit interruptions occurred in 146 patients (16.5%), with 95 (65.1%) rescheduling once, 27 (18.5%) twice, and 24 (16.4%) three or more times. Among 90 patients who underwent HFA regularly, 50 (55.6%) experienced worse-than-expected MD values and 12 (13.3%) deteriorated by 2 dB or more. Longer interruptions and high intraocular pressure before interruption worsened the MD values by 2 dB or more.

CONCLUSION

Patients with glaucoma with visit interruptions due to the pandemic should be monitored for the progression of visual field impairment.

Targeted Telephone-Based Outreach Reconnects Glaucoma Patients With Subspecialty Care

PRCIS

A personalized telephone-based intervention is a cost-effective method to return overdue patients with open angle glaucoma (OAG) to subspecialty care. Patients who accepted care overwhelmingly preferred in-person appointments with their provider instead of hybrid visits with telehealth.

PURPOSE

To evaluate the effectiveness of a telephone-based outreach strategy to reconnect OAG patients with subspeciality care.

PATIENTS AND METHODS

Established patients with OAG who were seen before March 1, 2021, but had not returned for care in the following year were contacted via a telephone-based intervention. Patients lost to follow-up (LTF) were offered the option of an in-person visit or a hybrid telehealth visit, which combined in-office testing of vision, intraocular pressure, and optic nerve imaging with a virtual consultation with their glaucoma specialist on a separate date.

RESULTS

Of 2727 patients with OAG, 351 (13%) had not returned for recommended care. Outbound calls reached 176 of those patients (50%). Nearly half of all patients contacted readily accepted care, with 71 scheduling in-person appointments (93%) and 5 selecting hybrid visits (6.6%). Medication refills were requested by 17 of those 76 patients, representing nearly a third of the 56 patients who were treated with topical glaucoma medications. Assessment of the program 90 days later found that 40 patients had returned for care, 100 patients had transferred or declined further care, and 40 patients were identified as deceased, lowering the LTF rate to 6.4%, with 15 patients still scheduled for future visits. On the basis of an average call duration of 2.8±2.0 minutes, the added cost of returning a patient with OAG to care by the program was $28.11.

CONCLUSIONS

Providing targeted outreach by telephone is an effective and cost-efficient strategy to reconnect OAG patients LTF with subspecialty care.

Annual trends of ophthalmic surgeries in Japan's super-aged society, 2014-2020: a national claims database study

This study aimed to analyze the trends and factors influencing the number of ophthalmic surgeries in Japan using the open data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan published by the Ministry of Health, Labour and Welfare. We calculated the number of cataract, glaucoma, and vitreoretinal surgeries, categorized by sex, age, and surgical type, for the fiscal years (FY) 2014 to 2020. The number of cataract surgeries remained stable at approximately 1.45 million cases from FY 2014 to 2018, increased to nearly 1.6 million cases in FY 2019, and decreased to 1.45 million cases in FY 2020. Among glaucoma surgeries, surgical treatments were increased 1.8 times over 7 years, from 33,000 to 60,000 cases. Laser treatment remained steady at around 55,000 cases from FY 2014 to 2017 and then increased to approximately 60,000 cases. The number of vitreoretinal surgeries was increased 1.2 times from FY 2014 to 2019, from 120,000 to 140,000, and decreased to 130,000 by FY 2020. Trends in ophthalmic surgeries over the past 7 years may be influenced by population aging, minimally invasive surgery, and the coronavirus disease pandemic. These findings have implications on surgical decision-making and resource allocation.

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.

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.

Impact of the COVID-19 Pandemic on Mental Health among Patients with Chronic Ocular Conditions

The COVID-19 pandemic had significant impacts on the mental and visual health of patients. This cross-sectional, survey-based, multicentric study evaluates the state of mental and visual health among patients with chronic ocular diseases such as glaucoma, neovascular age-related macular degeneration, diabetic retinopathy, or chronic uveitis during the lockdown period of the COVID-19 pandemic. Mental health was assessed using three questionnaires: the Patient Health Questionnaire-9 (PHQ-9), the Impact of Event Scale-Revised (IES-R), and the National Eye Institute Visual Function Questionnaire-25 (VFQ-25). A total of 145 patients completed the questionnaires. The PHQ-9 showed that most respondents (n = 89, 61%) had none or minimal depressive symptoms, while 31 (21%) had mild depressive symptoms, 19 (13%) had moderate depressive symptoms, 5 (3%) had moderately severe depressive symptoms, and 1 (1%) had severe depressive symptoms. Regarding stress surrounding the pandemic, the median IES-R showed mild distress in 16 (11%), moderate distress in 7 (5%), and severe distress in 4 (3%). The COVID-19 pandemic lockdowns had a negative impact on patients' mental health with close to 20% of the patients reporting at least moderately depressive symptoms and 19% reporting at least mildly distressful symptoms.

