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Patient Perceptions of SARS-CoV-2 Exposure Risk and Eye Care
TAKE-HOME MESSAGE
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A total of 348 patients, all of whom had been scheduled for a second intravitreal injection between March 13 and May 6, 2020, were surveyed by telephone between May 22 and August 18, 2020, regarding risk during the COVID-19 pandemic. Almost half were moderately or very concerned about vision loss related to missed appointments. Of the surveyed patients, 60% believed they were unlikely to be exposed to COVID-19 during their clinic visit. There was a strong association between loss to follow-up (defined as cancellation or “no show” of appointment by the patient and no follow-up visit within 14 days) and perceived risk of exposure to COVID-19, ethnicity, diagnosis of diabetic retinopathy, age, and worse health status.
- These authors stress the importance of communicating clinic COVID-19 safety precautions to patients.
abstract
This abstract is available on the publisher's site.
Access this abstract nowImportance
Patient perceptions regarding the risks of obtaining in-person ophthalmic care during the coronavirus disease 2019 (COVID-19) pandemic may affect adherence to recommended treatment plans and influence visual outcomes. A deeper understanding of patient perspectives will inform strategies to optimize adherence with vision-preserving therapies.
Objective
To evaluate perceptions of COVID-19 exposure risk and their association with appointment attendance among patients at high risk of both reversible and irreversible vision loss from lapses in care.
Design, Setting, and Participants
This survey study included a nonvalidated telephone survey designed in April and May of 2020 and a retrospective medical record review conducted in parallel with survey administration from May 22 to August 18, 2020. Participants were recruited from 2 tertiary eye care centers (Emory Eye Center in Atlanta, Georgia, and W.K. Kellogg Eye Center in Ann Arbor, Michigan). The study included a random sample of patients with diagnoses of exudative age-related macular degeneration (AMD) or diabetic retinopathy (DR) who received an intravitreal injection between January 6 and March 13, 2020, and were scheduled for a second injection between March 13 and May 6, 2020.
Main Outcomes and Measures
Association between perceptions regarding COVID-19 risks and loss to follow-up.
Results
Of 1004 eligible patients, 423 (42%) were successfully contacted, and 348 (82%) agreed to participate (participants' mean [SD] age, 75 [12] years; 195 women [56%]; 287 White [82%] patients). Respondents had a mean (SD) of 2.7 (1.1) comorbidities associated with severe COVID-19, and 77 (22%) knew someone with COVID-19. Of all respondents, 163 (47%) were very concerned or moderately concerned about vision loss from missed treatments during the pandemic. Although 208 (60%) believed the COVID-19 virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), exposure at the eye clinic was extremely unlikely or unlikely, 49 (14%) believed it was extremely likely or likely. Seventy-eight participants (22%) were lost to follow-up. Concern regarding COVID-19 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 increase in likelihood of loss to follow-up.
Conclusions and Relevance
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. 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.
Additional Info
Disclosure statements are available on the authors' profiles:
Patient Perceptions of SARS-CoV-2 Exposure Risk and Association With Continuity of Ophthalmic Care
JAMA Ophthalmol 2021 Mar 11;[EPub Ahead of Print], A Lindeke-Myers, PYC Zhao, BI Meyer, EA Liu, DA Levine, OM Bennett, S Ji, PA Newman-Casey, RC Rao, N JainFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Eye Care
This study evaluated retinal care specifically, but it really applies to all healthcare. As the authors write: "One year into the COVID-19 pandemic, we have a better understanding regarding transmission dynamics. It is unlikely we can assure zero risk of COVID-19 exposure in healthcare facilities, and we cannot control potential exposures during patient transportation to a facility." The survey conducted here was by medical students calling patients and posing these questions over the phone about perception about risk of infection versus understanding of the importance of ongoing retina monitoring or treatment. The authors concluded that, during these uncertain times, retinal specialists and their clinics/practices must proactively address unwarranted patient fears.