Outcomes of Eyes Lost to Follow-up with Neovascular Age-Related Macular Degeneration Receiving Intravitreal Anti-Vascular Endothelial Growth Factor

Soares, Rebecca R.; Mellen, Phoebe L.; Garrigan, Hannah; Obeid, Anthony; Wibbelsman, Turner D.; Borkar, Durga S.; Ho, Allen C.; Hsu, Jason

doi:10.1016/j.oret.2019.07.010

Cited by 41 publications

(49 citation statements)

References 14 publications

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“…Guidance to prioritise injections in those with nAMD is based on the known poor outcomes of these patients prior to the advent of anti-VEGF. Multiple studies have shown worsening VA and OCT features in patients who have anti-VEGF injections delayed [ 15 ], with some studies suggesting poor VA persisting on final follow-up despite normalisation of central foveal thickness after a period of delayed treatment [ 16 ]. Our study does support the belief that nAMD eyes do indeed seem to be most at risk of visual loss with delays in anti-VEGF treatment but also shows that RVO eyes have an increased risk from treatment delay.…”

Section: Discussionmentioning

confidence: 99%

Delayed follow-up of medical retina patients due to COVID-19: impact on disease activity and visual acuity

Stone

Grinton

Talks

2021

Graefes Arch Clin Exp Ophthalmol

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Purpose The coronavirus pandemic has prompted unprecedented delays to treatment with anti-VEGF intravitreal injections due to the need to reduce hospital attendances and prioritise the patients at highest risk of vision loss. This study aims to quantify the effect of these delays on visual acuity (VA) outcomes and optical coherence tomography (OCT) features for patients receiving treatment for neovascular age-related macular degeneration (nAMD), retinal vein occlusions (RVO) and diabetic macular oedema (DMO) and correlate to the Royal College of Ophthalmologists guidelines (RCOphth). Methods A retrospective data analysis of an electronic medical record was performed on a random sample of eyes receiving anti-VEGF injections for nAMD, RVO or DMO. Data collected included age, sex, reason for injection, number of weeks delay if > 8 weeks from that planned, VA at baseline and follow-up and the OCT features, if delayed. For those eyes not delayed, a visual acuity at 20 weeks was recorded to provide a control group. Results A sample of 981 eyes (858 patients) were analysed. There was a delay in review of 8 weeks or more in 39.6% of patients of which 30.4% had since returned for review (28.4% nAMD, 37.6% RVO and 30.0% DMO). There was no demographic difference identified between the delayed and non-delayed patients; however, the delayed group was significantly more likely to have better vision in their non-treated eye (p = 0.0003). A statistically significant difference was found in the change in VA between the delayed and the not-delayed group for eyes with nAMD (p = 0.001) but not for RVO or DMO. For the delayed group, mean CMT increased by 33 and 100 μm, respectively, for nAMD and RVO and decreased by 7.8 μm for DMO. The VA of 89.7% of DMO eyes returned to baseline, compared to 74.6% and 76.9% of nAMD and RVO eyes. Conclusion The RCOphth guidance to prioritise intravitreal injections for nAMD over DMO appears appropriate in this cohort but not for RVO. Eyes with nAMD experienced the greatest loss of vision with treatment delay, and nAMD and RVO eyes were less likely to return to baseline on restarting treatment.

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Section: Discussionmentioning

confidence: 99%

Delayed follow-up of medical retina patients due to COVID-19: impact on disease activity and visual acuity

Stone

Grinton

Talks

2021

Graefes Arch Clin Exp Ophthalmol

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“…A South Korean group showed marked VA deterioration after discontinuing treatment with a follow-up of 24 months in a different setting [ 18 ]. Soares et al [ 19 ] recently published data on eyes under anti-VEGF injections that were lost to follow-up for a mean of 12 months and concluded that the recovery would only be partially after re-treatment. As an initial consequence, a model calculation of the study cohort based on the long-term VA course of untreated eyes was performed to estimate the effect of the installed measures (unpublished results).…”

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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“…The neovascular form (nAMD) is currently the leading cause of legal blindness in the United States. 6 This pathology mainly affects elderly people who are also at higher risk of morbidity and mortality due to COVID-19. 7 These nAMD patients require regular follow-ups for assessments and treatment using intravitreal injections.…”

Section: Introductionmentioning

confidence: 99%

Fear Associated with COVID-19 in Patients with Neovascular Age-Related Macular Degeneration

Rozon¹,

Hébert²,

Bourgault³

et al. 2021

OPTH

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Purpose: Since the beginning of the COVID-19 pandemic, news related to the pandemic has created a feeling of fear, particularly among high-risk groups including elderly patients. This study aimed to assess the fear associated with COVID-19 and to evaluate the fear of vision decrease related to the delay of treatment in neovascular age-related macular degeneration patients (nAMD) during the pandemic. Patients and Methods: This is a prospective cross-sectional study of 160 actively treated patients with nAMD enrolled between September and November 2020 at a tertiary hospital in Québec, Canada. For each participant, demographic and clinical data were collected. The anxiety was rated in a questionnaire composed of two sections: the Fear of COVID-19 Scale (FCV-19S) and eight additional questions to assess ophthalmology-related COVID-19 statements. Results: The mean ± standard deviation level of FCV-19S was 17.05±4.38. In the multivariable analysis, it was significantly higher in women (p<0.001) and lower in patients with a high school education vs elementary school (p=0.009). In the ophthalmology-related statements, 16% feared vision loss because of difficulties in maintaining regular follow-ups during the pandemic. The female gender was significantly associated with a higher tendency to postpone their appointment (p=0.03). No association was found between the patients' underlying disease characteristics and higher fear of vision loss. Conclusion: Despite the massive impact of the pandemic, anxiety related to COVID-19 and delaying ophthalmology treatments remained relatively low in nAMD patients. Greater explanations to address this fear may reduce anxiety level, especially among female patients and those with an elementary school education.

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Outcomes of Eyes Lost to Follow-up with Neovascular Age-Related Macular Degeneration Receiving Intravitreal Anti-Vascular Endothelial Growth Factor

Cited by 41 publications

References 14 publications

Delayed follow-up of medical retina patients due to COVID-19: impact on disease activity and visual acuity

Delayed follow-up of medical retina patients due to COVID-19: impact on disease activity and visual acuity

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

Fear Associated with COVID-19 in Patients with Neovascular Age-Related Macular Degeneration

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