ABSTRACT
Purpose : Worldwide lockdown reduced global air pollution during the SARS-CoV-2 pandemic. In this study, we evaluate whether the UK lockdown impacted upon dry eye symptoms in severe ocular surface disease (OSD) patients and whether there is a relationship with changes in air pollution levels. Methods : 35 OSD patients (median age 70 (range 42-85) years;17(48.5%) females;22(63%) ocular mucous membrane pemphigoid;3(9%) high-risk corneal transplant recipients;4(12%) ulcerative keratitis;2(6%) Stevens-Johnson syndrome;3(9%) other (granulomatous polyangiitis, Sjögren's syndrome, pemphigus vulgaris) maintained on systemic immunosuppression including mycophenolate mofetil, azathioprine, tacrolimus, methotrexate and cyclophosphamide achieved a risk stratification score of >3, defined as coronavirus high-risk and fulfilled the government criteria for shielding for a minimum of 12 weeks. Symptoms and air pollutions data were considered from three different time periods categorised as pre, during and post-lockdown. Pre-lockdown symptoms were curated from hospital electronic databases using the OSDI symptom questionnaire (Allergan plc, Irvine, CA) whilst during and post-lockdown data were obtained via postal hardcopy. Air pollution data for patient postcodes were derived from Department for Environment, Food, & Rural Affairs (DEFRA) and from the Automatic Urban and Rural Network (AURN) monitoring network for nitrogen dioxides (NO ), nitrogen oxides (NOx) particulate matter 10μm (PM ) and 2.5μm (PM ). Results : A 12% increase in symptom scores were observed during versus pre periods (36.11±16.09 vs 32.24±29.17, p=0.381). Similarly, a 19% reduction was observed between the during and post periods (36.11±16.09 vs 29.46 ± 26.29, p=0.144). However, significant reduction of NO (35%, from 17.11±6.87 to 11.17±4.79, p<0.001) and NOx (44%, from 26.06±11.64 to 14.53±7.18, p<0.001) respectively, were observed between pre and during periods. Symptoms and air pollutants were not correlated across all the considered periods. Conclusions : Despite the reduction of air pollutants due to lockdown measures, dry eye symptoms experienced by immunosuppressed OSD patients were increased. This might be due to a range of environmental factors such as increase use of electronic blue screen electronic devices as well as the psychological impact of lockdown on patient wellbeing.
ABSTRACT
Purpose : Health seeking behaviour is influenced by driving factors and barriers to action. It has been suggested that such behaviour may have been linked to the negative impact of the COVID-19 pandemic on health care service provision and delivery. This study aimed to explore the health seeking beliefs held by the British public in relation to eye symptoms, and assess how these were influenced by the first COVID-19 lockdown. Methods : Methods: An anonymous web-based survey was made publicly available and disseminated through mailing lists and social media between June and August 2020. In addition to baseline demographics (including postcode-derived indices of deprivation), the survey sought respondents views on the severity and urgency of the need for medical review for four ophthalmic (dry eye disease, conjunctivitis, microbial keratitis and painless vision loss) scenarios on a five-point scale. Regarding urgency of medical review, respondents were asked to answer questions twice: once ignoring the COVID-19 pandemic, and once taking this into account. Results : A total of 402 respondents completed the survey, with a mean age of 61.6 years, and of whom 253 (63.1%) were female and 348 (87.7%) of white ethnicity. Scores for symptom severity and urgency of medical review increased significantly with the severity of the clinical scenario (both p<0.001). However, respondents gave significantly lower scores for urgency of medical attention when accounting for the COVID-19 pandemic (compared to no pandemic) for all scenarios (all p<0.001). Younger age, greater deprivation and non-white ethnicity were correlated with a lower perception of seriousness and urgency of medical attention. Conclusions : During the first UK lockdown of the COVID-19 pandemic, reduced urgency of medical review for ocular and systemic pathologies was reported in response to the pandemic, and represents a barrier to health seeking behaviour. This has the potential to critically delay medical review and timely management, negatively impacting patient outcomes. Younger individuals with higher deprivation and non-white ethnic backgrounds may be at greater risk of this.
ABSTRACT
The immunopathogenesis of COVID-19 remains ill-defined. Through hyperstimulation of the immune system, SARS-CoV2 may cause a multi-facetted inflammatory disease and generate immune-mediated organ damage even leading to fatal consequences. However, it is still unclear, if a modified course of COVID-19 occurs in patients with autoimmune and/or autoinflammatory diseases.