Comment on: The Impact of COVID-19 on Individuals Across the Spectrum of Visual Impairment.

Editor

We read with great interest the recent article published by Shalaby and associates. The authors compared the perceptions and implications of COVID-19 across individuals with varying degree of visual impairment (VI) in an Indian population. They observed that blind participants more commonly perceived vision as a risk factor for contracting COVID-19 and were more concerned about access to health care. In addition, at the time of their publication, the authors pointed out that there was no evidence in the literature that had examined the effect of VI on various aspects of life in relation to COVID-19. On this front, we would like to draw the authors’ attention to an article that was published by our group last year on a similar area where we had evaluated the psychosocial impact of COVID-19 pandemic on people with VI in the United Kingdom. Several similarities and discrepancies were noted between the 2 studies, of which some are worthy of further comments.

In May 2020, we conducted an online survey among 325 participants with varying degree of VI. Overall, we observed that COVID-19 pandemic lockdown had significantly affected the mental health (46%), loneliness (46%), social life (85.3%), anxiety related to hospital visits (55.1%), and fear of sight loss due to delayed review/treatment (46%). Similar to Shalaby et al, we noted that individuals with moderate VI were most likely to experience mental health issues such as depression and anxiety (3 times more likely than individuals with no/mild VI). In addition, we observed that individuals of working age group (18-64 years) were more likely to experience mental health issues than older individuals (>65 years), suggesting that age (and employment status) are important factors to be considered when assessing the impact of COVID-19. Notably, Shalaby and associates reported a positive correlation between the extent of VI and increased age in their study, though the potential confounding effect of age on various significant outcomes linked to the extent of VI was not examined. Potentially, the authors could consider performing multivariable logistic regressions (for several important outcomes) to account for the independent effect of age, extent of VI, level of education, and other factors.

In addition, although they observed that individuals with moderate VI were more concerned about health, the fear of further sight loss was similar across all age groups and extent of VI in our study. The discrepancy between the 2 studies might be related to the difference in the timing of administrating the survey (in relation to the timing of national lockdown), health care systems, culture, and level of education.

COVID-19 pandemic had led to significant disruption to the delivery of ophthalmic services. Telemedicine, with potential integration of artificial intelligence, has shown promise as an effective solution for improving the workflow efficiency and tackling the unprecedented crisis in ophthalmology.4, 5, 6 As individuals with VI are more commonly affected by the implications of COVID-19 pandemic, it is important to ensure that the new digital technologies are made as user-friendly as possible for this vulnerable group of individuals.