Effect of COVID-19 Pandemic on Anti-VEGF Treatment of Medical Retinal Conditions

Abstract

Introduction: Ophthalmology services have been significantly impacted by the COVID-19 pandemic. Frequency of intravitreal anti-vascular endothelial growth factor (Anti-VEGF) injections are important in visual outcomes. Methods: We conducted an audit on intravitreal services in an NHS district general hospital in the UK including all new patients with diabetic macular oedema (CI-DMO) and wet age-related macular degeneration (AMD) who were initiated on intravitreal injection of Aflibercept (EYLEA) between 1st January to 15th July 2020, and had subsequent injections until October 2020. Data on injection dates and visual acuity was extracted, and the total number of all intravitreal injections for all indications between January to September 2020 and the same period in 2019. Delay to treatment was defined as more than 14 days, according to the fixed dosing schedule. Results: We found 31% (n=17) of patients initiated on treatment for wet AMD and 44% (N=11) for CI-DMO had delayed injections. There was no correlation between total duration of delay and change in best-corrected visual acuity (BCVA). Similarly, we found no association between duration of delay and change in BCVA. The number of intravitreal injections declined during the COVID-19 pandemic by 17.8% compared to 2019. Conclusion: Majority of patients initiated on anti-VEGF injections just before the pandemic or during the pandemic received injections on time. Where there were significant delays to treatment, there was no detected loss in vision over the short term. However, the long-term impact and impact of overall reduction in intravitreal injections are unknown.

The impact of delayed anti-vascular endothelial growth factor treatment for retinal diseases during the COVID-19 lockdown

“…[ 18 ] Similarly, Mana et al In their study, 17 wet-AMD patients and 11 DME patients who received at least one dose of antiVEGF showed a significant decrease in visual acuity when the second and third doses were delayed, while visual acuity increased in DME patients, but this increase was not statistically significant. [ 19 ] Treatment delays and changes in visual acuity in these two studies were similar to our results. In addition, while patients in both studies received at least one dose of antiVEGF, the dose of antiVEGF was not administered in our study.…”

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

“…They also related the negative short-term effect on VA to the treatment interruption. Data records of a small British patient cohort ( n = 17) with a mean treatment delay of 47 days (median 26 days) showed no significant VA loss as compared to the latter year [ 17 ]. A South Korean group showed marked VA deterioration after discontinuing treatment with a follow-up of 24 months in a different setting [ 18 ].…”

Safety Outcomes of Brolucizumab in Neovascular Age-Related Macular Degeneration

“…Moreover, early 2020 coincided with the first wave of COVID-19 cases in the US, which led to decreased clinic attendance of patients with AMD for follow-up anti-VEGF injections. [25][26][27] Estimates of AEs could be subject to bias as a result of patient failure to attend follow-up appointments before the end of the study period. In defining the boundary conditions of the analysis, we attempted to balance this by providing enough time for patient follow-up and obtaining early insights into the prevalence of AEs following brolucizumab injection.…”