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The Influence of COVID-19 Lockdown in Jordan on Patients with Diabetic Retinopathy: A Case-Control Study
Rami Al-Dwairi1, Hamzeh Rwashdeh1, Moneera Otoom1
1Department of Special Surgery, Division of Ophthalmology, Faculty of Medicine, Jordan University of Science & Technology, Irbid, Jordan.
Insights
The COVID-19 lockdown in Jordan disrupted diabetic retinopathy (DR) care, leading to vision loss and disease progression in patients. Maintaining essential DR treatments during future public health crises is crucial for preserving patient vision.
Area of Science:
- Ophthalmology
- Public Health
- Retinal Diseases
Background:
- Diabetic retinopathy (DR) is a primary cause of vision loss in adults.
- Effective management of DR requires consistent patient follow-up and timely interventions.
- The COVID-19 pandemic necessitated a lockdown in Jordan, halting outpatient clinic services and disrupting DR patient care.
Purpose of the Study:
- To evaluate the impact of the COVID-19 lockdown-induced interruption of care on diabetic retinopathy (DR) progression and visual outcomes.
- To compare the clinical status of DR patients who experienced treatment delays with a control group.
Main Methods:
- A retrospective analysis of 137 eyes from 89 patients undergoing DR procedures during the March-June 2020 lockdown in Jordan.
- Inclusion of a control group of DR patients with similar characteristics treated prior to the pandemic (October-December 2019).
- Collection and comparison of demographic data, clinical information, procedural details, and visual acuity outcomes.
Main Results:
- Patients experiencing care interruption (case group) showed a mean visual acuity drop of 0.176 LogMAR, contrasting with a gain of -0.103 LogMAR in the control group.
- The case group exhibited significantly worse central subfield thickness (CST) values.
- Disease progression, including new and worsening findings, was significantly more prevalent in the case group compared to controls.
Conclusions:
- Disruptions in essential procedures and follow-up care for diabetic retinopathy (DR) patients can negatively impact visual outcomes.
- National policies during lockdowns should consider exemptions for critical DR treatments, implementing safety measures.
- Strategies like treat-and-extend protocols, home screening, portable OCT, and advanced anti-VEGF therapies are recommended to mitigate future care interruptions.
Background:
Diabetic retinopathy (DR) is a leading cause of vision impairment in working-age adults. Patients with DR need extensive follow-ups with timely proper treatment. In Jordan, a complete lockdown was decided during the COVID-19 pandemic including the closure of outpatients' clinic. In this study, we assess the effect of the lockdown on the progression and visual outcome for patients with DR who had interruption in their plan.
Methods:
Retrospectively, we identified all patients who were scheduled for procedures for the management of diabetic retinopathy (DR) during the COVID-19-related quarantine period in Jordan from March 16th to June 6th, 2020. All demographics and clinical data, procedure information, and visual outcome were collected. Another control group of patients with similar characteristics who were scheduled for procedures related to DR before the COVID-19 pandemic from October 15th to December 31st, 2019 were included.
Results:
One hundred and thirty-seven eyes planned for procedures from 89 patients were included. The case group comprises 56 eyes (40.9%). The mean age of the patients was 61.4 years. The right eye was involved in 69 procedures (50.4%). The mean change in visual acuity for the case group in the procedure eye was 0.176 in LogMAR (drop of almost 9 LogMAR letters) and the mean change in visual acuity for the control group in the procedure eye was -0.103 LogMAR (gain of about 5 LogMAR letters). Also, the central subfield thickness (CST) values were significantly worse in the case group. Furthermore, patients in the case group had significantly more disease progression (new findings and worsening of the already established findings).
Conclusion:
Interrupting the important procedures for DR patients and delaying their follow-up may adversely affect their visual outcome. National decisions should consider conducting these procedures and exempt those patients from any lockdown with proper precautions. Moreover, certain measures would be considered, such as treat-and-extend protocol, home screening and portable OCT examination, and newer long-acting anti-VEGF drugs.
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