Patel LG, Peck T, Starr MR, Ammar MJ, Khan MA, Yonekawa Y, Klufas MA, Regillo CD, Ho AC, Xu D. Clinical Presentation of Rhegmatogenous Retinal Detachment during the COVID-19 Pandemic: A Historical Cohort Study. Ophthalmology (2020). doi: 10.1016/j.ophtha.2020.10.009
At present, it has been over one year since the World Health Organization officially declared a worldwide pandemic with respect to the COVID-19 virus. The pandemic has led to strained healthcare resources and stay-at-home orders, particularly in the early months. Many studies during this time suggested that there were severe delays in seeking care for multiple systemic illnesses, such as myocardial infarction. Limited studies had been done to evaluate the effect of the pandemic on patients seeking ophthalmic care, particularly for conditions such as rhegmatogenous retinal detachment (RRD), which rely on timely repair to optimize visual acuity.
In this historical cohort study from Wills Eye Hospital, Patel et al evaluated the effect of the COVID-19 pandemic on the clinical presentation of acute, primary RRD. All patients presenting with RRD over a 50-day period during the COVID-19 pandemic (March 9-April 27, 2020) were compared to a historical control group of patients seeking treatment during the same period in 2019 (March 4-April 22, 2019). The primary outcome in this study was the proportion of patients who presented with macula-on RRD compared to macula-off RRD. Other outcomes included presenting Snellen VA, proportion of patients with symptom duration less than 1 day, mean duration of RRD symptoms, and the presence of grade C or higher proliferative vitreoretinopathy (PVR).
Overall, 82 patients were included in the 2020 Covid-19 pandemic cohort and 111 patients were included in the 2019 historical control. The two cohorts were found to be similar in terms of demographic characteristics. With respect to the primary outcome, a significantly lower percentage of patients presented with a macula-on RRD in the 2020 cohort (24.4%) compared to the 2019 cohort (49.5%, p=0.001). Additionally, patients in the 2020 cohort presented with worse VA (20/200 vs. 20/60 in 2019; p=0.008), a smaller proportion presented within one day of onset of symptoms (19.5% vs. 36.9% in 2019, p=0.005), and a greater proportion demonstrated primary PVR (13.4% vs. 4.5% in 2019, p=0.03) compared to the 2019 historical cohort.
This study supports anecdotal evidence that patients may delay seeking ophthalmic care during the COVID-19 pandemic, and this was likely especially true during the early months of the pandemic. These results are important since the clinical factors associated with these delays in seeking care portend a worse visual prognosis. Furthermore, the results of this study are consistent with studies in other specialties suggesting patients may delay seeking care or presenting to the emergency room for life-threatening conditions, such as myocardial infarction or stroke. Public awareness of the ability to seek medical care safely during the pandemic is essential.
Durga S. Borkar, MD
Duke Eye Center