COVID-19: A Catalyst for Change

Since the start of this pandemic, COVID-19 infection and death rates have been used to illustrate the detrimental impact the virus is having on society and the strain it is placing on our healthcare systems and economies. However, the wider consequences of the pandemic, particularly on the health and wellbeing of people living with other chronic conditions and their access to adequate and essential care have been less well considered.

The Ottawa Hospital’s Riverside Eye Care Centre (RECC), which is the largest outpatient facility of its kind in Canada has been closed since March due to the pandemic. As a result, an estimated 5000 patients are awaiting surgery, many of which are time-sensitive¹. While some procedures have resumed in recent times on the Ottawa campus hospital, the facility is operating barely at 20-30% of its pre-COVID capacity and as these delays continue, providing effective treatment becomes more complicated and ultimately results in an increase in preventable sight loss. The uncertainty over future steps is a major cause of anxiety and frustration for patients and professionals alike, and according to Dr. Peter Agapitos, a staff ophthalmologist at RECC, “If we open up in September, it will take a long time to get through those 5,000 patients that are waiting. It’ll take a number of years, and that’s just not acceptable.”

Ophthalmology is the busiest health specialty within the UK, managing approximately 9 million outpatient appointments every year^2,3. According to results from the Royal College of Ophthalmology WorkForce census conducted in 2018, the ophthalmic health sector has been struggling to cope with a shortage of ophthalmologists and clinic space to manage the demand on the sector, which has led to an estimated 22 patients per month losing vision due to hospital initiated system delays². Furthermore, the census reports a further 30-40% increase in demand is expected over the next 20 years³.

With the sudden and rapid arrival of the COVID-19 pandemic, these issues have become exacerbated and there are increasing concerns about how this predicted rise in demand will be managed with what is already an overstretched service. Thus, the need for new and alternative strategies to enhance the provision of care and tackle the issues contributing to this rise, such as delayed diagnostic screening and inaccessible or inequitable care and treatment has never been more pressing.

The introduction of virtual clinics in the midst of the COVID-19 pandemic has been instrumental in maintaining a direct line of communication between patients and professionals and ensuring patients can continue to receive care and counsel for their condition from the comfort of their home. This transition to remote care has also highlighted the wider benefits of telehealth for ophthalmology, particularly its potential to reduce our reliance on in-person appointments and thus shorten long waiting lists, as well as relieve some of the burden on healthcare professionals. Some studies of AI-supported systems to classify OCT scans and fundus images have even achieved results equivalent to expert assessment for Age-related Macular Degeneration and Diabetes-related Retinopathy screening which is very promising for future advances in the field, although further validation is required before applying to the real-life care setting^4,5.

Despite the fact that some telehealth features have been implemented as a matter of urgency and so require sizeable funding and investment to become an effective long-term service, according to Professor Andrew Lotery from the University of Southampton, “the cost of blindness is much higher”⁶.

It is vital that we learn from these lessons and recognise the importance of forward planning both in terms of preparing for disruptive events similar to this pandemic, but also so that we can think creatively to resolve and prevent pressing concerns within the community. “Instead of praising people for being ‘resilient’, change the systems that are making them vulnerable” – Dr. Muna Abdi, Lecturer in Psychology of Education at Sheffield Hallam University.

References:

1. Eye clinic’s closure could cost some patients their sight, doctor warns. Available at https://www.cbc.ca/news/canada/ottawa/ottawa-eye-surgery-waittimes-1.5651104?__vfz=medium%3Dsharebar. Accessed July 2020.
2. NHS Digital. Hospital Outpatient Activity, 2017-18. Available at https://digital.nhs.uk/data-and-information/publications/statistical/hospital-outpatient-activity/2017-18. Accessed July 2020.
3. The Royal College of Ophthalmologists WorkForce Census 2018. Available at https://www.rcophth.ac.uk/wp-content/uploads/2019/02/RCOphth-Workforce-Census-2018.pdf. Accessed July 2020
4. De Fauw, J., Ledsam, J.R., Romera-Paredes, B., Nikolov, S., Tomasev, N., Blackwell, S., Askham, H., Glorot, X., O’Donoghue, B., Visentin, D. and van den Driessche, G., 2018. Clinically applicable deep learning for diagnosis and referral in retinal disease. Nature medicine, 24(9), pp.1342-1350.
5. Abràmoff, M.D., Lavin, P.T., Birch, M., Shah, N. and Folk, J.C., 2018. Pivotal trial of an autonomous AI-based diagnostic system for detection of diabetic retinopathy in primary care offices. NPJ digital medicine, 1(1), pp.1-8.
6. Macular Society. What is the future for eye clinics after the coronavirus crisis? Available at: https://www.macularsociety.org/news/what-future-eye-clinics-after-coronavirus-crisis. Accessed July 2020.