The impacts of COVID-19 on glaucoma patient outcomes as assessed by POEM

Pujari, Rathin; Tapply, Ian; Khan, Maaz; Loh, Bryan L. C.; Nanthagopan, Gopija; Thirunavukarasu, Arun James; Fleming, Aaron; Yusuf, Suraya; Tan, Xiu Sheng; Gowrishankar, Shravan V.; Utukuri, Mrudula; Gilks, Gabriella C. A.; Cnudde, Marie-Julie Anna Maria; Rajani, Sajan; Dufour, Lionel; Pujari, Reema; Nitiahpapand, Rynda; Scollo, Paolo; Chan, Gerald; Springdal, Sharon; Kelly, Daniel; Page, Amy; Bourne, Rupert

doi:10.1038/s41433-021-01425-0

Cited by 14 publications

(13 citation statements)

References 4 publications

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“…In general, the follow-up visit was 16 to 24 weeks for patients with stable glaucoma. Similar findings were reported in Italy, the United Kingdom, and the United States [25][26][27]. These countries recorded higher prevalence and morbidity due to COVID-19 compared to Malaysia [28][29][30].…”

Section: Discussionsupporting

confidence: 82%

Lockdown: The Impact on Management of Glaucoma in a Suburban Tertiary Centre in Malaysia

Sidhu¹,

Yaakub²,

Tajudin³

2023

Cureus

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Introduction:The COVID-19 pandemic brought the world to a standstill in 2020. Many countries have imposed lockdowns, known as the movement-control order (MCO) in Malaysia, to prevent transmission of the disease.Aim: The objective of this study is to evaluate the impact of the MCO on the management of glaucoma patients in a suburban tertiary hospital.Methodology: We conducted a cross-sectional study of 194 glaucoma patients between June 2020 and August 2020 in the glaucoma clinic at Hospital Universiti Sains Malaysia. We evaluated the patients' treatment, visual acuity, intraocular pressure (IOP) measurements, and potential signs of progression. We compared the results with those of their last clinic visits prior to the MCO.Results: We studied 94 (48.5%) male and 100 (51.5%) female glaucoma patients with a mean age of 65 ± 13.7. The mean duration between pre-MCO and post-MCO follow-up was 26.4 ± 6.7 weeks. There was a significant increase in the number of patients with deterioration of visual acuity, and one patient lost his vision after the MCO. There was also a significant elevation of the mean IOP of the right eye: pre-MCO, 16.7 ± 7.8 mmHg, compared to post-MCO, 17.7 ± 8.8 mmHg (p = 0.027). The cup-to-disc ratio (CDR) for the right eye increased significantly from pre-MCO, 0.72 ± 0.18, to 0.74 ± 0.19 post-MCO (p < 0.001). However, there were no significant changes in IOP or CDR in the left eye. Twenty-four patients (12.4%) missed medications during the MCO period, and 35 patients (18%) required additional topical medications due to the progression of the disease. Only one patient (0.5%) required admission due to uncontrolled IOP. Conclusion: Lockdown, as a preventive step in the COVID-19 pandemic, indirectly caused the progression of glaucoma and uncontrolled IOP.

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Section: Discussionsupporting

confidence: 82%

Lockdown: The Impact on Management of Glaucoma in a Suburban Tertiary Centre in Malaysia

Sidhu¹,

Yaakub²,

Tajudin³

2023

Cureus

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“…To analyse the change in glaucoma patient experience and attitudes caused by the COVID pandemic, a survey was performed in 126 patients attending a glaucoma clinic at Cambridge in September 2020. 26 At this timepoint, just after the pandemic outbreak, more patients were likely to agree less with the responses related to their understanding of glaucoma treatment and confidence in their treatment team. 26 These findings are of immense clinical relevance given that impaired confidence in the glaucoma team may affect treatment compliance that can contribute to disease progression.…”

Section: Discussionmentioning

confidence: 95%

Effects of COVID-19 pandemic on glaucoma appointment scheduling in a tertiary hospital in London, UK

