Lindeke-Myers Aaron, Zhao Peter Yu Cheng, Meyer Benjamin I, Liu Elaine A, Levine David A, Bennett Olivia M, Ji Sunjong, Newman-Casey Paula Anne, Rao Rajesh C, Jain Nieraj
Emory University School of Medicine, Atlanta, Georgia.
Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor.
JAMA Ophthalmol. 2021 May 1;139(5):508-515. doi: 10.1001/jamaophthalmol.2021.0114.
Patient perceptions regarding the risks of obtaining in-person ophthalmic care during the coronavirus disease 2019 (COVID-19) pandemic may affect adherence to recommended treatment plans and influence visual outcomes. A deeper understanding of patient perspectives will inform strategies to optimize adherence with vision-preserving therapies.
To evaluate perceptions of COVID-19 exposure risk and their association with appointment attendance among patients at high risk of both reversible and irreversible vision loss from lapses in care.
DESIGN, SETTING, AND PARTICIPANTS: This survey study included a nonvalidated telephone survey designed in April and May of 2020 and a retrospective medical record review conducted in parallel with survey administration from May 22 to August 18, 2020. Participants were recruited from 2 tertiary eye care centers (Emory Eye Center in Atlanta, Georgia, and W.K. Kellogg Eye Center in Ann Arbor, Michigan). The study included a random sample of patients with diagnoses of exudative age-related macular degeneration (AMD) or diabetic retinopathy (DR) who received an intravitreal injection between January 6 and March 13, 2020, and were scheduled for a second injection between March 13 and May 6, 2020.
Association between perceptions regarding COVID-19 risks and loss to follow-up.
Of 1004 eligible patients, 423 (42%) were successfully contacted, and 348 (82%) agreed to participate (participants' mean [SD] age, 75 [12] years; 195 women [56%]; 287 White [82%] patients). Respondents had a mean (SD) of 2.7 (1.1) comorbidities associated with severe COVID-19, and 77 (22%) knew someone with COVID-19. Of all respondents, 163 (47%) were very concerned or moderately concerned about vision loss from missed treatments during the pandemic. Although 208 (60%) believed the COVID-19 virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), exposure at the eye clinic was extremely unlikely or unlikely, 49 (14%) believed it was extremely likely or likely. Seventy-eight participants (22%) were lost to follow-up. Concern regarding COVID-19 exposure during clinic visits (odds ratio [OR], 3.9; 95% CI, 1.8-8.4) and diagnosis of DR (vs AMD) (OR, 8.130; 95% CI, 3.367-20.408) were associated with an increase in likelihood of loss to follow-up.
Among patients at high risk for vision loss from lapses in care, many expressed concerns regarding the effect of the pandemic on their ability to receive timely care. Survey results suggest that fear of SARS-CoV-2 exposure was associated with a roughly 4-fold increase in the odds of patient loss to follow-up. These results support the potential importance of clearly conveying infection-control measures.
在2019年冠状病毒病（COVID-19）大流行期间，患者对获得面对面眼科护理风险的认知可能会影响其对推荐治疗方案的依从性，并影响视力结果。更深入地了解患者的观点将为优化视力保护治疗依从性的策略提供信息。
评估护理失误导致可逆性和不可逆性视力丧失风险高的患者对COVID-19暴露风险的认知及其与预约就诊的关联。
设计、设置和参与者：这项调查研究包括2020年4月和5月设计的一项未经验证的电话调查，以及2020年5月22日至8月18日与调查实施并行进行的回顾性病历审查。参与者从2个三级眼科护理中心（佐治亚州亚特兰大的埃默里眼科中心和密歇根州安娜堡的W.K.凯洛格眼科中心）招募。该研究包括2020年1月6日至3月13日期间接受玻璃体内注射且计划于2020年3月13日至5月6日进行第二次注射的渗出性年龄相关性黄斑变性（AMD）或糖尿病性视网膜病变（DR）诊断患者的随机样本。
关于COVID-19风险的认知与失访之间的关联。
在1004名符合条件的患者中，423名（42%）被成功联系，348名（82%）同意参与（参与者的平均[标准差]年龄为75[12]岁；195名女性[56%]；287名白人[82%]患者）。受访者与严重COVID-19相关的合并症平均（标准差）为2.7（1.1）种，77名（22%）认识COVID-19患者。在所有受访者中，163名（47%）非常担心或中度担心大流行期间错过治疗导致视力丧失。尽管208名（60%）认为在眼科诊所接触COVID-19病毒、严重急性呼吸综合征冠状病毒2（SARS-CoV-2）极不可能或不太可能，但49名（14%）认为极有可能或有可能。78名参与者（22%）失访。对诊所就诊期间COVID-19暴露的担忧（优势比[OR]，3.9；95%置信区间，1.8 - 8.4）以及DR（与AMD相比）的诊断（OR，8.130；95%置信区间，3.367 - 20.408）与失访可能性增加相关。
在因护理失误而有视力丧失高风险的患者中，许多人表达了对大流行对其及时接受护理能力影响的担忧。调查结果表明，对SARS-CoV-2暴露的恐惧与患者失访几率增加约4倍相关。这些结果支持了清晰传达感染控制措施的潜在重要性。
