Christine Blank

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In the first study of its kind, researchers found a majority of patients with coronavirus disease 2019 (COVID-19) also experience eye issues such as sore eyes and light sensitivity.

In fact, 81% of COVID-19 patients reported ocular issues within two weeks of other disease-related symptoms, according to the new research published in the journal 

 Of those, 80% said their eye problems lasted less than two weeks.

“This is the first study to investigate the various eye symptoms indicative of conjunctivitis in relation to COVID-19, their time frame in relation to other well-known COVID-19 symptoms, and their duration,” lead author Shahina Pardhan, Ph.D., professor and director of the Vision and Eye Research Institute at Anglia Ruskin University in Cambridge, U.K., said in a 

Sore eyes were significantly more common when the participants had COVID-19, with 16% reporting the issue as one of their symptoms. Only 5% reported having had the condition beforehand, according to a survey of 83 people.

While 18% of patients reported suffering from photophobia (light sensitivity) as one of their symptoms, this was only a 5% increase from their pre-COVID-19 state.

The most common reported symptoms overall were fatigue (suffered by 90% of respondents), a fever (76%), and a dry cough (66%).

“While it is important that ocular symptoms are included in the list of possible COVID-19 symptoms, we argue that sore eyes should replace ‘conjunctivitis’ as it is important to differentiate from symptoms of other types of infections, such as bacterial infections, which manifest as mucous discharge or gritty eyes,” Pardhan said.

“This study is important because it helps us understand more about how COVID-19 can infect the conjunctiva and how this then allows the virus to spread through the body,” Pardhan added.

Articles

The study investigates the various eye symptoms indicative of conjunctivitis in relation to COVID-19.

Eye Problems Common in COVID-19 Patients

While glucocorticoids are widely used to reduce inflammation in patients with many inflammatory diseases, doctors don’t know whether low to moderate glucocorticoid dose increases cardiovascular risk.

As a result, researchers at the University of Leeds in Leeds, UK, set out to quantify glucocorticoid dose-dependent cardiovascular risk in people with six immune-mediated inflammatory diseases in a new study published in 

The researchers conducted a population-based cohort analysis of medical records from 389 primary care practices contributing data to the United Kingdom Clinical Practice Research Datalink (CPRD) from 1998 to 2017.

They looked at the records for nearly 88,000 patients with giant cell arteritis and/or polymyalgia rheumatica, inflammatory bowel disease, rheumatoid arthritis, systemic lupus erythematosus, and/or vasculitiswho had no prior cardiovascular disease (CVD).

Incident CVD occurred in 15% of patients, including 6,013 who had atrial fibrillation, 7,727 who experienced heart failure, and 2,809 who had acute myocardial infarction events.

One-year cumulative risks of all-cause CVD increased from 1.4% in periods of non-use to 8.9% for a daily prednisolone-equivalent dose of greater than 5 mg. Five-year cumulative risks increased from 7% for periods of non-use to 28% with the daily dose greater than 5 mg. Compared to periods of non-glucocorticoid use, those with greater than 5 mg. daily prednisolone-equivalent dose had increased all-cause CVD risk, ranging from 1.52 for polymyalgia rheumatica and/or giant cell arteritis to 2.82 for systemic lupus erythematosus.

“Increased dose-dependent risk ratios were found regardless of disease activity level and for all type-specific CVDs,” the researchers wrote. “Individuals receiving steroids have an increased risk of developing a broad spectrum of fatal and nonfatal CVDs and that this risk increases with the dose of steroids and with the duration of steroid treatment.”

Experts previously believed that less than 5 mg. of prednisolone was safe over long term, the researchers wrote, but even at this “low dose,” patients with immune-mediated inflammatory diseases have a doubling of their underlying risk of CVD.

They believe that all patients requiring long-term steroid treatment should be prescribed the lowest effective steroid dose and have a personalized CVD risk prevention plan that takes into account current and prior steroid use.

“New treatment approaches that avoid the need for long-term steroid treatment and have better cardiovascular safety profile are required for immune-mediated inflammatory diseases,” the researchers wrote.

While glucocorticoids are widely used to reduce inflammation in patients with many inflammatory diseases, doctors don’t know whether a low to moderate glucocorticoid dose increases cardiovascular risk.

Steroids Increase Cardiovascular Risks in Inflammatory Disease Patients  

Avastin (bevacizumab) is less effective in treating Blacks with diabetic macular edema  — the most common cause of blindness in diabetics — than Whites, researchers discovered.

