The evolution of the changes in the clinical course: a multicenter survey-related impression of the ophthalmologists at the peak of the COVID-19 pandemic in Turkey.

PURPOSE: The coronavirus disease-2019 (COVID-19) has become a difficult pandemic to control worldwide. The high transmission risk and mortality rates of COVID-19 cause serious concerns in ophthalmologists and may cause disruptions in clinical functioning. This study aims to identify changes in the clinical approaches of ophthalmologists, understand their anxiety levels, and exhibit how patients' follow-up processes progress during the pandemic. METHODS: A questionnaire that including demographic information, ophthalmology clinical activity scale, and Beck anxiety scale was sent to ophthalmologists in Turkey. Google Forms was used as a survey platform in this study. RESULTS: A total of 121 ophthalmologists participated in the study. The participants stated that they could not continue routine interventional diagnosis and treatment practices during the outbreak. It was clearly stated that there were changes in their clinical approach and decreased patient examination quality. For this reason, 14.9% of physicians said to missed the diagnosis in this process. Physicians who encounter infected patients state that it is more difficult to provide ophthalmological services and their clinical approaches are affected more negatively. Anxiety levels of physicians who could access personal protective equipment (PPE) and show positive solidarity with their colleagues in the process were found to be lower. CONCLUSION: Our study revealed that ophthalmologists, like other healthcare professionals, were severely affected by the COVID-19 outbreak. Accordingly, healthcare managers should provide adequate PPE for ophthalmologists, organize the clinical operation, and support the mental health of ophthalmologists.

Survey of the Impact of the COVID-19 Pandemic on Ophthalmology Clinical Practice in Turkey

Objectives: To investigate the effect of the novel coronavirus disease 2019 (COVID-19) pandemic on the clinical practice of ophthalmologists in our country. Materials and Methods: A questionnaire consisting of 22 questions was delivered to 250 ophthalmologists via e-mail and a smartphone messaging application. A total of 113 ophthalmologists completed the survey. The questions included the participants' demographic data (age, years in practice, institution, and city), changes in their working conditions and institutional preventive measures implemented during the pandemic, their personal COVID-19 experiences, the prevalence of telemedicine applications, and their attitudes toward these practices. Results: Nearly half (47.8%) of the 113 ophthalmologists were 36 to 45 years old. In terms of years in practice, the largest proportion of respondents (28.3%) had 6-10 years of experience. Most of the participants worked in private/foundation universities (37.2%), while 22.1% worked in education and research clinics. Participants working at public universities most often reported that they or a close contact had to work in COVID wards (89.5%). Triage was performed in 51.5% of ophthalmology outpatient clinics, with 88.0% of these participants reporting that patients with fever, cough, or dyspnea were directed to the pandemic clinic without ophthalmological examination. All participants working in public hospitals, education and research clinics, and public university hospitals had postponed elective surgeries, whereas 12.5% of those working in private practice and 20.5% of those working in private/foundation universities reported that they continued elective surgeries. While 80.8% of the participants did not conduct online interviews or examinations, 40.4% stated that they considered telemedicine applications beneficial. Seventy-seven percent of participants expressed concern about a decrease in their income during the pandemic, with this being especially common among participants working in private practice (87.5%) and private/foundation university hospitals (85.7%). Conclusion: Ophthalmologists across our country have been affected by this pandemic at a level that will change their clinical approach. We think that ophthalmologists impacted by the difficulty of providing personal protective equipment and economic concerns should be supported more during the pandemic.

Association of Patient Characteristics With Delivery of Ophthalmic Telemedicine During the COVID-19 Pandemic.

