Barriers to Follow-Up Retinal Care During the COVID-19 Pandemic: A Survey Study

Abstract

BACKGROUND AND OBJECTIVE: To characterize patient-identified barriers to care in those non-compliant with retina appointments during the coronavirus disease 2019 (COVID-19) pandemic. PATIENTS AND METHODS: Inclusion criteria included non-compliant patients from March 1, 2020 to May 1, 2020. Ultimately, 1,345 patients were invited to complete a 14-question survey. A retrospective chart review correlated clinical and demographic information. Univariate logistic regression, independent-samples t -test, and Pearson correlation coefficient identified differences among subgroups. RESULTS: Of the 1,345 patients, 181 (13.5%) completed the survey. The most significant barriers to care included fear of COVID (76/181; 42.0%), wait times (21/181; 11.6%), and costs (11/181; 6.1%). Patients who got their COVID information from the Centers for Disease Control and Prevention (7.8 ± 2.4) and televised news (8.0 ± 2.0) had higher levels of fear. Finally, patients with diabetic retinopathy and higher Charlson Comorbidity Index scores had greater concerns of COVID ( P = .034 and P = .047, respectively). CONCLUSION: This survey study suggests fear of COVID-19 is a prominent new barrier to retinal care. Identifying those at risk for loss to follow-up can guide practices as the pandemic continues. [ Ophthalmic Surg Lasers Imaging Retina . 2021;52:526–533.]

Follow-up Rates After Teleretinal Screening for Diabetic Retinopathy: Assessing Patient Barriers to Care

“…[29][30][31] Because our study was performed during the COVID-19 pandemic, we sought to understand how strict travel restrictions affected patient follow-up. Recent work has identified fear of COVID-19 as a barrier to in-person retinal examinations, 32 which is consistent with the findings in our study. However, this concern was not as prevalent as other factors, including a poor understanding of DR and of the need for regular eye examinations.…”

Delayed anti-VEGF injections during the COVID-19 pandemic and changes in visual acuity in patients with three common retinal diseases: A systematic review and meta-analysis

“… 12 Similarly, Shields and coworkers and Lindeke-Myers and coworkers also found that fear of COVID-19 infection was the largest barrier to seeking care among patients with retinal diseases and that appointment reminders and clearer communications would be most helpful in improving clinic attendance. 20 , 32 In our own retinal clinic, some patients returned for treatment only when they noticed a significant worsening of their vision. Health administrators and clinics should therefore aim to address patients’ fears and concerns regarding COVID-19 infection, the health and safety measures adapted by the clinics and hospitals, as well as the necessity of regular injections to maintain their vision, even when they do not see a decrease in their visual acuity.…”

Challenges and solutions in clinical research during the COVID‐19 pandemic: A narrative review

“…• Low participation of volunteers in research 38,43,62 • Disturbance in data extraction 35,36,63 • Reduction of face-to-face visits due to the risk of contracting COVID-19 7,15,25 • lack of experience regarding the use of virtual platforms 39 • statistical models and methods 22,33 • funding and financial sponsorship 48 • Disturbance in follow up. 21,30 • Quality of publication during COVID-19. 31 • Refusals and losses of follow-up 32 • Research in a special population 26,47 • Accessing to epidemiological data for collecting data 25,43 • Artificial intelligence and deep learning algorithm in analysis 21,25 • Adapting statistical methods to the pandemic conditions 64 • Reduction the number of face-to-face visits 7,15,51 • Visits are conducted remotely or via phone or video call 7,14 • Mailing drug to the participants 47 and sending the medicine directly to the patient's home by site personnel or sponsors 20,63 • Using volunteer registry for enrolment of patients 18 • Making strong communication and commitment to participants 52 • Creatingtechnologicalcapabilitiesforteleworking, 34 visits 35,47 • Motivating to perform procedures at the patient's home 63 • Permitting-use, healthcare facilities, 65 3.3 | Administrative issues (REC or IRB approval)…”

“…Participants must also be provided with instructions for properly storing and using investigational drugs. 16,29 Result by Shields et al 30 showed that fear of COVID-19 was a major barrier to follow-ups. This fear included patients who felt unsafe exposing themselves or their family members or a patient's family member feeling unsafe exposing the patient.…”