Effect of COVID-19 Pandemic on Presentation of Patients With Diabetic Retinopathy in a Multitier Ophthalmology Network in India

Abstract

Objective: This study aimed to describe the demographics and clinical profile of patients with diabetic retinopathy (DR) presenting during the novel coronavirus disease 2019 (COVID-19) lockdown and unlock phases in India. Methods: This hospital-based cross-sectional study included patients presenting from March 25, 2019, to March 31, 2021. All patients who presented with DR were included as cases. The data were collected using an electronic medical record system. Results: In total, 88,012 patients diagnosed with retinal diseases were presented to the network and included for analysis. There were 21,271 (24%) DR patients during the study period and the majority were men (71%) from the urban area (45%). An increasing number of patients with proliferative DR (56%), sight-threatening DR (79%), need for vitreoretinal procedures (31%), and intravitreal injections (19%) were seen during the lockdown (phase one-four). There was a significant increase in the number of patients with blindness in pre-lockdown (20%), lockdown (32%), and post-lockdown (26%). Patterns of sight-threatening DR and blindness were similar in both fresh and follow-up patients. Conclusion: The presentation of DR patients in hospital is evolving because of the COVID-19 pandemic. The footfalls of patients during the unlock (phase 1-10) regained to two-thirds of the pre-COVID-19 level. There was an increase in patients with sight-threatening DR and the need for vitreoretinal surgery and intravitreal injections during the lockdown (phase 1-4).

The psychological status of patients with delayed intravitreal injection for treatment of diabetic macular edema due to the COVID–19 pandemic

“…Patients with diabetic retinopathy also tend to have uncontrolled glucose monitoring during lockdown. Therefore, the status of diabetic retinopathy would worsen and progress [ 21 ] to proliferative or advanced disease.…”

Examining Global Crises: Extracting Insights From the COVID-19 Pandemic and Natural Disasters to Develop a Robust Emergency Diabetic Retinopathy Strategy for Puerto Rico

“…Noteworthy advances in DR screening and diagnostic technologies were a recurrent theme across multiple studies [ 22 - 28 ]. A subset of articles scrutinized the impact of COVID-19 lockdowns on DR, with contributions from various nations, including Greece [ 29 ], Jordan [ 30 ], the United States [ 14 ], and India [ 31 ]. Furthermore, diverse perspectives emerged as the literature explored alternative strategies for fundoscopic imaging [ 32 - 35 ] and DR treatment and barriers [ 36 , 37 ] that hinder patients' adherence to follow-up care.…”

“…Greece [29], Jordan [30], the United States [14], and India [31]. Furthermore, diverse perspectives emerged as the literature explored alternative strategies for fundoscopic imaging [32][33][34][35] and DR treatment and barriers [36,37] that hinder patients' adherence to follow-up care.…”

Management of acute proliferative diabetic retinopathy related complications during the first COVID-19 wave

“…Karempela et al [12] also reported significantly fewer visits for retinal laser during this period and delays in care that led to poorer visual outcomes [13]. A large cross-sectional study in India observed an increase in patients presenting with proliferative diabetic retinopathy and significant visual impairment over the lockdown period compared to the previous year [14]. Chatziralli et al described how restricted access to hospital follow-up and treatment led to poorer visual outcomes and progression in PDR [15].…”