Algorithm Compares Risk of Cancelled Ophthalmology Appointments Against COVID-19

Nikhil K. Bommakanti, MD

The coronavirus disease 2019 (COVID-19) pandemic has forced many ophthalmologists across the US to cancel potentially necessary eye examinations with patients since March.

A team, led by Nikhil K. Bommakanti, MD, W.K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, developed a flexible and scalable scoring algorithm for patients with glaucoma that considers glaucoma severity and progression risk compared to the presence of high-risk features for morbidity from COVID-19, using information from a large data repository.

For the last few months, ophthalmologists treating patients with sight-threatening illnesses like glaucoma have had to determine whether some appointments could safely get postponed while weighting the individual risk the illness could worsen during the interim against the morbidity risk of acquiring the COCVID-19 virus while seeking ophthalmic care.

They also must prioritize appointment rescheduling during the ramp-up period when pandemic-associated service reductions are relaxed.

In the cross-sectional study, the investigators examined 1034 patients with upcoming clinic appointments for glaucoma between March 16 and April 16 at an academic institution enrolled in the Sight Outcomes Research Collaborative (SOURCE) Ophthalmology Electronic Health Record Data Repository.

The team then developed a risk stratification tool that calculated a glaucoma severity and progression risk score, as well as a COVID-19 morbidity risk score. The scores were summed to determine a total score for each patient.

The mean age of the patient population was 66.7 years old and the mean glaucoma severity and pressing risk score was 4.0 points. The mean COVID-19 morbidity risk score was 27.2 points and the mean total score was 31.2 points.

Using total score thresholds of 0, 25, and 50 points during the pandemic-associated reductions in services phase, the investigators identified 970 appoints (93.8%), 668 appointments (64.6%), and 275 appointments (26.6%), respectively, for postponement and rescheduling.

Using this algorithm, the researchers also helped prioritize appointment rescheduling during the ramp-up phrase.

“A tool that considers the risk of underlying ophthalmic disease progression from delayed care receipt and the morbidity risk from COVID-19 exposure was developed and implemented, facilitating the triage of upcoming ophthalmic appointments,” the authors wrote. “Comparable approaches for other ophthalmic and nonophthalmic care during the COVID-19 pandemic and similar crises may be created using this methodology.”

Following guidance from the US Centers for Disease Control and Prevention (CDC), on March 18, 2020, the American Academy of Ophthalmology recommended that ophthalmic practices limit care to only patients with urgent or emergency ocular conditions.

This put more of an onus on ophthalmologists to distinguish between urgent from nonurgent eye care and what the risks and benefits associated with decisions to proceed with or postpone care for patients with previously scheduled appointments.

The study, “Application of the Sight Outcomes Research Collaborative Ophthalmology Data Repository for Triaging Patients With Glaucoma and Clinic Appointments During Pandemics Such as COVID-19,” was published online in JAMA Ophthalmology.