Wills Eye: Ocular Trauma and COVID-19
Delayed presentation, longer distances to treatment centers, less insurance coverage – our patients face a host of new challenges in a pandemic
Connie Wu, Samir N. Patel, Thomas L. Jenkins, Anthony Obeid, Allen C. Ho and Yoshihiro Yonekawa, specialists at Wills Eye Hospital, Mid Atlantic Retina and Thomas Jefferson University in Philadelphia
Nationwide stay-at-home orders during the COVID-19 pandemic have caused serious issues for patients seeking emergency care. We conducted an investigation into the patients seeking urgent ophthalmic care for severe ocular injuries (1). We reviewed health records at the Wills Eye Emergency Room – one of the few 24/7 Emergency Departments exclusively dedicated to treating eye emergencies in the country – and found significant differences between the quarantine period and a comparable time period from the prior year.
Even though the overall number of patients presenting for emergency eye evaluations during the stay-at-home orders decreased, the number of severe ocular trauma patients remained unchanged. Compared with the previous year, patients who presented with severe ocular injuries during the pandemic were more likely to travel further to seek emergency care, more likely to have a delayed presentation after injury, and more likely to have suffered ocular trauma at home.
The significantly higher incidence of ocular injuries that happened at home is partly explained by a big spike in do-it-yourself home improvement projects. Most ocular injuries across both of our study periods occurred because of poor adherence to eye protection guidelines. To us, this highlights a need for patient education in the prevention of ocular injuries, specifically targeting the issues of health and safety, and protective eyewear. Education on eye protection for potentially hazardous at-home activities is especially important for a healthcare system already overburdened by a global pandemic.
During the pandemic, patients not only traveled further, but also waited longer to seek emergency eye care, which highlights problems with delivery of urgent ophthalmic care, with factors dependent on both patients and the healthcare system. Delayed presentation to the emergency room during the pandemic may be linked to the observed increase of uninsured patients, possibly the result of unprecedented levels of COVID-19-driven unemployment.
Other late-presenting patients may have been worried about the safety of visiting a medical center in the midst of a viral pandemic. This latter point underscores the need for i) robust personal protective equipment supply for both the patients and eye care professionals, ii) patient education to promote safety in seeking emergency care, iii) satellite emergency clinics, and iv) telemedicine, which can more efficiently assess and triage patients with ocular trauma.
The pandemic has forced us to cope with unprecedented alterations to the healthcare landscape, and severe ocular trauma is no exception. Our Wills Eye Hospital Emergency Room investigation clearly highlights a need for targeted healthcare interventions to address both patient and provider factors that play a role in the delivery of emergency care. Our Wills Eye Hospital mission remains undeterred by the global pandemic as we aim to provide superior 24/7 emergent eye regionally and inform others nationally and globally about best practices for severe ocular trauma.
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- C Wu et al., “Ocular trauma during COVID-19 stay-at-home orders: a comparative cohort study,” Curr Opin Ophthalmol, [Epub ahead of print] (2020). PMID: 32740065.