The Impact of COVID-19 on Intravitreal Injection Compliance

Wasser, Lauren M.; Weill, Yishay; Brosh, Koby; Magal, Itay; Potter, M; Strassman, Israel; Gelman, Evgeny; Koslowsky, Meni; Zadok, David; Hanhart, Joël

doi:10.1007/s42399-020-00614-4

Cited by 49 publications

(56 citation statements)

References 34 publications

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“… 12 Recent studies show that the 2020 pandemic closure resulted in a 53–75% reduction in IVIs when compared to 2019. 4 , 13 , 14 Our study demonstrates a relatively lower, but significant, 10% overall decrease in IVI volume in 2020 after the severest of restrictions were rescinded compared to the same period in 2019, with over 2.5 times as many delayed intravitreal injection treatment encounters. At least 42% of these delayed IVIs were directly related to pandemic-related constraints.…”

Section: Discussionmentioning

confidence: 62%

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Short-Term Effects of COVID-19-Related Deferral of Intravitreal Injection Visits

Ashkenazy¹,

Goduni²,

Smiddy³

2021

OPTH

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Purpose To determine secondary effects of the mandated COVID-19 pandemic closure period for elective treatment on non-elective, injection-based retina care and outcomes. Patients and Methods In this cross-sectional, retrospective analysis of a single-provider outpatient clinic across multiple satellites, consecutive patients returning for intravitreal injections (IVIs) of anti-vascular endothelial growth factor or corticosteroids were identified as “delayed” or “undelayed” during a six-week study interval during the COVID-19 pandemic that closely following a mandated period of prohibited elective encounters. A “delayed” encounter was defined as having a follow-up interval exceeding 33% of the recommended cycle. Patients seen for IVIs during the corresponding six-week interval a year previously were identified for study as pre-COVID-19 controls. Main outcome measures included best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) assessment based on findings of intraretinal or subretinal fluid consistent with new or recurrent neovascular events. Results The study included 183 eyes of 144 patients who underwent IVI-based care from June 18, 2020, through August 7, 2020, compared to 193 eyes of 154 patients injected during the corresponding interval 1 year before. There were 62 eyes of 46 patients seen in the study period later than scheduled (among 144 patients of 183 eyes in total), which represented a larger proportion of delayed patients compared to the previous year (31.9% vs. 14.9%, p<0.0005). Considering the patterns from the control group, the attributed delay due to COVID-19 was 15.0% of patients. The delayed return eyes had a greater decline in BCVA (3 letters), higher rates of worsened OCT results (48%), and prompted reduction in previously prescribed injection intervals (p<0.02). Conclusion The unintended consequence of delayed care of patients on established care regimens should be anticipated, and mitigate strategies considered if similar restrictions are mandated in the future.

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Section: Discussionmentioning

confidence: 62%

“…2 , 3 Consequently, an executive order by the Florida governor authorized only urgent encounters beginning on March 17, 2020 and ending on May 11, 2020. 4 …”

Section: Introductionmentioning

confidence: 99%

Short-Term Effects of COVID-19-Related Deferral of Intravitreal Injection Visits

Ashkenazy¹,

Goduni²,

Smiddy³

2021

OPTH

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“…The reduction in the average number of patients attending visits and IVI procedures during COVID-19 quarantine periods compared to the same periods from previous years has been demonstrated [ 27 – 30 ]. Considering the age and accompanying disorders of the nAMD patients, the fear of contracting COVID-19 from hospitals might have led to poor clinical attendance; therefore, informing the nAMD patients about precautions to minimize infection via an appointment letter or telephone call has been suggested to reduce non-attendance [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

