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Department of Ophthalmology and Visual Sciences, McGill University, Montreal, QueDepartment of Ophthalmology, Montreal Children's Hospital, Montreal, Que
Department of Ophthalmology and Visual Sciences, McGill University, Montreal, QueDepartment of Ophthalmology, Montreal Children's Hospital, Montreal, Que
This impacted health care, including ophthalmology. Although studies have documented reductions in urgent ophthalmic referrals during the first pandemic wave, few have examined its effects on pediatric ophthalmology.
We sought to characterize the impact of the first COVID-19 wave on pediatric emergency ophthalmic consultations and surgeries performed at a pediatric tertiary care hospital in Montreal, Quebec, the province with the highest number of cases during the first wave.
This study was approved by the McGill University Health Centre Institutional Review Board and adhered to the Declaration of Helsinki. A retrospective analysis of emergent pediatric ophthalmology consultations and surgeries at the Montreal Children's Hospital between March 13 and May 31, 2020, was compared with an analysis of identical periods in 2018 and 2019. Emergency department patient records were obtained from the Système Informatique d'Urgence (SIURGE) database (Logibec Groupe Informatique Inc, Montreal, Canada). Data extracted included patient age, sex, referral reason, diagnosis, investigations, and management. Surgical data retrieved from Opera (GE Healthcare, Chicago) included pre- and postoperative diagnosis, surgery type, and date of surgery and whether elective or urgent. The student t test was used for comparison of means and the χ2 test for categorical data analysis. A z test compared proportions. p values < 0.05 were considered statistically significant.
There were 330 patients referred to ophthalmology between March 13 and May 31 across 3 years, with 133 (40.3%) presenting during 2018, 138 (41.8%) during 2019, and 59 (17.9%) during 2020. In 2020, there was a 60% reduction in average number of daily urgent ophthalmic consultations (1.70 vs 0.74, p < 0.0001) compared with 2018 and 2019. The main reason for consultation was ocular trauma, particularly corneal abrasion (Fig. 1). More males presented with trauma than females (p < 0.0001). In 2020, the number of patients with trauma decreased, declining 53% from 2018 and 60% from 2019 (Fig. 1). However, the proportion of patients with ocular trauma in 2020 did not differ (p = 1.0). During the pandemic, there were fewer infectious conjunctivitis cases, declining 85% from 2018 and 71% from 2019 (Fig. 1). The proportion of patients with infectious conjunctivitis decreased in 2020 (p = 0.001) compared with 2018; however, a decrease also was noted between 2018 and 2019 (p = 0.028).
Fig. 1Diagnoses of patients referred to pediatric ophthalmology by year. “Other” category diagnoses include strabismus, ametropia, sixth nerve palsy, orbital mass, dacryocystitis, nasolacrimal duct obstruction, congenital dacryocele, keratoconjunctivitis sicca, scleritis, episcleritis, periocular herpes simplex virus, ophthalmia neonatorum, uveitis, retinal detachment, retinal tear, and optic neuritis. Note that the incidental chalazion finding in the patient with traumatic subconjunctival hemorrhage is listed under 2 categories (trauma and chalazion) in 2018.
In 2020, days from symptom onset to emergency presentation did not differ from 2018 (5.9 vs 33.3, p = 0.16) or 2019 (5.9 vs 9.6, p = 0.4). Also, days from emergency consultation to ophthalmology visit in 2020 did not differ from 2018 and 2019 (1.74 vs 1.52, p = 0.814). There was an 80% reduction in average number of daily ophthalmic surgeries, elective and emergent, during 2020 (1.20 vs 0.24, p < 0.0001) compared with 2018 and 2019. In 2020, there was an increased proportion of urgent surgeries compared with prior periods (p = 0.013). The most common indication was foreign-body removal (Table 1).
Table 1Preoperative diagnoses of patients requiring urgent surgery by year
Our study shows that the first pandemic wave resulted in reductions in urgent ophthalmic consultations and surgeries. This corresponds with decreases in pediatric emergency department visits in Quebec
Pediatric Emergency Research Canada (PERC) (2021). Effect of the COVID-19 Pandemic on Patient Volumes, Acuity, and Outcomes in Pediatric Emergency Departments: A Nationwide Study.
Additionally, there were fewer ocular traumas in 2020 than in 2018 and 2019, possibly due to cancellation of sports activities. A similar trend was observed in Italy.
Further, we observed fewer conjunctivitis cases during 2020 compared with previous periods, as reported in studies including adults, likely due to social distancing and hand hygiene.
Future studies could evaluate the pandemic's impact on pediatric ophthalmology follow-up care.
Footnotes and Disclosures
Daniela Toffoli is a member of the Sunshine Foundation Medical Advisory Board and is involved in a study for patients with spinomuscular atrophy (Sunfish Clinical Trial, Roche Pharmaceuticals). All other authors have no conflicts of interest to report.
Pediatric Emergency Research Canada (PERC) (2021). Effect of the COVID-19 Pandemic on Patient Volumes, Acuity, and Outcomes in Pediatric Emergency Departments: A Nationwide Study.
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