A decline in eye care utilization was found in older patients, with significant differences based on age, race, and ethnicity.
Results of a study presented at the American Academy of Ophthalmology conference (AAO 2022) show that utilization of eye care was reduced in patients older than 65 years during the peak months of the COVID-19 pandemic. The study also found that utilization had not improved by the end of 2020.
The pandemic affected the use of health care services around the world, with published studies able to document disruptions in the use of nonacute medical services. Experts note that this effect of the pandemic on the use of eye health services is likely to have significantlyaffected minority populations and older adult population due to their higher risk of severe COVID-19.
David Rein, PhD, program area director of NORC at the University of Chicago, who presented the results of the observational study, said that the aim of the study was to use Medicare claims data to understand the effect of the pandemic on eye health in older adults. Another goal was to determine if the pandemic reduced the number of eye care providers.
Participants in this study were all Medicare fee-for-service beneficiaries. The study measured the availability and number of performed eye exams, cataract surgeries, and glaucoma surgeries. The study collected data quarterly from January 2019 to December 2020 and took place in the United States.
Rein presented a figure on the amount of eye exams, cataract surgeries, and glaucoma surgeries that occurred per month from January 2019 to December 2020. “During that second quarter of 2020, as expected, people did not go to the eye doctor, which is not all that surprising as people didn’t go anywhere else. The big question for this presentation is whether these services recovered by the end of 2020,” he said.
The study found that service utilization did not recover fully to its 2019 levels. The number of eye exams was reduced to only 57.7% of its 2019 levels in Q2 and rose to 86.9% of 2019 levels by Q4 of 2020. Cataract surgeries were reduced to 47.4% of its 2019 levels in Q2 and improved to 89.8% in Q4. Lastly, glaucoma surgeries were reduced to 53.6% of its 2019 levels in Q2 of 2020 and improved to 88.0% by the end of Q4. Despite the improvement, all services had less than 90% of their expected utilization in 2020 compared with 2019.
Different subgroups of individuals were affected by a reduction in eye care services in the pandemic. Patients aged 85 years and older (20% decrease in utilization), were American and Alaskan Native (22%), were Asian or a Pacific Islander (21%), were Hispanic (18%), were disabled (19%), and those dually eligible for Medicaid (26%) were the most affected in terms of eye exam utilization.
The study also found that a decrease in labor occurred at the end of 2020, as 3% fewer ophthalmologists and 1.8% fewer optometrists billed Medicare compared with Q4 of 2019.
There were some limitations to this study. Service utilization was looked at in only 3 categories. The participants included were only those on fee-for-service and did not include patients on Medicare Advantage. The time period in which the study took place was from before vaccination and the delta surge in winter of 2020 to 2021. Mortality in Medicare was not an adjusted factor.
“I think we can fairly confident[ly] conclude that the pandemic substantially reduces eye care among a geriatric population [in] a fairly similar manner across the services that we observed,” said Rein. Differences in the amount of decline was affected by eligibility, race, ethnicity, and age group and utilization had not fully recovered by the end of 2020 across the board.
Rein D, Hartzman A, Wachsmuth J, Wittenborn J. Pandemic effect on social determinants in geriatric eye care. Abstract presented at: AAO 2022; October 1, 2022; Chicago, IL. Session SYM01.