Importance: Telemedicine has been shown to have had reduced uptake among historically marginalized populations within multiple medical specialties during the COVID-19 pandemic. An evaluation of health disparities among patients receiving ophthalmic telemedical care during the pandemic is needed. Objective: To evaluate disparities in the delivery of ophthalmic telemedicine at Massachusetts Eye and Ear (MEE) during the COVID-19 pandemic. Design, Setting, and Participants: This retrospective, cross-sectional study analyzed clinical visits at a single tertiary eye care center (MEE) from January 1 to December 31, 2020. Patients who had ophthalmology and optometry clinical visits at the MEE during the study period were included. Exposures: Telemedicine vs in-person clinical encounters. Main Outcomes and Measures: Variables associated with use of ophthalmic telemedicine during the study period. Results: A total of 2262 telemedicine ophthalmic encounters for 1911 patients were included in the analysis. The median age of the patients was 61 (interquartile range, 43-72) years, and 1179 (61.70%) were women. With regard to race and ethnicity, 87 patients (4.55%) identified as Asian; 128 (6.70%), as Black or African American; 23 (1.20%), as Hispanic or Latino; and 1455 (76.14%), as White. On multivariate analysis, factors associated with decreased receipt of telemedical care included male sex (odds ratio [OR], 0.86; 95% CI, 0.77-0.96), Black race (OR, 0.69; 95% CI, 0.56-0.86), not speaking English (OR, 0.63; 95% CI, 0.48-0.81), educational level of high school or less (OR, 0.83; 95% CI, 0.71-0.97), and age (OR per year of age, 0.99; 95% CI, 0.989-0.998). When comparing telephone- and video-based telemedicine visits, decreased participation in video-based visits was associated with age (OR per year of age, 0.96; 95% CI, 0.94-0.98), educational level of high school or less (OR, 0.54; 95% CI, 0.29-0.99), being unemployed (OR, 0.28; 95% CI, 0.12-0.68), being retired (OR, 0.22; 95% CI, 0.10-0.42), or having a disability (OR, 0.09; 95% CI, 0.04-0.23). Conclusions and Relevance: The findings of this cross-sectional study, though limited to retrospective data from a single university-based practice, suggest that historically marginalized populations were less likely to receive ophthalmic telemedical care compared with in-person care during the first year of the COVID-19 pandemic in the US. Understanding the causes of these disparities might help those who need access to virtual care.

Changes in patient visits and diagnoses in a large academic center during the COVID-19 pandemic.

BACKGROUND: To minimize the risk of viral transmission, ophthalmology practices limited face-to-face encounters to only patients with urgent and emergent ophthalmic conditions in the weeks after the start of the COVID-19 epidemic in the United States. The impact of this is unknown. METHODS: We did a retrospective analysis of the change in the frequency of ICD-10 code use and patient volumes in the 6 weeks before and after the changes in clinical practice associated with COVID-19. RESULTS: The total number of encounters decreased four-fold after the implementation of clinic changes associated with COVID-19. The low vision, pediatric ophthalmology, general ophthalmology, and cornea divisions had the largest total decrease of in-person visits. Conversely, the number of telemedicine visits increased sixty-fold. The number of diagnostic codes associated with ocular malignancies, most ocular inflammatory disorders, and retinal conditions requiring intravitreal injections increased. ICD-10 codes associated with ocular screening exams for systemic disorders decreased during the weeks post COVID-19. CONCLUSION: Ophthalmology practices need to be prepared to experience changes in practice patterns, implementation of telemedicine, and decreased patient volumes during a pandemic. Knowing the changes specific to each subspecialty clinic is vital to redistribute available resources correctly.

Home Monitoring for Glaucoma: Current Applications and Future Directions.

Technological advances provide a number of options for glaucoma monitoring outside the office setting, including home-based tonometry and perimetry. This has the potential to revolutionize management of this chronic disease, improve access to care, and enhance patient engagement. Here, we provide an overview of existing technologies for home-based glaucoma monitoring. We also discuss areas for future research and the potential applications of these technologies to telemedicine, which has been brought to the forefront during the ongoing COVID-19 pandemic.

COVID-19 pandemic and lockdown: Changing trends in Ophthalmology for in-patient and emergency services.

