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Shayaan Kaleem,1 Mitsuaki Sawano,2,3 Adith S Arun,4 Fred Warner,2,3 Tianna Zhou,5 Chenxi Huang,2,3 Bornali Bhattacharjee,6,7 Yuan Lu,2,3 Akiko Iwasaki,6– 8 Kristen Nwanyanwu,9 Iqbal Ike K Ahmed,10– 12 Harlan M Krumholz2,3,6,13 1Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; 2Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT, USA; 3Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA; 4Yale School of Medicine, New Haven, CT, USA; 5Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA; 6Center for Infection and Immunity, Yale School of Medicine, New Haven, CT, USA; 7Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA; 8Howard Hughes Medical Institute, Chevy Chase, MD, USA; 9Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT, USA; 10Department of Ophthalmology and Vision Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA; 11Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada; 12Prism Eye Institute, Mississauga, ON, Canada; 13Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USACorrespondence: Harlan M Krumholz, Center for Outcomes Research and Evaluation, Yale New Haven Hospital, 195 Church Street, 5th Floor, New Haven, CT, 06510, USA, Tel +1 203 497 1239, Fax +1 203 764 5653, Email harlan.krumholz@yale.eduIntroduction: This study compared demographics, socioeconomic characteristics, pre-pandemic health conditions, newly diagnosed health conditions, and long COVID symptoms between participants with and without self-reported new-onset ocular symptoms after COVID-19 infection.Material and Methods: We performed a cross-sectional analysis of the Listen to Immune, Symptom, and Treatment Experiences Now (LISTEN) study. Adults who self-reported long COVID, completed surveys between May 2022 and October 2023, and did not report post-vaccination syndrome were included. Ocular symptoms were defined as self-reported new-onset blurring or loss of vision, dry eyes, or floaters/flashes of light attributed to long COVID. Group comparisons used percentages for categorical variables and median and interquartile range (IQR) for continuous variables as well as Bonferroni-adjusted P-values. A gradient-boosted tree model was used to identify symptoms that differentiated groups.Results: Among 595 participants (median age 46 years [IQR 38– 56]; 73% female), 341 (57%) reported ocular symptoms. Pre-pandemic comorbidities were similar between groups. Participants with ocular symptoms had lower EuroQoL visual analogue scale health scores (median 40 [IQR 30– 59] vs 51 [IQR 39– 70], P < 0.001), greater financial difficulties (20% vs 8.8%, P < 0.001), increased worry about housing stability (16% vs 5.4%, P < 0.001), and higher rates of new-onset dysautonomia (38% vs 15%, P < 0.001) and myalgic encephalomyelitis/chronic fatigue syndrome (21% vs 9.1%, P = 0.005). Key differentiating symptoms included dizziness, cold intolerance, pressure at the base of the head, tinnitus, and tremors.Conclusion: Individuals with long COVID with self-reported new-onset ocular symptoms after infection may represent a more severe phenotype, with poorer health status and greater socioeconomic challenges despite similar pre-pandemic health profiles.Keywords: long COVID, vision, public health, epidemiology