Burgos-Blasco

Vidal‐Villegas

Yap

et al. 2023

European Journal of Ophthalmology

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Purpose To investigate the impact of the delay in patient appointments caused by the COVID-19 pandemic and the triage system on the glaucomatous disease of patients in a London tertiary hospital. Methods Observational retrospective study that randomly selected 200 glaucoma patients with more than 3 months of unintended delay for their post-COVID visit and other inclusion and exclusion criteria. Demographic information, clinical data, number of drugs, best-corrected visual acuity (BCVA), intraocular pressure (IOP), visual field (VF) mean deviation (MD), and global peripapillary retinal nerve fibre layer (pRNFL) thickness were obtained from the pre- and post-COVID visit. At the post-COVID visit, the clinical outcomes subjective clinical concern and change of treatment or need for surgery were also annotated. The variables were stratified by glaucoma severity (according to the MD into early, moderate and advanced) and by delay time (more and less than 12 months) and analysed using SPSS. Results We included 121 eyes (from 71 patients). The median patient age was 74 years (interquartile range -IQR- 15), 54% were males and 52% Caucasians. Different glaucoma types and all glaucoma severities were included. When data was stratified for glaucoma severity, at the pre-COVID visit, significant differences in BCVA, CCT and IOP were observed and there were significantly higher values in the early glaucoma group. The median follow-up delay was 11 months (IQR 8), did not differ between the glaucoma severity groups and did not correlate to the glaucoma severity. At the post-COVID visit, significant differences in BCVA, IOP, and Global pRNFL thickness were observed between the glaucoma severity groups, as lower BCVA and higher IOP and pRNFL thickness were observed in the early glaucoma group. At the post-COVID visit there was cause for concern in 40 eyes: 5 were followed more closely, 22 had a change of treatment and 13 were booked for surgery (3 for cataract and 10 for glaucoma surgery). However, the number of eyes with causes for concern were similar between the glaucoma severity groups and there was no correlation between these clinical outcomes and the delay of the post-COVID visit. The number of topical hypotensive medications increased significantly after the post-COVID visit, higher number of medications were observed in the advanced glaucoma group. When differences of IOP, MD and pRNFL thickness between the pre and post-COVID visit, only the MD difference was significantly different between the glaucoma severity groups because it was higher in the severe group. When data was stratified for delay longer or shorter than 12 months, no differences were observed between the groups except at the pre-COVID visit, when the numbers of patients with MD deviation >−6 dB had longer delay time. When differences in IOP, MD and RNFL thickness were calculated, only the pRNFL thickness showed significant differences between the delay groups, because it was higher in the longer delay group. Finally, when paired analysis of the variables at the pre- and post-COVID visits, stratified by glaucoma severity and delay were conducted, although there were no significant differences in IOP in any group, the BCVA decreased significantly in the overall group and in the longer delay groups, the number of hypotensive drugs increased significantly overall and in the moderate and advanced glaucoma, the MD of the VF worsened significantly in the overall group and in the early glaucoma and longer delay groups and the pRNFL thickness decreased significantly in all groups. Conclusions We document that delayed care impacts negatively on the glaucomatous disease of our patients because at the post-COVID visit there were reasons for clinical concern in a third of eyes that resulted in change of treatment or surgery. However, these clinical consequences were not related to IOP, glaucoma severity or delay time and reflect that the triage methods implemented worked adequately. The most sensitive parameter to indicate progression in our sample was the pRNFL thickness.

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“…[ 37 ] Pujari et al assessed the impact of COVID-19 on glaucoma patients using the patient-reported outcome and experience measure (POEM). They found that patients were more uncertain regarding how their glaucoma was being managed, and more anxious about disease progression [ 38 ]. These studies highlight the fundamental importance of the development of innovative measures such as drive-through IOP clinics in order to maintain effective delivery of glaucoma care, but also to lessen patient anxiety and worry surrounding their treatment and prognosis, especially during the uncertainty of COVID-19.…”

Section: Discussionmentioning

confidence: 99%

Audit of outcomes following attendance at the City West drive-through IOP glaucoma clinic during the COVID-19 pandemic

et al. 2022

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Background Glaucoma is the leading cause of irreversible blindness globally. During the COVID-19 pandemic, an enforced reduction in capacity resulted in the deferral of routine outpatient appointments for glaucoma patients. Aim This study analyses patient outcomes following the establishment of a drive-through intra-ocular pressure (IOP) clinic during the COVID-19 pandemic to alleviate increased pressure on the tertiary glaucoma services at Royal Victoria Eye and Ear Hospital (RVEEH) and Mater Misericordiae University Hospital (MMUH) between August 2020 and June 2021. Methods A 1-lane driveway system was established in a marquee on the grounds of City West hotel. IOPs were measured in patients’ cars using a hand held iCare100 tonometer. Results were reviewed by a consultant ophthalmologist. At hospital follow-up clinic visits, IOP was measured using the Goldmann applanation tonometer (GAT). Results Three hundred one patients of a total of 672 who attended the drive-through clinic have subsequently attended a designated hospital follow-up appointment. In this cohort, the mean drive-through iCare IOP of 19.4 mmHg ± 6.0 was significantly higher (< 0.005) than the mean GAT IOP at the pre-drive through clinic visit (16.3 mmHg ± 3.7) and the post drive-through hospital follow-up visit (17.2 mmHg ± 4.1). Two hundred twenty-six (75%) patients did not need any treatment change, 53 (18%) required eye drop medication changes, 10 (3%) underwent a laser procedure, 4(1%) required surgical intervention, and 8 (3%) were discharged. When patient outcomes were analysed according to IOP grade assigned at the drive-through clinic, those with an iCare IOP < 21 were significantly less likely to require a treatment change. The cohort with iCare IOP ≥ 30 were significantly more likely to have a laser or surgical intervention. Conclusion The implementation of a drive-through IOP clinic was a safe and effective way to monitor glaucoma patients during COVID-19, and identify those at high risk of poor IOP control or requiring a change in treatment.

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The impacts of COVID-19 on glaucoma patient outcomes as assessed by POEM

Cited by 14 publications

References 4 publications

Lockdown: The Impact on Management of Glaucoma in a Suburban Tertiary Centre in Malaysia

Lockdown: The Impact on Management of Glaucoma in a Suburban Tertiary Centre in Malaysia

Effects of COVID-19 pandemic on glaucoma appointment scheduling in a tertiary hospital in London, UK

Audit of outcomes following attendance at the City West drive-through IOP glaucoma clinic during the COVID-19 pandemic

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