Patient Concerns Regarding Suspended Ophthalmic Care Due to COVID-19.

PURPOSE: The temporary cessation and profound changes in ophthalmic care delivery that occurred as a result of the coronavirus disease 2019 (COVID-19) pandemic have yet to be fully understood. Our objective is to assess patients' self-reported impact of health care lockdown measures on their fears and anxieties during the crisis period of the COVID-19 pandemic in New York City. METHODS: We conducted a digital, self-reported, patient care survey distributed by an e-mail at Columbia University's Department of Ophthalmology outpatient faculty practice. Inclusion criteria were age greater than or equal to 18 years, a diagnosis of either retinal disease or glaucoma, and a canceled or rescheduled ophthalmology established patient appointment during the acute phase of the COVID-19 pandemic in New York City. Patients without an e-mail address listed in their electronic medical records were excluded. The survey occurred between March 2, 2020, to May 30, 2020. Primary measures were survey responses to assess key areas of patient anxiety or concern during the pandemic including the safety of care delivery in a COVID pandemic, difficulties contacting or being seen by their ophthalmologist, concern of vision loss or disease progression, and concern over missed or access to treatments. Secondary measures were correlating survey response to factors such as visual acuity, intraocular pressure, diagnosis, disease severity, follow-up urgency, recent treatments, and diagnostic testing data. RESULTS: Of the 2594 surveys sent out, 510 (19.66%) were completed. Over 95% of patients were at least as concerned as in normal circumstances about their ocular health during the peak of the pandemic. Overall, 76% of respondents were more concerned than normal that they could not be seen by their ophthalmologist soon enough. Increased concern over ocular health, disease progression, and access to care all showed positive correlations (P<0.05) with worse disease severity as measured with testing such as visual fields and optical coherence tomography. In addition, 55% of patients were afraid of contracting COVID-19 during an office visit. CONCLUSION AND RELEVANCE: We found a majority of our patients were concerned about limitations in access to ophthalmic care and were fearful of disease progression. In addition, we found a number of demographic and clinical factors that correlated with increased anxiety in our patients.

Measurement of choroidal perfusion and thickness following systemic sildenafil (Viagra(®) ).

PURPOSE: To demonstrate anatomic and physiologic changes in the human choroid following systemic sildenafil citrate (Viagra®) using enhanced depth imaging spectral domain-optical coherence tomography (EDI-OCT) and swept-scan high-frequency digital ultrasound. METHODS: Seven healthy male subjects (mean age 32.7 years) were evaluated at baseline and 2 hr after ingesting 50 mg of sildenafil. Swept-scan high-frequency digital ultrasound and EDI-OCT were utilized to measure choroidal perfusion and thickness, respectively. Results were read by masked observers. The Wilcoxon signed-rank test and t-test were used to analyse differences in choroidal flow and thickness at baseline and 2 hr after ingestion of sildenafil. RESULTS: Two hours following sildenafil, increased choroidal perfusion was observed in 11 of 12 eyes measured by swept-scan high-frequency digital ultrasound. The mean increase was 3.46 (±2.00) times baseline with a range of 0.47-7.80 times baseline (p = 0.004). Increased choroidal thickness was observed in 12 of 12 eyes measured with EDI-OCT. The average choroidal thickness increased by 11.6% temporal to the fovea, 9.3% nasal to the fovea and 10.7% underneath the fovea (p < 0.001 for all values). CONCLUSIONS: Choroidal perfusion and thickness both increase in response to systemic sildenafil. These changes could secondarily affect retinal function, explain previously reported clinical symptoms and potentially be a useful adjunct for treatment of ocular diseases that would benefit from increased choroidal blood flow.