Impact of Delayed Intravitreal Anti-Vascular Endothelial Growth Factor (VEGF) Therapy Due to the Coronavirus Disease Pandemic on the Prognosis of Patients with Neovascular Age-Related Macular Degeneration

Abstract

This study estimated the outcome of delayed intravitreal anti-vascular endothelial growth factor (VEGF) therapy due to the coronavirus (COVID-19) disease pandemic on the prognosis of patients with neovascular age-related macular degeneration (nAMD). This study retrospectively enrolled 57 nAMD patients whose intravitreal anti-VEGF injections were delayed for >2 weeks between February and June 2020. Best-corrected visual acuity (BCVA), central subfield thickness (CST), and anatomical characteristics were evaluated before (baseline), on the day, and at 2, 4, and 6 months after the delayed injection, and risk factors were identified. The average injection interval before and after treatment delay was 3.05 ± 1.45 and 2.41 ± 1.46 months, respectively (p = 0.002). The CST at baseline and on the day of delayed injection was 227.82 ± 62.46 and 267.26 ± 77.74 µm, respectively (p < 0.001). The average BCVA decreased from 0.29 ± 0.29 logMAR (baseline) to 0.38 ± 0.31 logMAR (6 months) (p = 0.001). The maximum subretinal fluid (SRF) height increased from 84.32 ± 89.33 µm (baseline) to 121.38 ± 103.36 µm (6 months) (p = 0.027). A higher baseline maximum SRF height was associated with less SRF height deterioration 6 months later (p < 0.001). Delayed intravitreal anti-VEGF therapy caused by the COVID-19 pandemic has worsened BCVA and residual SRF in nAMD patients after a temporary recovery. The baseline SRF reduce the degree of SRF height deterioration.

Diagnostic Accuracy of the Amsler Grid Test for Detecting Neovascular Age-Related Macular Degeneration

“…A key factor for treatment success is early intervention before onset of irreversible subretinal fibrosis . Treatment delay translates to significantly worse visual acuity, which has become especially apparent during the COVID-19 pandemic . Thus, diagnostic tools for early detection of neovascular AMD are essential to preserve vision in patients with AMD.…”

“…[3][4][5] Treatment delay translates to significantly worse visual acuity, which has become especially apparent during the COVID-19 pandemic. [6][7][8] Thus, diagnostic tools for early detection of neovascular AMD are essential to preserve vision in patients with AMD.…”

Two-Year Follow-Up Study of Patients with Neovascular Age-Related Macular Degeneration Undergoing Anti-VEGF Treatment during the COVID-19 Pandemic

“…The maximum SRF height showed a relatively worse course in the delayed group until the 18th follow-up month compared to the other parameters. As previously mentioned [22], the slow recovery of SRF in the delayed group could be attributed to the inclusion of patients with nAMD and refractory SRF [23,24]. In such patients, the SRF showed a relative response to intravitreal anti-VEGF injections even after changing the treatment regimen and shortening the injection interval.…”

“…We previously showed that delayed anti-VEGF injections due to the COVID-19 pandemic significantly aggravated BCVA and anatomical pathology, and the condition did not improve to the pre-pandemic status 6 months after the onset of the pandemic [22]. However, our previous study was limited by the lack of a control group and the short follow-up period (6 months).…”

Impact of COVID‐19 on ophthalmic medical access during successive waves: Demographics, disease factors, and wave locations

“…Varied experiences regarding management and care delivery during the COVID‐19 pandemic have been reported in subspecialties, including glaucoma treatment, medical retina treatment, neuro‐ophthalmology, and uveitis treatment 4–8 . Decreased ophthalmology‐related medical use was also reported in Korea 9–12 . Intravitreal anti‐vascular endothelial growth factor therapy was delayed because of the COVID‐19 pandemic and worsened prognosis 12 …”