Retinal detachment during COVID-19 era: a review of challenges and solutions <span class="so-article-trans-title" dir="auto"> Translated title: Netzhautabhebung während der Corona-Pandemie: Überblick über Herausforderungen und Lösungen </span>

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Summary

Background

Since the beginning of the Coronavirus disease 2019 (COVID-19) pandemic, there have been obstacles in the proper diagnosis and management of many diseases. We evaluated the changes in retinal detachment (RD) presentation and surgery during the COVID-19 pandemic and propose solutions to minimize the detrimental effects of lockdown on RD diagnosis.

Materials and methods

PubMed, Embase, Scopus, Web of Science, and Google Scholar were searched for relevant articles with the keywords “Retinal detachment” AND “Coronavirus OR COVID-19 OR SARS OR MERS.”

Results

The COVID-19 lockdown was associated a 53–66% reduction in RD presentation. The decrease in the rate of macula-on RD, the increase in the mean duration of symptoms, and the rise in the number of patients with proliferative vitreoretinopathy were all suggestive of a delayed presentation of RD. Moreover, a drop of 56–62% in RD repair surgeries was observed. However, the most frequently performed ophthalmic surgery changed from cataract surgery in April 2019 to RD repair in April 2020. Using phacovitrectomy instead of vitrectomy alone can reduce the number of operations in ophthalmology centers, decrease the use of personal protective equipment by 50%, and cut costs per patient by 17–20%. Also, developing a well-organized telemedicine system can decrease unnecessary visits and delayed presentations.

Conclusion

Delay in RD presentation and surgery is associated with a poorer prognosis. Optimizing the guidelines of RD management and developing a well-organized telemedicine system can minimize the impact of lockdown on RD management.

Translated abstract

Hintergrund

Seit Beginn der Coronavirus-Pandemie 2019 (COVID-19) sind Diagnose und Therapie vieler Erkrankungen mit großen Problemen konfrontiert. In der vorliegenden Arbeit wurden die Veränderungen bei der primären Diagnostik von Netzhautabhebungen und beim chirurgischen Prozedere während der COVID-19-Pandemie erhoben. Lösungsansätze zur Minimierung negativer Auswirkungen eines Lock-downs für Diagnose und Therapie von Netzhautabhebungen werden vorgestellt.

Material und Methode

Die Datenbanken PubMed, Embase, Scopus, Web of Science und Google Scholar wurden mit den Schlüsselwörtern „Netzhautabhebung“ und „Coronavirus oder COVID 19 oder SARS oder MERS“ auf relevante Artikel hin durchsucht.

Ergebnisse

Während des COVID-19-Lock-downs kam es zu einer Reduktion von 53–66 % bei der primären Diagnose von Netzhautabhebungen. Für die verspätete Vorstellung von Patienten mit Netzhautabhebung sprechen der höhere Anteil von Netzhautabhebungen mit präoperativ bereits abgehobener Makula („macula-off“), eine längere Dauer der Symptomatik und die größere Zahl von Patienten mit proliferativer Vitreoretinopathie. Parallel dazu wurde eine Reduktion um 56–62 % bei Netzhautoperationen verzeichnet, obwohl die häufigste Augen-Op. im April 2019 die (elektive) Katarakt-Op. und im April 2020 die Ablations-Op. war. Durch die kombinierte Katarakt-Op. mit Vitrektomie lässt sich die Op.-Gesamtzahl reduzieren. Dies könnte den Verbrauch von protektivem Material für das Personal um 50 % senken und die Kosten pro Patient um etwa 17–20 %. Ein gut organisiertes Telemedizinsystem kann zur Reduktion unnötiger Arztbesuche, aber auch einer verzögerten Diagnosestellung beitragen.

Schlussfolgerung

Die Verzögerung von Diagnose und Therapie einer Netzhautabhebung geht mit schlechterer Prognose einher. Die Richtlinien des Managements von Netzhautabhebungen zu optimieren und ein gut organisiertes telemedizinisches Netzwerk zu entwickeln, könnten die Auswirkungen eines Lock-downs in der Behandlung von Netzhautabhebungen minimieren.

