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Practice Patterns and Responsiveness to Simulated Common Ocular Complaints Among US Ophthalmology Centers During the COVID-19 Pandemic

Educational Objective
To understand the how comprehensive ophthalmology practices can be used to address common ocular complaints amongst patients with COVID-19
1 Credit CME
Key Points

Question  How are comprehensive ophthalmology practices responding to common ocular complaints from patients during the coronavirus disease 2019 (COVID-19) pandemic as of April 30, 2020?

Findings  In this cross-sectional study of 60 US ophthalmology practices, there were fairly uniform responses to 3 common ocular complaints across comprehensive ophthalmological practices. Private practices were more likely to schedule cataract evaluations and patients with posterior vitreous detachments sooner than university centers, while all practices were likely to ask about COVID-19 symptoms when scheduling urgent visits.

Meaning  These results suggest most practices were complying with the American Academy of Ophthalmology guidelines for scheduling patients during the COVID-19 pandemic.


Importance  The coronavirus disease 2019 (COVID-19) pandemic has drastically changed how comprehensive ophthalmology practices care for patients.

Objective  To report practice patterns for common ocular complaints during the initial stage of the COVID-19 pandemic among comprehensive ophthalmology practices in the US.

Design, Setting, and Participants  In this cross-sectional study, 40 private practices and 20 university centers were randomly selected from 4 regions across the US. Data were collected on April 29 and 30, 2020.

Interventions  Investigators placed telephone calls to each ophthalmology practice office. Responses to 3 clinical scenarios—refraction request, cataract evaluation, and symptoms of a posterior vitreous detachment—were compared regionally and between private and university centers.

Main Outcomes and Measures  The primary measure was time to next appointment for each of the 3 scenarios. Secondary measures included use of telemedicine and advertisement of COVID-19 precautions.

Results  Of the 40 private practices, 2 (5%) were closed, 24 (60%) were only seeing urgent patients, and 14 (35%) remained open to all patients. Of the 20 university centers, 2 (10%) were closed, 17 (85%) were only seeing urgent patients, and 1 (5%) remained open to all patients. There were no differences for any telemedicine metric. University centers were more likely than private practices to mention preparations to limit the spread of COVID-19 (17 of 20 [85%] vs 14 of 40 [35%]; mean difference, 0.41; 95% CI, 0.26-0.65; P < .001). Private practices had a faster next available appointment for cataract evaluations than university centers, with a mean (SD) time to visit of 22.1 (27.0) days vs 75.5 (46.1) days (mean difference, 53.4; 95% CI, 23.1-83.7; P < .001). Private practices were also more likely than university centers to be available to see patients with flashes and floaters (30 of 40 [75%] vs 8 of 20 [40%]; mean difference, 0.42; 95% CI, 0.22-0.79; P = .01).

Conclusions and Relevance  In this cross-sectional study of investigator telephone calls to ophthalmology practice offices, there were uniform recommendations for the 3 routine ophthalmic complaints. Private practices had shorter times to next available appointment for cataract extraction and were more likely to evaluate posterior vitreous detachment symptoms. As there has not been a study examining these practice patterns before the COVID-19 pandemic, the relevance of these findings on public health is yet to be determined.

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Article Information

Accepted for Publication: July 6, 2020.

Corresponding Author: Ajay E. Kuriyan, MD, Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut St, Ste 1020, Philadelphia, PA 19107 (ajay.kuriyan@gmail.com).

Published Online: August 5, 2020. doi:10.1001/jamaophthalmol.2020.3237

Author Contributions: Drs Starr and Kuriyan had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Starr, Patel, Khan, Yonekawa, Cohen, Kuriyan.

Acquisition, analysis, or interpretation of data: Starr, Israilevich, Zhitnitsky, Cheng, Soares, Ammar, Yonekawa, Ho, Cohen, Sridhar, Kuriyan.

Drafting of the manuscript: Starr, Ho.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Starr, Soares, Ammar, Yonekawa, Cohen.

Administrative, technical, or material support: Starr, Israilevich, Zhitnitsky, Yonekawa, Cohen.

Study supervision: Starr, Khan, Yonekawa, Cohen, Sridhar, Kuriyan.

Conflict of Interest Disclosures: Drs Khan and Cohen have received personal fees for consulting from Allergan. Dr Yonekawa has received personal fees from Alcon, Allergan, and Genentech. Dr Ho has received grants from Genentech as well as financial support from Allergan, Alcon, and Iconic Therapeutics. Dr Sridhar has received personal fees for consulting from Alcon and Regeneron. Dr Kuriyan has received grants from Roche/Genentech and Second Sight and personal fees for consulting from Roche/Genentech, Allergan, Alimera Sciences, Bausch Health, Regeneron, and Novartis. No other disclosures were reported.

Meeting Presentation: This work was presented in part at the First Annual Virtual Resident Ophthalmic Trauma Competition; June 20, 2020.

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AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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