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Chauhan MZ, Eleiwa TK, Abdelnaem S, Kwok A, Hunter DG, Phillips PH, Sallam AB, Elhusseiny AM. Risk of abducens nerve palsy following COVID-19 vaccination. J AAPOS 2024; 28:103867. [PMID: 38458601 DOI: 10.1016/j.jaapos.2024.103867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 11/15/2023] [Accepted: 11/20/2023] [Indexed: 03/10/2024]
Abstract
PURPOSE To investigate the prevalence and risk of new-onset abducens nerve palsy and acute-onset diplopia following mRNA COVID-19 vaccination. METHODS In this retrospective, population-based study, patient data from the COVID-19 Research Network of TriNetX was searched via the TriNetX Analytics platform for patients who received specific vaccinations based on Common Procedural Technology codes. We recorded instances of newly diagnosed abducens nerve palsy and diplopia within 21 days following each vaccination event. RESULTS Of the 3,545,224 patients (mean age at vaccination, 46.2 ± 21.3 years) who received the mRNA COVID-19 vaccine, 12 (<0.0001%) patients had a new diagnosis of abducens nerve palsy and 453 (0.013%) had acute-onset diplopia within 21 days of first dose of COVID-19 vaccination. After propensity score matching, the relative risk for new abducens nerve palsy diagnosis after the first dose of COVID-19 vaccination was not significantly different from that after influenza (RR, 0.77), Tdap (RR, 1.0), or the second dose of the COVID-19 vaccinations (RR, 1.00). Furthermore, there was a lower risk of abducens nerve palsy diagnosis after the first dose of the COVID-19 vaccination compared with the risk after COVID-19 infection (RR, 0.15). CONCLUSIONS The risk of a new abducens nerve palsy diagnosis following the first dose of the COVID-19 vaccine is lower than the risk associated with COVID-19 infection itself. There is no evidence to suggest a causal relationship between COVID-19 vaccination and the development of abducens nerve palsy.
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Affiliation(s)
- Muhammad Z Chauhan
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock
| | - Taher K Eleiwa
- Department of Ophthalmology, Benha University, Benha, Egypt
| | - Salah Abdelnaem
- Department of Immunology, University of Arkansas for Medical Sciences, Little Rock
| | - Alexander Kwok
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock
| | - David G Hunter
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts
| | - Paul H Phillips
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock
| | - Ahmed B Sallam
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock; Department of Ophthalmology, Ain Shams University, Cairo, Egypt
| | - Abdelrahman M Elhusseiny
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock; Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts.
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Lum F, Li C, Khurana RN. Retinal Vascular Occlusions Did Not Increase Since the Start of the Coronavirus Disease 2019 Pandemic. Ophthalmol Retina 2024; 8:415-417. [PMID: 38176456 DOI: 10.1016/j.oret.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Flora Lum
- American Academy of Ophthalmology, San Francisco, California.
| | - Charles Li
- American Academy of Ophthalmology, San Francisco, California
| | - Rahul N Khurana
- Northern California Retina Vitreous Associates, San Jose, California
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3
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Rodriguez JA, Samal L, Ganesan S, Yuan NH, Wien M, Ng K, Huang H, Park Y, Rajmane A, Jackson GP, Lipsitz SR, Bates DW, Levine DM. Patient Safety Indicators During the Initial COVID-19 Pandemic Surge in the United States. J Patient Saf 2024:01209203-990000000-00203. [PMID: 38470958 DOI: 10.1097/pts.0000000000001216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
OBJECTIVE The COVID-19 pandemic presented a challenge to inpatient safety. It is unknown whether there were spillover effects due to COVID-19 into non-COVID-19 care and safety. We sought to evaluate the changes in inpatient Agency for Healthcare Research and Quality patient safety indicators (PSIs) in the United States before and during the first surge of the pandemic among patients admitted without COVID-19. METHODS We analyzed trends in PSIs from January 2019 to June 2020 in patients without COVID-19 using data from IBM MarketScan Commercial Database. We included members of employer-sponsored or Medicare supplemental health plans with inpatient, non-COVID-19 admissions. The primary outcomes were risk-adjusted composite and individual PSIs. RESULTS We analyzed 1,869,430 patients admitted without COVID-19. Among patients without COVID-19, the composite PSI score was not significantly different when comparing the first surge (Q2 2020) to the prepandemic period (e.g., Q2 2020 score of 2.46 [95% confidence interval {CI}, 2.34-2.58] versus Q1 2020 score of 2.37 [95% CI, 2.27-2.46]; P = 0.22). Individual PSIs for these patients during Q2 2020 were also not significantly different, except in-hospital fall with hip fracture (e.g., Q2 2020 was 3.42 [95% CI, 3.34-3.49] versus Q4 2019 was 2.45 [95% CI, 2.40-2.50]; P = 0.01). CONCLUSIONS The first surge of COVID-19 was not associated with worse inpatient safety for patients without COVID-19, highlighting the ability of the healthcare system to respond to the initial surge of the pandemic.
