Changes in patient visits and diagnoses in a large academic center during the COVID-19 pandemic

Abstract

Background To minimize the risk of viral transmission, ophthalmology practices limited face-to-face encounters to only patients with urgent and emergent ophthalmic conditions in the weeks after the start of the COVID-19 epidemic in the United States. The impact of this is unknown. Methods We did a retrospective analysis of the change in the frequency of ICD-10 code use and patient volumes in the 6 weeks before and after the changes in clinical practice associated with COVID-19. Results The total number of encounters decreased four-fold after the implementation of clinic changes associated with COVID-19. The low vision, pediatric ophthalmology, general ophthalmology, and cornea divisions had the largest total decrease of in-person visits. Conversely, the number of telemedicine visits increased sixty-fold. The number of diagnostic codes associated with ocular malignancies, most ocular inflammatory disorders, and retinal conditions requiring intravitreal injections increased. ICD-10 codes associated with ocular screening exams for systemic disorders decreased during the weeks post COVID-19. Conclusion Ophthalmology practices need to be prepared to experience changes in practice patterns, implementation of telemedicine, and decreased patient volumes during a pandemic. Knowing the changes specific to each subspecialty clinic is vital to redistribute available resources correctly.

The Impact of COVID-19 on Diabetic Retinopathy Monitoring and Treatment

“…DR screening was also frequently postponed during the pandemic, particularly in areas with high COVID-19 community transmission [ 12 ]. For example, at the Wilmer Eye Institute, diabetic eye exams decreased from 1,145 visits in the 6 weeks prior to pandemic-related clinical practice changes to just 59 in the first 6 weeks after these changes were implemented [ 13 ].…”

Effect of COVID-19 Lockdowns on Eye Emergency Department, Increasing Prevalence of Uveitis and Optic Neuritis in the COVID-19 Era

“…Prior to COVID-19 pandemic retinopathy of prematurity, diabetic retinopathy, and age-related macular degeneration were the mainstay of remotely controlled disorders in ophthalmology [ 13 , 14 , 15 ]. However, both the range of telemedicine tools (programs, devices) and the number of centers and doctors engaged in tele-visits, contributed to its development and providing care to patients with a broader spectrum of ocular disorders [ 16 , 17 , 18 ]. Nevertheless, some of the ocular disorders might not be properly diagnosed virtually, retina and choroid inflammations being the typical examples [ 12 , 17 , 19 ].…”

“…However, both the range of telemedicine tools (programs, devices) and the number of centers and doctors engaged in tele-visits, contributed to its development and providing care to patients with a broader spectrum of ocular disorders [ 16 , 17 , 18 ]. Nevertheless, some of the ocular disorders might not be properly diagnosed virtually, retina and choroid inflammations being the typical examples [ 12 , 17 , 19 ]. Additionally, considering an increasing number of reports on the autoimmune background of various post-Covid syndromes, it might be of special interest to investigate patterns of emergency eye consultations related to optic neuritis and uveitis [ 20 , 21 ].…”

Impact of COVID-19 on the Management of Diabetic Retinopathy

“…DR testing was also routinely delayed throughout this outbreak, particularly in communities where COVID-19 infection was prevalent [12]. Diabetic eye exams, for instance, fell from approximately 1,145 visits in the six weeks before disease outbreak clinical practisemodifications to just 59 in the first six weeks after they were adopted at the Wilmer Eye Institute [13]. The American Academy of Ophthalmology and Vision Academy Steering Committee's revised guidelines for DR management and treatment, patient preferences of eye clinic visits during the global epidemic, changes in intravitreal injection frequency, and the resulting changes in conclusions such as vision acuity will be the subject of this article.…”