Treatment of neovascular age related macular degeneration during COVID-19 pandemic: The short term consequences of unintended lapses

Abstract

Aim: To investigate the short-term effects of COVID-19 pandemic related unintended treatment lapses on neovascular age related macular degeneration (nAMD) patients. Methods: In this prospective cross-sectional study, 140 patients who had at least one anti-vascular endothelial growth factor (VEGF) injection for nAMD within 12 months before COVID-19 pandemic and who had at least 3 months of unintended lapse for control visits during pandemic were recruited and underwent a detailed opthalmological examination and optical coherence tomography imaging. Results: Of these 140 eyes, 113 (80.7%) were active with presence of either intraretinal and/or subretinal fluid and necessitated intravitreal anti-VEGF injections; and 20 (14.3%) of them complicated with subretinal hemorrhage. The mean interval of clinical visits and intravitreal antiVEGF injections were found to be prolonged during COVID-19 pandemics, which demonstrates a statistically significant lapse for both ( p = 0.001 and p = 0.003 consecutively). The decreased visual acuity due to lapse was positively correlated with number of intravitreal anti-VEGF injections at last 6 months before COVID-19 pandemic ( r = 0.217, p = 0.010) and central subfoveal thickness at first post-COVID-19 visit ( r = 0.175, p = 0.038); and negatively correlated with follow-up duration ( r = −0.231, p = 0.006) and number of control visits ( r = −0.243, p = 0.004). Fifteen (16.9%) of the 89 patients who had drusen in the fellow eye before COVID-19 pandemic evolved to nAMD with an accompanying subretinal and/or intraretinal fluid. Conclusion: Unintended lapses during COVID-19 pandemic resulted with poor functional and structural outcomes for nAMD patients, especially for those at the beginning of the treatment period and who still have an unstable clinical course.

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

“…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.…”

The Effect of Treatment Discontinuation During the COVID-19 Pandemic on Visual Acuity in Exudative Neovascular Age-Related Macular Degeneration: 1-Year Results

“…Similar 6-month results were extracted from a data registry, which stated that VA remained stable if re-treatment interval was extended by not more than 10–12 weeks [ 12 ]. Another study group associated unintended lapses over 3 months with poor functional and structural outcomes for patients with nAMD, especially in unstable clinical courses [ 13 ]. In our study cohort, four eyes with a long treatment interval before the lockdown did not experience a persistent VA loss due to the extended interval (Table 1 V3 and Fig.…”

Delayed anti-VEGF injections during the COVID-19 pandemic and changes in visual acuity in patients with three common retinal diseases: A systematic review and meta-analysis

“… 2 , 27 , 28 , 36 In the end, 14 studies (including 1,931 patients) were included in the quantitative synthesis. 4 , 5 , 8 , 24 , 29 , 30 , 31 , 33 , 34 , 35 , 37 , 44 , 45 , 46 The PRISMA diagram detailing the study screening process is shown in Supplementary File, Figure S1 .…”