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Affiliation(s)
| | | | - Sandya Ganesan
- From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital
| | - Nina H Yuan
- From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital
| | - Matthew Wien
- From the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital
| | | | - Hu Huang
- IBM Watson Health, Cambridge, Massachusetts
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Shen AA, Gutierrez KG, Villegas NC, Moss HE. Evolution of Disparities in Outpatient Ophthalmic Care at a Tertiary Care Center in California at the Beginning of and One Year into the COVID-19 Public Health Emergency. Ophthalmic Epidemiol 2024; 31:21-30. [PMID: 36803530 PMCID: PMC10439972 DOI: 10.1080/09286586.2023.2180807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 01/23/2023] [Accepted: 02/10/2023] [Indexed: 02/22/2023]
Abstract
PURPOSE To compare disparities in outpatient ophthalmic care during early and later periods of the COVID-19 public health emergency. METHODS This cross-sectional study compared non-peri-operative outpatient ophthalmology visits by unique patients at an adult ophthalmology practice affiliated with a tertiary-care academic medical center in the Western US during three time periods: pre-COVID (3/15/19-4/15/19), early-COVID (3/15/20-4/15/20), and late-COVID (3/15/21-4/15/21). Differences in participant demographics, barriers to care, visit modality (telehealth, in person), and subspeciality of care were studied using unadjusted and adjusted models. RESULTS There were 3095, 1172 and 3338 unique patient-visits during pre-COVID, early-COVID and late-COVID (overall age 59.5 ± 20.5 years, 57% female, 41.8% White, 25.9% Asian, 16.1% Hispanic). There were disparities in patient age (55.4 ± 21.8 vs. 60.2 ± 19.9 years), race (21.9% vs. 26.9% Asian), ethnicity (18.3% Hispanic vs. 15.2% Hispanic), and insurance (35.9% vs. 45.1% Medicare) as well as changes in modality (14.2% vs. 0% telehealth) and subspecialty (61.6% vs. 70.1% internal exam specialty) in early-COVID vs. pre-COVID (p < .05 for all). In late-COVID, only insurance (42.7% vs. 45.1% Medicare) and modality of care (1.8% vs. 0% telehealth) persisted as differences compared to pre-COVID. CONCLUSIONS There were disparities in patients receiving outpatient ophthalmology care during early-COVID that returned close to pre-COVID baseline one year later. These results suggest that there has not been a lasting positive or negative disruptive effect of the COVID-19 pandemic on disparities in outpatient ophthalmic care.
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Affiliation(s)
- Andrew A. Shen
- University of California San Diego
- Department of Ophthalmology, Stanford University
| | | | | | - Heather E. Moss
- Department of Ophthalmology, Stanford University
- Department of Neurology & Neurological Sciences, Stanford University
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Li C, Lum F, Chen EM, Collender PA, Head JR, Khurana RN, Cunningham ET, Moorthy RS, Parke DW, McLeod SD. Shifts in ophthalmic care utilization during the COVID-19 pandemic in the US. Commun Med (Lond) 2023; 3:181. [PMID: 38097811 PMCID: PMC10721809 DOI: 10.1038/s43856-023-00416-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/24/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Healthcare restrictions during the COVID-19 pandemic, particularly in ophthalmology, led to a differential underutilization of care. An analytic approach is needed to characterize pandemic health services usage across many conditions. METHODS A common analytical framework identified pandemic care utilization patterns across 261 ophthalmic diagnoses. Using a United States eye care registry, predictions of utilization expected without the pandemic were established for each diagnosis via models trained on pre-pandemic data. Pandemic effects on utilization were estimated by calculating deviations between observed and expected patient volumes from January 2020 to December 2021, with two sub-periods of focus: the hiatus (March-May 2020) and post-hiatus (June 2020-December 2021). Deviation patterns were analyzed using cluster analyses, data visualizations, and hypothesis testing. RESULTS Records from 44.62 million patients and 2455 practices show lasting reductions in ophthalmic care utilization, including visits for leading causes of visual impairment (age-related macular degeneration, diabetic retinopathy, cataract, glaucoma). Mean deviations among all diagnoses are 67% below expectation during the hiatus peak, and 13% post-hiatus. Less severe conditions experience greater utilization reductions, with heterogeneities across diagnosis categories and pandemic phases. Intense post-hiatus reductions occur among non-vision-threatening conditions or asymptomatic precursors of vision-threatening diseases. Many conditions with above-average post-hiatus utilization pose a risk for irreversible morbidity, such as emergent pediatric, retinal, or uveitic diseases. CONCLUSIONS We derive high-resolution insights on pandemic care utilization in the US from high-dimensional data using an analytical framework that can be applied to study healthcare disruptions in other settings and inform efforts to pinpoint unmet clinical needs.
