Virtual Assessment of Patients with Dry Eye Disease During the COVID-19 Pandemic: One clinician’s experience

  1. Pierre Ibrahim
  2. Caroline G. McKenna
  3. Rookaya Mather

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Abstract

Objectives

To report on 1) the impact of DED on social, mental, and financial well-being, and 2) the use of virtual consultations to assess DED during the COVID-19 pandemic.

Design & Methods

An exploratory retrospective review of 35 charts. Telephone consultations for patients with DED conducted during the first lock-down period in Ontario in 2020 were reviewed.

Results

The most commonly reported DED symptoms were ocular dryness, visual disturbances, and burning sensation. The most common dry eye management practices were artificial tears, warm compresses, and omega-3 supplements. 20.0% of charts documented worsening of DED symptoms since the onset of the pandemic and 17.1% reported the lockdown had negatively affected their ability to perform DED management practices. 42.8% of patients reported an inability to enjoy their daily activities due to DED symptoms. 52.0% reported feeling either depressed, anxious, or both with 26.9% of patients accepting a referral to a social worker for counselling support. More than a quarter of the charts recorded financial challenges associated with the cost of therapy, and more than a fifth of patients reported that financial challenges were a direct barrier to accessing therapy.

Conclusions

Patients living with DED reported that their symptoms negatively affected their daily activities including mental health and financial challenges, that in turn impacted treatment practices. These challenges may have been exacerbated during the COVID-19 pandemic. Telephone consultations may be an effective modality to assess DED symptom severity, the impact of symptoms on daily functioning, and the need for counselling and support.

AUTHOR SUMMARY

Dry Eye Disease occurs when your tears do not provide enough lubrication for your eyes, which can be caused by either decreased tear production, or by poor quality tears. This study reviewed 35 patient charts to examine 1) the impact of Dry Eye Disease on patients’ well-being, and 2) the use of telephone appointments to assess Dry Eye Disease during the COVID-19 pandemic. Patients reported an inability to enjoy their daily activities due to symptoms of dry eye including burning sensation and blurred vision. Over half of patients reported mental health challenges. Over a quarter of patients reported that financial challenges prevented them from treating their Dry Eye Disease, such as affording eye drops, dietary supplements, and appointments to see their optometrist. These findings highlight that healthcare providers should considering quality of life, mental health, and financial challenges when treating patients with Dry Eye Disease. Through the experience of an ophthalmologist who specializes in Dry Eye Disease, telephone appointments may be an effective way to assess Dry Eye Disease symptoms, the impact of symptoms on daily functioning, and the need for counselling and support.

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  1. ScreenIT

    SciScore for 10.1101/2022.03.07.22272050: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Cell Line AuthenticationAuthentication: Consultations were provided virtually over the phone using a structured questionnaire based on questions routinely asked in-person, and using validated questionnaires that are typically self-administered by patients during in-person consultations.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    JASP (v0.14.1) was used to conduct statistical analysis and results were considered statistically significant if P<0.05.
    JASP
    suggested: (JASP, RRID:SCR_015823)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations: This study had a limited sample size due to the study objectives: to provide preliminary exploratory data to examine patient experience with DED during the COVID-19 pandemic, and report on the use of telephone consultations for DED referrals. Further studies are needed to better understand the effect of the COVID-19 pandemic on DED patients, as well as to evaluate the use of telephone, or other virtual care modalities, for DED consultations. Secondly, there are limitations to the composite scoring used in data analysis to capture how many elements of self-care patients were engaging in. The composite score weighed each self-care practice equally and without regard for variation, for example using one drop of artificial tears per day versus four times per day. In addition, not all therapies, or frequencies of therapies, are necessarily equally effective. Finally, there are limitations to the virtual care modality itself. There were communication challenges over the telephone with some patients. This was especially evident in elderly patients, patients who were hard of hearing, and patients with language barriers. With regards to ophthalmological considerations, physical exam parameters such as VA, IOP, and SLE are impossible to conduct virtually. Though the most recently documented VA and IOP values were obtained from optometrist and ophthalmologist referral letters, the lack of contemporaneous VA, IOP, and SLEs may represent a limitation to care.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a protocol registration statement.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2022.03.07.22272050v1 on medRxiv