Early Months of Pandemic Saw Decreased Rates of Vitreoretinal Surgical Procedures

In order to minimize patients’ and providers’ risks of contracting COVID-19, ophthalmologic practices implemented a series of precautions at the onset of the pandemic. These included deferral or delay in routine visits, elective surgical procedures, and screening consultations.

As a part of these guidelines, the American Academy of Ophthalmology (AAO) also released a compilation of urgent and emergent procedures deemed to be appropriate to carry out during the pandemic’s initial phases while also deferring elective and routine care. However, the effects these changes on patients’ visual health remain unknown.

To analyze the extent of changes in the frequency of urgent or emergent vitreoretinal surgical procedures across multiple centers during an expanded time frame, researchers compiled billing data from January 2019 through May 2020 from 17 US institutions representing 15 states.

Results, published in JAMA Ophthalmology, show that early in the COVID-19 pandemic, there was a nationwide decrease in critical vitreoretinal surgical procedures deemed as urgent or emergent.

As part of the cross-sectional study, the researchers categorized institutions into regional groups (Northeast, South, Midwest, and West Coast) while publicly available records were used to determine when stay-at-home orders were initiated. Using Current Procedural Terminology (CPT) codes, the investigators identified incidents of urgent or emergent vitreoretinal surgical procedures via the deidentified data. Codes were then classified as intravitreal injections, lasers and cryotherapy, retinal detachment (RD) repairs, and other vitrectomies.

A total of 17 (12 academic [tax-exempt] and 5 private [non–tax-exempt]) institutions accounting for 526,536 billed operations and procedures were included in the final analysis. Of the codes included, 483,313 accounted for injections; 19,257 for lasers or cryotherapy; 14,949 for RD repairs; and 9017 for other vitrectomies.

According to authors, “relative to 2019, a weekly institutional decrease in injections was observed from March 30 to May 2, 2020, with a maximal 38.6% decrease (from a mean [SD] of 437.8 [436.3] to 273.8 [269.0] injections) from April 6 to 12, 2020 (95% CI, −259 to −69 injections; P = .002).”

In addition, weekly decreases were identified that spanned a longer interval, at least until May 31, 2020:

• For lasers and cryotherapy, with a maximal 79.6% decrease (from a mean [SD] of 6.6 [7.7] to 1.5 [2.0] procedures) from April 6 to 12, 2020 (95% CI, −6.8 to −3.3 procedures; P < .001)
• For RD repairs, with a maximal 59.4% decrease (from a mean [SD] of 3.5 [4.0] to 1.6 [2.2] repairs) from April 13 to 19, 2020 (95% CI, −2.7 to −1.4 repairs; P < .001)
• For other vitrectomies, with a maximal 84.3% decrease (from a mean [SD] of 3.0 [3.1] to 0.4 [0.8] other vitrectomies) from April 6 to 12, 2020 (95% CI, −3.3 to −1.8 other vitrectomies; P < .001)

The researchers found no differences after adjusting for region, setting, or state-level stay-at-home orders. Results show that during the initial exponential growth phase of the COVID-19 pandemic in the United States, there was a widespread reduction in urgent ophthalmic procedures.

“Although it is unknown to what extent vitreoretinal intervention would have decreased without AAO recommendations, this change suggests that ophthalmologists were engrossed in a transformation that may continue to affect a large subset of US retina practices and their patients,” the authors wrote. As the pandemic persists, this number may remain low due to office-level precautions.

Notably, the significant decrease in the frequency of intravitreal injections observed in April 2020 did not persist into the later weeks of May 2020, as declines were continuously observed in other groups during this time frame. This may be due to the fact that patients receiving intravitreal injections were more diligent about maintaining their treatment schedule to preserve their vision. However, health system factors, socioeconomic factors, and other variables may account for this observation.

The limited time frame included in this study marks a limitation, in addition to the exclusion of some CPT codes.

“It remains unclear what the ultimate long-term effects will be from the decrease in urgent or emergent surgical procedures across the US, and whether the decrease will be sustained during the COVID-19 resurgences,” the researchers concluded. “Future investigation will be required to assess the full duration of this decrease and the long-term visual impact. Research is currently ongoing to assess this end point.”

Reference:

Breazzano MP, Nair AA, Arevalo JF, et al. Frequency of urgent or emergent vitreoretinal surgical procedures in the United States during the COVID-19 pandemic. JAMA Ophthalmol. Published online March 4, 2021. doi:10.1001/jamaophthalmol.2021.0036