PURPOSE: The aim of this study was to evaluate the changing trends in terms of patient load, presenting complaints, surgical procedures and resource utilization in a multispeciality tertiary care hospital after lockdown due to COVID-19. METHODS: Retrospective.data were collected from Ophthalmology in-patient and emergency services of a government medical college and multispecialty tertiary care hospital in North India. Data pertaining to patient census, presenting complaints, surgical procedures and resource consumption were compared in the 6-month period (March 25 to September 30, 2020) following national lockdown and subsequent gradual unlock to data of same time period last year. RESULTS: A total of 1152 new patients visited Ophthalmology emergency service, whereas 324 sought tele-ophthalmology consultation.Majority were males (61.8%, n = 712), whereas average age of presentation was 34 ± 7.2 years. The number.of patients seeking emergency ophthalmic care reduced by 23.9% in the current year, in-patient record reduced by 96.53% and number of surgeries reduced by 98.13%. Tele-ophthalmology services comprised 21.95% of the total patient load. Use of triple layered surgical masks increased by 85.7%, use of disposable gloves increased by 89.5% but interestingly the availability of chlorhexidine hand rub fell by 15.9%, in the current year compared to last year. CONCLUSION: COVID-19 pandemic and lockdown have reduced the number of patients visiting tertiary health care facility for ophthalmic care. As manpower and resource consumption has increased, smart management is needed to tackle the current scenario efficiently. Tele-ophthalmology must be promoted and we must understand the changing trends to plan for the future accordingly.

Impact of COVID-19 on longitudinal ophthalmology authorship gender trends.

BACKGROUND: The COVID-19 pandemic increased the gender gap in academic publishing. This study assesses COVID-19's impact on ophthalmology gender authorship distribution and compares the gender authorship proportion of COVID-19 ophthalmology-related articles to previous ophthalmology articles. METHODS: This cohort study includes authors listed in all publications related to ophthalmology in the COVID-19 Open Research Dataset and CDC COVID-19 research database. Articles from 65 ophthalmology journals from January to July 2020 were selected. All previous articles published in the same journals were extracted from PubMed. Gender-API determined authors' gender. RESULTS: Out of 119,457 COVID-19-related articles, we analyzed 528 ophthalmology-related articles written by 2518 authors. Women did not exceed 40% in any authorship positions and were most likely to be middle, first, and finally, last authors. The proportions of women in all authorship positions from the 2020 COVID-19 group (29.6% first, 31.5% middle, 22.1% last) are significantly lower compared to the predicted 2020 data points (37.4% first, 37.0% middle, 27.6% last) (p < .01). The gap between the proportion of female authors in COVID-19 ophthalmology research and the 2020 ophthalmology-predicted proportion (based on 2002-2019 data) is 6.1% for overall authors, 7.8% for first authors, and 5.5% for last and middle authors. The 2020 COVID-19 authorship group (1925 authors) was also compared to the 2019 group (33,049 authors) based on journal category (clinical/basic science research, general/subspecialty ophthalmology, journal impact factor). CONCLUSIONS: COVID-19 amplified the authorship gender gap in ophthalmology. When compared to previous years, there was a greater decrease in women's than men's academic productivity.

Ocular surface assessment in times of sanitary crisis: What lessons and solutions for the present and the future?

PURPOSE: To describe the immediate consequences of SARS-CoV-2 and the COVID-19 pandemic on the ocular surface and eye-care professionals, and to discuss the need for a mandatory switch from currently performed tele-screening to true teleconsultation for remote ocular surface assessment. MAIN FINDINGS: Ophthalmologists have been largely impacted by the COVID-19 sanitary crisis, due to both the ocular manifestations of SARS-CoV-2 and to the high contagiousness of the virus. The proximity of ophthalmologists to their patients have pushed eye-care providers to readapt their practices and develop alternatives to face-to-face consultations. However, teleconsultation has some major limitations and drawbacks, especially for ocular surface assessment that relies on high-quality graphic data for adequate diagnosis. Tele-screening, on the other hand, emphasizes on the importance of history-taking and listening to the patient in order to adequately prioritize appointments based on the presumed degree of emergency. CONCLUSION: Despite all the enthusiasm, tele-screening as currently performed with the available tools is still not capable of completely replacing a standard ophthalmic examination for the assessment of ocular surface diseases. While waiting for new emerging technologies and future implementation of imaging modalities and artificial intelligence, decision making algorithms can help eye-practitioners remotely screen their patients to assess the optimal time for follow-up appointments.

Open-care telemedicine in ophthalmology during the COVID-19 pandemic: a pilot study. / Telemedicina en oftalmología durante la pandemia de COVID-19: una experiencia piloto.

