Abstract
Purpose :
The COVID-19 pandemic provided unique insight into delayed glaucoma care, as one of the first events in living memory during which in-person health care services, such as eye care, were abruptly curtailed. In this retrospective cohort study, we tested the hypothesis that among patients with glaucoma, delayed care was associated with increased risk of disease progression necessitating change in clinical management.
Methods :
Manual chart review was performed for 172 patients with glaucoma at the Veterans Affairs (VA) Tennessee Valley Healthcare System (TVHS) Eye Clinic. The exposure cohort was a random sample of 78 patients who were already established at the VA and had a scheduled outpatient clinic visit during the closure of the clinic between 3/20/2020 and 6/1/2020. The comparator group involved 94 patients with glaucoma who had at least two appointments before COVID (1/1/2018-2/28/2020). Left eyes were analyzed, and demographics, time between recommended and actual follow-up visits, stage of glaucoma, and change in treatment regimen were compared between the 2 cohorts. Fisher’s exact test and Pearson’s chi-squared test were used to determine whether there were significant differences in disease progression between the groups.
Results :
In the exposure cohort, 56.4% of patients had postponed appointments, 28.2% never returned to clinic, and 15.4% had no delay compared to 13.8%, 0%, and 86.2% respectively in the comparator cohort with a statistically significant difference in all three categories (p<0.0001). In addition, 37.5% of all patients had disease progression during the pandemic compared to 17.0% in pre-pandemic times. There is evidence to suggest that there is a significant difference in disease progression in the exposure group compared to the comparator group (p<0.0190). A larger sample size is needed to determine significance in progression of disease between the cohorts when stratified by delayed/not delayed.
Conclusions :
Our results are consistent with our hypothesis that delayed care during the pandemic resulted in a change of clinical management due to an increased risk of disease progression. Moreover, many patients were lost to follow up and did not return for their visit. Further research is needed to determine if disease progression is sustained after multiple appointments.
This is a 2021 ARVO Annual Meeting abstract.