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Affiliation(s)
- Charles Li
- American Academy of Ophthalmology, San Francisco, CA, USA.
| | - Flora Lum
- American Academy of Ophthalmology, San Francisco, CA, USA
| | - Evan M Chen
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Philip A Collender
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | - Jennifer R Head
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | - Rahul N Khurana
- Department of Ophthalmology, University of California, San Francisco, CA, USA
- Northern California Retina Vitreous Associates, Mountain View, CA, USA
| | - Emmett T Cunningham
- Department of Ophthalmology, California Pacific Medical Center, San Francisco, CA, USA
- The Francis I. Proctor Foundation, UCSF School of Medicine, San Francisco, CA, USA
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, USA
| | - Ramana S Moorthy
- Associated Vitreoretinal and Uveitis Consultants, Carmel, IN, USA
- Department of Ophthalmology, Indiana University Medical Center, Indianapolis, IN, USA
| | - David W Parke
- American Academy of Ophthalmology, San Francisco, CA, USA
| | - Stephen D McLeod
- American Academy of Ophthalmology, San Francisco, CA, USA
- Department of Ophthalmology, University of California, San Francisco, CA, USA
- The Francis I. Proctor Foundation, UCSF School of Medicine, San Francisco, CA, USA
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6
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Beckman JJ, Webster CR, Richardson C, Fullmer M, Kendall E, Hazariwala V, Bondira I, Nguyen B, Gao M, Speicher M, Aggarwal H. A cross-sectional study of the impact of the COVID-19 pandemic on an ophthalmology consult service in four Michigan community hospitals. Indian J Ophthalmol 2023; 71:2856-2861. [PMID: 37417134 PMCID: PMC10491085 DOI: 10.4103/ijo.ijo_82_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/13/2023] [Accepted: 03/27/2023] [Indexed: 07/08/2023] Open
Abstract
Purpose During the coronavirus disease 2019 (COVID-19) pandemic, private practice, inpatient consult services, and academic residency programs in ophthalmology saw a decrease in patient encounters. This study elucidates how community hospital ophthalmology consult (OC) services were affected during the pandemic. We aim to determine whether there was a change in resident OC volume in a community-based ophthalmology program consult service during the COVID-19 pandemic. Secondary objectives included analyzing the change in the types of diagnoses and the number of patients seen for diabetic retinopathy over the same time. Methods A retrospective cross-sectional study was conducted reviewing the electronic health record (EHR) charts from OCs for the period 2017-2021. Records were categorized by referral source and the nature of OCs (trauma, acute, or chronic); OCs were further grouped by year and weak of referral. An intermonth analysis of weekly OC counts in each category was performed for the average number of consults in February-April 2017-2019 and for February-April 2020. A one-tailed t-test was performed. All t-tests assumed equal variances. Results Weekly OCs in 2020 revealed no statistically significant differences in overall cases or in acute or chronic cases when the volume before the COVID-19 pandemic was compared to the volume after the onset of the pandemic. However, a statistically significant increase in the average weekly trauma cases was noted when 2020 (an average of 2.7 cases per week) was compared to the weekly average for the same weeks of years 2017- 2019 (0.4; P = 0.016). This statistically significant increase in trauma in 2020 disappeared when comparing weeks 11-17 in 2020 (2.2 cases per week) and the average of 2017-2019 (1.1). Conclusion This report outlines no significant change in OCs before and after the onset of the pandemic compared to three previous years. There was, however, an increase in trauma consults during the pandemic and an increase in the number (though not the proportion) of diabetic retinopathy (DR+) patients seen by residents. This report uniquely describes no significant changes in the resident volume of patients seen during the COVID-19 global pandemic.
