Patient perception of COVID-19: Too risky for seamless eye care

Patients who are at an increased risk for vision loss from lapses in care have frequently expressed concerns about the impact of the pandemic on their ability to receive timely care.

Patient fears about contracting COVID-19 have resulted in interrupted care for those who need in-person evaluations to prevent vision loss from vision-threatening diseases, despite physician recognition of their needs.

The COVID-19 pandemic has resulted in a 79% drop in the numbers of patient visits in clinical eye care practices in the United States,1 largely from cancellation of routine visits.2

However, a recent study noted an “alarming trend of patients not attending retained appointments deemed time-sensitive by their clinician.”3

While cancellation of routine visits likely is not harmful to patients over the long term, those with retinal diseases need medical treatment for age-related macular degeneration (AMD), among others.

In addition, the authors of a recent article also commented that patients with AMD and diabetic retinopathy (DR) are at high risk for severe COVID-19 because of aging and comorbidities.

Physicians know the importance of continuing care for these patients. However, patients’ perceptions in large part have not been explored.

A study4 led by Aaron Lindeke-Myers, MD, from Emory University School of Medicine, Atlanta, commented, “…there has been limited assessment of patient perspectives. Treatment decisions, which ostensibly intend to provide the best possible patient care, have been made without fully accounting for patient-centered views on the competing risks of vision loss and virus exposure.”

In light of this observation, the authors conducted a survey study that included a nonvalidated telephone survey in April and May 2020, and a retrospective medical record review conducted in parallel with survey administration from May 22, 2020, to August 18, 2020.

Participants from the Emory Eye Center and W.K. Kellogg Eye Center, Ann Arbor, Michigan, were included. The patients represented a random sample of those with exudative AMD or DR who had been treated with an intravitreal injection between January 6 and March 13, 2020, and were to undergo a second injection between March 13 and May 6, 2020.

A total of 348 patients agreed to participate (mean age, 75 years; mean comorbidities associated with severe COVID-19, 2.7).

Noteworthy results showed that 163 (47%) were very concerned/moderately concerned about visual declines because of missed treatments; 60% believed that exposure to the COVID-19 virus at the eye clinic was extremely unlikely/unlikely, 14% considered exposure to be extremely likely/likely; 22% were lost to follow-up.

The authors reported that concern about viral exposure during clinic visits (odds ratio [OR], 3.9; 95% CI, 1.8-8.4) and diagnosis of DR (vs AMD) (OR, 8.130; 95% CI, 3.367-20.408) were associated with an increased likelihood of loss to follow-up.

“Among patients at high risk for vision loss from lapses in care, many expressed concerns regarding the effect of the pandemic on their ability to receive timely care,” they concluded. “Survey results suggest that fear of SARS-CoV-2 exposure was associated with a roughly 4-fold increase in the odds of patient loss to follow-up. These results support the potential importance of clearly conveying infection-control measures.”

References

1. Mehrotra A, Chernew M, Linetsky D, Hatch H, Cutler D. The impact of the COVID-19 pandemic on outpatient visits: a rebound emerges. Published May 19, 2020. Accessed July 28, 2020. https://www.commonwealthfund.org/publications/2020/apr/impact-covid-19-outpatient-visits

2. American Academy of Ophthalmology. Recommendations for urgent and nonurgent patient care. Published March 18, 2020. Accessed July 28, 2020. https://www.aao.org/headline/new-recommendations-urgent-nonurgent-patient-care

3. American Society of Retina Specialists. COVID-19 Survey July 14, 2020. Published July 2020. Accessed August 29, 2020. https://www.asrs.org/content/documents/covid19july14survey.pdf

4. Lindeke-Myers A, Zhao PYC, Meyer BI, et al. Patient perceptions of SARS-CoV-2 exposure risk and association with continuity of ophthalmic care. JAMA Ophthalmol; Published online March 11, 2021. doi:10.1001/jamaophthalmol.2021.0114