The pandemic has impacted individuals across the globe, but COVID-19 may have disproportionately affected those with visual impairment (VI) in their perceptions of access to healthcare and concerns that their vision status could contribute to adverse outcomes if they became ill, new research published in the American Journal of Ophthalmology suggests.

In particular, more than half of the blind patients polled in the study said they were most concerned about healthcare access. These obstacles were augmented by the forced closure of many health systems and increased dependence on telehealth during the pandemic, the authors noted.

 “Even without COVID-19, visually impaired individuals experience increased challenges in healthcare access, from the identification of a potential problem to the ongoing management of diagnosed illnesses,” the researchers wrote in their paper.

The study included 232 South Indian participants who were treated at a tertiary care center. From July to August 2020, investigators conducted telephone surveys in which participants were asked about their knowledge and experience with COVID-19. Subjects were also queried about COVID safety measures they undertook, their perceptions of how their VI might affect COVID-19 outcomes, delivery of eye care and their general physical and mental health. Caregivers were also polled in the study.

The investigative team from the U.S. and India divided the patients into four groups of 58 participants each: blind (BCDVA less than 3/60 or VF of less than 10 central degrees); severe VI (BCDVA between 3/60 and 6/60, vertical cup-to-disc ratio of 0.85 or greater, or neuroretinal rim width of 0.1 or less); moderate VI (BCDVA between 6/60 and 6/18); or no/mild VI (the control group, BCDVA of 6/18 or more).

Patients were about 59 years old, and individuals who had more pronounced VI were older and had lower education levels.

Blind participants more commonly perceived vision as a risk factor for contracting COVID-19 and obtained news about the pandemic through word of mouth vs. traditional news outlets. This group also wore masks less frequently.

More blind individuals believed their vision put them at greater risk of contracting COVID (about 14%), and they felt their blindness would lead to poor outcomes if they contracted the illness (about 17%).

Those with moderate VI had the greatest levels of concern about difficulty seeing the eye doctor (approximately 83%).

On the other hand, participants in the control group washed their hands more frequently, were aware of telemedicine, and had fewer concerns about social interactions compared to subjects with substantial VI.

Additionally, the majority of survey participants (about 73%) reported travel concerns, including limitations in seeing an ophthalmologist or going to the pharmacy. Seeing an eye doctor was a challenge for roughly 44% of all participants and was highest amongst those with moderate VI. This group most commonly reported anxiety and fear in the COVID-19 era, difficulty seeing with glasses, and challenges with transportation.

Each of the four groups reported similar levels of worsening vision during the shutdown (about 14%-28%).

Also of note: All caregivers reported more frequent patient care since COVID-19 began.

The pandemic response must include individuals with VI and other disabilities, as evidence-based assessments inclusive of all populations are necessary to demonstrate a potential disproportionate impact of COVID-19, investigators said.

Shalaby WS, Odayappan A, Venkatesh R, et al. The impact of COVID-19 on individuals across the spectrum of visual impairment. Am J Ophthalmol. March 26, 2021 (E-pub, ahead of print).