Changes in Retina Practice Patterns During the COVID-19 Pandemic in the Philippines

Figures & data

Table 1 Socio-Demographic Characteristics of the Participating Retina Specialists

Characteristic		n (%)
Age	31–40	19 (39.6%)
	41–50	13 (27.1%)
	51–60	12 (25%)
	61–70	4 (8.3%)
Sex	Male	26 (54.2%)
	Female	22 (45.8%)
Place of Practice in the Philippines	National Capital Region	24 (50%)
	Region I (Ilocos Region)	1 (2.1%)
	CAR (Cordillera Administrative Region)	1 (2.1%)
	Region III (Central Luzon)	8 (16.7%)
	Region IVA (CALABARZON)	3 (6.3%)
	Region IVB (Southwestern Tagalog Region)	2 (4.2%)
	Region VI (Western Visayas)	2 (4.2%)
	Region VII (Central Visayas)	4 (8.3%)
	Region VIII (Eastern Visayas)	3 (6.3%)
	Region XI (Davao Region)	1 (2.1%)
	Region XII (Soccskarsargen)	1 (2.1%)
Years of Practice	Less than 1	4 (8.3%)
	1 to 5	9 (18.8%)
	5 to 10	13 (27.1%)
	More than 10	22 (45.8%)
Type of Practice	Private – individual	26 (54.2%)
	Private – joint (ie group practice)	15 (31.3%)
	Government – employee	6 (12.5%)
	Medical college/academe	1 (2.1%)

Figure 1 Clinical services performed by vitreoretinal specialists in the Philippines during the COVID-19 Pandemic.

Table 2 Changes in Clinic Set-Up and Consultations

Query	Response	n (%)
Percentage of Usual Clinic Load Seen	0%	5 (10.4%)
	1–25%	39 (81.3%)
	26–50%	2 (4.2%)
	51–75%	1 (2.1%)
	76–100%	1 (2.1%)
Scheduling of Clinic Consults	Both walk-in and with appointment consults with usual work hours	6 (12.5%)
	Both walk-in and with appointment consults with redacted work hours	9 (18.8%)
	Strictly with appointment consults only	28 (58.3%)
	No clinic	5 (10.4%)
Ophthalmic Symptoms Considered Urgent Enough to Warrant Clinic Consult	Blurring of vision	44 (91.7%)
	Visual field loss	38 (79.2%)
	Metamorphopsia	32 (66.7%)
	Micropsia/macropsia	22 (45.8%)
	Floaters	27 (56.3%)
	Flashes	38 (79.2%)
	Eye pain	37 (77.1%)
	Eye redness	25 (52.1%)
Retinal Cases Considered Urgent Enough to Warrant Clinic Consult	Diabetic retinopathy	22 (45.8%)
	Retinal vein occlusion	39 (81.3%)
	Retinal artery occlusion	40 (83.3%)
	Age-related macular degeneration	14 (29.2%)
	Central serous retinopathy	5 (10.4%)
	Polypoidal choroidal vasculopathy	25 (52.1%)
	Pathologic myopia	2 (4.2%)
	Retinal breaks and/or retinal detachment	48 (100%)
	Retinopathy of prematurity	45 (93.8%)

Figure 2 Personal protective equipment (PPE) used by vitreoretinal specialists in the Philippines during the COVID-19 pandemic for clinic, laser procedures, and intravitreal injections.

Figure 3 Estimated number of patients during the COVID-19 pandemic of vitreoretinal specialists in the Philippines compared to their usual patient load for (A) clinical consults, (B) laser procedures, (C) intravitreal injections, and (D) vitreoretinal surgeries.

Table 3 Changes in Laser Procedures

Query	Response	n (%)
Percentage of Usual Number of Laser Procedures Still Performed	0%	13 (27.1%)
	1–25%	33 (68.8%)
	26–50%	1 (2.1%)
	51–75%	1 (2.1%)
	76–100%	0 (0%)
Laser Procedures Considered Urgent Enough to Warrant Scheduling	PRP for diabetic retinopathy	33 (68.8%)
	PRP for central retinal vein occlusion	26 (54.2%)
	PRP for branch retinal vein occlusion	19 (39.6%)
	PRP for retinopathy of prematurity	4 (6.3%)
	FLT for choroidal neovascularization	10 (20.8%)
	FLT for central serous chorioretinopathy	2 (4.2%)
	FLT for retinal breaks	47 (97.9%)
	FLT for subclinical retinal detachment	35 (72.9%)
Schedule of Follow-Up Visit After Vitreoretinal Surgery	A day after	0 (0%)
	Within 1 week	8 (16.7%)
	Within 1 month	26 (54.2%)
	As needed if with problems	14 (29.2%)

Abbreviations: PRP, panretinal photocoagulation; FLT, focal laser treatment.