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Affiliation(s)
- Jamie J Beckman
- Taylor Ophthalmology Residency Program, Beaumont Hospital, Dearborn MI, United States
| | - Court R Webster
- Department of Neuro- Ophthalmology, Michigan State University, East Lansing, MI, United States
| | - Cole Richardson
- Taylor Ophthalmology Residency Program, Beaumont Hospital, Dearborn MI, United States
| | - Matthew Fullmer
- Taylor Ophthalmology Residency Program, Beaumont Hospital, Dearborn MI, United States
| | - Emerson Kendall
- Taylor Ophthalmology Residency Program, Beaumont Hospital, Dearborn MI, United States
| | - Vikisha Hazariwala
- Taylor Ophthalmology Residency Program, Beaumont Hospital, Dearborn MI, United States
| | - Inna Bondira
- Taylor Ophthalmology Residency Program, Beaumont Hospital, Dearborn MI, United States
| | - Brian Nguyen
- Taylor Ophthalmology Residency Program, Beaumont Hospital, Dearborn MI, United States
| | - Mary Gao
- Taylor Ophthalmology Residency Program, Beaumont Hospital, Dearborn MI, United States
| | - Mark Speicher
- American Association of Colleges of Osteopathic Medicine, Bethesda, MD, United States
| | - Himanshu Aggarwal
- Taylor Ophthalmology Residency Program, Beaumont Hospital, Dearborn MI, United States
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7
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Dorney I, Shaia J, Kaelber DC, Talcott KE, Singh RP. Risk of New Retinal Vascular Occlusion After mRNA COVID-19 Vaccination Within Aggregated Electronic Health Record Data. JAMA Ophthalmol 2023; 141:441-447. [PMID: 37052897 PMCID: PMC10102921 DOI: 10.1001/jamaophthalmol.2023.0610] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/31/2023] [Indexed: 04/14/2023]
Abstract
Importance New-onset retinal vascular occlusion (RVO) occurring acutely after messenger RNA (mRNA) COVID-19 vaccination has been described in recent literature. Because RVO can cause vision loss or blindness, an epidemiologic investigation evaluating this potential association is of great importance to public health. Objective To investigate how often patients are diagnosed with new RVO acutely after the mRNA COVID-19 vaccine compared with influenza and tetanus, diphtheria, pertussis (Tdap) vaccines. Design, Setting, and Participants A retrospective population-based cohort design using the TriNetX Analytics platform, a federated, aggregated electronic health record (EHR) research network containing the deidentified EHR data of more than 103 million patients, was used to examine aggregate EHR data. Data were collected and analyzed on October 20, 2022. Data on patients within the TriNetX Analytics platform were searched for the presence of vaccination Common Procedural Technology codes, and instances of newly diagnosed RVO within 21 days of vaccination were recorded and reported. Propensity score matching based on demographic characteristics (age, sex, race and ethnicity) and comorbidities (diabetes, hypertension, and hyperlipidemia) was performed between vaccination groups for evaluation of relative risks (RRs). Main Outcomes and Measures The appearance of a new-encounter diagnosis of RVO within 21 days of the mRNA COVID-19 vaccination was the primary outcome. Historical comparison cohorts of patients receiving influenza and Tdap vaccinations allowed for evaluation of the RRs for RVO. Results Of 3 108 829 patients (mean [SD] age at vaccination, 50.7 [20.4] years; 56.4% women) who received the mRNA COVID-19 vaccine, 104 (0.003%; 95% CI, 0.003%-0.004%) patients had a new diagnosis of RVO within 21 days of vaccination. After propensity score matching, the RR for new RVO diagnosis after the first dose of COVID-19 vaccination was not significantly different from that after influenza (RR, 0.74; 95% CI, 0.54-1.01) or Tdap (RR, 0.78; 95% CI, 0.44-1.38) vaccinations, but was greater when compared with the second dose of the COVID-19 vaccination (RR, 2.25; 95% CI, 1.33-3.81). Conclusions and Relevance The findings of this study suggest that RVO diagnosed acutely after mRNA COVID-19 vaccination occurs extremely rarely at rates similar to those of 2 different historically used vaccinations, the influenza and Tdap vaccines. No evidence suggesting an association between the mRNA COVID-19 vaccination and newly diagnosed RVO was found.
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Affiliation(s)
- Ian Dorney
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jacqueline Shaia
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - David C. Kaelber
- Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
- The Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, Ohio
| | - Katherine E. Talcott
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Rishi P. Singh
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
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Mani K, Canarick J, Ruan E, Liu J, Kitsis E, Jariwala SP. Effect of Telemedicine and the COVID-19 Pandemic on Medical Trainees' Usage of the Electronic Health Record in the Outpatient Setting. Appl Clin Inform 2023; 14:309-320. [PMID: 36758613 PMCID: PMC10132927 DOI: 10.1055/a-2031-9437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVES This study aimed to (1) determine the impact of COVID-19 (coronavirus disease 2019) and the corresponding increase in use of telemedicine on volume, efficiency, and burden of electronic health record (EHR) usage by residents and fellows; and (2) to compare these metrics with those of attending physicians. METHODS We analyzed 11 metrics from Epic's Signal database of outpatient physician user logs for active residents/fellows at our institution across three 1-month time periods: August 2019 (prepandemic/pre-telehealth), May 2020 (mid-pandemic/post-telehealth implementation), and July 2020 (follow-up period) and compared these metrics between trainees and attending physicians. We also assessed how the metrics varied for medical trainees in primary care as compared with subspecialties. RESULTS Analysis of 141 residents/fellows and 495 attendings showed that after telehealth implementation, overall patient volume, Time in In Basket per day, Time outside of 7 a.m. to 7 p.m., and Time in notes decreased significantly compared with the pre-telehealth period. Female residents, fellows, and attendings had a lower same day note closure rate before and during the post-telehealth implementation period and spent greater time working outside of 7 a.m. to 7 p.m. compared with male residents, fellows, and attendings (p < 0.01) compared with the pre-telehealth period. Attending physicians had a greater patient volume, spent more time, and were more efficient in the EHR compared with trainees (p < 0.01) in both the post-telehealth and follow-up periods as compared with the pre-telehealth period. CONCLUSION The dramatic change in clinical operations during the pandemic serves as an inflection point to study changes in physician practice patterns in the EHR. We observed that (1) female physicians closed fewer notes the same day and spent more time in the EHR outside of normal working hours compared with male physicians, and (2) attending physicians had higher patient volumes and also higher efficiency in the EHR compared with resident physicians.
