Dr. Gaurav Arora, Regional Medical Director and Dr. Bhanu Prakash, Sr Consultant Ophthalmologist from Dr. Agarwal's Eye Hospital, speaking during a PC on COVID 19 impact on eye health
HYDERABAD: The pandemic significantly worsened the severity of most eye conditions in people, with an increased number of patients suffering from advanced cataracts, eye infections, severe dry eyes (digital eye strain), and even corneal graft rejection, according to the doctors of Dr. Agarwals Eye Hospital. The worst impact was seen in cases of advanced cataracts and dry eyes, all resulting from delayed treatment or loss of work-life balance due to working from home.
Giving statistics comparing the pre and post-pandemic situation, Dr. Gaurav Arora, Regional Medical Director – Telangana, Dr. Agarwals Eye Hospital said, “In the last quarter of 2019, less than 10 percent of all cataract patients coming to our hospital were suffering from advanced cataract. In the last quarter of 2020, this figure jumped to 50%, a five-fold increase. The cases of dry eyes due to digital eye strain similarly jumped from 10% to 30-50% over the same period. We noticed worsening of existing cases of glaucoma in many patients as they hesitated to come for regular follow-ups. There were also complications in previous corneal transplant patients such as rejection of cornea and high eye pressure. People with diabetes ignored their period eye check-ups during the pandemic period, leading to severe complications in their retina.”
Dr. Bhanu Prakash, Sr. Consultant Ophthalmologist, Dr. Agarwals Eye Hospital highlighted some examples of eye patients suffering from increased morbidity due to delay in seeking treatment.
Case 1 – An old person who delayed his cataract surgery after a few months suffered high eye pressure and partial loss of vision.
Case 2 – An elderly woman’s poor overall health condition led to bilateral corneal infection and eventual loss of vision in both eyes.
Case 3 – A patient with vision only in one eye had a cornea transplant done earlier. He developed an eye infection and could not see an eye doctor due to the lockdown. He is now blind in both eyes and awaiting a repeat cornea transplant.
Case 4 – A young woman who had earlier undergone corneal transplant develop graft rejection and graft failure due to lack of timely eye treatment.
According to Dr. Gaurav Arora of Dr. Agarwals Eye Hospital, Conjunctivitis is the most common manifestation and can develop at any stage of the disease. Direct effect due to virus, immune-mediated tissue damage, activation of the coagulation cascade and prothrombotic state induced by the viral infection, the associated comorbidities, and drugs used in the management are responsible for the findings in the eye. Covid eye connection can be either directly related to the covid infection and its treatment or to the indirect effect of working from home. We believe the direct effects of COVID infection on the eye can be in the form of rare eye problems like Conjunctivitis, Keratoconjunctivitis, Blepharitis, Retinal microvascular problems like vein occlusions, cotton wool spots, Neuro-Ophthalmic complications – Nerve paresis/optic neuritis and other rare problems in ICU admitted patients – corneal infections, ischemic optic neuropathy, Valsalva retinopathy, acute angle-closure glaucoma, endogenous endophthalmitis, orbital fungal infections. Some rare eye problems may also arise from the drugs used to treat corona virus-like anti-malarial, immunomodulators, anti-virals, etc.
“During the last few months, we have also been seeing an increasing number of people with digital eye strain and dry eyes, which are stemming from excessive use of gadgets and loss of work-life balance. In the early phases of the lockdown, we also saw a few patients with conjunctivitis and others with retinal vascular blockage. They were later confirmed to be corona positive,” added Dr. Bhanu Prakash.
The medical experts of Dr. Agarwals Eye Hospital explained that the patients were worried about contracting coronavirus if they visit the hospitals. This fear was very strong in the early phases of the pandemic. As a result, the treatment of patients got impacted in a big way. Most people with pre-existing eye problems did not go for regular follow-ups, leading to aggravation of their existing eye problems. Others with new eye problems waited to consult the doctors which led to serious consequences, including loss of vision. Even the patients who took teleconsultations wanted all the solutions remotely and there was a strong unwillingness to come to the hospital for physical eye check-ups and investigations even when it was deemed necessary.
Suggesting better care for the eyesight, Dr. Gaurav Arora said, “Diabetic patients above 50 years old need to get their eyes screened at least once a year by an ophthalmologist, as over 30% of these patients end up developing some form of diabetic eye diseases such as diabetic retinopathy, diabetic macular edema, cataract, and glaucoma. And about 10% of the patients who are diagnosed with diabetic eye disease get vision-threatening diabetic retinopathy. Talking about the examinations, he said that when diabetic patients visit an eye doctor, they may have to undergo examinations such as vision check along with spectacle power, measurement of intraocular pressure, and retinal evaluation. The doctor can suggest blood tests and relevant eye scans. When diabetic eye disease is diagnosed, investigations like fluorescein fundus angiography, optical coherence tomography, and B scan ultrasonography are recommended, depending on the stage of the disease. These scans are essential to stage the disease, plan treatment and monitor the progression of the disease.
Dr. Bhanu Prakash also said that no health problem is too small that merits neglect in the pandemic times. To begin with, teleconsultation is a great option and, in many cases, should be enough to get the right advice and treatment. Sometimes the doctor will advise consulting in person but that is the time when not doing anything can aggravate a minor eye problem to a more serious one. Take all precautions with a face mask, hand sanitization, social distancing, and choose an eye hospital where all safety precautions are being implemented.
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