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When much of the country locked down in response to the COVID-19 pandemic in March 2020, ophthalmology practices saw a nearly one-third drop in patients with urgent ophthalmic issues, including management of rhegmatogenous retinal detachments (RRD), compared with years prior, according to a study published in the Journal of VitreoRetinal Diseases.
The study looked at patients who presented at Beth Israel Lahey Health (BILH), Boston Medical Center (BMC), and Massachusetts Eye and Ear (MEE) between the COVID-19 state of emergency in Massachusetts (March 10) and phase 1 of the state’s reopening plan (June 1, 2020) with acute, symptomatic, primary RRD that caused vision loss, photopsias, or floaters for up to 1 month.
The researchers compared the control group with patients from March 10 to June 1 in 2018 and 2019.
Acute RRDs declined from 145 in 2018 and 151 in 2019 to 125 in 2020. Primary RD repair decreased 37% at BILH, 60% at BMC, and 7% at MEE. RRDs in 2020 were more likely to be macula-off compared with those of 2018 and 2019.
The 2020 patients were less likely to be members of a racial or ethic minority group compared with the 2019 control group (10.4% vs 19.2%, P =.02) and the 2018 group, although the latter was not a statistically significant difference. The 2020 cohort experienced macula-off detachment and longer symptom duration (median 7 days) compared with the prior 2 years’ cohorts (median 4 days). The 2020 group tended to have shorter time to repair compared with the 2018 group (P =.006), but not the 2019 group. Ophthalmologists performed primary vitrectomy without scleral buckle (SB) more frequently in 2020 patients compared with 2018 and 2019 patients.
In 2020, patients with Medicaid/MassHealth insurance were more likely to be macula-off at presentation (95% CI 0.009-0.932, P =.04). One of 11 low-income insurance patients who presented in 2020 was macula-on, compared with 36.4% in 2018 and 2019.
“As subsequent waves of the pandemic continue to affect the delivery of care in the United States and elsewhere, or could in future potential health crises, practitioners should be aware of these issues and should encourage any patient with new visual symptoms to be evaluated promptly,” according to the researchers. “Increased public awareness of RD symptoms and the urgent nature of RD repair may improve early diagnosis. Informational campaigns directed at underserved and socioeconomically vulnerable populations may be especially beneficial as these populations had the greatest decline in primary RD presentations during the COVID-19 pandemic in our region.”
Limitations of the study included reliability of patients’ self-report of symptom duration, disproportionate inclusion of cases performed at MEE, and the reliance of basing financial status on zip code.
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Reference
Port AD, Gong D, Shaikh N, et al. Socioeconomic and demographic factors contributing to COVID-19–related delays and reductions in primaryretinal detachment repair in a US Hot Spot. J VitreoRetinal Diseases. Published online September 9, 2021. doi:10.1177/24741264211039960