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Affiliation(s)
- Kyle Mani
- Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, United States
| | - Jay Canarick
- Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, United States
| | - Elise Ruan
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States
| | - Jianyou Liu
- Division of Biostatistics, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, United States
| | - Elizabeth Kitsis
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States
| | - Sunit P. Jariwala
- Division of Allergy/Immunology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States
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9
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Gallop J, Andrasik W, Lucas J. Successful Use of Percutaneous Dissolvable Sutures During COVID-19 Pandemic: A Retrospective Review. J Cutan Med Surg 2023; 27:34-38. [PMID: 36471621 DOI: 10.1177/12034754221143083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The COVID-19 pandemic has had dramatic effects on all fields of medicine, including an effort to limit in-person visits. Within dermatologic surgery, one strategy is to close surgical incisions using percutaneous absorbable sutures. To the authors' knowledge, there are no large studies comparing changes in suture preferences and subsequent outcomes during the pandemic. OBJECTIVE To assess changes in suture preference and frequency of post-operative complications for percutaneous absorbable and non-absorbable sutures during the pandemic. METHODS A retrospective review of 1358 Mohs surgeries completed at the Cleveland Clinic during a 2-month period prior to COVID-19 and a matched 2-month period during the pandemic. RESULTS Sutures were used to close 1103 cases. Significantly more closures were performed with percutaneous absorbable sutures during COVID-19 (87.6%, 39.6%; P < .0001). There was no significant difference in the frequency of post-operative complications between suture materials (P = .48). The use of absorbable sutures were associated with a significantly higher frequency of suture hypersensitivity reaction (P = .020) but significantly lower frequency of infection (P = .021) and wound dehiscence (P < .0001). CONCLUSIONS Suture preference shifted towards absorbable sutures during the COVID-19 pandemic. Percutaneous absorbable sutures offered a formidable alternative to non-absorbable sutures and could reduce in-person follow-up visits without increasing post-operative complications.
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Affiliation(s)
- Joshua Gallop
- 2569 Cleveland Clinic Lerner College of Medicine, OH, USA
| | - Wyatt Andrasik
- 2569 Dermatology and Plastic Surgery Institute, Cleveland Clinic, OH, USA
| | - Jennifer Lucas
- 2569 Dermatology and Plastic Surgery Institute, Cleveland Clinic, OH, USA
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10
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Chuter BG, Lieu A, Dayao JKO, Bu JJ, Chen K, Nishihara T, Baxter SL. Impact of COVID-19 on the Delivery of Eye Care to Uninsured Diabetic Patients at a Student-Run Free Clinic: A Comprehensive Evaluation of Eye Clinic Performance. J Stud Run Clin 2022; 8:358. [PMID: 36890867 PMCID: PMC9991481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
Background Diabetic retinopathy is the leading cause of blindness among working-age adults in the United States and requires timely screening and management. This study evaluates the impact of the coronavirus disease 2019 (COVID-19) pandemic on diabetic retinopathy screening (DRS) for uninsured, predominantly Latino patients at the University of California San Diego Student-Run Free Clinic Project (SRFCP). Methods A retrospective chart review was conducted of all living diabetic patients at SRFCP who were seen in 2019 (n=196), 2020 (n=183), and 2021 (n=178). Ophthalmology clinic referrals, scheduled patient visits, and visit outcomes were analyzed longitudinally to determine the impact of the pandemic on screening patterns. Results The study population was 92.1% Latino, 69.5% female, with a mean age of 58.7 years. The distribution of patients seen (p<0.001), referred (p=0.012), and scheduled (p<0.001) in 2020 and 2021 significantly differed from 2019. In 2019, 50.5% of 196 patients eligible for DRS were referred, 49.5% were scheduled, and 45.4% were seen. In 2020, 41.5% of 183 eligible patients were referred, but only 20.2% were scheduled and 11.4% were seen. In 2021, there was a rebound: 63.5% of 178 patients were referred, 56.2% scheduled and 46.1% seen. No shows and cancellations represented 12.4% and 6.2% of the 97 encounters scheduled in 2019, but were markedly higher (10.8% and 40.5% respectively) for the 37 encounters scheduled in 2020. Conclusions The COVID-19 pandemic significantly impacted the delivery of eye care at SRFCP. The need for annual DRS exceeded the capacity of the ophthalmology clinic in all years studied, but the difference was especially pronounced with more stringent COVID-19 restrictions in 2020. SRFCP patients could benefit from telemedicine DRS programs to improve screening capacity.
