![]() Second, many ophthalmologic procedures are elective. First, patients who visit ophthalmic clinics are typically older and thus have a higher risk of poor outcome in the event of a COVID-19 infection. There are four possible reasons for this. In addition to the health administration recommendation to avoid unnecessary ER visits, many ophthalmological societies recommended avoiding all ocular treatments unless they were urgent. During COVID-19, in certain countries optometrists helped coping with the reduced hospital capacity and were responsible for managing the majority of urgent patients, while in other countries optometrist services declined drastically. In many countries, optometrists, who serve as eye care practitioners, are another source of referral. Such examples include retinal tear, macula-on retinal detachment, and high intraocular pressure. This is why a substantial proportion of OER referrals are secondary to examination findings during a routine examination by an eye care practitioner, such as primary ophthalmologists. An additional reason which may be overlooked is that in many ocular emergencies there is no ocular pain, and signs and symptoms may be subtle. ![]() This might occur either due to fear of contracting the COVID-19 virus, fear of spreading the virus to immediate household family members, and concern over breaking lockdown curfew rules. ![]() Alternatively, it may reflect avoidance of leaving home and accessing the OER even when sight threatening conditions exist. Any decrease in OER visits during lockdown may reflect several underlying tendencies: a tendency to avoid presenting with non-urgent conditions as requested by the health authorities and a general reduction in trauma cases resulting from fewer people leaving their homes during lockdown, and thus fewer work, sport and recreation-related injuries, as has been described. The latter tend to increase as access to ophthalmologic services at primary care settings is reduced, and waiting time increased. Reasons for OER visits include ophthalmic conditions requiring urgent assessment and intervention such as trauma and loss of vision, as well as a significant proportion of non-urgent conditions such as conjunctivitis. Furthermore, it is possible that government directions will not be similarly accepted and followed in different countries, cultures, age groups, genders, etc., creating differential effects depending on such parameters. While an equivalent reduction in the rate of visits to the ophthalmologic ER (OER) during lockdown is likely, the demographics and ocular conditions at presentation may also vary between lockdown and non-lockdown periods. This observation raised concerns regarding the risk/benefit of discouraging ER visits during the COVID-19 pandemic, even for severe illness requiring immediate medical intervention. Worldwide, a few public health studies have assessed the effects of the COVID-19 pandemic on general ER visits, demonstrating a sharp reduction in visits after declaration of a lockdown. The lockdown was accompanied by a recommendation to avoid visiting the emergency room (ER) unless deemed necessary. As the incidence of COVID-19 rose, the government declared a national state of emergency on March 2020, and a full, general lockdown was announced. In the beginning of 2020 the first cases of the 2019 coronavirus disease (COVID-19) were detected in Israel.
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