BACKGROUND: To report a pilot experience of telemedicine in ophthalmology in open-care modality (i.e. direct video call), in a confinement period due to the COVID-19 pandemic. METHODS: Descriptive study of the demographic and clinical characteristics of patients attended in a 10-week confinement period. Reported satisfaction of the participating patients and doctors was evaluated through an online survey. RESULTS: In the 10-week period, 291 ophthalmologic telemedicine consultations were performed. The main reasons for consultation were inflammatory conditions of the ocular surface and eyelids (79.4%), followed by administrative requirements (6.5%), non-inflammatory conditions of the ocular surface (5.2%), strabismus suspicion (3.4%) and vitreo-retinal symptoms (3.1%). According to previously defined criteria, 22 patients (7.5%) were referred to immediate face-to-face consultation. The level of satisfaction was high, both in doctors (100%) and in patients (93.4%). CONCLUSIONS: Open-care modality of telemedicine in ophthalmology during the pandemic period is a useful instrument to filter potential face-to-face consultations, either elective or emergency, and potentially reduce the risk of COVID-19 infection.

The Importance of Telemedicine during COVID-19 Pandemic: A Focus on Diabetic Retinopathy.

Recently, telemedicine has become remarkably important, due to increased deployment and development of digital technologies. National and international guidelines should consider its inclusion in their updates. During the COVID-19 pandemic, mandatory social distancing and the lack of effective treatments has made telemedicine the safest interactive system between patients, both infected and uninfected, and clinicians. A few potential evidence-based scenarios for the application of telemedicine have been hypothesized. In particular, its use in diabetes and complication monitoring has been remarkably increasing, due to the high risk of poor prognosis. New evidence and technological improvements in telemedicine application in diabetic retinopathy (DR) have demonstrated efficacy and usefulness in screening. Moreover, despite an initial increase for devices and training costs, teleophthalmology demonstrated a good cost-to-efficacy ratio; however, no national screening program has yet focused on DR prevention and diagnosis. Lack of data during the COVID-19 pandemic strongly limits the possibility of tracing the real management of the disease, which is only conceivable from past evidence in normal conditions. The pandemic further stressed the importance of remote monitoring. However, the deployment of device and digital application used to increase screening of individuals and monitor progression of retinal disease needs to be easily accessible to general practitioners.

[Impacts of the SARS-CoV-2 pandemic on ophthalmic care in Germany]. / Auswirkungen der SARS-CoV-2-Pandemie auf die ophthalmologische Versorgung in Deutschland.

BACKGROUND: Survey by the commission for cross-sectoral ophthalmology, as a joint commission of the German Ophthalmological Society (DOG) and the Professional Association of German Ophthalmologists (BVA) on the effects of the SARS-CoV­2 pandemic on ophthalmological patient care in Germany. METHODS: Online-based survey. RESULTS: A total of 1190 questionnaires were (partly) answered. With respect to outpatient care and consultations from 15 March to 15 April 2020, a total of 69 (5.8%) participants indicated unlimited, 756 (63.5%) reduced and 330 (27.7%) emergency care only, independent of the type of institution. Outpatient surgery was restricted to emergency surgery in 68% of clinics, 42.0% of inpatient wards, 45.0% of surgical medical care centers and group practices and 33.0% of private practices. Inpatient procedures were limited to emergency care in 75.0% of inpatient wards and in 71.0% of clinics. With the exception of endophthalmitis (+8.2%), the number of urgent indications and emergencies declined: retinal detachment (-34.8%), perforating eyeball injuries (-7.3%), acute glaucoma (-17.8%), central retinal artery occlusion and anterior ischemic optic neuropathy (-31.0%), others (-30.9%), penetrating keratoplasty and amniotic membrane transplantation (-59.1%). Institutional or professional policy requirements (76.0%) and appointment cancellation by patients (84.0%) were the most common reasons for limitations in ophthalmic patient care. CONCLUSION: The initial phase of the pandemic was characterized by a massive reduction in non-urgent conservative and surgical treatment that affected all areas of ophthalmology. Due to intensive care capacities required for COVID-19 patients, inpatient treatment was largely restricted to emergencies. Treatment of ophthalmological patients, including ocular emergencies and urgent treatment, was maintained across all sectors with a (considerable) decrease in the number of cases even in these groups.