key: cord-278775-xntvl7jp
authors: Gangaputra, Sapna S.; Patel, Shriji N.
title: Ocular symptoms among non-hospitalized patients who underwent COVID-19 testing
date: 2020-06-22
journal: Ophthalmology
DOI: 10.1016/j.ophtha.2020.06.037
sha: 
doc_id: 278775
cord_uid: xntvl7jp

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Meeting presentation 9

No portion of this work has been presented at any conference. 10 11

Acknowledgements 12

Research reported in this publication was supported by the National Center for Advancing 13

Translational Sciences of the National Institute of Health under Award Number UL1 14

TR000445. The content is solely the responsibility of the authors and does not necessarily 15 represent the official views of the National Institutes of Health. 16

The study was also supported in part by a The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), known as 44 has been designated a global pandemic by the World Health Organization. 1 The vast majority of 45 patients with COVID-19 are advised to isolate and recuperate at home. The "stay at home" 46 restrictions and limited access to ambulatory ophthalmology care may inadvertently delay the 47 recognition of ocular signs and symptoms associated with Currently, we have minimal data on the incidence and severity of ocular manifestations of non-49 hospitalized COVID-19 positive patients. Characterizing ocular manifestations in this cohort 50 will help ophthalmologists learn how, if at all this virus affects the eye in an ambulatory 51

population. To answer these questions, an electronic REDCap 2,3 survey was developed and 52 distributed to participants of the COVID Volunteer Research database, which was created by 53 the Vanderbilt Institute for Clinical and Translational Research (VICTR). Every adult who 54 underwent testing for COVID-19 at one of Vanderbilt University Medical center (VUMC) walk-in 55 locations was provided the opportunity to volunteer to participate in future research studies. 56

Patients were tested either due to COVID like symptoms, or if at risk due to occupational 57 reasons or following exposure to an affected person. The database is maintained at a central 58 secure location and the survey was approved exempt by the IRB/Ethics committee of VUMC 59 and performed in accordance with the tenets of the Declaration of Helsinki. Study data were 60 collected and managed using REDCap 2,3 electronic data capture tools hosted at Vanderbilt 61 University Medical center. The survey questionnaire was sent to participants independent of 62 their COVID-19 test results. Basic demographic questions as well as underlying medical and 63 ocular history were investigated. Allergy questions were added to tease out seasonal ocular and 64 systemic symptoms that are common in the middle Tennessee region and may be mistaken for 65 COVID-19 during the pandemic. Descriptive statistics were performed for this analysis. 66

The survey was distributed to approximately 1100 eligible persons who had provided written 67 informed consent. Participants responded to the survey 1 to 4 weeks following the results of 68 their COVID-19 testing. A total of 458 surveys were completed during the study period. Eight 69 surveys were removed from the analysis due to incomplete or missing data. Of the remaining 70 COVID-19 negative patients in our cohort. Red eye (21.9%) and excessive tearing (17.6%) were 86 both found at a significantly higher rate in COVID-19 negative survey respondents (Table) To date, the reports on ocular findings have been limited. Conjunctivitis 4 has been reported, 94 however, recent reports show low prevalence of conjunctivitis and chemosis in COVID-19 95 hospitalized patients. 5,6 OCT and retinal findings of 12 adult patients from Sao Paulo, Brazil, 96 described cotton wool spots and microhemorrhages suggestive of ischemic changes in the 97 papillomacular bundle with no signs of intraocular inflammation. 7 As clinics start to re-open, we 98 must anticipate the ocular conditions that could present as either direct end organ damage 99 from COVID-19 infection or as sequalae following cytokine release or thromboembolic 100 phenomena or secondary ischemic events. 101

In our cohort, the most common symptoms experienced were red eye, photophobia, epiphora 102 and eye pain. Interestingly, some of these symptoms were more likely to be noted among 103 COVID-19 negative patients than COVID-19 positive patients. While it is important to take all 104 necessary precautions, we hope this data will reassure patients and physicians that every red 105 eye is NOT necessarily a sign of COVID-19. To further elucidate why several patients may have 106 red eyes and "allergic" ocular symptoms, we explored the history of drug and environmental 107 allergies among cohorts. COVID-19 negative patients had higher rates of self-reported drug 108 allergies; this is of unclear clinical significance. 109

There are several limitations to this analysis. The analysis is based on patient reports and 110 therefore subject to recall bias and selection bias. We received responses from 458 of over 111 1000 participants, which may suggest patients with ocular symptoms were more likely to 112 respond to a study about ocular associations with COVID-19. The study was conducted in an 113 urban setting where the prevalence of COVID-19 was higher than surrounding counties, and 114 our respondents were predominantly white. The strengths of the study are the large number of 115 responses from patients who are non-hospitalized, which is over 80% of affected In conclusion, this retrospective patient survey found no association between ocular symptoms 118 and COVID-19 positivity in an outpatient population. 

WHO Declares COVID-19 a Pandemic

Research electronic data 123 capture (REDCap) -A metadata-driven methodology and workflow process for providing 124 translational research informatics support

The REDCap consortium: Building an 127 international community of software partners

Keratoconjunctivitis as the initial medical presentation of the novel 130 coronavirus disease 2019 (COVID-19)

Clinical Characteristics of Coronavirus Disease

Ocular Findings and Proportion with Conjunctival SARS-135 COV-2 in COVID-19 Patients

Retinal findings in 138 patients with COVID-19