TY - JOUR
T1 - Frequency of Urgent or Emergent Vitreoretinal Surgical Procedures in the United States during the COVID-19 Pandemic
AU - Breazzano, Mark P.
AU - Nair, Archana A.
AU - Arevalo, J. Fernando
AU - Barakat, Mark R.
AU - Berrocal, Audina M.
AU - Chang, Jonathan S.
AU - Chen, Andrew
AU - Eliott, Dean
AU - Garg, Sunir J.
AU - Ghadiali, Quraish
AU - Gong, Dan
AU - Grewal, Dilraj S.
AU - Handa, James T.
AU - Henderson, Matthew
AU - Leiderman, Yannek I.
AU - Leng, Theodore
AU - Mannina, Amar
AU - Mendel, Thomas A.
AU - Mustafi, Debarshi
AU - De Koo, Lisa C.Olmos
AU - Patel, Shriji N.
AU - Patel, Tapan P.
AU - Prenner, Jonathan
AU - Richards, Paige
AU - Singh, Rishi P.
AU - Wykoff, Charles C.
AU - Yannuzzi, Nicolas A.
AU - Yu, Hannah
AU - Modi, Yasha S.
AU - Chang, Stanley
N1 - Funding Information:
Vision, Bausch & Lomb, Bayer, Bionic Vision Technologies, Chengdu Kanghong Biotechnologies (KHB), Clearside Biomedical, Corcept Therapeutics, DORC, EyePoint (formerly pSivida), Genentech, Gyroscope, IVERIC Bio, Kodiak Sciences, Merck, NGM Biopharmaceuticals, Notal Vision, Novartis, OccuRx, ONL Therapeutics, Opthea, Oxurion, Palatin, Polyphotonix, Recens Medical, Regeneron, RegenXBio, Roche, Santen, Takeda, Thea Open Innovation, and Verana Health; grants for research support from Adverum, Aerie Pharmaceuticals, Aldeyra, Allergan, Apellis, Boehringer Ingelheim, Chengdu Kanghong Biotechnologies (KHB), Clearside Biomedical, Gemini Therapeutics, Genentech, Graybug Vision, Gyroscope, IONIS Pharmaceutical, IVERIC Bio, Kodiak Sciences, LMRI, Mylan, Neurotech Pharmaceuticals, NGM Biopharmaceuticals, Novartis, Opthea, Outlook Therapeutics, Recens Medical, Regeneron, RegenXBio, Roche, Samsung Bioepis, Santen, Senju, Taiwan Liposome Company, and Xbrane BioPharma; and fees for serving on the speakers bureau from Regeneron. Dr Yannuzzi reported receiving personal fees from Genentech, Novartis, and Alimera Sciences outside the submitted work. Dr S. Chang reported receiving personal fees from Genentech outside the submitted work. No other disclosures were reported.
Funding Information:
Funding/Support: This research was supported
Funding Information:
holding a patent for Springer SBM LLC with royalties paid. Dr Barakat reported receiving personal fees from Alcon, Allegro, Allergan, Alimera, Bausch & Lomb, EyePoint Pharmaceuticals, Kodiak Sciences, Genentech, Novartis, Ocular Therapeutix, and RegenxBio; nonfinancial support from Clearside Biomedical; stock ownership in NeuBase and Oxurion outside the submitted work. Dr Berrocal reported serving on advisory boards for Alcon, DORC, Zeiss, Allergan, Visunex, Proqr, and Agtc. Dr Chen reported receiving grants from Research to Prevent Blindness and the National Institutes of Health outside the submitted work. Dr Eliott reported receiving personal fees from Alcon, Allergan, Dutch Ophthalmic, Genentech, Glaukos, and Aldeyra Therapeutics; grants from Neurotech; stock ownership in Pykus Therapeutics outside the submitted work; and having a patent for Methotrexate for PVR with royalties paid from Aldeyra Therapeutics. Dr Garg reported receiving personal fees from Apellis, Allergan, Kanaph, and Bausch and Lomb; and grants from Boehringer-Ingelheim, Regeneron, Genentech, and Aerpio outside the submitted work. Dr Leiderman reported receiving personal fees and nonfinancial support from Alcon outside the submitted work. Dr Leng reported receiving grants from Kodiak and 3T; and serving as a consultant for Genentech, Regeneron, and Verana. Dr Olmos de Koo reported receiving personal fees from Alcon Surgical, ScienceBased Health, and PixiumVision outside the submitted work. Dr Singh reported receiving personal fees from Alcon, Genentech, Regeneron, Bausch & Lomb, and Novartis; and grants from Aerie, Graybug, and Apellis outside the submitted work. Dr Wykoff reported receiving personal fees for consulting from Acucela, Adverum, Aerpio, Alcon, Alimera Sciences, Allergan, Alnylam, Apellis, Arctic
Publisher Copyright:
© 2021 American Medical Association. All rights reserved.
