Impact of COVID-19 on follow-up and medication adherence in patients with glaucoma in a tertiary eye care centre in south India

Abstract

Purpose: COVID-19 pandemic has affected the healthcare system worldwide hindering the continuum of treatment of chronic disease patients. The objective of the study is to analyze the barriers encountered by the glaucoma patients for the follow-up visit and medication adherence during the pandemic. Methods: This cross-sectional study included glaucoma patients who did not attend the scheduled appointment from April 1, 2020 to July 31, 2020 in a tertiary eye care center (88.21%). Eligible patients of age >18 years and advised antiglaucoma medication in Madurai Zone were interviewed with validated questionnaire through telephonic call. Results: 363 patients answered the questionnaire through telephonic interview. 57.3% of the patients were found to be non-adherent to medication. The main barriers for glaucoma follow-up visit during the pandemic were lockdown restriction, transport problem, and financial difficulties. The top barriers for medication adherence were non availability of medication (54.81%), financial difficulties (30.29%), did not feel much improvement with eye drops (20.19%). On multiple regression analysis, longer distance to hospital, low socioeconomic status, more than one antiglaucoma medication use, lack of awareness of glaucoma, non-complaint before COVID-19 and stress due to the pandemic were found to be significant factors for medication non adherence. Conclusion: COVID-19 pandemic has emphasized the need for reformation in health care system for accessibility of medical care to patients in rural areas. Decentralization of health system to primary care level and utilization of teleophthalmology should be considered by health care planners in future.

Influence of COVID‑19 on the Prognosis and Medication Compliance of Glaucoma Patients in the Nile Delta Region

“…Those restrictions were expected to affect vulnerable people, especially those with chronic diseases. 13 Glaucoma is a chronic eye disease that needs efficient and regular follow-up to avoid its potentially blinding effect. [5][6][7] Poor compliance and adherence to medications are well-known drawbacks for glaucoma patients, especially in Africa.…”

“…Our results are in line with several recently published studies. For instance, Subathra GN et al 13 carried out a study to evaluate the impact of COVID-19 on patients with glaucoma in a tertiary eye care center in South India. They found lockdown restrictions, transport problems, and financial difficulties as significant barriers to adherence to glaucoma treatment.…”

The Impact of Covid-19 in the Follow-Up of Glaucoma Patients in a Tertiary Center: A Comparison Between Pre-Pandemic and Pandemic Periods

“…Comparable findings were also reported by another Brazilian institution, where 42.03% of the patients already had unilateral visual loss by advanced glaucoma 26 in their first appointment. A recent study in India, 20 a country that shares comparable socioeconomic issues and pandemic impact with Brazil, investigated patients' medication adherence and loss of follow-up during the country's lockdown. Among the 393 telephone-interviewed patients who had lost follow-up, 90.63% reported lockdown restrictions; 74.38%, transportation problems; 9.09%, absence of symptoms; and 4.13%, financial difficulties as the reason to miss an appointment.…”

“…Some studies verified the impact of lockdown on ophthalmology assistance 15 and resident training, 16–18 while others investigated the impact on glaucoma practice and patients’ assistance. 19 , 20 However, to the best of our knowledge, none of these studies verified the impact of the pandemic on glaucoma patients followed at a large public glaucoma service. This would help to understand the impact on patients’ assistance and prepare health services to better perform when the pandemic is resolved.…”

Changes to Glaucoma Surgery Patterns during the COVID-19 Pandemic: A Shift Toward Less Invasive Procedures

“…In the period before the SARS-CoV-2 pandemic, each patient routinely underwent the 24-2 visual field examination (Humphery Field Analyzer, Zeiss Medical Technology, USA.) During the COVID-19 pandemic, when social distancing measures were introduced, examinations were conducted according to the disease spread containing guidelines [16,17]. Consequently, visual field examination was performed only in cases in which optical OCT measurements of the optic nerve head and retinal nerve fiber layer were insufficient to assess the severity of glaucomatous optic neuropathy.…”