Impact of COVID-19 on outpatient visits and intravitreal treatments in a referral retina unit: let's be ready for a plausible "rebound effect"

Abstract

Purpose: To quantify the shrinking in outpatient and intravitreal injections' volumes in a tertiary referral retina unit secondary to virus causing coronavirus disease 2019 (COVID-19).

Methods: In this retrospective cross-sectional study, we reviewed the charts of all patients who had a visit at a medical retina referral center during the Italian quarantine (from 9th of March 2020 to 3rd of May 2020). Number and characteristics of these data were compared with data from the same period in 2019 (from 9th of March 2019 to 3rd of May 2019).

Results: In the 2019 study period, there were 303 patients attending clinic (150 males, 153 females). In the 2020 study period, patients decreased to 75 (48 males, 27 females; P = 0.022 comparing gender prevalence between the two periods) with an overall reduction of 75.2%. Mean ± SD age was 71.4 ± 14.3 years (range 25-93 years) in the 2019 study period and 66.7 ± 13.1 years (range 32-91 years) in the 2020 study period (P = 0.005). The largest drop in outpatient volume was recorded in AMD patients (- 79.9%). Regarding the intravitreal treatments, there were 1252 injections in the 2019 period and 583 injections in the 2020 period (- 53.6% in injections). The drop in intravitreal treatments was larger in patients with posterior uveitis, retinal vein occlusion, and diabetes (- 85.7%, - 61.9%, and - 59.6%, respectively).

Conclusion: The volume of outpatient visits and intravitreal injections declined during the COVID-19 quarantine. The short- and long-term impacts are that routine in-person visits and intravitreal injections are expected to increase after the quarantine and, even more, after the pandemic.

Keywords: COVID-19; Intravitreal injections; Outpatient visits; Retina.

Fig. 1

Bar charts showing comparisons between outpatient volumes in the 2019 and 2020 study periods. (Left) Error-bar chart displaying study cohorts’ ages in the two study groups. The height of the bars corresponds to the mean value, while the error bars represent the standard deviation (SD) of the data. Groups’ ages significantly differ between groups (P = 0.005). (Middle and right) Stacked bar charts showing the contribution of different sub-groups to each separate category in the two study periods. (Middle) The difference in gender prevalence was statistically significant (P = 0.022) between the two groups. (Right) The largest drop in outpatient volume was recorded in AMD patients (− 79.9%)

Fig. 2

Weekly volume of outpatient visits during the COVID-19 Italian quarantine in 2020 (left), relative to the weekly incidence of new COVID-19 cases (right). The number of in-person visits was higher in the last 3 weeks of quarantine. Inversely, the incidence of COVID-19 cases tended to be descending in the last 4 weeks of quarantine

Fig. 3

Bar charts showing comparisons between intravitreal injections’ volumes in the 2019 and 2020 study periods. Stacked bar charts showing the contribution of different sub-groups to each separate category in the two study periods. (Left) The type of medication was different in terms of prevalence between the two study groups (P = 0.014) with a largest drop in corticosteroid injections during the 2020 study period. (Right) The largest reduction in intravitreal treatments was recorded in patients with posterior uveitis, retinal vein occlusion, and diabetes (− 85.7%, − 61.9%, and − 59.6%, respectively)