PY - 2021/4
Y1 - 2021/4
N2 - Importance: The American Academy of Ophthalmology (AAO) indicated that urgent or emergent vitreoretinal surgical procedures should continue during the coronavirus disease 2019 (COVID-19) pandemic. Although decreases in the frequency of critical procedures have been reported outside the field of ophthalmology, analyses are limited by volume, geography, and time. Objective: To evaluate whether the frequency of ophthalmic surgical procedures deemed urgent or emergent by the AAO changed across the United States during the COVID-19 pandemic. Design, Setting, and Participants: Vitreoretinal practices from 17 institutions throughout the US participated in this multicenter cross-sectional study. The frequency of 11 billed vitreoretinal Current Procedural Terminology (CPT) codes across respective weeks was obtained from each practice between January 1, 2019, and May 31, 2020. Data were clustered into intravitreal injections (code 67028), lasers and cryotherapy (codes 67141, 67145, and 67228), retinal detachment (RD) repairs (codes 67107, 67108, 67110, and 67113), and other vitrectomies (codes 67036, 67039, and 67040). Institutions were categorized by region (Northeast, Midwest, South, and West Coast), practice setting (academic [tax-exempt] or private [non-tax-exempt]), and date of respective statewide stay-at-home orders. Main Outcomes and Measures: Nationwide changes in the frequency of billing for urgent or emergent vitreoretinal surgical procedures during the COVID-19 pandemic. Results: A total of 526536 CPT codes were ascertained: 483313 injections, 19257 lasers or cryotherapy, 14949 RD repairs, and 9017 other vitrectomies. Relative to 2019, a weekly institutional decrease in injections was observed from March 30 to May 2, 2020, with a maximal 38.6% decrease (from a mean [SD] of 437.8 [436.3] to 273.8 [269.0] injections) from April 6 to 12, 2020 (95% CI, -259 to -69 injections; P =.002). A weekly decrease was also identified that spanned a longer interval, at least until study conclusion (March 16 to May 31, 2020), for lasers and cryotherapy, with a maximal 79.6% decrease (from a mean [SD] of 6.6 [7.7] to 1.5 [2.0] procedures) from April 6 to 12, 2020 (95% CI, -6.8 to -3.3 procedures; P <.001), for RD repairs, with a maximal 59.4% decrease (from a mean [SD] of 3.5 [4.0] to 1.6 [2.2] repairs) from April 13 to 19, 2020 (95% CI, -2.7 to -1.4 repairs; P <.001), and for other vitrectomies, with a maximal 84.3% decrease (from a mean [SD] of 3.0 [3.1] to 0.4 [0.8] other vitrectomies) from April 6 to 12, 2020 (95% CI, -3.3 to -1.8 other vitrectomies; P <.001). No differences were identified by region, setting, or state-level stay-at-home order adjustment. Conclusions and Relevance: Although the AAO endorsed the continued performance of urgent or emergent vitreoretinal surgical procedures, the frequency of such procedures throughout the country experienced a substantial decrease that may persist after the COVID-19 pandemic's initial exponential growth phase. This decrease appears independent of region, setting, and state-level stay-at-home orders. It is unknown to what extent vitreoretinal intervention would have decreased without AAO recommendations, and how the decrease is associated with outcomes. Although safety is paramount during the COVID-19 pandemic, practices should consider prioritizing availability for managing high-acuity conditions until underlying reasons for the reduction are fully appreciated..