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Most cited references 27

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Fewer cancer diagnoses during the COVID-19 epidemic in the Netherlands

Avinash G Dinmohamed, Otto Visser, Rob Verhoeven … (2020)

The dreadful consequences of coronavirus disease 2019 (COVID-19) put an unprecedented pressure on health-care services across the globe. 1 The Netherlands, a country with 17·4 million inhabitants that provides its citizens with universal access to essential health-care services—with the general practitioner as the gatekeeper to secondary care—is no exception in this regard. The first patient with COVID-19 in the Netherlands was confirmed on Feb 27, 2020, in the southern part of the country. 2 Thereafter, the disease spread rapidly throughout the country. Subsequently, strict social distancing policies were implemented by the Dutch government as of March 15, 2020, to mitigate the spread of COVID-19.3, 4 The mayhem caused by COVID-19 has brought about substantial changes in cancer diagnosis in the Netherlands. Data from the nationwide Netherlands Cancer Registry in the period between Feb 24, 2020, and April 12, 2020—which are based on initial case ascertainment through pathological cancer notifications from the Nationwide Network of Histopathology and Cytopathology—show that there is a notable decrease in cancer diagnoses when compared with the period before the COVID-19 outbreak. This effect was most pronounced for skin cancers (figure ) and observed across all age groups and geographical regions, and almost all cancer sites (appendix). Several arguments might explain this decrease. First, individuals with potential, non-specific symptoms of cancer might have barriers to consulting a general practitioner, including moral concerns about wasting the general practitioner's time for non-COVID-19-related symptoms, assumptions about insufficient capacity for essential non-COVID-19-related health-care services, and anxiety about acquiring COVID-19 in a health-care setting. Second, most of the general practitioner consultations for non-acute issues are transitioned to telehealth. A general practitioner might, therefore, postpone initial investigations for symptoms that do not immediately hint towards a potential cancer diagnosis, resulting in delayed or postponed hospital referrals. Third, hospitals might have postponed diagnostic evaluation or have longer turnaround times for diagnostic evaluation because many hospital-based resources are being allocated to tackle COVID-19. Lastly, national screening programmes for breast, colorectal, and cervical cancer are temporarily halted as of March 16, 2020, to alleviate the demand on the health-care system due to COVID-19. The effect of this pause in cancer diagnosis might be more pronounced after extended periods of follow-up. However, this effect might be less notable for cervical cancer because screening aims to identify precancerous lesions. Collectively, fewer cancer diagnoses in the COVID-19 era will result from patient, doctor, and system factors. 5 Figure Number of cancer diagnoses by week in the Netherlands in the period between Jan 6, 2020 (calendar week 2) and April 12, 2020 (calendar week 15) Basal cell carcinoma of the skin is not included in the statistics. The point estimates for the change in cancer diagnoses per calendar week are based on the mean total number of cancer diagnoses in the calendar weeks from 2 to 8; that is, the period before the COVID-19 outbreak in the Netherlands. Approximately 3400 malignancies were notified per week to the Netherlands Cancer Registry in the calendar weeks from 2 to 8. Of note, these figures do not yet include cases diagnosed in one of the 74 hospitals in the Netherlands. COVID-19=coronavirus disease 2019. The upsetting findings of fewer cancer diagnoses were initially disseminated among the Dutch community on April 2, 2020, and again on April 15, 2020, by the Netherlands Comprehensive Cancer Organisation—which hosts the Netherlands Cancer Registry—to create awareness of this issue. The aims of this dissemination were multifold. First, individuals were encouraged to consult their general practitioner whenever symptoms continued to be troublesome. Second, general practitioners were encouraged to refer patients with suspected cancer to oncology specialists. Third, an appeal was made to restart national cancer screening programmes. Lastly, misconceptions were eliminated about a heightened risk of contracting COVID-19 in a health-care setting because of inadequate policies for infection control at the institutional level and resource constraints in the delivery of essential oncological care. Priorities for cancer care amid the COVID-19 pandemic will be meticulously triaged on the basis of a multitude of factors that are outside the scope of this Comment. General frameworks to inform cancer treatment decisions during the COVID-19 pandemic are discussed elsewhere.6, 7, 8, 9 It does merit brief acknowledgment that the effect of a reasonable delay in the management of particular low-risk malignancies (eg, many skin cancers) will only marginally affect the quantity and quality of life. Conversely, the treatment for potentially curable cancers with an imminent risk of early death (eg, acute leukaemias) cannot be safely postponed. The data discussed here support the National Oncology Taskforce and the National Coordination Centre for Patient Distribution to safeguard optimal patient access to essential oncological care throughout all hospitals in the Netherlands. The Netherlands Cancer Registry will, in due course, complete the registration of current and new cases via retrospective medical records review. These more detailed data—including various patient (eg, COVID-19 positivity), tumour, and treatment characteristics, and follow-up—will ultimately establish the effect of the COVID-19 outbreak on oncological care in the Netherlands. This information can also guide the public, policymakers, and physicians in the future whenever an outbreak of a similar magnitude occurs. This online publication has been corrected. The corrected version first appeared at thelancet.com/oncology on May 4, 2020

