Negative impact of COVID-19 lockdown on papilloedema and idiopathic intracranial hypertension
Mark Thaller, Georgios Tsermoulas, Rosa Sun, Susan P. Mollan, Alexandra J. Sinclair
Abstract
The neurological complications of SARS-CoV-2 infection are increasingly being recognised, as is the impact of enforced lockdown on both acute admissions and those with pre-existing neurological conditions. Papilloedema is a medical emergency requiring correct identification, timely investigations and a multidisciplinary approach.1 During the first National lockdown, access to optometric and hospital services, in the UK, was limited to absolute emergencies. The aim of this study was to evaluate the impact of lockdown on those presenting with new onset papilloedema and those with existing idiopathic intracranial hypertension (IIH) at a neuroscience centre in the UK. A 10-week prospective evaluation (15 May 2020 to 30 July 2020) of emergency papilloedema and IIH clinics. Patients seen were referred urgently with new papilloedema or potential exacerbation of existing IIH. IIH follow-up appointments, cancelled due to enforced national lockdown and deployment of staff to frontline services, were also seen. Data collected included demographics, final diagnosis, weight, visual acuity (logarithm of the minimum angle of resolution (logMAR)), perimetric mean deviation (MD) (Humphrey 24–2 (Swedish Interactive Testing Algorithm (SITA)) central threshold) and papilloedema (optical coherence tomography (OCT), average global peripapillary retinal nerve fibre layer (RNFL)). Headache frequency (days per month) and the headache impact test-6 questionnaire (HIT-6) were noted. Depression and anxiety were evaluated (Hospital Anxiety and Depression Scale (HADS) scores: 0–7 normal, 8–10 mild, 11–14 moderate, 15–21 severe). Cerebrospinal fluid (CSF) shunt data for IIH from 2019 were recorded retrospectively. Mean and SD have been reported. Worst eye data were reported. Changes were evaluated using the χ2 test with the significance set at p<0.05. Missing data were excluded (constituting <16%). Hundred and thirty adult patients were assessed in 10 weeks. 92% were women with mean age of 32.5 and …