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Investigative Ophthalmology and Visual Science ; 62(8), 2021.
Article in English | EMBASE | ID: covidwho-1378835


Purpose : Coronavirus disease 2019 (COVID-19) has impacted individuals seeking preventative, follow-up, and emergent ophthalmic care. In this retrospective study, we assessed the impact of COVID-19 on inpatient and emergency department (ED) ophthalmology care at a large tertiary academic hospital in the United States. Methods : We analyzed 570 ED and inpatient ophthalmology consults from March 13 to May 15 in 2020 and over the same period in 2019. Our primary endpoints were the number of consults and the percentage of consults that were 'vision-threatening' between the time periods. Our secondary endpoints were the demographics of the patients, relation to trauma, relation to an exacerbation of a chronic ocular condition, if the consult required surgical intervention, and time to surgery. Results : The total number of ED and inpatient consults decreased by 35.2% in 2020 compared to 2019. The total number of visually threatening diagnoses decreased, 97 in 2019 to 83 in 2020. The proportion of presentations with visually threatening diagnosis increased from 28.0% to 37.1% (p=0.0237). In 2020, there were a higher proportion of consults related to trauma (31.7% compared to 23.4%, p=0.0289), and consults requiring surgical intervention (19.6% compared to 12.4%, p=0.0192). The time to surgery was similar between time periods studied (p=0.902). There was not a significant difference in proportion of consults resulting from exacerbations of chronic ocular conditions (p=0.554). Conclusions : The volume of ophthalmic consults to our tertiary eye center and ED declined during the COVID-19 pandemic. There was an increase in the proportion of visually threatening diseases indicating a higher overall acuity seen by the consulting service. There was a total decrease in visually threatening diseases (despite an increase in numbers of consults from trauma), suggesting that some patients may have avoided urgent ophthalmic care due to fear of COVID-19 and the lockdown. Further research is needed to characterize the effect of COVID-19 and the regional stay-at-home order on emergent ophthalmic care delivery so we can better prepare for later stages of the pandemic and also for future pandemics.

Investigative Ophthalmology and Visual Science ; 62(8), 2021.
Article in English | EMBASE | ID: covidwho-1378553


Purpose : To describe the experience of tele-ophthalmology at a large academic medical center during the COVID-19 pandemic. Methods : This is a retrospective review of tele-ophthalmology encounters conducted at the Duke Eye Center between March 13 and July 15 , 2020. Collected data includes patient demographics, mode of communication (video or telephone), visit type (new, routine return, or urgent), diagnoses, prescribed medications, management plan, and follow-up care. Results : Five hundred and ninety-two routine return visits, 75 urgent visits, and 75 new patient visits were conducted over 742 tele-ophthalmology encounters spanning nine ophthalmology sub-specialty services: pediatric ophthalmology (224), oculoplastics (118), glaucoma (115), vitreoretina (69), cornea (67), inherited retinal disease (45), comprehensive ophthalmology (37), neuro-ophthalmology (34), and ocular oncology (24). The average patient age was 44.2 years (range, 1 month - 100 years). Figure 1 shows the most common diagnoses addressed. Video was the preferred mode of communication over telephone (439 versus 276 encounters). The show rate was 97.4%. The average time spent with patients was 18.0 minutes. The longest average visits occurred during inherited retinal disease (38.2 minutes) and neuro-ophthalmology (23.2 minutes) encounters. An active management decision was made in 36 of the new patient encounters (47.3%), 51 urgent encounters (70.8%), and 116 routine return encounters (20.2%). Figure 2 shows the top prescribed medication classes by subspecialty. In-person follow-up within 4 weeks was required for 28.0% urgent visits, 12.0% new patients, and 4.2% routine return visits. Conclusions : Tele-ophthalmology was utilized during the COVID-19 pandemic across a wide range of patient ages and ophthalmology sub-specialties. A substantial percentage of virtual encounters led to an active management decision, and the majority of encounters did not require a sooner than scheduled in-person follow-up. More research and follow-up are needed to determine if the accuracy of tele-ophthalmology diagnosis and management matches that of in-person encounters.