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Impact of the COVID-19 pandemic on the symptomatic diagnosis of cancer: the view from primary care

Daniel Jones, Richard D. Neal, Sean Duffy … (2020)

The entire landscape of cancer management in primary care, from case identification to the management of people living with and beyond cancer, is evolving rapidly in the face of the coronavirus disease 2019 (COVID-19) pandemic. 1 In a climate of fear and mandated avoidance of all but essential clinical services, delays in patient, population, and health-care system responses to suspected cancer symptoms seem inevitable. Screening, case identification, and referral in symptomatic cancer diagnosis have all been affected by the COVID-19 pandemic. UK national cancer screening programmes—accounting for approximately 5% of all cancer diagnoses each year—have been suspended. 2 Consequently, early diagnoses from screening will be delayed and symptom-based diagnosis of cancer will become more important. 3 Unfortunately, postponing screening sends a message to the public and primary care that cancer can wait. Timely presentation to primary care of patients with symptoms is driven by a combination of appraising symptoms as warranting attention, perceived or actual ability to consult a health-care professional, perceived consequences of seeking help, and priority over competing goals. 4 It is probable that patients with well recognised red flag symptoms, such as a new lump or rectal bleeding, will continue to present to primary care. With COVID-19 at the forefront, however, vague cancer symptoms such as fatigue, change in bowel habit, and weight loss might be dismissed by the patient as trivial. 5 Respiratory symptoms, including persistent cough, might be attributed to COVID-19 and not acted on. Patients might be reluctant to present because of fear of interacting with others, limited capacity to use video or teleconsultations, and concerns about wasting the doctor's time.6, 7 For family doctors, the COVID-19 pandemic is affecting all aspects of normal working life, including a reduced workforce due to illness and self-isolation, and the reduced availability of appointments and investigations in primary and secondary care. The huge shift to telephone triage and video consultations might result in missed cues, reduced examination findings, and loss of the clinician's gut feeling. Remote consulting might also be less suited to vulnerable patients and individuals from low socioeconomic backgrounds than to patients from high socioeconomic settings, compounding inequalities already apparent in early cancer diagnosis. 8 If patients with cancer symptoms do present to primary care, there is no consensus on how they should be managed during the pandemic, or safety-netted. When patients are referred, they are likely to be triaged or delayed. 9 For example, the cancellation of all but emergency endoscopy will inevitably prolong the time to diagnosis of gastrointestinal cancers. Management and follow-up of patients with cancer is also affected by the COVID-19 pandemic. Many patients with cancer, especially those undergoing chemotherapy, radical radiotherapy, and immunotherapy, are at greater risk from the symptoms and sequelae of COVID-19. The National Health Service guidelines state that patients will want to discuss whether the benefits of continuing active cancer treatment outweigh the risks of potentially being seriously unwell if they contract COVID-19, which is a role that could well fall to primary care. 9 The UK cancer charity Macmillan Cancer Support reports that a quarter of calls to its support line are from patients with cancer who are anxious about COVID-19. 10 Although cancer charities provide a vital support role, primary care needs to support the physical and mental health of patients for whom potentially lifesaving cancer treatments are being postponed. Cancer treatments are a priority in the health-care system, but as health-care become increasingly occupied with caring for patients with COVID-19, these patients will inevitably take precedence. Patients needing immediate care are receiving treatment, but when possible, treatments will be delayed. Guidance to help make these difficult decisions might be variable, inconsistent, and hurried, with the inevitable risk to patient outcomes. In this situation, the psychological effect on patients and clinical staff will be enormous. The COVID-19 pandemic has implications for primary care and the crisis has highlighted potential solutions for dealing with future global health threats. Although these are unprecedented times, it is probable that the use of remote consultations will grow. Increased flexibility in accessing health care might serve to advantage some population groups, but risks disadvantaging others. If done well, remote consulting could benefit previously underserved patient populations (ie, individuals living in remote areas). Behavioural interventions to encourage the timely symptomatic diagnosis of cancer are important. Public awareness campaigns should signal that early help-seeking is welcome and legitimate, and might use social media and community networks that have grown in response to COVID-19. Clinicians should be aware of so-called diagnostic overshadowing from COVID-19 and remember that patients might have markedly delayed presentation already and need additional support navigating the next steps in terms of their referral and safety-netting. If cancer is suspected, clinicians should not be deterred from referring patients urgently because of COVID-19 or other future global health threats. However, health-care professionals might have to accept triage and risk stratification of patients with potentially serious disease. Biomarker and machine-learning approaches might support prioritisation of patients who are at greatest risk, diverting health-care resources towards managing patients who are seriously ill. When patients are diagnosed with cancer, or are living with or beyond cancer, providers of primary care might have to accept enhanced roles in supporting decisions on cancer treatment, palliative care, and advanced planning around resuscitation and preferred places of care. When normal service resumes at a population and health-service level, there will be a huge backlog of patients with potential cancer symptoms needing urgent assessment. Planning for recovery should commence as soon as possible. © 2020 Bacho/shutterstock.com 2020 Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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The impact of COVID policies on acute ophthalmology services—experiences from Moorfields Eye Hospital NHS Foundation Trust

