ABSTRACT
Purpose of Study: Severe COVID-19 infection has been associated with a hypercoagulable state, contributing to the formation of clots. Retinal vascular occlusion (RVO) is a common cause of vision impairment and is due to blockage of the retinal arteries and veins. There have been reported cases of patients with previous history of COVID-19 presenting with new RVO. Given the minimal research delving into this relationship, the purpose of this study was to investigate the short-term prevalence and risk for RVO following infection by COVID-19 compared to Influenza A. Methods Used: Two cohorts were created using TrinetX, a national federated electronic health record (EHR). The two cohorts consisted of patients with a history of COVID-19 (n=2,352,475) and patients with a history of Influenza A (n=67,065). Both cohorts were balanced using 1:1 propensity score matching (PSM) addressing demographics and medical comorbidities. Outcomes between the two cohorts were compared using adjusted risk ratios (aRR), with a confidence interval of 95%. Summary of Results: After PSM, two cohorts of 67,063 patients each were compared. Patients in the COVID-19 cohort had an average age of 41.4+/-23.0 years compared to 34.4+/-27.7 years in the Influenza cohort. Between the two cohorts, there was no significant difference in risk of developing retinal vascular occlusion (aRR [95% CI] = 0.72 [0.49,1.06];p=0.097) and patients with COVID-19 had a significantly lower risk for developing retinal vein occlusion (aRR [95% CI] = 0.45 [0.27,0.77];p=0.03). Incidence of retinal vascular occlusion was 0.1% between both cohorts. Retinal artery occlusion was excluded from analysis due to obfuscation of the data by the EHR. Conclusion(s): Between the two cohorts, there was no significant difference in risk for developing RVO within 120 days. However, while there was no significant difference, vascular occlusions were found at a relatively younger age than the general population. Although incidence of RVO was low between the two cohorts, both viruses could be considered a risk factor for development of RVO, particularly in younger patients lacking classic risk factors for the disease.
ABSTRACT
Purpose : SARS-CoV-2, the viral infection that causes COVID-19, is known to induce a hypercoagulable state in patients. While there have been isolated reports of retinal vascular occlusion among patients with a pre-existing COVID-19 infection, research into this topic remains scant. Therefore, the purpose of this study is to investigate the shortterm prevalence and risk for retinal vascular occlusion between COVID-19 and influenza A patients. Methods : TrinetX is a national, federated database that was utilized in this retrospective cohort analysis. At the time of the study, electronic medical records from over 80 million patients across 57 healthcare organizations were analyzed to create two cohorts of patients. At the time of the analysis, 1,224,770 patients with a previous history for COVID19 were compared to 61,555 patients with a previous history for influenza A. Then, 1:1 propensity score matching (PSM) was utilized to balance each cohort by demographics and comorbidities (age, sex, BMI, history of hypertension, chronic lower respiratory disease, diabetes mellitus, nicotine dependence, heart failure, and alcohol related disorders). Adjusted risk ratios (aRR) using 95% confidence intervals (CI) were used to assess risk of retinal vascular occlusion 120 days after initial diagnosis for COVID-19 or influenza A. Results : Before PSM, COVID-19 patients were at significantly lesser risk for retinal vascular occlusion within 120 days of initial diagnosis than influenza A patients (aRR [95% CI] = 0.58 [0.42,0.8];p<0.001). However, the incidence for influenza patients to develop retinal vascular occlusion was very small (0.1%). After PSM, two balanced cohorts of 61,555 patients were compared to one another and revealed that there is no significant difference in developing a retinal vascular occlusion after a previous diagnosis of COVID19 or influenza A (0.92 [0.58,1.46];p=0.725). Likewise, the incidence for retinal vascular occlusion remained very small (0.1% between both cohorts) (Table 1). Conclusions : This is the first large-scale study investigating the risk of retinal vascular occlusion among COVID-19 and influenza A patients. We found that each cohort was at similar risk for developing retinal vascular occlusion within 120 days. Likewise, the incidence for retinal vascular occlusion was miniscule among patients in this study.
ABSTRACT
Purpose : To evaluate the relationship between COVID-19 case volume and ophthalmic procedural volume during the pandemic. Methods : A retrospective cohort study using TriNetX (Cambridge, MA, USA), a federated electronic health records research network comprising multiple large health organizations in the United States. Monthly Current Procedural Terminology (CPT)- specific volumes per HCO were clustered chronologically to calculate average volumes into three-month seasons to calculate average volumes. Seasonal averages from a combination of 2018 and 2019 data were used to provide a baseline comparison to pre-pandemic procedural volume. An aggregate of the total pandemic period (March 2020-August 2021) was compared to the corresponding figures in pre-pandemic timeframes. Results : 670,541 unique ophthalmic procedures from among 573 HCOs between March 2018 and August 2021 were included. Intravitreal injections was the most prevalent procedure with 320,106 occurrences. Phacoemulsification cataract surgery was the second most prevalent (N = 176,095) procedure with 144,816 uncomplicated (82.2%) and 31,279 complicated (17.8%). Intravitreal injections had the highest mean seasonal volume per HCO for each of the five COVID-19 pandemic seasons. From March 2020-August 2021, a mean pandemic volume of 266.7 (SD = 15) was observed, a 5% decrease (p<0.05) in procedures compared to pre-pandemic mean of 280.8 (SD = 26.1). During the five COVID-19 pandemic seasons, the seasonal mean volume almost always differed from pre-pandemic comparisons. Spring 2020 exhibited the sharpest seasonal decrease in procedural volume (88%). Spring 2021 had the largest count of significant increase in procedure volume (18%). 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 10/17 procedures over the 18-month March 2020-August 2021 timeframe. A relative inverse relationship between COVID-19 case volume and ophthalmic procedure volume was observed. Conclusions : This study highlights the relative inverse relationship between COVID-19 cases and ophthalmic procedure volume in the US. Reduction in procedural volume may result in delayed care with potential for vision loss. Awareness and understanding of these trends could help ophthalmologists prepare should a similar cycle occur in the setting of the omicron and future variants.
ABSTRACT
Purpose : To assess national and international internet search trends and public interest in refractive diseases and interventions during the COVID-19 pandemic compared to existing trends prior to the pandemic. Methods : A Google Trends search for refractive terms was performed between the time periods of January 1, 2016 to November 1, 2020. Refractive terms were divided into two groups: disease terms and procedure/treatment terms. Relative search volume (RSV) indices for refractive terms were assessed in the United States (US) and worldwide from the initial 18-week COVID-19 pandemic period (March 1, 2020 to July 4, 2020) and the subsequent 18-week period. (July 5, 2020 to November 1, 2020) These results were compared to pooled data of overlapping weeks between 2016-2019. A t-test of two independent samples assuming unequal variances was utilized to compare the two groups. Results : The relative public interest in refractive disease and procedure/treatment terms showed a sharp decline in the initial 18-weeks of the pandemic with a slow increase over the following 18-weeks compared to prior to the pandemic (Figure 1). There was a statistically significant decrease in mean RSV for multiple refractive disease terms (near far sighted/sightedness, keratoconus, hyperopia, cataract, astigmatism, myopia, near sighted/sightedness, blurry/blurred vision) and refractive procedure/treatment terms (intraocular lens, LASIK, cataract surgery/removal/extraction, LASEK, contact lens/lenses) both in the US and worldwide in 2020 compared to 2016-2019. Conclusions : The onset of the COVID-19 pandemic correlates with declining relative popularity of searches related to refractive disease and elective refractive procedures/treatments. Declining interest in refractive diseases and treatments may lead to poorer health literacy, delay in care, and potentially worse outcomes for these conditions.