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

Abstract

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.

The Impact of COVID-19 on Diabetic Retinopathy Monitoring and Treatment

“…While the decrease in clinical volume was not as dramatic, the number of intravitreal injections administered did not experience full recovery. At the Bascom Palmer Eye Institute in the USA during the “new normal” of operations from June 18 to August 7, 2020, a 9.9% decrease in intravitreal injections was noted compared to the corresponding period in 2019 [ 27 ]. Similarly, in France, there was a 11.5% decrease in observed intravitreal anti-VEGF injections compared to expected injections (extrapolated from the prior two years) in the period following lockdown (May 11–June 7, 2020).…”

The Impact of Non-Ophthalmic Factors on Intravitreal Injections During the COVID-19 Lockdown

“…Reports have already shown that missed injections during COVID-19 have resulted in more submacular hemorrhages, which can cause significant visual loss. 7 , 8 …”

The Influence of COVID-19 Lockdown in Jordan on Patients with Diabetic Retinopathy: A Case–Control Study

“…Ashkenazy et al studied the short-term effect of deferral of intravitreal injection visits due to COVID-19 pandemic. 17 They found that patients with delayed visits had a greater decline in visual acuity of 3 letters and higher rates of worsening OCT results. 17 In their study about the delay of intravitreal injection, Elfalah et al concluded that delay of more than 2 months and the previous need for 3 or more injections were significant poor prognostic factors for visual outcome for patients with DME.…”

“… 17 They found that patients with delayed visits had a greater decline in visual acuity of 3 letters and higher rates of worsening OCT results. 17 In their study about the delay of intravitreal injection, Elfalah et al concluded that delay of more than 2 months and the previous need for 3 or more injections were significant poor prognostic factors for visual outcome for patients with DME. 18 Another important issue is the negative impact of delaying the treatment of diabetic patients for their diabetes and co-morbidities.…”