COVID-19 and Access to Eyecare

Eye Doctor Wearing Mask Examining Child with Mask

Editor’s Note: We are continuing with our series on COVID-19 and the Eyes, bringing you information about current research findings and the importance of continuing to keep up with your eye care regimen.

A significant consequence of the pandemic on vision throughout the world is discussed in a recent article in the World Economic Forum, which states, “The COVID-19 pandemic is having a major and negative impact on the provision of eye health services around the world. Although 75% of all blindness and visual impairment is treatable, that access to treatment is shrinking especially in developing countries…The COVID-19 pandemic and associated safety measures have prompted a change in the provision and delivery of eye health services.” (COVID-19 is putting millions of people at risk of blindness | World Economic Forum (weforum.org)

Delivery of Eye Care in the United States

Early in the pandemic, the American Academy of Ophthalmology (AAO), detailed procedures for doctors to protect patients and staff. According to the AAO article, “…most eye clinics are scheduling in-person appointments, and many also continue to offer ‘virtual’ telemedicine visits over the phone or through video chat on a computer or smartphone.” And “…ophthalmologists are always available to treat urgent/emergency eye issues, deliver eye injections and provide critical care.”

Telemedicine

Further, a study in 2020 on disparities in eyecare utilization at the University of Michigan Kellogg Eye Care Center indicated that, “Telemedicine was critical in maintaining access to eye care, as ophthalmology was the specialty most negatively impacted by a decline in in-person patient visits as of May 2020.” (p. 2) However, according to the study, telemedicine has downsides, including accessibility. The article cites concerns about access to eye care for minorities and older people. The study concludes “…to ensure that health disparities are not worsened by the heightened use of remote care, health care providers and insurance carriers must find ways to make telemedicine accessible, particularly for older Americans, racial and ethnic minority Americans, and those with lower socioeconomic status. This may require making new modalities of telemedicine available via telephone.” (p. 10)

Benefits of Telehealth

On a more positive note, Dr. David Ramsey, an ophthalmologist, and director of ophthalmic research at Lahey Hospital and Medical Center of Beth Israel Lahey Health. Ramsey presented research at the 2021 AAO conference showing that:

“… telehealth services delivered to patients with diabetes and diabetic retinopathy benefited most patients who received them, as far as they returned, subsequent to the telehealth service, for an in-person visit. Patients that received telehealth were 50%, or, in times, up to 100% more likely to return for in-person care in the first year of the pandemic, compared with those that had not received telehealth services…”
“Further, …it appears …there is an even greater benefit for patients who are neither White nor Hispanic. Patients in groups, such as those who are Black or African American, Asian, or Asian American, Hispanic, or Latino, had an even more beneficial effect of telehealth in that it made them more likely to return for in-person visits if they had received the service compared with those members of the very same groups that had not. … after the outbreak of COVID-19, we saw that patients… that were Black, Hispanic, or Asian, had a lower overall return rate compared to non-Hispanic White patients.”

Impact of COVID-19 on the Eyes

For World Sight Day in October, we covered the impact of COVID-19 on the eyes, including the research reported by the American Academy of Ophthalmology. This research included topics such as ‘cotton wool’ spots, eye stroke, retinal vein occlusion, and retinal hemorrhage. Further, recent studies indicate that conjunctivitis (pink eye) could be an early indicator of the omicron variant.

The American Academy of Ophthalmology (AAO) lays out some of the differences between pink eye, allergies, and coronavirus. Audrey Demmitt, RN and VisionAware peer advisor has also written a very informative post on this topic.

Mask Associated Dry Eye -MADE—Another Eye Care Concern

A recent article on the effects of COVID, states that , “… the ophthalmologists, as well as the general population, need to be aware that the facial mask together with prolonged use of digital devices is giving rise to increased reports of dry eyes in a large number of patients. Scientists from the Centre for Ocular Research & Education (CORE), Waterloo, Canada termed dry eye after use of face mask as mask-associated dry eye (MADE)”

Additional advice on mask usage is given in this Ophthalmology and Therapy review: “Lubricant eye drops and eye protection, such as goggles, should be used in conjunction with masks. Additional care should be taken by individuals using masks for extended periods and by patients with prior history of dry eye disease, recent ophthalmic surgery, or other surface inflammatory diseases, such as Sjogren syndrome.” (Face Mask Associated Ocular Irritation)

In conclusion, it is critical to stay in touch with your eye care professional during the pandemic and to follow the treatment protocols that they outline for you. As cited in the post, telehealth is both a panacea and a concern. If you need help accessing your appointments, whether in person or through telehealth, you need to discuss this problem with your doctor.