Effects of the COVID-19 pandemic on neovascular age-related macular degeneration and response to delayed Anti-VEGF treatment

Yalınbaş, Duygu; Dursun, Demet; Bozali, Erman; Özeç, Ayşe Vural; Erdoğan, Haydar

doi:10.1016/j.jfo.2021.02.001

Cited by 33 publications

(41 citation statements)

References 28 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: 66%

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: 66%

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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“…Yeter et al [ 29 ] in Turkey found similar results of decrease in BCVA after the lockdown in a cohort of 106 nAMD patients that didn´t received any IVI treatment or visit during the lockdown, however, the follow-up period of the study is not clear.…”

Section: Discussionmentioning

confidence: 78%

“…To our knowledge, to date, there are only a few studies analyzing the early impact of the COVID-19 outbreak on BCVA changes, due to the delay or block in retinal diseases treatments. Additionally, these studies have potential bias and limitations, such as a heterogeneous study cohort or a limited number of patients enrolled, and the different protocols adopted in countries and periods of lockdown [ 27 , 28 , 29 ].…”

Section: Introductionmentioning

confidence: 99%

Impact on Visual Acuity in Neovascular Age Related Macular Degeneration (nAMD) in Europe Due to COVID-19 Pandemic Lockdown

Arruabarrena

Toro

Önen

et al. 2021

JCM

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This is a retrospective, multicenter study of consecutive patients with nAMD scheduled for a visit and/or a treatment with an intravitreal injection (IVI) during the 3 months before lockdown in the Ophthalmology Departments of six centers of Europe.The study was conducted on 546 patients, of which 55.13% were females, almost 100% of the patients were White/Caucasian race, and 71.53% of the patients presented a type 1 macular neovascularization (NVM). A total of 62.82% of patients (343 patients) that were on scheduled clinic visits and/or intravitreal injection treatment during the 3 months before the quarantine did not attend either to visit or for treatment during the lockdown. The mean number of injections during the lockdown was significantly reduced. This was followed by a significant reduction in the mean best-corrected visual acuity (BCVA) between the 3 months before the lockdown (mean BCVA of 60.68 ± 19.77 letters) and 6 months after lockdown (mean BCVA of 56.98 ± 22.59 letters). Patients with better BCVA before the lockdown and the ones showing neovascular activity were more likely to attend their scheduled visits and/or IVI treatments. The COVID-19 pandemic and the lockdown have led to a decrease in the number of IVI treatments in patients with nAMD, evidencing a significant vision loss at 6 months.

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“…An Italian study group recently evaluated the effects of COVID-19 and its restrictions on short-term VA outcomes of eyes with nAMD and found proof of significant worsening [ 15 ]. In France, a comparable patient cohort (116 eyes in 106 patients) was analyzed for differences in VA and OCT findings after postponing treatment for nAMD [ 16 ]. They also related the negative short-term effect on VA to the treatment interruption.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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Introduction To evaluate the effect of a 9-week treatment deferral due to healthcare restrictions caused by Austria’s first governmental lockdown associated with the coronavirus disease 2019 (COVID-19) pandemic on visual acuity (VA) in eyes compromised by exudative neovascular age-related macular degeneration (nAMD) after 1 year. Methods Retrospective data collection of 98 eyes (98 patients) with a treatment discontinuation at a tertiary eye care center (Clinic Landstraße, Vienna Healthcare Group, Austria) between March 16 and May 4, 2020. Prior to the lockdown, patients received multiple intravitreal injections (IVI) of anti-vascular endothelial growth factor with a personalized treatment interval for 3 years on average and at least three IVI after the lockdown. Results When the treatment interval doubled to 117.6 ± 31.4 days in spring 2020, patients lost 2.2 ± 4.6 ETDRS letters ( p = 0.002) on average before reinitiating therapy. In total, 4.1 ± 8.1 letters ( p < 0.0001) were lost despite continuous individual re-treatment over the course of the next year. In a univariate analysis, the extended interval time remained statistically significant ( p < 0.0001), indicating a larger VA reduction within intervals with increasing interval time in days. Conclusion The short-term treatment interruption had a persistent negative impact on the VA course of eyes under therapy after 1 year. Continuous therapy independent of the underlying treatment regimen remains of utmost importance in exudative nAMD. Our data should create awareness to regulators regarding future decisions despite the global pandemic. Supplementary Information The online version contains supplementary material available at 10.1007/s40123-021-00381-y.

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Effects of the COVID-19 pandemic on neovascular age-related macular degeneration and response to delayed Anti-VEGF treatment

Cited by 33 publications

References 28 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

Impact on Visual Acuity in Neovascular Age Related Macular Degeneration (nAMD) in Europe Due to COVID-19 Pandemic Lockdown

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

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