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Huy Nguyen, Bennett Edward Ahearn, Jeong-Hyeon Sohn; COVID-era influence on follow-up trends and the impact on retinovascular disease progression. Invest. Ophthalmol. Vis. Sci. 2022;63(7):588 – A0153.
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COVID changed follow-up logistics starting 3/2020 in South Texas (STX). The incidence of proliferative retinovascular (RV) events in the emergent setting increased after shut down in STX. We investigate patterns of follow-up behavior in patients with and without proliferative complications of RV diseases.
We used CPT and ICD-10 codes in date range 1/2018 to 4/2021 to include patients diagnosed with diabetic retinopathy (DR) and retinal vein/artery occlusions (RVO/RAO) and analyzed them as two groups: anti-VEGF ± panretinal photocoagulation (PRP) (nonvitrectomy group) vs vitrectomies. We compared before and after COVID-era: appointment intervals and lapses, rate of progression in EDTRS staging for patients with DR.
At initial encounter, 2/133/125 patients of 1503 had mild/moderate/severe DR. 40/5 patients had RVO/RAO. There were 429/1074 patients in the vitrectomy/nonvitrectomy group. Vitrectomy group had 123 non-clearing vitreous hemorrhages, 72 tractional retinal detachments, and 189 unclassified proliferative retinovascular complications. Prior to COVID, visit interval was 28.4 ± 43.2 vs 30.8 ± 47.8 days in the vitrectomy vs nonvitrectomy group (p=0.61). After COVID, the interval duration for the vitrectomy group increased to 39.8 ± 76.5 days with no increase in the nonvitrectomy group (p<0.001). Time to diagnosis of EDTRS-staged progression after COVID increased by an average of 21.5 days in the vitrectomy group and by 26.7 days in the nonvitrectomy group.After COVID restrictions, missed appointments in the vitrectomy vs nonvitrectomy group changed from 24.5% to 30.8% vs 28.1% to 33.4%. Across all encounters, the vitrectomy versus nonvitrectomy group had 19.1% vs 21.9% cancellation rate (6.08 vs 5.85 appointments/patient) and 7.81% vs 8.39% no show rate (3.09 vs 2.97 appointments/patient). Overall, patients with DR who experienced EDTRS-staged progression missed 21.2% of appointments (6.8 per patient for those with missed appointments).
Patients who required vitrectomy versus those able to be managed in clinic missed appointments in the same proportion and quantity before COVID and increased appointment lapses similarly after COVID restrictions, but interval duration and variability was significantly higher in patients that eventually suffer a complication severe enough to necessitate vitrectomy.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.
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