The Impact of COVID-19 on Missed Ophthalmology Clinic Visits

Figures & data

Table 1 Characteristics of Patients in the Pre-COVID-19 and COVID-19 Time Periods Based on Missed Visit Status^a

	Pre-COVID-19 Period	COVID-19 Period	Difference in % Missed Visits	Tests of Statistical Significance
				Missed Visits in Pre-COVID-19 vs COVID-19 Period^c	Completed vs Missed Visits in COVID-19 Period^d
	N (%) of Patients with No Missed Visits^b	N (%) of Patients with No Missed Visits^a	COVID-19 Period vs Pre-COVID-19 Period
				p-value	p-value
Total	14,635 (81.98%)	15,224 (59.25%)	−22.73%
Sex				<0.001	0.242
Male	6268 (83.77%)	6747 (61.39%)	−22.38%
Female	7687 (80.84%)	8175 (56.43%)	−24.41%
Missing	679 (78.35%)	299 (88.29%)	9.94%
Race/Ethnicity				<0.001	0.003
White	5098 (82.29%)	5401 (55.99%)	−26.3%
Black	361 (73.96%)	392 (54.59%)	−19.37%
Asian	3242 (79.73%)	3402 (48.71%)	−31.03%
Hispanic	2178 (83.75%)	2344 (65.23%)	−18.52%
Other	1602 (78.71%)	1651 (55.91%)	−22.81%
Missing	2154 (86.63%)	2034 (82.25%)	−4.38%
Age				<0.001	<0.001
Age <50 years	5426 (87.08%)	5980 (75.37%)	−11.71%
Age 50–64 years	2761 (76.35%)	2840 (51.06%)	−25.29%
Age 65–74 years	2800 (78.82%)	2876 (45.9%)	−32.92%
Age 75–84 years	2036 (81.53%)	2240 (45.85%)	−35.68%
Age 85+ years	933 (82.1%)	989 (45.7%)	−36.4%
Language				0.401	0.107
English	12,038 (81.91%)	12,914 (58.84%)	−23.07%
Other	1906 (83.95%)	1991 (57.81%)	−26.14%
Missing	691 (77.86%)	319 (84.95%)	7.09%
Married				<0.001	0.029
Married	7024 (79.9%)	7204 (49.15%)	−30.74%
Not married	6920 (84.54%)	7700 (67.58%)	−16.95%
Missing	691 (77.57%)	320 (85.94%)	8.37%
Diagnosis				<0.001	0.089
DME	477 (79.45%)	559 (54.92%)	−24.54%
Wet AMD	409 (77.75%)	455 (53.19%)	−24.56%
Dry/Unspecified AMD	909 (79.21%)	1042 (43.28%)	−35.93%
Cataract	3816 (78.85%)	4587 (42.66%)	−36.19%
Pseudophakia or Aphakia	2177 (80.02%)	2748 (44.32%)	−35.7%
Cataract	3816 (78.85%)	4587 (42.66%)	−36.19%
Glaucoma
Mild glaucoma	411 (80.29%)	531 (45.95%)	−34.34%
Moderate glaucoma	520 (82.69%)	627 (50.08%)	−32.61%
Severe glaucoma	444 (79.5%)	567 (49.56%)	−29.95%
Unspecified glaucoma	986 (82.45%)	1152 (51.48%)	−30.98%
Diabetic retinopathy
Mild DR	171 (79.53%)	230 (44.78%)	−34.75%
Moderate DR	73 (82.19%)	105 (54.29%)	−27.91%
Severe DR	52 (75.0%)	66 (48.48%)	−26.52%
Proliferative DR	188 (75.53%)	222 (55.41%)	−20.13%
Distance from Clinic				<0.001	<0.001
< 20km	4707 (84.49%)	4961 (55.84%)	−28.66%
20–49km	5190 (80.92%)	5566 (57.1%)	−23.83%
50–149km	2610 (81.38%)	2900 (63.83%)	−17.55%
150–299km	863 (80.76%)	895 (65.81%)	−14.95%
> 300km	514 (79.38%)	520 (59.62%)	−19.76%
Insurance				<0.001	<0.001
Private	5138 (82.74%)	5696 (64.33%)	−18.41%
Medicare	4852 (80.36%)	5207 (46.36%)	−34.0%
Medicaid	2316 (85.06%)	2513 (72.54%)	−12.52%
Other	218 (76.61%)	227 (56.83%)	−19.78%
Income				<0.001	<0.001
<$20,000	2215 (83.75%)	2358 (57.08%)	−26.66%
$20,000–$49,999	6190 (82.29%)	6633 (57.35%)	−24.94%
$50,000–$99,999	4193 (80.87%)	4444 (60.26%)	−20.61%
$100,000+	1029 (82.99%)	1129 (65.63%)	−17.36%

Notes: Income. ^aPatients who had multiple missed visits during each period are reported only once in this table. ^bPercentages are reported out of all patients with scheduled visits in a given time period. Evaluated percentage of all patients with scheduled visits who completed all visits within 7 days of the original scheduled date(s) (ie, no missed visits). Pre-COVID-19 time period is 1/1/2020-2/29/2020; COVID-19 is 3/16/20-5/31/20. ^cComparison of % missed visits between time periods (pre-COVID-19 versus COVID-19), based on chi-squared. ^dComparison of % missed visits vs % completed visits within COVID-19 time period, based on chi-squared.

Abbreviations: DME, diabetic macular edema; AMD, age-related macular degeneration; DR, diabetic retinopathy.

Figure 1 Timeline of completed and cancelled appointments in 2021. (A) The percentage of weekly appointments cancelled by specialty. (B) The percentage of weekly appointments cancelled by visit type (return or new).

