King Fai C. Leung, Mojtaba Golzan, Chaminda Egodage, Simon Rodda, Richard Cracknell, Peter Macken, Shweta Kaushik

Purpose: To analyse the pattern of ophthalmic presentations to an outer metropolitan and a rural emergency department (ED) during the COVID-19 pandemic in New South Wales (NSW), Australia.

Method: A retrospective audit of emergency department (ED) coding data for ophthalmic emergency presentations to Campbelltown Hospital (fifth busiest metropolitan ED in NSW with a population coverage of 310,000) and Bowral and District Hospital (a rural ED with a population coverage of 48,000) for the period of 1 March to 31 May in 2019 and 2020 was conducted. Variables including patient demographics, triage category, referral source, discharge diagnosis, length of stay, departure status and follow-up location were assessed. Differences before and during COVID-19 were analysed using chi-squared tests or inde- pendent samples t-tests.

Results: While there was a significant drop in total presentations to both EDs (p < 0.01), there was no change in ophthalmic presentations during COVID-19 at Campbelltown (+1.75%, p = 0.12) and an increase in ophthalmic presentations at Bowral (+11%, p < 0.01). Non-urgent ophthalmic presentations increased for both EDs (p = 0.03 for Campbelltown, p < 0.01 for Bowral). Urgent ophthalmic presentations decreased at Bowral ED (p = 0.0075). Patients presenting with visual disturbance decreased at Campbelltown ED (-71%, p = 0.017). Conclusion: Despite a significant drop in total ED presentations during the COVID-19 pandemic, an upward and varied trend in ophthalmic presentations to two EDs in an outer metropolitan and a rural location was observed, suggesting a need for a flexible ophthalmic healthcare delivery strategy such as tele-ophthalmology to optimise patient care during and after the pandemic