By ROB Editors
June 30, 2021
The pandemic had a damaging impact on numerous aspects of our lives. Eye health is no different. Here is how one sight-threatening condition went undetected and neglected due to patients who delayed care because they feared catching COVID at the doctor’s office.
One of the hidden tragedies of the COVID-19 pandemic is the degree to which people put off treatments for serious health conditions, says Patrice A. Harris, MD, MA, immediate past president of the American Medical Association.1 A recent Kaiser Family Foundation poll found that 48 percent of Americans said they or a family member have skipped or delayed medical care because of the pandemic, and 11 percent of them said the person’s condition worsened as a result of the delayed care.2
As ODs know, exudative AMD can occur rapidly, with CNV leading to permanent vision loss. To prevent this from happening, it is imperative that optometrists maintain communication with AMD patients—including those with early stage disease. “Education is the most important thing right now,” says Amanda Legge, OD, of Wyomissing Optometric Center in Pennsylvania. “Patients need to know the details of their disease, including the severity and correlated risk to wet AMD conversion.”
Correlation Between AMD & Serious COVID
Like many other diseases, it’s a well-established fact that AMD is the manifestation of a much larger systemic irregularity. In the case of AMD, dysfunctions associated with complement (one of the immune system’s oldest branches) are the culprit. This connection between complement and AMD is particularly troublesome because complement is likewise a factor in COVID patients.
A recent study demonstrated that AMD patients, in particular, are more susceptible to the virus and have worse outcomes.3 Among 11,116 COVID-19 patients at Columbia University Irving Medical Center with suspected virus infection, researchers found more than 25 percent of those with AMD died (compared with the average mortality rate of 8.5 percent) and roughly 20 percent required intubation.
“This new data speaks to significant risks that we never thought about prior to COVID,” says Chief Clinical Editor for Review of Optometry Paul Karpecki, OD, FAAO. “As a profession, optometrists need to step up their AMD game.”
Importance of Diagnosing AMD Early
Drs. Karpecki and Legge both strongly advocate for earlier diagnosis —a topic some have shied away from in the past due to concerns about alarming patients and causing too much worry and distress. Indeed, not long ago doctors couldn’t distinguish between early AMD and AMD risk, leading doctors to be more reserved about sharing potentially bad news.
“Now it’s different—we can detect subclinical AMD with 90 percent accuracy three years before it can be observed clinically using functional dark adaptation testing,4” says Dr. Legge. “As such, it’s our duty to share this information with patients so they have an opportunity to take control of their disease right away.”
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Early detection can change patient behavior. “Patients can react very differently when they know for sure that they have a disease versus a risk factor,” says Chapman University health communication scholar Amy Hellem, MLA. “Individuals have a strong motivation to reduce uncertainty5 and a diagnosis supplies that, often along with a sense of empowerment that could lead to improved compliance with follow-up care, supplementation and lifestyle changes.”
Address Patients’ Ongoing COVID Fears
Dr. Legge says a small percentage of her patients who are considered high risk still do not feel comfortable coming to the office while the possibility of catching COVID still exists. In these cases, she re-educates on the importance of using an Amsler Grid or the ForeseeHome device. More often, she finds a way to get them in the office, in many cases by scheduling them as the first or last appointment of the day to minimize their contact with other patients.
When the patient arrives for the appointment, Dr. Legge always includes a study of structure as well as a study of function. This includes dark adaptation testing, OCT, fundus photography, fundus autofluorescence, electoretinography, Amsler grid testing, contrast sensitivity and visual acuity.
“AMD and COVID are both very scary diseases,” says Dr. Karpecki. “But with early detection diagnostics like dark adaptation and consistent in-office and at-home monitoring, we can get our arms around at least one of these conditions right here, right now—which means an awful lot for our profession and to the patients we serve.”