Table 4 Changes in Intravitreal Injections

Query	Response	n (%)
Percentage of Usual Number of Intravitreal Injections Still Performed	0%	18 (37.5%)
	1–25%	24 (50%)
	26–50%	1 (2.1%)
	51–75%	4 (8.3%)
	76–100%	1 (2.1%)
Change in Consultation Pattern for Patients Undergoing Intravitreal Anti-VEGF Injection	Continue with face-to-face consult and diagnostics	11 (22.9%)
	Forego face-to-face consult and just do diagnostics	14 (29.2%)
	Do face-to-face consult only and forego diagnostics	5 (10.4%)
	Do teleconsult	5 (10.4%)
	Forego any consult and proceed directly with injection	6 (12.5%)
	Other responses	7 (14.6%)
Change in Injection Schedule for Age-Related Macular Degeneration Patients	Continue with usual injection schedule	8 (16.7%)
	Switched to treat-and-extend	7 (14.6%)
	Switched to treat-and-extend but used maximum interval	8 (16.7%)
	Switched to pro re nata (PRN)	9 (18.8%)
	Deferral of injections until further notice	9 (18.8%)
	Other responses	7 (14.6%)
Change in Injection Schedule for Diabetic Macular Edema Patients	Continue with usual injection schedule	6 (12.5%)
	Continued injections but with longer interval	19 (39.6%)
	Deferral of injections until further notice	18 (37.5%)
	Other responses	5 (10.4%)
Change in Injection Schedule for Retinal Vein Occlusion Patients	Continue with usual injection schedule	10 (20.8%)
	Continued injections but with longer interval	16 (33.3%)
	Deferral of injections until further notice	17 (35.4%)
	Other responses	5 (10.4%)
Schedule of Follow-Up Visit After Intravitreal Injection	A day after	5 (10.4%)
	Within 1 week	8 (16.7%)
	Within 1 month	10 (20.8%)
	As needed if with problems	25 (52.1%)

Table 5 Changes in Vitreoretinal Surgeries

Query	Response	n (%)
Percentage of Usual Number of Surgeries Still Performed	0%	19 (39.6%)
	1–25%	25 (52.1%)
	26–50%	4 (8.3%)
	51–75%	0 (0%)
	76–100%	0 (0%)
Surgical Cases Considered Urgent Enough to Warrant Scheduling	Macula-on rhegmatogenous retinal detachment	45 (93.8%)
	Macula-off rhegmatogenous retinal detachment	32 (66.7%)
	Endophthalmitis	47 (97.9%)
	Epiretinal membrane and/or macular hole	0 (0%)
	Diabetic tractional retinal detachment	12 (25%)
	Vitreous hemorrhage in a diabetic patient	11 (22.9%)
	Vitreous hemorrhage in a non-diabetic patient	12 (25%)
	Dropped cataract	15 (31.3%)
	Dropped intraocular lens	3 (6.3%)
	Floater removal	0 (0%)
	Ocular trauma	44 (91.7%)
	Retinopathy of prematurity	39 (81.3%)
Requiring COVID-Negative Test Prior to Surgery	Yes	28 (58.3%)
	No	6 (12.5%)
	Undecided	14 (29.2%)
Sentiment on How PPE Affects Surgical Performance	Does not affect surgical performance	4 (8.3%)
	Affects surgical performance but will wear anyway	30 (62.5%)
	Affects surgical performance and will consider removing it if it interferes with surgical performance	10 (20.8%)
	Not performing surgeries	4 (8.3%)
Course of Action if Patient Scheduled for Urgent Vitreoretinal Surgery Becomes COVID-Positive	Go ahead with surgery with precautions	9 (18.8%)
	Defer surgery	34 (70.8%)
	Refer to COVID-handling institution	3 (6.3%)
	Other responses	2 (4.2%)
Schedule of Follow-Up Visit After Vitreoretinal Surgery	A day after	26 (54.2%)
	Within 1 week	20 (41.7%)
	Within 1 month	1 (2.1%)
	As needed if with problems	1 (2.1%)