Addressing COVID-19 fear to improve clinic attendance for patients with wet age-related macular degeneration.

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In line with the recommendations from national (Royal College of Ophthalmologists, 2020) and international (American Academy of Ophthalmology, 2020) ophthalmology societies, only urgent or emergent care is being provided in our ophthalmology department. Despite implementing precautions to reduce the risk of COVID-19 transmission in our clinics (Royal College of Ophthalmologists, 2020), we have noticed a sharp fall in patients with sight-threatening conditions, such as wet age-related macular degeneration (wAMD) attending their appointments. There is increasing evidence that patients are avoiding hospital for fear of contracting COVID-19 (Wong et al., 2020). We evaluated the effect of COVID-19 on the clinic attendance rate for patients with wAMD, and whether non-attendance could be improved by addressing patients’ fears of contracting COVID-19 in the ophthalmology department. We invited all patients with wAMD scheduled to attend an intravitreal injection clinic at our institution, from 27 April 2020 to 1 May 2020, to participate in an anonymous survey to assess their perception of personal safety in clinic, during the COVID-19 pandemic. Patients who attended were provided with a self-completion survey whilst a telephone survey was conducted for patients who did not attend their appointment. For all patients, the survey asked about awareness of current COVID-19 clinic precautions in place to minimize infection, and their perception of safety if there was a requirement to wear a facemask or covering. For patients who did not attend their appointment, the survey also asked the reasons for non-attendance and if they would have been more likely to attend if informed beforehand of the precautions taken. For patients who attended the clinic, the survey also asked whether they felt fearful coming to the clinic, and if they would have been less fearful had they been informed of the clinic precautions taken. A total of 264 patients were scheduled to attend clinic – 46% did not attend their appointment. Overall 253 patients completed the survey (96% completion rate) – 123 from patients who did not attend the clinic and 130 from patients who did attend. For patients who did not attend their appointment, 85% stated the reason was because they felt fearful of contracting COVID-19. Ninety-eight per cent of patients who did not attend were not aware of any precautions in place to minimize infection, whilst 71% stated that they would have attended had they been made aware beforehand of these precautions. For patients who attended, 51% were fearful of contracting COVID-19, 62% were unaware of the clinic precautions put in place, and 53% stated that they would have been less fearful had they been informed beforehand of these precautions. For all patients, 53% stated that they felt safer in the clinic if there was a requirement to wear a facemask or covering. Our study has shown that during the COVID-19 pandemic, there is a significant problem with poor clinic attendance for patients with wAMD, associated with a fear that it is not safe enough to attend. Informing patients beforehand about the local precautions in place to minimize infection may be the most effective way of making patients feel safer and reducing non-attendance. Informing patients via an appointment letter or telephone could readily achieve this. Whilst the debate on the use of patient facemasks and coverings continues globally, our findings show that many patients would feel safer if it became a requirement to wear one in the clinic. Ophthalmology departments should take steps to address patients’ fears of contracting COVID-19 to increase clinic attendance. Crucially, this will minimize sight loss for those with wAMD and other sight-threatening conditions. Not only is this of paramount importance during the COVID-19 pandemic but it is also of great relevance in the coming months as more ophthalmology care is reopened.