To compare rates of diagnosis of neuro-ophthalmic conditions across the COVID-19 pandemic with pre-pandemic levels.
Multicenter, retrospective observational study.
Patients seen for eye care between March 11, 2019, and December 31, 2021.
A multicenter electronic health record database, Sight Outcomes Research Collaborative (SOURCE), was queried for new diagnoses of neuro-ophthalmic conditions (cranial nerve (CN) III, IV, VI, VII palsy; diplopia; and optic neuritis), and new diagnoses of other ophthalmic conditions from January 1, 2016, to December 31, 2021. Data were divided into 3 periods (pre-COVID, pre-COVID vaccine, and after introduction of COVID vaccine), with a 3-year look back period. Logistic regressions were used to compare diagnosis rates across periods. Two-sample z-test was used to compare the log odds ratio of the diagnosis in each period with emergent ocular conditions: retinal detachment (RD) and acute angle closure glaucoma (AACG).
Diagnosis rate of neuro-ophthalmic conditions in each study period.
323,261 unique patients, median age 59 (IQR 43-70), 58% female, 68% white, across five academic centers were included, with 180,009 patients seen in the pre-COVID period, 149,835 patients in the pre-COVID vaccine period, and 164,778 patients in the COVID vaccine period. Diagnosis rates of CN VII palsy, diplopia, glaucoma, and cataract decreased from pre-COVID to pre-vaccine periods. However, the diagnosis rate of optic neuritis increased at a significantly different rate compared with retinal detachment (p=0.021). Comparing the diagnosis rates before and after widespread vaccination, all eye conditions evaluated were diagnosed at higher rates in the COVID vaccination period compared with pre-COVID and pre-vaccine periods. The log odds ratio of the diagnosis rates between period comparisons were largely similar between neuro-ophthalmic diagnoses and emergent conditions (RD and AACG), but differed significantly in most comparisons with cataract or glaucoma and emergent conditions.
Neuro-ophthalmic diagnoses had a similar reduction in diagnosis rates to emergent eye conditions in the first part of the pandemic, except optic neuritis. After widespread COVID-19 vaccination, all ophthalmic diagnosis rates increased compared with pre-pandemic rates, and the increase in neuro-ophthalmic diagnosis rates did not exceed the increase in RD and AACG diagnosis rates.

Copyright © 2023. Published by Elsevier Inc.