Impact of the COVID-19 pandemic and a regional stay-at-home order on Emergency Department and inpatient consults for ocular complaints at a tertiary hospital

ABSTRACT

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.