The impact of COVID-19 on glaucoma care, in numbers
We all know COVID-19 has had an enormous impact on glaucoma care, with appointments being postponed or surgeries being cancelled.
But how much has changed?
The pandemic has had a significant impact on glaucoma services. Closure of clinics, social distancing requirements and staff redeployment has led to:
Large reduction in hospital referrals.
Reduced outpatient appointments.
Cancellation of waiting list surgery.
Glaucoma related procedures in England
COVID-19 has delayed surgical procedures such a Trabeculectomies and MIGS (minimal invasive glaucoma surgery). These are generally carried out for people at highest risk of losing sight. The backlog will need to be addressed, which may result in further delays and could mean an individual’s vision may have worsened before they receive the treatment they need.
Specsavers* referrals for glaucoma in England
The number of referrals from optometry into hospitals for glaucoma has been reduced by around 70% compared to 2019. The missing referrals will need to be fitted into glaucoma clinics, which are also trying to manage normal workload as well as catch up on cancelled or postponed appointments for those already diagnosed with glaucoma.
*Carries out 45% of eye checks
Outpatient appointment activity in England
Tele-appointments alone cannot replace face-to-face appointments for glaucoma. Deterioration is asymptomatic so patients need to be risk-stratified and tested in person.
But the increase in the number of telephone appointments should provide us with some reassurance. Even though many face-to-face appointments have been cancelled, ophthalmologists are contacting people who are deemed high risk, and checking in with them by phone or video call. However, in order for these appointments to be of maximum value, they still need to be accompanied by the usual tests, such as pressure and visual fields, to check the status of the glaucoma.
Impact on patients
- Prior to the pandemic, inadequate service capacity and lack of timely follow-up for glaucoma patients was a recognised national issue causing avoidable sight loss.
- The further constraints brought about by COVID-19 have dire consequences for people with glaucoma.
- Fewer glaucoma patients are able to access in-person eye checks, which is the only way to assess glaucoma and save sight.
Implement a risk stratification process to identify patients who need to be followed-up as a priority.
Ensure systems are in place to manage the patient backlog; this will require innovative solutions that include the wider multidisciplinary team.
Make all patients aware of their risk level and what that means for their care.
Integrate systems to ensure electronic patient records are accessible across community and hospital-based care.
Although the figures look quite scary, there is lots that can be done, as shown in our action plan. Many of these ideas have been talked about for some time, and the hope is that the massive changes brought about by COVID-19 will give impetus to their development and drastically improve services. Although the pandemic has been devastating for anyone personally affected and for society as a whole, we hope that eye care services will emerge in a better position and better able to prevent glaucoma sight loss.Joanna Bradley
Head of Support Services, Glaucoma UK
This infographic is the first piece of work Wilmington Healthcare have produced for us. It will be followed by research into the state of glaucoma care across England, which will help us plan our future glaucoma support services.
Secondary care data is taken from the English Hospital Episode Statistics (HES) database produced by NHS Digital, the new trading name for the Health and Social Care Information Centre (HSCIC) Copyright © 2021, the Health and Social Care Information Centre. Re-used with the permission of the Health and Social Care Information Centre. All rights reserved.