AB - Importance: The American Academy of Ophthalmology (AAO) indicated that urgent or emergent vitreoretinal surgical procedures should continue during the coronavirus disease 2019 (COVID-19) pandemic. Although decreases in the frequency of critical procedures have been reported outside the field of ophthalmology, analyses are limited by volume, geography, and time. Objective: To evaluate whether the frequency of ophthalmic surgical procedures deemed urgent or emergent by the AAO changed across the United States during the COVID-19 pandemic. Design, Setting, and Participants: Vitreoretinal practices from 17 institutions throughout the US participated in this multicenter cross-sectional study. The frequency of 11 billed vitreoretinal Current Procedural Terminology (CPT) codes across respective weeks was obtained from each practice between January 1, 2019, and May 31, 2020. Data were clustered into intravitreal injections (code 67028), lasers and cryotherapy (codes 67141, 67145, and 67228), retinal detachment (RD) repairs (codes 67107, 67108, 67110, and 67113), and other vitrectomies (codes 67036, 67039, and 67040). Institutions were categorized by region (Northeast, Midwest, South, and West Coast), practice setting (academic [tax-exempt] or private [non-tax-exempt]), and date of respective statewide stay-at-home orders. Main Outcomes and Measures: Nationwide changes in the frequency of billing for urgent or emergent vitreoretinal surgical procedures during the COVID-19 pandemic. Results: A total of 526536 CPT codes were ascertained: 483313 injections, 19257 lasers or cryotherapy, 14949 RD repairs, and 9017 other vitrectomies. Relative to 2019, a weekly institutional decrease in injections was observed from March 30 to May 2, 2020, with a maximal 38.6% decrease (from a mean [SD] of 437.8 [436.3] to 273.8 [269.0] injections) from April 6 to 12, 2020 (95% CI, -259 to -69 injections; P =.002). A weekly decrease was also identified that spanned a longer interval, at least until study conclusion (March 16 to May 31, 2020), for lasers and cryotherapy, with a maximal 79.6% decrease (from a mean [SD] of 6.6 [7.7] to 1.5 [2.0] procedures) from April 6 to 12, 2020 (95% CI, -6.8 to -3.3 procedures; P <.001), for RD repairs, with a maximal 59.4% decrease (from a mean [SD] of 3.5 [4.0] to 1.6 [2.2] repairs) from April 13 to 19, 2020 (95% CI, -2.7 to -1.4 repairs; P <.001), and for other vitrectomies, with a maximal 84.3% decrease (from a mean [SD] of 3.0 [3.1] to 0.4 [0.8] other vitrectomies) from April 6 to 12, 2020 (95% CI, -3.3 to -1.8 other vitrectomies; P <.001). No differences were identified by region, setting, or state-level stay-at-home order adjustment. Conclusions and Relevance: Although the AAO endorsed the continued performance of urgent or emergent vitreoretinal surgical procedures, the frequency of such procedures throughout the country experienced a substantial decrease that may persist after the COVID-19 pandemic's initial exponential growth phase. This decrease appears independent of region, setting, and state-level stay-at-home orders. It is unknown to what extent vitreoretinal intervention would have decreased without AAO recommendations, and how the decrease is associated with outcomes. Although safety is paramount during the COVID-19 pandemic, practices should consider prioritizing availability for managing high-acuity conditions until underlying reasons for the reduction are fully appreciated..
KW - COVID-19/epidemiology
KW - Cross-Sectional Studies
KW - Emergency Medical Services
KW - Humans
KW - SARS-CoV-2
KW - Vitrectomy/statistics & numerical data
KW - Vitreoretinal Surgery/statistics & numerical data
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U2 - 10.1001/jamaophthalmol.2021.0036
DO - 10.1001/jamaophthalmol.2021.0036
M3 - Article
C2 - 33662093
AN - SCOPUS:85102124071
SN - 2168-6165
VL - 139
SP - 456
EP - 463
JO - JAMA Ophthalmology
JF - JAMA Ophthalmology
IS - 4
ER -