Short term visual and structural outcomes of anti-vascular endothelial growth factor (anti-VEGF) treatment delay during the first COVID-19 wave: A pilot study

Naravane, Ameay V.; Mundae, Rusdeep; Zhou, Yujia; Santilli, Christopher; Kuijk, Frederik J.G.M. van; Nazari, Hossein; Yamanuha, Justin; Emerson, Geoffrey G.; Koozekanani, Dara D.; Montezuma, Sandra R.

doi:10.1371/journal.pone.0247161

Cited by 37 publications

(40 citation statements)

References 17 publications

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“…General guidelines on the management of nAMD were prepared after the onset of the pandemic [13,14], recommending treatment administration for every nAMD patient every two months, regardless visual functional or macular anatomical aspects, in an empirical attempt to minimize what was expected to be a mayor disaster. It is clear that this catastrophic situation has had a negative impact on functional and anatomic outcome of nAMD, as can be seen in our cohort and also in the majority the studies published in 2021 about this subject [15][16][17][18][19][20][21][22]. Even with an average delay of one month, Borrelli et al [15] found significant loss of BCVA and proportional to visit delay.…”

Section: Discussionsupporting

confidence: 67%

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Effect of COVID-19 Lockdown in Spain on Structural and Functional Outcomes of Neovascular AMD Patients

Valverde-Megías

Rego-Lorca

Fernández‐Vigo

et al. 2021

JCM

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This is a retrospective single-center study of patients with neovascular age-related macular degeneration whose follow-up was delayed due to COVID-19 pandemic with at least three months between visits in Madrid, Spain. The purpose of the study was to evaluate best corrected visual acuity (BCVA) changes and try to identify features in optical coherence tomography (OCT) that could be related to more profound visual loss. It included 270 eyes. The two last visits before lockdown were used for comparison with the visit after lockdown. BCVA changed from 60.2 ± 18.2 to 55.9 ± 20.5 ETDRS letters. 29% of the eyes lost more than 5 letters. OCT was active in 67% of eyes before lockdown and in 80.4% after lockdown. Multiple lineal analysis showed that patients whose OCT before lockdown presented with a combination of intra and subretinal fluid were more likely to suffer a greater visual loss (p = 0.002). These patients should be encouraged to not miss any visits in case a new lockdown is imposed.

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Section: Discussionsupporting

confidence: 67%

“…In the study by Naravane et al [16], 36 patients diagnosed with neovascular AMD experienced delays in treatment (defined as more than 14 days) and visual acuity decreased 6.2 letters (from 48.6 to 42.3, p = 0.04). In our study with 270 eyes, mean delay of 110 days meant a change of −3.6 letters.…”

Section: Discussionmentioning

confidence: 98%

Effect of COVID-19 Lockdown in Spain on Structural and Functional Outcomes of Neovascular AMD Patients

Valverde-Megías

Rego-Lorca

Fernández‐Vigo

et al. 2021

JCM

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“…Within the DME subgroup, patients whose injections were delayed trended towards a decline in vision from logMAR 0.544 (Snellen 20/70) pre-lockdown to logMAR 0.722 (Snellen 20/105) on follow-up (p = 0.06). In contrast, patients whose injections were not delayed did not experience a statistically significant decline in vision (p = 0.40) [31]. Delayed anti-VEGF treatment in patients with DME also resulted in an increase in mean central subfield thickness from 341 to 447 µm (p = 0.007).…”

Section: Impact Of Delayed Care On Visual Outcomesmentioning

confidence: 93%

The Impact of COVID-19 on Diabetic Retinopathy Monitoring and Treatment

Ahmed

Liu

2021

Curr Diab Rep

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Purpose of Review Diabetic retinopathy (DR) is one of the leading causes of vision loss worldwide. Although screening and early treatment guidelines for DR have significantly reduced the disease burden, restrictions related to the COVID-19 pandemic have changed real-world practice patterns in the management of DR. This review summarizes evolving guidelines and outcomes of the treatment of DR in the setting of the pandemic. Recent Findings Intravitreal injections for DR have decreased significantly globally during the pandemic, ranging from approximately 30 to nearly 100% reduction, compared to corresponding timepoints in 2019. Most studies on functional outcomes show a decrease in visual acuity on delayed follow-up. Summary Changing practice patterns in the management of DR has led to fewer intravitreal injections and overall reduction in visual acuity on follow-up. As COVID variants emerge, it will be necessary to continue evaluating practice guidelines.

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“…Although diabetic retinopathy represents the largest subgroup of patients, there was a significant decline in the number of patients with diabetic retinopathy attending the clinic during the pandemic period. Naravane et al [22] reported that treatment delays had a negative impact on the visual and anatomic outcomes of patients with neovascular AMD and DME during the COVID-19 lockdown in Minnesota. They compared the VA and structural changes in the retina using ocular OCT and observed worse visual outcomes in the delayed treatment group [22].…”

Section: Discussionmentioning

confidence: 99%

Intravitreal injections during the COVID-19 pandemic era

Dülger¹,

Çıtırık²,

Camgoz³

et al. 2021

Med Hypothesis Discov Innov Optom

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Background: This study aimed to evaluate the clinical characteristics and changes in the number of patients receiving intravitreal injections (IVIs) at a tertiary hospital during the coronavirus disease 2019 (COVID-19) pandemic as compared to the pre-pandemic period. Methods: This retrospective, cross-sectional study included 3,211 patients with retinal disease, who received IVIs of anti-vascular endothelial growth factor (anti-VEGF) between January and May 2020. This 5-month period was divided into a pre-pandemic and a pandemic period. Clinical and demographic data were collected and were compared between the patients in each period. All COVID-19 infection precautions were implemented to minimize the potential transmission of COVID-19 to both healthcare workers and patients. Results: A total of 3,211 IVIs were administered to patients with diabetic retinopathy, age-related macular degeneration, retinal vein occlusion, and other retinal conditions. Diabetic retinopathy was the most common indication for treatment in the pre-pandemic as well as pandemic periods. Bevacizumab (Avastin, Roche) was the most common IVI type, followed by aflibercept (Eylea, Bayer). Of 3,211 IVIs, 2,943 (91.7%) were administered during the pre-pandemic period and 268 (8.3%) during the pandemic period. There was a statistically significant decrease in injections between the pre-pandemic and pandemic periods, with an overall reduction of 90.8% in IVIs (P < 0.05). No cases of confirmed transmission of COVID-19 orcomplications associated with IVIs were recorded. Conclusions: This study showed that the number of IVIs and patient visits decreased significantly, by more than 10-fold, during the lockdown period. These findings show that COVID-19 has turned the management of sight-threatening eye diseases into a challenging process and must be addressed if future healthcarerestrictions are imposed.

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Short term visual and structural outcomes of anti-vascular endothelial growth factor (anti-VEGF) treatment delay during the first COVID-19 wave: A pilot study

Cited by 37 publications

References 17 publications

Effect of COVID-19 Lockdown in Spain on Structural and Functional Outcomes of Neovascular AMD Patients

Effect of COVID-19 Lockdown in Spain on Structural and Functional Outcomes of Neovascular AMD Patients

The Impact of COVID-19 on Diabetic Retinopathy Monitoring and Treatment

Intravitreal injections during the COVID-19 pandemic era

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