Effects of lockdown on retinal detachment incidence in Scotland

Abstract

Wickham et al. [1] have highlighted the impact of COVID policies on ophthalmology services. Their findings are supported by our experience in Scotland. Rhegmatogenous retinal detachments (RRDs) are acute conditions that require prompt surgery [2]. The annual incidence of RRDs in Scotland was reported as 12.05/100,000 in 2010 [3]. The SARS-CoV-19 outbreak has been unprecedented. Healthcare services have worked hard to stay afloat. Subspecialty care has taken a back seat to intensive care and acute COVID wards. With UK eye departments providing only emergency care, outpatient clinics have been cancelled and workloads reduced. Anecdotal evidence from units all over the country suggests that RRD presentations have declined. Fortuitously, since August 2019 a study has been running across Scotland, prospectively collating all new RRDs, aiming to establish the incidence 10 years after the Scottish Retinal Detachment Study [3]. This has allowed us to assess the impact of the COVID-19 lockdown on RRD presentations. Fifteen surgeons in all six Vitreoretinal units across Scotland prospectively recorded all RRD presentations since August 2019. These records were collated centrally. Details such as age, sex, laterality and macular status were documented. We examined the data prior to and 5 weeks after the UK lockdown on the 23 rd March 2020. As the announcement was late in the afternoon, most of the RRDs operated on the 24 th would have presented prior to this. We therefore started counting the post lockdown numbers from 25 th March.

Impact of the COVID-19 pandemic on emergency eye care provision: A perspective from the Manchester Royal Eye Hospital

“…Shams et al reported a decrease in the cases of retinal detachment (RD) presenting to eye departments in Scotland suggesting that some cases of RD were left untreated during the lockdown period (10). In contrast, we have found increased cases of retinal detachment during the CP (N = 22) compared to the PCP (N = 19).…”

Impact of the COVID-19 pandemic on characteristics of retinal detachments: the Canadian experience

“…Contrary to other reports from the United Kingdom and North America 11 , 12 , 13 , 14 , 16 citing a significant reduction in the total volume of RDs seen over a 3- to 5-month period from the onset of the pandemic, we continued to treat a high volume of patients for the 6 months after March 14, 2020 ( Fig. 1 ).…”

“…Previous literature has suggested that RDs occurred less frequently during the COVID-19 pandemic owing to reduced patient activity and fewer opportunities to disturb the vitreous interface from eye surgery or trauma. 11 , 14 , 16 Although this may be true, other factors are likely to be more significant based on our results. The significant shift in the percentage of macula-off RDs suggests that, despite stable volumes of RDs over time, patients were waiting longer before seeking care.…”

“… 9 , 10 Small studies from the United Kingdom and North America have reported lower numbers of RD presentations within 1 to 3 months of the COVID-19 pandemic. 11 , 12 , 13 , 14 Although not statistically significant, previous authors have reported a reduced percentage of macula-on detachments, and a higher incidence of proliferative vitreoretinopathy (PVR) after the onset of the pandemic.…”

Reduction in Ophthalmic Presentations to Australian Emergency Departments During the COVID-19 Period: Are We Seeing the Full Picture?

“… 12 Similarly, across all vitreoretinal units in Scotland, a 55% decrease in the number of retinal detachments was seen in the five weeks following introduction of lockdowns (March 25, 2020 to April 29, 2020) compared to the average of the four five-week periods (excluding Christmas and New Year) leading up to March 25, 2020. 20 These changes may reflect issues beyond decreased incidence as outlined.…”