Visual fields in glaucoma: Where are we now?

Visual fields are an integral part of glaucoma diagnosis and management. COVID has heightened the awareness of the potential for viral spread with the practice of visual fields modified. Mask artefacts can occur due to fogging of the inferior rim of the trail lens. Fortunately, the risk of airborne transmission when field testing is low. The 24-2c may be useful to detect early disease and the 10-2 more sensitive to detect advanced loss. The SITA faster test algorithm is able to reduce testing time thereby improving clinic efficiency, however, may show milder results for moderate or severe glaucoma. The technician has an important role of supervising the visual field performance to achieve reliable output. Home monitoring can provide earlier detection of progression and thus improve monitoring of glaucoma as well as reduce the burden of in-clinic assessments. Artificial Intelligence has been found to have high sensitivity and specificity compared to expert observers in detecting field abnormalities and progression as well as integrating structure with function. Although these advances will improve efficiency and guide accuracy, there will remain a need for clinicians to interpret the results and instigate management.

Detailed intraocular pressure curve by telemetric tonometry with an implanted pressure sensor before and after PreserFlo® MicroShunt implantation: a case report

Continuous control of intraocular pressure (IOP) is crucial to preventing long-term damage to the optic nerve in glaucoma. Recently, a novel telemetric IOP sensor (EYEMATE-IO™, Implandata Ophthalmic Products GmbH, Hannover, Germany) has been developed that continuously records IOP. The patient can read the IOP measurements wirelessly using a hand-held reading device. We present the case of a 70-year-old patient with primary open-angle glaucoma who had been implanted with an EYEMATE-IO™ and recently underwent minimally invasive bleb-filtering surgery with the PreserFlo^® MicroShunt (Santen, Osaka, Japan). This case demonstrates both the benefits of continuous pressure measurement with EYEMATE-IO™ and the ability of the PreserFlo^® MicroShunt to significantly reduce IOP fluctuations.

Year One of COVID-19 Pandemic: Effect on Presentation of Patients With Glaucoma in a Multi-Tier Ophthalmology Network in India

Objective

To describe the demographics and clinical profile of patients with glaucoma presenting during the novel coronavirus (COVID-19) lockdown and unlock phases in India.

Methods

This retrospective hospital-based comparative study included patients presenting between March 25, 2017, and March 31, 2021. All patients who presented with glaucoma disorders were included as cases. The demographic and clinical data of these glaucoma patients were collected using an electronic medical record system.

Results

Overall, 34,419 patients (mean 47 per day) diagnosed with glaucoma diseases presented to the network and were included for analysis. The mean age of the patients was 54.16 ± 18.74 years and most were male (n=21,140; 61.42%) from the urban region (n=12,871;37.4%). On categorizing based on the timeline of the COVID-19 pandemic, most of the patients presented pre-COVID-19 (n=29,122; 84.61%), followed by a minority (n=175; 0.51%) during the lockdown and the rest (n=5,122; 14.88%) during unlock phase. An increasing number of patients with secondary glaucoma (n=82; 46.86%) and presenting from the local intra-city (n=82; 46.86%) was seen during the lockdown. There was a 6.6-fold increase in neovascular glaucoma and a 2.7-fold increase in lens induced glaucoma during the lockdown phase ((p<0.001) for both). There was a significant increase in subjects in 4th decade (p<0.03) and a decrease in subjects in 7th decade (p<0.008) during the lockdown period.

Conclusion

The presentation of patients with glaucoma disorders to the hospital is evolving due to the COVID-19 pandemic. The footfalls of patients during the unlock regained to two-thirds of the pre COVID-19 level. During the lockdown, the older patients were less, there was an increase in younger patients and those with secondary glaucoma, and the majority presenting from within the city.