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Affiliation(s)
- Benton G Chuter
- School of Medicine, University of California San Diego, La Jolla, California, USA.,Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, USA
| | - Alexander Lieu
- School of Medicine, University of California San Diego, La Jolla, California, USA.,Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, USA
| | - John Kevin O Dayao
- School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Jennifer J Bu
- School of Medicine, University of California San Diego, La Jolla, California, USA.,Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, USA
| | - Kevin Chen
- School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Taiki Nishihara
- School of Medicine, University of California San Diego, La Jolla, California, USA.,Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, USA
| | - Sally L Baxter
- Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, USA.,Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California, USA
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Choi HG, Kim SY, Baek SU. Changes in mean and variance of ophthalmic disease incidences during COVID-19 pandemic in Korea. Sci Rep 2022; 12:20364. [PMID: 36437348 PMCID: PMC9701753 DOI: 10.1038/s41598-022-24975-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/23/2022] [Indexed: 11/28/2022] Open
Abstract
This study undertook to determine the changes in the numbers of outpatient visits for various ophthalmic diseases during the COVID-19 pandemic compared with before. The monthly outpatient visits for 14 common ophthalmic diseases were enumerated based on the ICD-10 codes in Korean National Health Insurance Service data. The differences in the mean outpatient visits and disease variance 'before' and 'during COVID-19' were calculated. Subsequently, subgroup analyses according to age and sex were performed. The number of outpatient visits for conjunctivitis, scleritis & episcleritis, keratitis, cataract, diabetic retinopathy, and traumatic ophthalmic disease were lower during than before COVID-19 (all P < 0.001). The lower numbers of outpatient visits for ophthalmic disorders during COVID-19 were consistent across the age and sex subgroups. All ophthalmic diseases other than endophthalmitis showed no change of variation 'during' relative to 'before' COVID-19. In conclusion, during the COVID-19 pandemic, the ophthalmic outpatient visits decreased for infectious and inflammatory diseases, screening diseases, and traumatic diseases. However, COVID-19 is not considered to have had a significant effect on variation.
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Affiliation(s)
- Hyo Geun Choi
- grid.256753.00000 0004 0470 5964Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, Korea ,grid.488421.30000000404154154Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - So Young Kim
- grid.410886.30000 0004 0647 3511Department of Otorhinolaryngology-Head & Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Sung Uk Baek
- grid.488421.30000000404154154Department of Ophthalmology, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-Ro 170Beon-Gil, Dongan-Gu, Anyang-Si, Gyeonggi-Do 14068 South Korea
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12
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Dinh RH, Moushmoush O, Kolyvas P, Jacobsen BA, Mathai M, Sanghavi K, Levinson JD, Do BK. Describing Adverse Events Associated with Bilateral Same-Day Intravitreal Dexamethasone Implants. Ophthalmic Surg Lasers Imaging Retina 2022; 53:612-618. [PMID: 36378615 DOI: 10.3928/23258160-20221018-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVES To explore the incidence of adverse events after bilateral same-day intravitreal 0.7-mg dexamethasone implant (SDIDI) injections. MATERIALS AND METHODS We performed an IRB approved, single-center, retrospective review of patients receiving bilateral SDIDI injections from January 1, 2016 to October 31, 2021 and reviewed adverse events that occurred within 3 months of injection. RESULTS A total of 206 bilateral (412 eyes) SDIDI injections were performed in 59 patients. Ocular hypertension or the addition of intraocular pressure (IOP) lowering drops occurred in 121 (29.4%) eyes after IDI. Two (0.5%) eyes required glaucoma drainage surgeries. Of the 117 phakic eyes, 32 (27.4%) had progression of cataract or cataract extraction. There were two (0.5%) episodes of vitreous hemorrhage and one (0.2%) retinal tear with retinal detachment. There were no cases of endophthalmitis. CONCLUSION Serious complication rates after bilateral same-day IDI injections appears low. Increased IOP that requires intervention can occur. [Ophthalmic Surg Lasers Imaging Retina 2022;53:612-618.].
