Data reporting in ophthalmology during COVID-19 pandemic: need for a Canadian registry

The new SARS-CoV-2 responsible for the potentially fatal COVID-19 disease causes a primarily respiratory illness and asymptomatic community transmission is the leading cause of infection with most patients not demonstrating symptoms. Twenty to 30% of patients may present with acute respiratory distress syndrome, sometimes requiring admission to intensive care units and ventilation. The COVID-19 death rate in hospitalized patients is around 14% and increases with age and comorbidities such as hypertension, diabetes, coronary heart disease, and chronic kidney disease. Ocular manifestations of COVID-19 have been described (e.g., epiphora, conjunctivitis, conjunctival congestion, and chemosis). However, the extent of ocular manifestations is largely unknown as data from complete ophthalmologic examinations in infected patients is limited. There are hints from our understanding of other coronaviruses that there may be a wide range of findings including not only conjunctivitis at the onset of infection (reported in up to one-third of patients), but also uveitis, retinopathy, and neuropathy.

Owing to the large number of asymptomatic patients, this virus has reached pandemic proportion not seen with other related coronaviruses like SARS and Middle East Respiratory Syndrome. It can create an important inflammatory reaction with widespread thrombogenic processes with reports of these complications in multiple organ systems, including the eye. Many medical societies have established registries to track manifestations affecting their organ system, such as the American Association of Dermatology and the American Heart Association. It is important that the Canadian ophthalmology community now do the same.

Much is yet to be discovered about the possible ophthalmologic manifestations of COVID-19 and its effects on our most vulnerable patients. For instance, hyper-reflective lesions of the retina have been described on optical coherence tomography of the retina in addition to cotton-wool spots and microhemorrhages, although the clinical effects of this are unclear. Retina involvement is not surprising given the finding of viral RNA in the retina of deceased patients. Additionally, orbital emphysema after mechanical ventilation and bilateral optic neuritis simultaneously positive for myelin oligodendrocyte glycoprotein antibodies have been described in patients with COVID-19. Not only is it likely that more signs and symptoms will be found in the acute setting such as inflammatory vasculitis, uveitis, and thromboembolic vessel occlusions in the eye, but also that subtle underlying chronic sequelae of disease may be found if specifically investigated with appropriate imaging including optical coherence tomography.

As we continue to learn more about COVID-19, early diagnoses may assist in self-isolation before the onset of symptoms with appropriate contact tracing to inform others of their risk. Registries will also prove useful to help the ophthalmology and wider eye care community to better appreciate the variety of eye manifestations and the occurrence of ocular complications. Being aware of possible subtle findings may prompt clinicians to investigate COVID-19 patients. Patients infected with COVID-19 may otherwise have underlying undiagnosed visual or ocular issues. An important benefit of a registry is to enable the ophthalmology community to better treat the millions of COVID-19 patients who may develop lasting ocular sequelae when the worst of the pandemic will be behind us. As such, the COVID-19 Eye Registry (COVER) was created. This multi-institution, pan-Canadian national effort will allow clinicians to submit data for COVID-19 patients who may or may not have a preexisting ocular condition. Accepted cases include patients who developed ocular manifestations during or after an infection with COVID-19 that may or may not be related to the illness, and patients with preexisting ocular conditions who contracted COVID-19. Only non-identifying information will be collected in the database and all the information will be stored on a secure REDCap server hosted by the Centre intégré universitaire de santé et de services sociaux of the Est-de-l'Île-de-Montréal region. The success of this collaborative effort depends on the active participation of the health care community to obtain comprehensive, accurate, and reliable data. To contribute to the registry and submit clinical data for a patient, a case report form can be filled out at the following address after having obtained a signed consent form to be kept in the patient's file: https://redcap.cemtl.rtss.qc.ca/redcap/surveys/?s=X8TKWPH38A. The link will be distributed to members of the Canadian Ophthalmological Society to increase awareness of and access to this initiative.

Moving forward, regular updates on the results of the registry provided on the behalf of the Canadian Ophthalmological Society will hopefully guide future COVID-19 recommendations in ophthalmology and allow clinicians to tailor their care of patients with prior infections of COVID-19.

The authors have no proprietary or commercial interest in any materials discussed in this article.