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Outcomes Research

Keeping an Eye on COVID-19

A Houston Methodist team assessed the impact of COVID-19 on neuro-ophthalmology practices in the United States.

The global healthcare landscape was profoundly impacted by the COVID-19 pandemic, especially in the field of neuro-ophthalmology. The emergence of an extremely contagious respiratory virus posed an unparalleled challenge for ophthalmologists who usually spend more than several minutes in close proximity to patients for a comprehensive exam. In March 2020, the American Academy of Ophthalmology (AAO) reacted swiftly to the pandemic by advising ophthalmologists to suspend all non-urgent or non-emergency eye care services. However, just one month later, the AAO revised its guidance and advocated for a prudent reopening of ophthalmic services.
Andrew G. Lee, MD
In addition, non-contact tonometry, a common diagnostic procedure, was identified as a potential source of micro-aerosol generation due to disturbances in the tear film, which could further elevate the risk of virus transmission. Given these inherent risks, a team led by Houston Methodist’s Andrew G. Lee, MD, Herb and Jean Lyman Centennial Chair in Ophthalmology and Chair of the Department of Ophthalmology, Blanton Eye Institute, conducted a survey to assess the impact of COVID-19 on neuro-ophthalmology practices in the United States. To date, this study appears to be the most extensive examination of the impact of COVID-19 on this subspecialty.
They learned that neuro-ophthalmologist patient volume drastically slowed during the first two months of the pandemic in the U.S., normalized around six months into the pandemic, and increased significantly after one year. They also found a significant increase in the use of telemedicine in neuro-ophthalmology.
Pre-pandemic survey data indicated that only 19% of practitioners utilized telemedicine. During and after the pandemic, however, telemedicine adoption surged to 78% in this field, though this varied among age groups. Notably, neuro-ophthalmologists younger than 40 demonstrated full adoption, with 100% utilization of telemedicine. Conversely, the 40-49 age group exhibited the lowest use of telemedicine, which could be attributed in part to the limited response from this age cohort. In contrast, other age categories displayed relatively uniform levels of telemedicine usage.
Optometrist examining young woman's eye. Getty Images.
Innovative solutions such as home-based, portable, or even "pop-up" testing sites could be effective measures in mitigating care limitations during future pandemics
Andrew G. Lee, MD
Neuro-ophthalmologist Chair, Department of Ophthalmology Blanton Eye Institute
Following the issuance of initial stay-at-home orders, 68% of the neuro-ophthalmologists in the study temporarily suspended all patient consultations. This hiatus from patient care varied widely in duration, with 11% resuming in less than a week, 36% after more than a week but less than a month, and 18% after more than a month but less than three months. Meanwhile, 32% continued to see patients without interruption, and 4% were compelled to self-quarantine during this period. The patient volume in neuro-ophthalmology practices exhibited significant fluctuations throughout the pandemic. During the initial month, patient numbers sharply declined, with many practitioners reporting minimal to no patient visits. Two months into the pandemic, the majority of neuro-ophthalmologists continued to experience significantly reduced patient volumes. However, by the sixth month, patient numbers began to approach pre-pandemic levels. One year after the pandemic's onset, patient volumes had notably rebounded.
Compressive Optic Neuropathy
Optic Neuritis
Survey respondents reported increased severity in a range of neuro-ophthalmic conditions during the pandemic, with 77% acknowledging this phenomenon. Among these conditions, idiopathic intracranial hypertension increased the most, closely followed by compressive optic neuropathies. Twenty-three percent of the participating neuro-ophthalmologists, however, observed no significant change in disease severity during the pandemic. The COVID-19 pandemic underscored the crucial role of telemedicine within neuro-ophthalmic practice. Phone consultations proved valuable for discussing recent laboratory results, neuroimaging findings, and monitoring medication tolerance and adherence. While not a perfect substitute for in-person visits, video telemedicine also served its purpose by facilitating external examinations to assess conditions like ptosis, strabismus, or orbital issues. Nonetheless, further advancements are essential to enable a comprehensive neuro-ophthalmic assessment without the necessity for a physical presence. Such technological progress would not only bolster preparedness for future pandemics, it will also enhance access to ophthalmic care for patients in remote areas. Our survey identified a notable scarcity of neuro-ophthalmologists practicing in smaller cities, reflecting a broader trend in the field. Addressing the challenges highlighted by the pandemic necessitates additional research in the realm of in-person patient care. “Innovative solutions such as home-based, portable, or even "pop-up" testing sites could be effective measures in mitigating care limitations during future pandemics,” Lee noted. “Our group is currently developing a head-mounted visual assessment device designed initially for assessing subtle visual changes in astronauts during spaceflight. This pioneering technology holds promise for terrestrial use, enabling ophthalmologists to conduct rapid and comprehensive visual assessments in remote locations or patients' homes.” Houston Methodist physician-scientists are dedicated to addressing the evolving needs of patients under challenging circumstances. The ability to perform accurate visual assessments with cost-effective headsets could prove invaluable for ophthalmic monitoring in isolated communities and developing nations.
Ethan Waisberg, Joshua Ong, Nasif Zaman, Sharif Amit Kamran, Alireza Tavakkoli and Andrew G. Lee
Heather Lander, PhD
October 2023
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