Purpose: To analyze the cohort of clinical patients seen during the COVID-19 pandemic shutdown at Emory Eye Center in comparison with prior weeks. Method: We conducted a retrospective chart review from three outpatient clinical sites over a period of eighteen weeks, which covered pre-COVID-19 dates as well as the dates of when our clinics were closed near the beginning of the COVID-19 pandemic. We utilized data from providers assigned to daily triage coverage for in-person exams. Primary diagnosis and visit type data were extracted to look for trends and commonalities among urgent or time-sensitive patients. Results: For the nine weeks prior to clinic closure, there were 11,700 primary visit codes. During the nine-week closure, there were 1,624 in-person visit codes. We were able to observe some trends for descriptive purposes. Diagnoses of patients seen in person with higher frequency during the closure included vitreous disorders (i.e., posterior vitreous detachment), corneal ulcer, optic nerve disorders, idiopathic intracranial hypertension and post-operative care. We also looked at our telehealth visit numbers. However, there were very few telehealth visits (n=25), which rendered the telehealth analysis statistically insignificant. Conclusion: Through an analysis of the pool of non-COVID patients who were seen during the shutdown in our clinics via in-person urgent or time-sensitive exams, we were able to observe a breakdown of visit type and diagnosis. A comparison of those patients with the distribution seen in person during the previous nine weeks was reviewed. Although our numbers for data analysis during closure were too small to devise an evidence-based algorithm, there were still several lessons we learned from this first wave of the COVID-19 pandemic such as: 1) how to predict which patients may be more time-sensitive or urgent from a pre-determined list of diagnoses; and 2) how to immediately establish an ophthalmologist/optometrist (MD/OD) daily triage coverage schedule. We found it difficult to successfully incorporate a significant number of telehealth visits because most eye conditions, which were already deemed urgent by our call center, were in general considered conditions that required further evaluation by a provider. We hope that these take-away lessons will further improve ophthalmic care for any future pandemic or widespread closure.

Purpose Studies have reported that knowledge and skills to operate smartphones among people with profound visual loss are limited especially in low- to middle-income countries as many important functions of smartphones are unknown to them. This report presents smartphone use, its challenges, and enablers in two persons with profound visual impairment while executing their daily routine and instrumental living activities amidst the COVID-19 pandemic. Case selection and interview During the lockdown period, we provided tele (vision) rehabilitation service. From the list of the callers, we purposely selected two callers with significant visual impairment, one woman and one man, to allow us to gather rich information related to smartphone use, enablers, and challenges faced during the usage. A semistructured interview was done to obtain insights into the information. The selection criteria were (1) continuous smartphone use independently for more than 5 years; (2) graduation-level education or higher; and (3) no additional disabilities. Discussion We found substantial use of smartphones in executing their daily and instrumental daily living activities by these two participants. The extent of the use of mainstream apps for various tasks was almost equivalent to what we observed among sighted persons. The most important enabling factors were the presence of a screen reader “TalkBack” on Android phones and data connection of the mobile, followed by the ability to assess multiple languages using the text-to-speech feature. A supportive environment from peers or family members is important for the beginner. Poor battery backup, frequent unwanted ads or pop-ups while using the phone, not readable contents with a screen reader, e.g., CAPTCHA, and slow or unresponsiveness of the screen reader were frequent challenges faced by them. Both cases reported that around 80% of daily solutions were helped by using a smartphone. Conclusions The current advances in accessible technology of smartphones enable an individual with profound visual loss to use them almost equivalently as a sighted person. To reduce the gap in digital inclusion, people with visual impairment should be encouraged to use the smartphone for their daily solutions with attention to proper training.

Age-related macular degeneration (AMD) is the leading cause of severe, permanent visual impairment and blindness in people over the age of 60. The World Health Organization (WHO) estimates that 8.7% of global blindness is caused by AMD. The financial burden is enormous with global costs of visual impairment reaching US $343 billion. In 2020, estimated 15.2 million people aged over 50 years were blind worldwide, and an additional 78.8 million had moderate-to-severe vision impairment due to cataracts.1 Cataract and age-related macular degeneration are common causes of decreased vision, causing visual impairment that often occurs simultaneously. Although modern cataract surgery is a safe and effective treatment for cataract-induced visual loss, some ophthalmologists have had fear in the past that surgery could worsen macular degeneration. This has been disproven by various studies in the past.2,3 It was shown that Quality of Life (QOL) benefits were predominant in the group that underwent cataract surgery and that there was no increased risk of progression of maculopathy.4 Recent clinical and scientific evidence does not find cataract surgery to cause or worsen AMD.5 Nevertheless, the reduced prognosis and possible effects should be discussed in detail with the patients already preoperatively.

The COVID-19 pandemic has disproportionately affected racial and ethnic minorities in the United States, especially Black, Latinx and Native American communities. While recent meta-analyses have identified the prevalence of ocular manifestations in COVID-19 infection, no studies with these potential findings, to the authors' knowledge, have been implemented in examining ophthalmic disparities in racial and ethnic minorities. It is additionally clear that patient access to eye care from COVID-19 has been disproportionate in underserved communities. Large public hospitals and urban academic medical centers provide a unique opportunity to further study ocular disease presentation and health disparities from COVID-19 in these populations.