The medication adherence among glaucoma patients during the coronavirus disease 2019 pandemic in Croatia

PURPOSE

This study aimed to evaluate the level of treatment adherence and identify predictors of adherence in glaucoma patients during the coronavirus disease 2019 (COVID-19) pandemic in Zagreb, Croatia.

METHODS

The cross-sectional study was conducted among primary open-angle glaucoma (POAG) patients at the Department of Ophthalmology, University Hospital Centre Zagreb, between 1st April 2020 and 1st April 2021. The sociodemographic data, clinical, and drug information were recorded. The treatment adherence was assessed through a self-administered questionnaire, the Culig Adherence Scale (CAS). Statistical analyses were performed using TIBCO Statistica™ 14.0.0.

RESULTS

113 POAG patients (48M/65F) with a mean age of 65.89 ± 8.53 years were included in this study. According to the CAS, only 39.8% of patients adhered to topical glaucoma treatment. Educational level was positively related to adherence to treatment (p = 0.022). The main predictors for adherence were the patients' positive attitude towards the drug's effect, family support, and good relationship with the healthcare providers (p < 0.05, respectively). The majority of patients stated forgetfulness as the main reason for skipping drug dosing.

CONCLUSIONS

Non-adherence to treatment was prevalent among patients with POAG during the COVID-19 pandemic in Zagreb, Croatia. Personal beliefs and attitudes towards treatment, family support, and patient-healthcare provider relationship were significant predictors of adherence. Special consideration should be given to the whole health system-level strategies targeting the adherence to treatment, especially in crises, in order to achieve positive therapeutic outcomes.The study protocol was registered in the DRKS - German Clinical Trials Register, DRKS-ID: DRKS00022081.

The Impact of the First COVID-19 Lockdown Period on the Inpatient and Outpatient Volume of a University Based Tertiary Referral Center with Corneal Subspecialization in Germany

Background/Aims

To determine the impact of COVID-19 on the number of in- and outpatients surgical and diagnostic procedures performed at a southwestern German university hospital with corneal subspecialization.

Methods

A retrospective examination of the number of inpatients, several outpatients subunits, in- and outpatient surgeries as well as diagnostic procedures at the Department of Ophthalmology, Saarland University Medical Centre during the COVID-19 pandemic "lockdown period" from 18 March until 8 May 2020 in comparison with the corresponding period in 2019 (source: SAP database and electronic patient record FIDUS).

Results

The year 2020 showed a significant decrease in the number of inpatient surgeries with a total number of 285 vs 412 in 2019. However, the number of corneal transplantations increased significantly (60 in 2020 vs 54 in 2019, p=0.0089). In the various outpatient units of our department, we observed a significant decrease in the number of consultations (1.711 in 2020 vs 3.194 in 2019), especially for cataract surgery consultations (34 vs 137, p<0.0001). The number of outpatient surgeries was significantly reduced in 2020, especially for cataract surgery (64 vs 216, p=0.007) and intravitreal injections (577 vs 768, p<0.0001).

Conclusion

Despite taking all the necessary precautions to ensure that our medical care can continue to be available reliably and completely safe during the "Corona lockdown period", the number of in- and outpatient surgeries and the number of outpatient consultations decreased significantly. However, the number of corneal transplantations still increased.

[Fixed combination of latanoprost and timolol in the long-term treatment of patients with normal-tension glaucoma]

The most well-studied and widely prescribed fixed-combination drug for open-angle glaucoma is latanoprost/timolol. Its significant hypotensive effect is especially important in challenging cases, among which are patients with normal-tension glaucoma. With long life expectancy and the constant need for treatment, requirements are high for both the effectiveness of the drug and its tolerability. This paper presents a follow-up of 7 patients with normal-tension glaucoma who have been using the fixed combination of latanoprost/timolol for 10 years. All patients showed very good tolerability to the drug and their quality of life was preserved. A moderate rate of disease progression according to static perimetry was noted in one case. A mild degree of dry eye syndrome according to the OSDI questionnaire and an objective assessment of the state of the ocular surface was observed in one patient. The latanoprost/timolol fixed combination is a well-tolerated, highly effective and safe long-term treatment choice for normal-tension glaucoma.