Delayed hospital presentation of acute central retinal artery occlusion during the COVID-19 crisis: the HORA study brief report No. 4.

Abstract

Dear Editor, Under the COVID-19 pandemic, many patients avoided hospital attendance out of fear.[1] There are also observed delays in presentation in patients with acute vascular diseases, including cerebral stroke and myocardial infarction.[23] However, literature search (via PubMed, Medline, EMBASE, Scopus, Cochrane library, and Google Scholar) on whether patients suffering from an acute ocular stroke (i.e., central retinal artery occlusion (CRAO)) behaved similarly did not reveal any previous publication. We retrospectively reviewed our HORA study’s data on acute CRAO patients’ onset-to-arrival time[4] and analyzed their differences before and during the COVID-19 local outbreak. HORA study was conducted in a tertiary hyperbaric oxygen therapy (HBOT) center serving 7 million populations as the only territory-wide public and private referral center providing the standard HBOT treatment for every acute CRAO patient. Approved by the local research ethics committee (HKECREC-2020-116), we retrospectively reviewed the onset-to-arrival time (in minutes) of Group 1 (from the start of the HBOT center in November 2018 to the start of the COVID-19 local outbreak in February 2020) and Group 2 (during the four local waves of COVID-19 outbreak, ending on March 2021) patients. Normal distribution was tested by the Shapiro–Wilk test, and data were then compared using SPSS version 27. Results are shown in Table 1. Group 1’s onset-to-arrival time was 124.1+/−102.9 minutes, which was not normally distributed. In contrast, Group 2’s onset-to-arrival time was in a normal distribution and was 236.2+/−108.7 minutes. Nonparametric test (Mann–Whitney U) was used to compare the data, which yielded Z = −2.96 and P = 0.003.Table 1: Demographics and symptom onset-to-arrival time data for acute central retinal artery occlusion (CRAO) patients attending the hyperbaric oxygen therapy (HBOT) center in the HORA studyAcute CRAO patients presented to the hospital 112.1 minutes later during the COVID-19 outbreak, which is a critical timeframe for irreversible photoreceptor changes. Our study is the first to report a delay in hospital presentation of acute CRAO during the COVID-19 crisis. Given the low incidence of CRAO, our limited sample size of 40 is comparable to most published CRAO HBOT studies.[5] Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.