The disease is the main cause of irreversible blindness in the world, and affected more than 76 million people in 2020, and is expected to reach another 40 million in the coming years
Researchers of Ophthalmology Outpatient Clinic from the Hospital de Clínicas da Unicamp evaluated the impact of the pandemic on the monitoring of patients with glaucoma. To do this, they compared the total number of outpatient clinical consultations, visual field exams, surgical procedures and medications released in the pre-pandemic period (March 2019 to February 2020) with the period of the Covid-19 pandemic (March 2020 to February 2021). The data were obtained from the HC's electronic medical records.
The research gave rise to the article “The impact of Covid-19 on the follow-up of glaucoma patients in a tertiary center: a comparison between the pre-pandemic and pandemic periods”, published in the journal Clinical Ophthalmology. According to the authors - Gabriel Ayub, José Paulo Cabral de Vasconcelos and Vital Paulino -, ophthalmologists from HC Unicamp who conducted the survey, this is the first study in Brazil to measure the impact of Covid-19 on clinical care for a chronic disease. “The Covid-19 pandemic drastically reduced the number of outpatient consultations and surgical procedures, impacting the monitoring of glaucoma patients at the HC. Our expectation is of a possible overload of patients with uncontrolled glaucoma in the future”, warn the ophthalmologists.
During the pre-pandemic period, a total of 7.170 clinical visits (3.965 patients), 1.525 visual field examinations (1.410 patients), 682 glaucoma surgical procedures (466 patients) and 23.259 medications released (813 patients) were recorded. During the Covid-19 outbreak period, there were 532 clinical visits (514 patients), 94 visual field exams (94 patients), 145 glaucoma surgical procedures (127 patients) and 18.692 medications released (616 patients).
These numbers represent a reduction of 92,52% in outpatient clinical consultations, 93,84% in visual field examinations, 72,74% in surgical procedures and 19,63% in released medications. “These are very impressive numbers, but the positive point is the smaller impact of the pandemic on the supply of high-cost medication. Around 80% of patients had access to clinical treatment during the period, which may have prevented more serious outcomes during that year”, says Ayub. “Although we have not measured the real consequences of this reduction in glaucoma control, it is likely that inadequate monitoring has favored the progression of the disease, particularly in patients with advanced glaucoma, who are more sensitive to variations in uncontrolled intraocular pressure”, comments ophthalmologist Vital Paulino Costa, research advisor.
Glaucoma and Covid-19
Glaucoma is the main cause of irreversible blindness in the world, and affected more than 76 million people in 2020, and is expected to reach another 40 million in the coming years. In Brazil, it is estimated that 3,1% of the population is affected by the disease. The diagnosis and treatment of patients with glaucoma are fully covered by the Unified Health System (SUS).
Unicamp's HC is a reference for 42 municipalities and provides SUS care to an estimated population of 3,2 million people. The Ophthalmology Outpatient Clinic is responsible for all clinical consultations and visual field examinations; the outpatient surgical center, for all surgical procedures and the High Cost Pharmacy, for the release of medications for the treatment of glaucoma.
During the pandemic, HC suspended all elective surgeries in order to concentrate human and economic resources on the care of patients with Covid-19. The Ophthalmology Clinic has postponed surgeries and non-urgent care, as recommended by different ophthalmology societies. “Our study will guide planning for the return of care at the HC, in addition to serving as a basis for other health units impacted by the pandemic”, explains ophthalmologist José Paulo Cabral de Vasconcelos.
Services
With the reduction in Covid-19 cases, the HC is resuming its activities to care for elective patients. The hospital's Care Coordination (COAS) released 20% of scheduled appointments at the ophthalmology outpatient clinic and surgeries returned to normal. “The gradual resumption of services is part of HC’s planning to combat the pandemic. We are predicting that, by March 2022, we will have 100% of services available”, explains Elaine de Ataíde, assistance coordinator at HC.
