The Impact of COVID-19 on Ophthalmologic Outcomes at a Tertiary Academic Center

The COVID-19 pandemic has reshaped every aspect of life and will continue to greatly impact patient care and care delivery. How this disruption to patient care will affect patient outcomes is yet to be determined. From March 16 to May 4, 2020, ophthalmology patients at our tertiary academic center were canceled or rescheduled unless deemed urgent or emergent by providers. Additionally, many patients cancelled out of their own volition even if a provider still wanted to see the patient. The American Academy of Ophthalmology released guidance on specific surgical procedures and indications that were considered urgent or emergent, however decisions regarding clinic patients were largely left to provider discretion. The decision to delay care is likely easy for routine appointments such as cataract evaluations or annual examinations. However, for many other ophthalmic conditions (e.g. diabetic macular edema and glaucoma), the impact and severity of delayed care is not fully known. In this study, we will examine whether the delays in care caused by COVID-19 differentially impacted patient outcomes across four main ocular conditions. Our study will be a prospective, single-institution, cohort study of patients who had delayed care during 3/16/20 through 5/4/20 compared to those who were seen as scheduled. We will specifically study four main ocular conditions: non-exudative age-related macular degeneration, exudative macular degeneration, diabetic retinopathy, and glaucoma as these conditions represent the largest contributors of irreversible vision loss. We will report their demographics, imaging, examination, and treatments and examine their ocular outcomes. We hypothesize that patients whose care was delayed will have worse ophthalmic outcomes as measured by ophthalmic examination, multimodal imaging, and incidence of adverse events. If the results support this hypothesized conclusion, given the severity of the pandemic and the possibility of continued delays in care, we can provide objective evidence to guide future clinical decisions on care delivery.