Impact of the COVID-19 pandemic and Honey Rose case on hospital attendances of patients suspected to have papilloedema

OBJECTIVE To measure the impact of the COVID-19 pandemic and Honey Rose case on hospital attendances of patients with suspected papilloedema METHODS Retrospective observational study of patients attending a specialist eye hospital in Bristol for investigation of papilloedema and/or headache. Exposures were the first lockdown of the COVID-19 pandemic in England in 2020 and the widespread media coverage of the Honey Rose case in 2016. Outcomes were the number and proportion of true positive and false positive referrals of patients with suspected papilloedema and/or headache before and after the exposures. RESULTS Hospital attendances within the neuro-ophthalmology service in Bristol had increased 5-6 times following the Honey Rose case and was associated with an increase in false positive referrals for suspected papilloedema from 33.3% in 2015 to 60.9% in 2016. Hospital attendances fell during the first COVID-19 lockdown, predominantly affecting false negative referrals for suspected papilloedema (78.1% before, 64.3% during, and 79.7% after lockdown) of which 60.1% had completely normal optic discs. CONCLUSIONS Ophthalmology is the now the busiest outpatient medical specialty in the UK, in part, due to changes to undergraduate medical training and the lower threshold for hospital eye service referrals since Honey Rose and the introduction of OCT to optician practices. Advances in digital technology that were accelerated by the pandemic might help to improve communication between primary and secondary care and the diagnostic accuracy of referrals for suspected papilloedema to avoid unnecessary hospital appointments and costly false positive diagnostic cascades.