More than six million people in Brazil over the age of 40 are affected by glaucoma. While the diagnosis and treatment of glaucoma are both fully covered by the country’s public health system (SUS), the COVID-19 outbreak has forced the government to focus the bulk of its resources on emergency care for high numbers of acute COVID in a short period of time, leaving many patients with chronic conditions–like glaucoma–without medical assistance. 

Though scientists have investigated the impact of lockdown restrictions on resident training and glaucoma practice, no studies, to date, have explored the pandemic’s impact on glaucoma patients’ use of public services. A recent study, published in the Journal of Clinical Ophthalmology, examined this issue in an effort to help health service organizations better prepare for future performance. 

What They Did

The data for this single-center retrospective cohort study were obtained from the electronic records of the Hospital das Clínicas da Faculdade de Ciências Médicas da Unicamp in Brazil, which provides public tertiary healthcare as part of SUS. Tertiary healthcare is advanced, specialized care provided within a hospital, usually over an extended period of time. 

The records were divided into a pre-pandemic group (March 1, 2019 to February 28, 2020) and a pandemic group (March 1, 2020 to February 28, 2021). The first case of COVID-19 detected in Brazil was confirmed on February 26, 2020. All appointments and elective surgeries at the hospital were suspended as of March 2020, and only emergency attendance and emergency procedures were allowed during the pandemic period.

For the study, the research team compared the total number of outpatient clinical visits, visual field exams, surgical procedures performed, and medications released during the pre-pandemic and pandemic periods. 

What They Found

Comparisons between the pre-pandemic and pandemic periods showed a:

• 92.52% decrease in total outpatient clinical visits (7117 vs. 532)
• 93.84% decrease in total visual field exams (1525 vs. 94)
• 72.74% decrease in total surgical procedures (682 vs. 145) 
• 19.63% decrease in total medications released (23,259 vs. 18,692)

The average number of annual clinical visits per patient (1.8 vs. 1.04) and surgical procedures per patient (1.46 vs. 1.13) also decreased significantly, though the average number of medications released per patient (28.62 vs. 30.34) showed no significant change. 

Specifically, the pre-pandemic period clocked a total of:

• 3965 patients attending clinical visits
• 1410 patients receiving visual field exams 
• 466 patients undergoing glaucoma surgical procedures
• 813 patients receiving medications

In contrast, the one-year-long pandemic period documented:

• 514 patients attending clinical visits
• 94 patients receiving visual field exams
• 127 patients undergoing glaucoma surgical procedures 
• 616 patients receiving medications

A total of 423 patients attended clinical visits during both periods, but even those showed a substantial decrease in the average number of visits, from 1.86 to 1.04, representing a 44% reduction.

What It Means

The COVID-19 pandemic dramatically decreased the number of outpatient visits, visual field exams, and surgical procedures, impacting the follow-up of glaucoma patients in a tertiary healthcare center. Despite the significant findings, the study does have some limitations.

• The hospital system data did not include patients’ demographics, which prevented the research team from analyzing the influences of age, gender, residence location, and previous diagnoses. 
• Using the number of medications released to patients as a measure of adherence does not yield reliable data. The employment of a direct method such as a questionnaire would have provided information about compliance and reasons for not attending a visit. 
• There was no data available on non-emergency vs. emergency visits, which would have helped clarify the types of patients not seen during the pandemic.

Overall, however, the research results show clear discrepancies in health service usage by glaucoma patients before lockdown vs. during lockdown. The study authors encourage other healthcare units to quantify the pandemic’s impact on their own populations to better prepare for a possible future overload of patients with uncontrolled glaucoma.

*Ayub, G., Vasconcelos, J., and Costa, V. (2021, Nov. 3). The Impact of Covid-19 in the Follow-Up of Glaucoma Patients in a Tertiary Center: A Comparison Between Pre-Pandemic and Pandemic Periods. Journal of Clinical Ophthalmology, 15: 4381-4387. https://www.dovepress.com/the-impact-of-covid-19-in-the-follow-up-of-glaucoma-patients-in-a-tert-peer-reviewed-fulltext-article-OPTH