Louisa Wickham, Gordon Hay, Robin Hamilton … (2020)

Early in the national response to the COVID-19 crisis, Moorfields Eye Hospital NHS Foundation Trust (MEH) anticipated that its key contribution to the London health and care system would be to continue to provide safe, effective, eye care to patients requiring sight saving intervention in an environment where many other ophthalmic units would be closed or be unable to access surgical facilities. As a hospital based in London, an epicentre of infection, it was clear that the organisation would rapidly need to respond to the crisis. The overarching premise of this response was that the Trust would move to providing emergency sight- or life-threatening (ocular oncology) care only from March 23rd 2020. MEH consists of a network of 26 sites across London. It was anticipated that its smaller, peripheral sites would be more susceptible to total closure due to staff sickness or reallocation and/or space requirements of host Trusts. A decision was therefore made to converge critical services to larger or independent sites. Intravitreal injections would be continued at all sites that remained open in recognition of the increased risk and burden of travel on the elderly population that were the majority users of the service. Emergency or urgent surgery would only be continued at the central site and all closed units would be required to redirect appropriate patients to the nearest centre. MEH developed and used a similar risk stratification approach to that described by ophthalmic professional bodies such as the Royal College of Ophthalmologists and the American Academy of Ophthalmologists as well as in other COVID-19-related articles [1, 2]. Clinical teams were assigned to hot (on site) and cold (off site or non-patient facing) working weeks to deliver clinical work and, patient triage and remote consultation, respectively. Early indications suggested that surrounding general hospitals in Greater London would become overwhelmed with COVID-19 patients and that many ophthalmic units within general hospitals would no longer be able to perform ophthalmic surgery. It was expected that Moorfields would see a sharp rise in patients attending A + E. Communication networks with other clinical leads were vital in understanding the pressures of neighbouring units. Ophthalmic units were encouraged to continue to triage local emergencies and urgent cases, even if access to theatres for emergency or elective surgery ceased, and only to refer onward to MEH for emergency surgery. Where possible, patients would be redirected at the front entrance of the unit to use Attend Anywhere, an online consultation service run by the department, for any condition that was not an emergency and, for those deemed to be high risk of being COVI-19 positive from screening questions. Virtual consultation platforms would allow both vulnerable patients and staff members to access and provide clinical care. Subspecialty stations were created around the hospital to deal with the anticipated increase in ophthalmic emergencies and to allow direct triage of patients into relevant clinics to facilitate early clinical diagnosis and management, avoid re-examination of patients and avoid subsequent unnecessary patient reviews and travel. Contrary to the anticipated increase in patient numbers either in response to local units closing or reduced outpatient appointments, MEH experienced a significant reduction in total attendance numbers. Prior to the lockdown, the A&E department would manage an average of 1900 cases per week, this reduced by >50% (Table 1). Low attendance rates for face–face appointments enabled swift triage and management with an average wait time of 1 h from registration to discharge in contrast to the government target of 4 h. The lower numbers also facilitated appropriate social distancing of patients within the department. Table 1 Total attendances at Moorfields A + E (face to face and Attend Anywhere), City Road for week commencing 15th March 2020 as compared with 2019. A + E attendances Date 2020 15/03 22/03 29/03 05/04 12/04 19/04 1371 833 502 517 673 714 2019 17/03 24/03 31/03 07/04 14/04 21/04 1960 1911 1868 1861 1943 1808 −30% −56% −73% −72% −65% −61% Prior to the COVID-19 outbreak 40% of attendances to the A&E were not considered to be life- or sight-threatening emergencies. Following implementation of ‘at-the-door’ triage with digital platform support, the majority of attendances were potentially site threatening conditions. Trauma and painful conditions such as corneal ulcers and orbital cellulitis continued to present to the department (Table 2). Of concern, however, was that some conditions were presenting with more advanced or severe disease, suggesting that patients were reluctant to risk exposure to COVID-19 in order to seek medical attention. The number of trauma patients, particularly those related to domestic abuse, increased. Table 2 Top five A + E presentations before and after the initiation of COVID-19 isolation measures and introduction of Attend Anywhere. Diagnoses for Jan and Feb 2020 Diagnoses for March and April 2020 Primary diagnosis Number Primary diagnosis Number Blepharitis 628 Acute anterior uveitis 349 Posterior vitreous detachment 609 Corneal abrasion 343 Acute anterior uveitis 606 Posterior vitreous detachment 270 Corneal abrasion 577 Blepharitis 218 Dry eyes 574 Chalazion 191 Total 2994 Total 1371 Digital consultations proved very successful with up to 57% of cases being managed using Attend Anywhere (Fig. 1). The majority were for minor symptoms managed with reassurance, advice or self-care. Other consultations were for advice following cancellation of outpatient appointments and for prescription requests. 