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13
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Przybek-Skrzypecka J, Szewczuk A, Kamińska A, Skrzypecki J, Pyziak-Skupień A, Szaflik JP. Effect of COVID-19 Lockdowns on Eye Emergency Department, Increasing Prevalence of Uveitis and Optic Neuritis in the COVID-19 Era. Healthcare (Basel) 2022; 10:healthcare10081422. [PMID: 36011079 PMCID: PMC9408570 DOI: 10.3390/healthcare10081422] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/25/2022] [Accepted: 07/27/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The COVID-19 pandemic led to the reorganization of the health care system. A decline in health- and life-saving procedures has been reported in various medical specialties. However, data on ophthalmic emergencies during lockdowns is limited. Methods: We conducted a retrospective, observational, case-control study of 2351 patients registered at the ophthalmic emergency department of a tertiary hospital in Poland during three national COVID-19 lockdowns (March/April 2020, November 2020, and March/April 2021) and corresponding months in 2019. Results: The total number of visits declined from a mean of 720/month in the non-COVID era to 304/month during COVID-19 lockdowns (p < 0.001). Ocular trauma incidence dropped significantly from 2019 (non-COVID months) to 2020/2021 (COVID group mean 201 vs. 97 patients monthly, respectively, p = 0.03). Of note, the percentage of foreign bodies removal was significantly higher during lockdowns than corresponding time in the non-COVID era. A downward trend for vitreous detachment and macular disorders cases was observed between COVID and non-COVID time. Uveitis and optic neuritis patients were seen more often during lockdowns (p < 0.001 and p = 0.0013, respectively). In contrast, the frequency of conjunctivitis and keratitis, potentially COVID-related problems, decreased significantly in COVID-19 time (mean 138 vs. 23 per month in non-COVID vs. COVID lockdowns, respectively, p < 0.001). Conclusions: The overall number of eye emergency visits declined during COVID-19 lockdowns. Conjunctivitis and keratitis rates dropped during the lockdowns. Interestingly, the frequency of immune-mediated ocular conditions (uveitis, optic neuritis) increased significantly which might be triggered by SARS-CoV2 infection.
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Affiliation(s)
- Joanna Przybek-Skrzypecka
- Department of Ophthalmology, The Medical University of Warsaw, 61 Żwirki i Wigury Street, 02-091 Warsaw, Poland; (A.K.); (J.P.S.)
- SPKSO Ophthalmic University Hospital, 24/26 Marszałkowska Street, 00-576 Warsaw, Poland; (A.S.); (J.S.)
- Correspondence:
| | - Alina Szewczuk
- SPKSO Ophthalmic University Hospital, 24/26 Marszałkowska Street, 00-576 Warsaw, Poland; (A.S.); (J.S.)
| | - Anna Kamińska
- Department of Ophthalmology, The Medical University of Warsaw, 61 Żwirki i Wigury Street, 02-091 Warsaw, Poland; (A.K.); (J.P.S.)
- SPKSO Ophthalmic University Hospital, 24/26 Marszałkowska Street, 00-576 Warsaw, Poland; (A.S.); (J.S.)
| | - Janusz Skrzypecki
- SPKSO Ophthalmic University Hospital, 24/26 Marszałkowska Street, 00-576 Warsaw, Poland; (A.S.); (J.S.)
- Department of Experimental Physiology and Pathophysiology, The Medical University of Warsaw, 3C Pawińskiego Street, 02-106 Warsaw, Poland
| | - Aleksandra Pyziak-Skupień
- Department of Children’s Diabetology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 16 Medyków Street, 40-752 Katowice, Poland;
| | - Jacek Paweł Szaflik
- Department of Ophthalmology, The Medical University of Warsaw, 61 Żwirki i Wigury Street, 02-091 Warsaw, Poland; (A.K.); (J.P.S.)
- SPKSO Ophthalmic University Hospital, 24/26 Marszałkowska Street, 00-576 Warsaw, Poland; (A.S.); (J.S.)
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14
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Levine H, Sepulveda-Beltran PA, Altamirano DS, Sabater AL, Dubovy SR, Flynn HW, Amescua G. Risk and Impact of Severe Acute Respiratory Syndrome Coronavirus 2 Infection on Corneal Transplantation: A Case-Control Study. Cornea 2022; 41:224-231. [PMID: 35037905 PMCID: PMC8916615 DOI: 10.1097/ico.0000000000002897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/19/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the risk of symptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection after corneal transplantation surgery, with cataract surgeries as controls, and the impact of the novel coronavirus disease pandemic in the clinical and surgical complications of corneal transplantation and cataract surgeries. METHODS A retrospective matched case-control study of 480 consecutive individuals who underwent surgery at the Bascom Palmer Eye Institute between May 2020 and November 2020. A total of 240 patients who underwent corneal transplantation with tissue obtained from the Florida Lions Eye Bank were age, race, ethnicity, and sex matched with 240 patients who underwent cataract surgery during the same day and by the same surgical team. Only the first corneal transplant or cataract surgery during this period was considered for each individual. All donors and recipients were deemed SARS-CoV-2 negative by a nasopharyngeal polymerase chain reaction test before surgery. Postoperative SARS-CoV-2 infections were defined as previously SARS-CoV-2(-) individuals who developed symptoms or had a positive SARS-CoV-2 polymerase chain reaction test during the first postoperative month. RESULTS Mean age, sex, race, and ethnicity were similar between groups. There were no differences between the corneal transplant and cataract groups in the rates of SARS-CoV-2 infection before (5.8% vs. 7.5%, P= 0.6) or after surgery (2.9% vs. 2.9%, P = 1). The rates of postoperative complications did not increase during the pandemic, compared with previously reported ranges. CONCLUSIONS In this study, postoperative SARS-CoV-2 infection was similar for individuals undergoing corneal transplantation or cataract surgery. Further research is required to evaluate the transmission of SARS-CoV-2 through corneal tissue.
