PONE-D-21-36763Changing trends in ophthalmological emergencies during the COVID-19 pandemicPLOS ONE

Dear Dr. Escribano Villafruela,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please read over the reviewer's comments carefully and make the required modifications. Take attention that the single-center study is not suitable to draw the manuscript's conclusions. Patients may have been referred to another hospital. There are no data or details on how local ophthalmology patient management was manage or whether these patients were able to be managed in another ophthalmology center. The data presented in this respect cannot therefore be evaluated on its own.

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Adrienne Csutak, MD, PhD, MSc

Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: No

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The authors aimed to examine how the trends in ophthalmological emergency cases changed during the COVID-19 pandemic in one of the largest tertiary referral hospitals in Spain. Data from more than 90 000 patients were collected retrospectively and compared with data from the previous year.

The conclusion is that the proportion of more severe ophthalmological conditions increased during the pandemic, while the number of cases decreased dramatically. In addition, the number of consultations for milder (e.g. conjunctival) diseases decreased partly for hygienical reasons and partly to fear of going to hospital.

The number of visits to ocular emergency consultations has fallen dramatically. The single-center study is not suitable to draw this conclusion. Patients may have been referred to another hospital. There are no data or details on how local ophthalmology patient management was manage or whether these patients were able to be managed in another ophthalmology center. The data presented in this respect cannot therefore be evaluated on its own.

Table 2 shows that the number of consultations for pathologies of the vitreous, retina and choroid has decreased to less than half, while the rate has increased by a statistically significant but only a few percent. Behind all statistically significant p-values is a difference of up to 6% between groups, which is not clinically significant in any way. This should be emphasized and all conclusions should be reconsidered and reassessed.

The message with the data in Table 1 is not transparent in this form (perhaps a graph is needed?).

The only real that is really clinically significant is that the number of monthly visits to the ophthalmology emergency department is decreased under COVID, which is an understandable fact; and is partly due to the population’s reluctance to consult the hospital for fear of contagion.

In summary, the conclusions of the study as presented are overstated and need to be reassessed and rewritten accordingly.

Reviewer #2: The topic of the article is current, analyzing the changes of ophthalmic care due to the COVID pandemic.

The topic of the article makes no mention of an important factor. Did patients have any opportunity for non-personal ophthalmic consultation/telemedicine during the pandemic? The number of patients appearing in the ohthalmic care system can be significantly affected by the possibility of a telephone consultation (one of the most common ophthalmic emergency conditions, conjunctivitis, can be treated during a pandemic by telephone and/or email consultation, followed by a prescription). This question should be added to the article.

The increase of uveitis cases during the pandemic period is mentioned in the last paragraph of the results chapter. What could have been the reason for this insignificant increase?

The number in the second column of the sixth row of Table 2 is incorrect (.7)

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Reviewer #1: No

Reviewer #2: No

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Changing trends in ophthalmological emergencies during the COVID-19 pandemic

PONE-D-21-36763R1

Dear Dr. Escribano Villafruela,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Adrienne Csutak, MD, PhD, MSc

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: (No Response)

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The revised manuscript is OK in its current form.

The revised manuscript is OK in its current form.

Reviewer #2: By reading the corrected manuscript, I accept the answers of the authors and recommend the article for publication.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No