21.1% required onward referral to the A&E or to a subspecialty service. This was particularly noteworthy given that the digital platform was only launched within 48 h of the lockdown, demonstrating how teams can work together proactively and positively to support new initiatives. Fig. 1 A bar chart demonstrating the number of Attend Anywhere consultations per day following its active implementation in week commencing March 23rd, 2020. The number of consultations increased dramatically following introduction of isolations measures and the use of active triage at the entrance to the department encouraging its use. The Number of Attend Anywhere consultations following its active implementation in week commencing March 23rd, 2020. In the medical retina service, particular attention was focussed on the importance of maintaining intravitreal injections for the treatment of choroidal neovascular membranes primarily secondary to age-related macular degeneration (ARMD). Existing patients were triaged such that only those most at risk of irreversible visual loss would continue to receive treatment (Fig. 2). Despite limiting the service to high-risk patients only there were multiple patient-initiated cancellations, the average DNA rate increased to 24.9% (range 13–42.9%). Similarly, the number of new presentations of ARMD also decreased significantly (Fig. 3). Fig. 2 Bar chart showing the number of injections performed across Moorfields Eye Hospital Trust showing the impact on isolation measures on attendance and first injection rates. Following introduction of isolation measures the number of injections performed in April fell significantly for both follow up and new patients. Fig. 3 A bar chart showing the number of new AMD cases presenting by week (grey) starting the first week in March 2020 compared with presentation rates in 2019 (orange) and 2018 (blue) for the same week. Week 4 represents the week commencing March 23rd when the Trust mobilised to restrict services to emergency care only, the speed of onset of these measures meant that many patients were not contactable prior to their planned appointment. Despite this numbers still fell significantly as compared to previous years due to high DNA rates. Subsequent weeks show further decreases in patient numbers and represent those with active disease or patients undergoing treatment in their only seeing eye. An increase in patients presenting for rhegmatogenous retinal detachment (RRD) and emergency surgery was expected due to the closure of surrounding ophthalmic theatres. MEH theatres were configured to provide three emergency theatres and the VR service divided into three teams comprising of three consultants and 2/3 fellows working hot and cold weeks. Contrary to our expectations, the number of patients presenting with retinal detachment fell significantly following introduction of isolation measures (Fig. 4). The number of retinal detachment operations fell to an average of 14 cases per week, an average drop of 62% compared with the same period in 2019. Fig. 4 A bar chart showing the number of patients presenting to VRE in March/April 2019 (blue) and 2020 (orange). The number of patients presenting with retinal detachment fell an average of 62% compared with same period in 2019. These observations have also been made by VR surgeons in departments across the UK. In an analysis by David Yorston, using data from the Scottish Retinal Detachment Census, 53% of RD are neither presenting nor being treated (personal communication). These figures across urgent and emergency ophthalmic services show a worrying trend that patients are neglecting symptoms of visual loss. Although it is possible that the rate of ocular trauma and retinal detachment is actually reduced due to inactivity during isolation, one can also infer that reduced presentation represents concerns regarding the risk of contracting COVID-19, particularly in a perceived high-risk environment such as a hospital. It may also reflect poor awareness of how to access ophthalmic care, many patients are familiar with initially seeking advice from an optometrist or GP. The closure of most optometry practices has limited access to ophthalmic advice. Unfortunately, websites such as NHS 111 advocate visiting an optician if patients have concerns regarding their vision. In response to this, the ophthalmic community have raised concerns through the Royal College of Ophthalmologists, the Macular Society, NHS 111 and NHS England to increase awareness of the importance of presenting in a timely manner with sight threatening conditions. There has also been increasing media coverage of concerns raised across the medical profession that patients are not presenting or presenting too late with life threatening conditions. Despite this, presentation rates remain well below those expected. This has wide ranging implications on the long-term health of our population. Ophthalmologists need to consider the hidden burden of ophthalmic disease when planning their recovery strategies. It is likely that we will see a considerable increase in emergency presentations which may be more advanced due to delayed presentation as the lockdown is eased. Similarly, when optometry services resume it is likely that we will see a further surge in ophthalmic referrals. It would be prudent to allow for increased emergency work when planning recovery strategies to deal with the potential back-log of known patients.

