COVID-19 has shifted the way clinicians approach patient care. In the case of uveitis specifically, every step of the process, from diagnosis to management, has been affected. Clinicians recently outlined the changes in an Ophthalmology article:
Diagnosis. COVID-19 is changing what tests are considered necessary to diagnose a patient with uveitis. The uveitis specialists noted that, for the most part, only syphilis and tuberculosis testing are to be performed in all cases of uveitis. Unless presenting signs and symptoms are inconsistent with those of classic uveitis, tests that pose a higher risk of infection should avoided.
Treatment. Although no published reports of COVID-19-associated uveitis exist, findings show a higher risk of infection in immunosuppressed patients and those with infectious uveitis whose treatment regimen includes anti-microbial and anti-inflammatory drugs. At the same time, these patients may experience worse outcomes if their therapy is interrupted.
Eyecare providers, as well as those in other fields, have found that immunomodulatory treatment is not a major risk factor for severe COVID-19 and should not be discontinued unless a patient has been exposed to the virus or has a suspected or confirmed infection. In the case of infection, locally delivered corticosteroids are an effective option to avoid systemic drug use in non-infectious uveitis.
Management. As in other cases, telemedicine has become the standard of care for uveitis consultation in light of COVID-19. However, eyecare providers have indicated they prefer in-person visits that allow for comprehensive eye examinations in the case of patients who have a new presentation, experience recurrent inflammation or adjust their treatment regimen.
If an office-based appointment is deemed appropriate, personal protective equipment and proper hygiene techniques have proved to be more important than ever in lowering the risk of infection in both the patient and the provider.
Despite the need for more hands-on care in certain cases, providers and patients alike have acknowledged the feasibility of telemedicine in managing and comanaging uveitis, a practice that could persist even after the pandemic.
|Smith JR, Lai TYY. Managing uveitis during the COVID-19 pandemic. Ophthalmology. May 18, 2020. [Epub ahead of print].|