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

Abstract

Purpose : To assess the clinical status of treatment-naive patients who had to delay 3-dose loading anti-VEGF (anti-vascular endothelial growth factor) injections during the COVID-19 lockdown, and to evaluate the effect of the delayed visual acuity treatment on spectral domain optical coherence tomography (SD-OCT) parameters. Method : A total of 55 eyes of 46 patients who were received in the study period participated in this retrospective study, including 28 patients (37 eyes) with diabetic macular edema (DME), 11 patients (11 eyes) with retinal vein occlusion (RVO), and 7 patients (7 eyes) with wet age-related macular degeneration ( wet- AMD). The patients were diagnosed with DME, RVO, or wet-AMD in February 2020 and had planned 3-dose loading injections in March, April, and May 2020, but could not be injected due to the COVID-19 pandemic. Results : From the patients’ initial examination in February 2020, the mean best corrected visual acuity (BCVA) was 0.72 ± 59 logMAR. After the patients’ lockdown visit in July 2020, the mean BCVA was 0.76 ± 64 logMAR. BCVA was stable in 11 eyes, decreased in 12 eyes, and increased in 14 eyes for patients with DME. BCVA was stable in 6, decreased in 3, and increased in 2 eyes for patients with RVO, and it was stable in 4 eyes and decreased in 3 eyes for patients with wet- AMD. Conclusion : We concluded that 6-month delay in treatment of DME patients with non-proliferative DRP had no adverse effect on the visual acuity. However, the loading dose in wet- AMD and RVO patients should be applied as soonas possible.

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 .…”

“…All included studies were observational in nature. All studies measured changes in patients with nAMD while 10 studies measured changes in patient with DME 5 , 8 , 24 , 27 , 28 , 29 , 33 , 34 , 36 , 44 and 9 studies measured changes in those with RVO. 5 , 8 , 24 , 28 , 29 , 33 , 34 , 36 , 44 The mean length of time between the last pre-pandemic visit and the first visit during the pandemic was four months or greater for eight studies.…”

“…All studies measured changes in patients with nAMD while 10 studies measured changes in patient with DME 5 , 8 , 24 , 27 , 28 , 29 , 33 , 34 , 36 , 44 and 9 studies measured changes in those with RVO. 5 , 8 , 24 , 28 , 29 , 33 , 34 , 36 , 44 The mean length of time between the last pre-pandemic visit and the first visit during the pandemic was four months or greater for eight studies. 5 , 30 , 33 , 35 , 37 , 44 , 45 , 46 BCVA was measured using logMAR in 10 studies, ETDRS letters in seven studies, and decimal Snellen in one study.…”

COVID-19 pandemic decreased the ophthalmic outpatient numbers and altered the diagnosis distribution in a community hospital in Taiwan: An observational study

“…DM-related diseases and RVO both lead to macular edema and loss of retinal photoreceptors and retinal pigment epithelium; these may also cause visual impairment or distortion [ 46 , 47 ]. Bulut et al also investigated the impact of delayed anti-VEGF treatment for retinal diseases and found that a six-month delay in intravitreal injection of loading doses of anti-VEGF had adverse effects in macular edema from RVO [ 48 ]. A prompt detection and treatment of these ophthalmic diseases and related chief complaints may maximize the effects of adequate eye care when it comes to cost-benefit analysis during the COVID-19 pandemic.…”

Postponed care due to COVID-19 lockdown impact on visual acuity of retinal vein occlusion patients: a large cohort

“…At the same time, for their part, patients tried to avoid exposure to the virus by delaying and avoiding elective visits [ 12 ]. During that period, patients received a reduced number of injections and less frequent medical follow-ups, which was associated with adverse outcomes in patients with RVO [ 13 ].…”