Figure 2 Reason for cancelled appointments during COVID-19 time period.

Table 2 Multivariable Logistic Regression for Odds of Missing at Least One Scheduled Clinic Visit During Pre-COVID-19 and COVID-19 Time Periods

	Pre-COVID-19 Time Period^a		COVID-19 Time Period^b		Significance of Interaction with Time Period (pre-COVID-19 vs COVID)^c
	Odds Ratio (95th CI)	p-value	Odds Ratio (95th CI)	p-value	p-value
Female (Ref=Male)	1.13 (1.04–1.24)	0.004	1.23 (1.15–1.32)	<0.001	0.166
Race (Ref=White)
Black	1.76 (1.37–2.27)	<0.001	1.51 (1.21–1.88)	<0.001	0.356
Asian	1.25 (1.12–1.40)	<0.001	1.67 (1.52–1.83)	<0.001	<0.001
Hispanic	1.03 (0.89–1.19)	0.670	1.31 (1.17–1.46)	<0.001	0.011
Other	1.35 (1.17–1.55)	<0.001	1.41 (1.26–1.58)	<0.001	0.618
Age (Ref=<50 years)
50–64 years	1.76 (1.55–1.99)	<0.001	2.13 (1.92–2.36)	<0.001	0.021
65–74 years	1.5 (1.28–1.76)	<0.001	2.29 (2.01–2.60)	<0.001	<0.001
75–84 years	1.26 (1.05–1.52)	0.013	2.31 (1.99–2.68)	<0.001	<0.001
≥85 years	1.21 (0.96–1.53)	0.111	2.62 (2.17–3.15)	<0.001	<0.001
English preferred language (Ref=Non-English preferred language)	0.86 (0.76–0.98)	0.019	1.12 (1.01–1.25)	0.036	0.002
Married (Ref=Not married)	1.07 (0.97–1.18)	0.160	1.39 (1.28–1.50)	<0.001	<0.001
DME (Ref=no DME)	0.88 (0.64–1.21)	0.424	0.77 (0.61–0.98)	0.032	0.527
Wet AMD (Ref = no wet AMD)	1.34 (1.01–1.78)	0.046	0.72 (0.57–0.91)	0.005	0.001
Dry AMD (Ref=no dry AMD)	1.07 (0.87–1.32)	0.515	1.25 (1.07–1.47)	0.006	0.248
Cataract (ref = no cataract)	1.18 (1.04–1.34)	0.011	1.73 (1.56–1.91)	<0.001	<0.001
Pseudophakia/Aphakia (Ref=no pseudophakia or aphakia)	1.06 (0.90–1.25)	0.500	1.3 (1.15–1.48)	<0.001	0.052
Pathologic Myopia (Ref=no pathologic myopia)	0.93 (0.72–1.20)	0.579	1.47 (1.22–1.77)	<0.001	0.004
Multiple diagnoses	0.96 (0.77–1.20)	0.722	0.81 (0.69–0.95)	0.011	0.214
Glaucoma
Unspecified glaucoma	0.97 (0.70–1.35)	0.865	0.98 (0.76–1.26)	0.868	0.973
Mild glaucoma	0.91 (0.66–1.27)	0.595	1.23 (0.98–1.55)	0.079	0.150
Moderate glaucoma	0.79 (0.60–1.05)	0.108	0.93 (0.76–1.14)	0.482	0.362
Severe glaucoma	0.98 (0.76–1.27)	0.875	0.94 (0.77–1.13)	0.492	0.777
Diabetic retinopathy
Mild	0.98 (0.60–1.59)	0.929	1.58 (1.12–2.22)	0.009	0.115
Moderate	0.66 (0.30–1.46)	0.308	0.91 (0.58–1.45)	0.705	0.491
Severe	1.47 (0.65–3.36)	0.358	1.17 (0.60–2.28)	0.640	0.673
Proliferative	1.39 (0.91–2.12)	0.130	1.08 (0.78–1.50)	0.647	0.359
Distance from Clinic (ref=<20km)
20–49km	1.14 (1.02–1.28)	0.017	0.97 (0.89–1.06)	0.555	0.025
50–149km	1.23 (1.08–1.40)	0.002	0.92 (0.83–1.02)	0.121	0.001
150–299km	1.32 (1.09–1.61)	0.005	1.01 (0.86–1.19)	0.889	0.038
> 300km	1.43 (1.14–1.81)	0.002	1.16 (0.96–1.42)	0.131	0.178
Insurance (Ref=private insurance)
Medicare	0.93 (0.81–1.07)	0.334	1.05 (0.94–1.17)	0.399	0.200
Medicaid	0.8 (0.69–0.92)	0.003	0.8 (0.71–0.89)	< 0.001	0.959
Other insurance	1.23 (0.89–1.71)	0.208	1.16 (0.87–1.54)	0.310	0.778
Household Income (Ref = <$20,000)
$20,000–$49,999	0.92 (0.82–1.04)	0.188	1.0 (0.91–1.10)	0.919	0.276
$50,000–$99,999	1.0 (0.87–1.14)	0.965	1.0 (0.90–1.11)	0.999	0.974
$100,000+	0.9 (0.74–1.11)	0.328	0.93 (0.79–1.09)	0.351	0.860

Notes: ^aPre-COVID-19 time period is 1/1/2020-2/29/2020. ^bCOVID-19 time period is 3/16/20-5/31/20. ^cBased on aggregate regression including patients from both time periods, with an independent variable for time period (pre-COVID-19 vs COVID-19). This statistic represents the p-value indicating level of statistical significance for an interaction term with each listed covariate and the time-period variable.

Abbreviations: DME, diabetic macular edema; AMD, age-related macular degeneration; CI, confidence interval.