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Affiliation(s)
- Harry Levine
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Diego S. Altamirano
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Alfonso L. Sabater
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sander R. Dubovy
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Florida Lions Ocular Pathology Laboratory, Miami, FL
| | - Harry W. Flynn
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Guillermo Amescua
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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15
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Shoji MK, Venincasa MJ, Sridhar J. The Impact of the COVID-19 Pandemic on Ophthalmology Resident Perceptions of Clinical Experience, Surgical Training, and Personal Life. Journal of Academic Ophthalmology 2021. [DOI: 10.1055/s-0041-1740314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Objective The coronavirus disease 2019 (COVID-19) pandemic has affected multiple areas of health care, including residency training programs. Elucidating the effect of the COVID-19 pandemic on resident clinical experience, surgical training, and wellness is essential to identify areas in which programs can provide additional educational and personal resources to trainees. This study aims to evaluate the experiences of ophthalmology residents during the pandemic.
Design The design is a cross-sectional, nonvalidated survey study. The survey was administered online with data collection from August 22 to August 31, 2020.
Participants Applicants to the Bascom Palmer Eye Institute ophthalmology residency program during the 2016 to 2019 application cycles were invited to complete the survey to encompass trainees currently in ophthalmology residency during the COVID-19 pandemic. Applicants who were not training at an ophthalmology residency program during the pandemic were excluded.
Methods This study involved eliciting feedback from ophthalmology residents on the perceived impact of COVID-19 on their residency experiences through survey questions.
Main Outcome Measures Perceived didactic, clinical, surgical, and overall experiences of residents during the COVID-19 pandemic, effect on cataract and noncataract surgical case volume, and perceived effects on resident personal life.
Results Responses were obtained from 357 (22.8%) individuals, 193 of which met inclusion criteria (59.1% male, 54.9% aged 30–34). Most participants reported overall worsening of their ophthalmology training experience due to COVID-19 (75.1%), with worsening of clinical training reported by 72.5% of participants and worsening of surgical training reported by 89.1% of participants. There were no significant differences in the perception of the impact of COVID-19 on overall training experience, clinical training experience, or surgical training experience among geographic regions (p = 0.43, p = 0.23, p = 0.27, respectively). A higher percentage of post-graduate year 3 (PGY3) and PGY4 trainees reported worsened clinical (p = 0.003) or surgical (p = 0.03) experience compared with PGY2 trainees. Participants also reported impact on personal life including time spent away from family (52.9%), worsened friendships with co-residents (29.5%), forced changes in living situation (15.0%), and increased expenses (13.5%).
Conclusion The COVID-19 pandemic has substantially impacted clinical and surgical experience of ophthalmology residents, who also report personal stressors due to the pandemic. Identifying alterations in the ophthalmology residency experience is essential to provide additional resources to support ophthalmology trainees professionally and personally during this time.
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Affiliation(s)
- Marissa K. Shoji
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Michael J. Venincasa
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Jayanth Sridhar
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
- Department of Vitreoretinal Surgery, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
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16
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Abtahi SH, Nouri H, Moradian S, Yazdani S, Ahmadieh H. Eye Disorders in the Post-COVID Era. J Ophthalmic Vis Res 2021; 16:527-530. [PMID: 34840673 PMCID: PMC8593548 DOI: 10.18502/jovr.v16i4.9740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This is an Editorial and does not have an abstract. Please download the PDF or view the article HTML.
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Affiliation(s)
- Seyed-Hossein Abtahi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hosein Nouri
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Siamak Moradian
- Ophthalmic Epidemiology Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahin Yazdani
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Ahmadieh
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Abstract
PURPOSE OF REVIEW Diabetic retinopathy (DR) is one of the leading causes of vision loss worldwide. Although screening and early treatment guidelines for DR have significantly reduced the disease burden, restrictions related to the COVID-19 pandemic have changed real-world practice patterns in the management of DR. This review summarizes evolving guidelines and outcomes of the treatment of DR in the setting of the pandemic. RECENT FINDINGS Intravitreal injections for DR have decreased significantly globally during the pandemic, ranging from approximately 30 to nearly 100% reduction, compared to corresponding timepoints in 2019. Most studies on functional outcomes show a decrease in visual acuity on delayed follow-up. Changing practice patterns in the management of DR has led to fewer intravitreal injections and overall reduction in visual acuity on follow-up. As COVID variants emerge, it will be necessary to continue evaluating practice guidelines.
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Affiliation(s)
- Ishrat Ahmed
- grid.21107.350000 0001 2171 9311Wilmer Eye Institute, Johns Hopkins University, 600 N. Wolfe Street, Maumenee 726, Baltimore, MD 21287 USA
| | - T. Y. Alvin Liu
- grid.21107.350000 0001 2171 9311Wilmer Eye Institute, Johns Hopkins University, 600 N. Wolfe Street, Maumenee 726, Baltimore, MD 21287 USA
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