Long-Term Consequences of COVID-19 Lockdown in Neovascular AMD Patients in Spain: Structural and Functional Outcomes after 1 Year of Standard Follow-Up and Treatment

Abstract

Consequences of the COVID-19 pandemic on medical care have been extensively analyzed. Specifically, in ophthalmology practice, patients suffering age-related macular degeneration (AMD) represent one of the most affected subgroups. After reporting the acute consequences of treatment suspension in neovascular AMD, we have now evaluated these same 242 patients (270 eyes) to assess if prior functional and anatomical situations can be restored after twelve months of regular follow-up and treatment. We compared data from visits before COVID-19 outbreak and the first visit after lockdown with data obtained in subsequent visits, until one year of follow-up was achieved. For each patient, rate of visual loss per year before COVID-19 pandemic, considered “natural history of treated AMD”, was calculated. This rate of visual loss significantly increased during the lockdown period and now, after twelve months of regular follow-up, is still higher than before COVID outbreak (3.1 vs. 1.6 ETDRS letters/year, p < 0.01). Percentage of OCT images showing active disease is now lower than before the lockdown period (51% vs. 65.3%, p = 0.0017). Although anatomic deterioration, regarding signs of active disease, can be apparently fully restored, our results suggest that functional consequences of temporary anti-VEGF treatment suspension are not entirely reversible after 12 months of treatment, as BCVA remains lower and visual loss rate is still higher than before the COVID-19 pandemic.

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

“…The BCVA and anatomical findings of the patients did not return to the pre-pandemic status even after 1 post-pandemic year, which is consistent with the results of previous studies [16,17]. However, these results should be interpreted with caution because patients with nAMD may exhibit a worsening long-term course despite receiving appropriate treatment during the follow-up period [18,19].…”

“…However, there is a gap in these previous studies as they did not consider the impact of natural disease progression on nAMD [18,19], given that they did not compare it with a control group receiving timely treatment. In fact, although BCVA did not recover in a previous study, anatomic deterioration was reported to be fully restored [16]. Moreover, no study has applied a follow-up period of more than 2 years.…”

“…Several studies have followed patients who experienced delayed treatment because of the pandemic for up to one year [16,17]. In these studies, it was reported that delayed treatment due to COVID-19 in nAMD patients resulted in impaired BCVA, which did not recover over the subsequent year.…”