The effect of COVID-19 pandemic restrictions on neovascular AMD patients treated with treat-and-extend protocol

et al. 2021

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Purpose To investigate the adherence rate of neovascular age-related macular degeneration (nAMD) patients in treat-and-extend (TAE) protocol to their anti-vascular endothelial growth factor (anti-VEGF) intravitreal injection (IVI) appointments and to evaluate the functional and anatomical outcomes of the patients who attended and did not attend their IVI appointments during the coronavirus disease 2019 (COVID-19) restriction period (RP). Methods The patients with nAMD having IVI appointments between March 16 and June 1, 2020 (RP in Turkey) were included in this retrospective study. For adherence analysis, the patients who attended (Group 1, n = 44) and who did not attend (Group 2, n = 60) their IVI appointment visits during the RP ( V RP ) were evaluated according to their last visit before the RP ( V 0 ). For outcome analysis, the patients who attend V RP and have follow-up (Group 1a, 46 eyes) and who did not attend V RP but later attended for follow-up (Group 2a, 33 eyes) were evaluated for functional (best-corrected visual acuity, BCVA [logMAR]) and anatomical (optical coherence tomography [OCT] disease activity) outcomes at the first visit after RP ( V 1 ) and last visit within six months after RP ( V 2 ). Patients received a complete ophthalmologic evaluation with anti-VEGF (Aflibercept) IVI administration at all visits. Results The adherence rate of the patients to V RP was 42.3% (44/104). The patients in Group 1 were significantly younger (mean ± SD years, 71.0 ± 8.1 vs. 74.7 ± 8.0, p = 0.024), had better median [IQR] BCVA at their first presentation (0.30 [0.54] vs. 0.61 [1.08], p = 0.023) and V 0 (0.40 [0.48] vs. 0.52 [0.70], p = 0.031), and had less hypertension (36.4% vs. 58.3%, p = 0.044) than Group 2. The mean ± SD delay of planned IVI at V RP in Group 2a was 13.9 ± 6.2 weeks. Disease activity in OCT was significantly higher in Group 2a than Group 1a at V 1 (60.6% vs. 32.6%, p = 0.025). In Group 2a, the median (IQR) BCVA was significantly worse at V 1 (0.70 [0.58]) and V 2 (0.70 [0.59]) than V 0 (0.52 [0.40], p = 0.047 and p = 0.035, respectively). Conclusions More than half of the scheduled nAMD patients in TAE protocol mi...

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“…Despite many clinics’ efforts to provide a safe environment for intravitreal injections during the pandemic, patient adherence to treatment regimens declined during the initial wave of the COVID-19 pandemic. By comparing the total number of intravitreal injection visits from March 15 th to April 14 th in 2020 to the same time period over the past four years, Wasser et al estimated a 50% reduction in the number of clinic visits for intravitreal injections in 2020 [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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Regularly scheduled intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections are essential to maintaining and/or improving many ocular conditions including: neovascular age-related macular degeneration (nAMD), diabetic retinopathy, and retinal vein occlusions with macular edema (RVO). This study aims to assess the effect of unintended delays in anti-VEGF treatment during the first wave of the COVID-19 pandemic. This retrospective case series identified patients receiving regularly scheduled anti-VEGF intravitreal injections based on current procedural terminology (CPT) code at two practices in Minnesota. Diagnoses were limited to nAMD, diabetic macular edema (DME), proliferative diabetic retinopathy, and RVO. Patients were divided into two groups based on whether they maintained or delayed their follow-up visit by more than two weeks beyond the recommended treatment interval during the COVID-19 lockdown. The ‘COVID-19 lockdown’ was defined as the period after March, 28th, 2020, when a lockdown was declared in Minnesota. We then compared the visual acuity and structural changes to the retina using ocular coherence tomography (OCT) to assess whether delayed treatment resulted in worse visual outcomes. A total of 167 eyes from 117 patients met criteria for inclusion in this study. In the delayed group, the average BCVA at the pre- and post-lockdown visits were 0.614 and 0.715 (logMAR) respectively (p = 0.007). Central subfield thickness (CST) increased from 341 to 447 in the DME delayed group (p = 0.03) while the CST increased from 301 to 314 (p = 0.4) in the nAMD delayed group. The results of this pilot study suggests that treatment delays may have a negative impact on the visual and anatomic outcomes of patients with nAMD and DME. Future studies with larger sample sizes are required for further investigation.

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The Impact of COVID-19 on Intravitreal Injection Compliance

Cited by 49 publications

References 34 publications

Short-Term Effects of COVID-19-Related Deferral of Intravitreal Injection Visits

Short-Term Effects of COVID-19-Related Deferral of Intravitreal Injection Visits

The effect of COVID-19 pandemic restrictions on neovascular AMD patients treated with treat-and-extend protocol

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

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