Researchers at Boston Medical Center conducted a first-of-its-kind retrospective cohort study looking at race as a factor in treatment of diabetic macular edema, and the results were published in the 

They found that Black patients were significantly less likely than White patients to show short-term visual improvement after both a single injection and a series of three injections with Avastin, the most common treatment in the U.S. for diabetic  macular edema.

African American are 60% more likely to have been diagnosed with diabetes than White, non-

Hispanic adults, according to the HHS Office of Minority Health. In addition, Black individuals have at least twice the prevalence of diabetic macular edema compared to white individuals, “and should be represented in future research accordingly," said 

, M.D., an ophthalmologic surgeon at Boston Medical Center and an assistant professor at the Boston University School of Medicine, said in a press release. Subramanian is the study's senior and corresponding author.

"The results from our study show a gap in treatment for black individuals with diabetic macular edema, despite the fact that they are more heavily impacted by this disease," Subramanian said. ”When clinical research trials don't include enough diversity, it will not provide comprehensive data about the efficacy across different racial and ethnic groups, which as we can see, results in disparities in care."

The researchers reviewed the electronic medical records of patients with diabetic macular edema who were treated with Avastin at Boston Medical Center. After the first injection, 27% of Black patients compared to 40% of Hispanic and 50% of White patients experienced improved visual acuity.

For those who received three injections of Avastin, 34% of Black patients compared to 55% of Hispanic patients and 59% of White patients experienced improvements in their visual acuity.

“Further research is warranted to understand the effect of race and ethnicity on anti-VEGF efficacy to ensure optimal treatment for each individual,” the researchers wrote.

Researchers say their study is the first to look at race as a factor in how people with diabetic macular edema respond to treatment with Avastin.

BU Researchers: Avastin For Diabetic Macular Edema Less Effective Among Blacks Than Whites

Millions of Americans need continued access to telehealth services, 

 those with rare disorders, many of which are autoimmune diseases, according to the National Organization for Rare Disorders (NORD).

“Currently, the Trump administration, Congress and state governments are trying to decide which changes to telehealth should be made permanent beyond the COVID-19 public health emergency,” NORD said in a new report, 

Ensuring Access to Telehealth for Rare Diseases

. “For the more than 25 million Americans with rare and undiagnosed diseases, having consistent access to healthcare providers is critical to their immediate and long-term health.”

NORD is an umbrella organization for about 300 patient advocacy organizations. The 1983 Orphan Drug Act defined a rare disease as one that affects less than 200,000 people in the United States. By some estimates, there are some 7,000 such diseases, and among the  autoimmune disorders included in the NORD database of rare disorders are Balo Disease, a rare variant of multiple sclerosis; Evans syndrome, an autoimmune disorder that attacks red and white blood cells; and Addison's disease, which about 75% of the time is the result of autoimmunity.

Often people with rare disorders depend on a small group of physicians and other clinicians who are knowledgeable about their disease. Prior to the pandemic that would often mean traveling long geographic distances to receive care. 

According to the NORD report, the organization's recent surveys of 800 rare disease patients found that, since the start of the coronavirus pandemic, more than 83% had been offered a telehealth visit by their healthcare provider and 88% accepted those visits.

Of those who had a telehealth visit, 92% described it as a positive experience, and 70% said they would like the option of telehealth for future medical appointments.

“Fortunately, during this time period, telehealth emerged as an increasingly common way for people to safely access medical care without risking exposure to the virus,” says the report.

In addition to preventing exposure to COVID-19, telehealth helps access to care by removing the transportation barriers that many rare disease patients face, suggests the NORD report.  

“The burden of travel is so great, that 17% have moved or are considering relocation to be closer to treatment to manage their rare disorder over the long term,” NORD said.

The federal government took important steps to temporarily expand coverage for telehealth services during the pandemic, including removing barriers for Medicare patients. Plus, most states are allowing out-of-state healthcare providers in good standing to practice telehealth across state lines.Many private insurers have also temporarily expanded access to telehealth services.

NORD is advocating for those changes to become permanent. “Many telehealth improvements are time-limited to the COVID-19 public health emergency declaration….our continued advocacy can help on this issue so that the positive changes that we have seen during the pandemic will endure after it ends,” the organization said.

Telehealth during the COVID-19 pandemic has been especially important to patients with rare disorders, many of which are autoimmune diseases, according to a recent report from the National Organization for Rare Disorders.

Christine Blank

Articles

Eye Problems Common in COVID-19 Patients

Steroids Increase Cardiovascular Risks in Inflammatory Disease Patients

BU Researchers: Avastin For Diabetic Macular Edema Less Effective Among Blacks Than Whites

NORD Report: COVID-19 Telehealth Surge Especially Important for People With Rare Diseases