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Author and article information

Contributors

Amirhossein Roshanshad:

ORCID: http://orcid.org/0000-0001-6725-0045

Aroshanshad@gmail.com

Susanne Binder: susanne@susannebinder.com

Journal

Journal ID (nlm-ta): Spektrum Augenheilkd

Journal ID (iso-abbrev): Spektrum Augenheilkd

Title: Spektrum Der Augenheilkunde

Publisher: Springer Vienna (Vienna )

ISSN (Print): 0930-4282

ISSN (Electronic): 1613-7523

Publication date (Electronic): 30 June 2021

Pages: 1-6

Affiliations

[1 ]GRID grid.412571.4, ISNI 0000 0000 8819 4698, Student Research Committee, , Shiraz University of Medical Sciences, ; Shiraz, Iran

[2 ]GRID grid.412571.4, ISNI 0000 0000 8819 4698, MPH Department, School of Medicine, , Shiraz University of Medical Sciences, ; Shiraz, Iran

[3 ]GRID grid.263618.8, ISNI 0000 0004 0367 8888, Department of Ophthalmology, , Sigmund Freud University, ; Vienna, Austria

[4 ]GRID grid.5386.8, ISNI 000000041936877X, Department of Ophthalmology, , Weill Cornell Medicine, ; New York, USA

Author information

Amirhossein Roshanshad http://orcid.org/0000-0001-6725-0045

Article

Publisher ID: 493

DOI: 10.1007/s00717-021-00493-7

PMC ID: 8243622

SO-VID: a7e5fa94-e614-4b45-93e2-d801a51af19d

License:

This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

Retinal detachment during COVID-19 era: a review of challenges and solutions Translated title: Netzhautabhebung während der Corona-Pandemie: Überblick über Herausforderungen und Lösungen

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Summary

Background

Materials and methods

Results

Conclusion

Translated abstract

Related collections

Novel Coronavirus Disease COVID-19

Most cited references 27

Fewer cancer diagnoses during the COVID-19 epidemic in the Netherlands

Impact of the COVID-19 pandemic on the symptomatic diagnosis of cancer: the view from primary care

The impact of COVID policies on acute ophthalmology services—experiences from Moorfields Eye Hospital NHS Foundation Trust

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