Social, personal and medical factors influencing treatment delay for patients with primary glaucoma during the COVID-19 pandemic: a qualitative interview study

Abstract

Background: Primary glaucoma patients faced many difficulties that affected their treatment during the COVID-19 pandemic. Glaucoma treatment often starts with prescription eye-drops. However, delays in ophthalmic therapy often occur due to poor awareness of the dangers of glaucoma, which subsequently leads to irreversible visual field defects and eventual blindness.

Objective: This study aimed to explore the social, personal and medical factors that contributed to barriers in the treatment of primary glaucoma during the COVID-19 pandemic, with the overarching goal of providing insights to develop measures that can identify the barriers of the treatment process and prevent consequent adverse outcomes.

Methods: We adopted a phenomenological approach and used purposive sampling to recruit 122 patients into our study. Face-to-face, semistructured, one-on-one interviews were conducted in a private office. The data were analysed using Colaizzi's seven-step method. In cases where classification was difficult, consensus was reached among the three researchers who formed the core assessment team.

Results: A total of 122 glaucoma patients experienced delayed pharmaceutical treatment during the outbreak. Delays were longer among females and patients over 75 years old, highlighting that treatment delays were a significant issue for glaucoma patients during the COVID-19 pandemic, particularly for older females. Coding of the transcripts yielded three themes (eight subthemes): (1) the impact of social support on glaucoma pharmaceutical treatment: (a) the inability to seek pharmaceutical treatment alone and (b) online reservation and payment requirements; (2) the impact of personal reasons on glaucoma pharmaceutical treatment: (c) fear of being infected with COVID-19, (d) being infected with COVID-19 or coming into contact with COVID-19 patients, (e) being busy with work or life; (3) the impact of medical resources on glaucoma pharmaceutical treatment: (f) abnormal diagnosis and treatment processes, (g) insufficient medical manpower and (h) insufficient communication from medical staff.

Conclusions: To prevent medication delays and potential irreversible damage to the visual field in primary glaucoma patients during health crises, it is essential to further explore personalised strategies for coping with the impact of pandemics. Special attention should be given to glaucoma patients facing significant life burdens, such as the elderly and females, and efforts should be made to increase their awareness of the risks of glaucoma. Future studies could explore the feasibility of providing more support to glaucoma patients, such as online payment and appointment scheduling options, to reduce delays and alleviate patient anxiety.

Keywords: COVID-19; Glaucoma; Health Services.

Figure 1. Theoretical basis of treatment delay. Our investigation of pharmaceutical treatment delay was conducted after the diagnosis of glaucoma.

Figure 2. The frequency of the three major themes and the number of glaucoma patients involved in each subtheme.