The Influence of COVID-19 Lockdown in Jordan on Patients with Diabetic Retinopathy: A Case-Control Study

Background: Diabetic retinopathy (DR) is a leading cause of vision impairment in working-age adults. Patients with DR need extensive follow-ups with timely proper treatment. In Jordan, a complete lockdown was decided during the COVID-19 pandemic including the closure of outpatients' clinic. In this study, we assess the effect of the lockdown on the progression and visual outcome for patients with DR who had interruption in their plan. Methods: Retrospectively, we identified all patients who were scheduled for procedures for the management of diabetic retinopathy (DR) during the COVID-19-related quarantine period in Jordan from March 16th to June 6th, 2020. All demographics and clinical data, procedure information, and visual outcome were collected. Another control group of patients with similar characteristics who were scheduled for procedures related to DR before the COVID-19 pandemic from October 15th to December 31st, 2019 were included. Results: One hundred and thirty-seven eyes planned for procedures from 89 patients were included. The case group comprises 56 eyes (40.9%). The mean age of the patients was 61.4 years. The right eye was involved in 69 procedures (50.4%). The mean change in visual acuity for the case group in the procedure eye was 0.176 in LogMAR (drop of almost 9 LogMAR letters) and the mean change in visual acuity for the control group in the procedure eye was -0.103 LogMAR (gain of about 5 LogMAR letters). Also, the central subfield thickness (CST) values were significantly worse in the case group. Furthermore, patients in the case group had significantly more disease progression (new findings and worsening of the already established findings). Conclusion: Interrupting the important procedures for DR patients and delaying their follow-up may adversely affect their visual outcome. National decisions should consider conducting these procedures and exempt those patients from any lockdown with proper precautions. Moreover, certain measures would be considered, such as treat-and-extend protocol, home screening and portable OCT examination, and newer long-acting antiVEGF drugs.