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

Abstract

Purpose Early on in the COVID-19 pandemic, it was difficult to know what factors would affect patient and physician decision-making regarding ophthalmic care utilization. The purpose of this study is to investigate the effect of non-ophthalmic factors on patient decision-making to receive intravitreal injections during the COVID-19 lockdown. Patients and Methods Data on patients who had intravitreal injection appointments at a tertiary care Veterans Health Administration clinic during a seven-week period (March 19, 2020–May 8, 2020) of the COVID-19 outbreak in Los Angeles County were collected and compared to patients who had intravitreal injection appointments during the same time period in 2019. Demographic characteristics, injection diagnoses, visual acuities, body mass indices, co-morbidities, and psychiatric conditions of patients and clinic volumes were tabulated and compared between the two time periods. Results There were 86 patients in the injection clinic in 2020 compared to 176 patients in 2019. The mean age and gender of patients in the injection clinic did not differ between 2019 and 2020. Compared to 2019, the number of patients who identified as Hispanic or Latino remained nearly the same, but the number of patients who identified as White, Black, or Asian or Pacific Islander decreased by nearly half. In 2020, a greater proportion of patients came to the injection clinic for neovascular age-related macular degeneration (56.5% vs 39.3%, p=0.017), but a decreased proportion of patients diagnosed with a heart condition (OR 0.57, 95% CI 0.33, 0.96), chronic obstructive pulmonary disease (OR 0.43, 95% CI 0.21, 0.91), or asthma (OR 0.09, 95% CI 0.01, 0.70) came to the injection clinic. Conclusion The COVID-19 pandemic was associated with behavioral changes in eyecare utilization influenced by race and systemic co-morbidities. These data can be used to design and implement strategies to address disparities in essential ophthalmic care among vulnerable populations.

Socioeconomic Disparities in Patients Receiving Intravitreal Injections for Age-Related Macular Degeneration Amid the COVID-19 Pandemic

“…10,[12][13][14] To our knowledge, only 1 study has studied the effect of nonophthalmic factors (ie, race/ethnicity and systemic comorbidities) on adherence to intravitreal injection appointments during the pandemic. 15 This study found that compared with 2019, there was a drop in visit adherence in all racial and ethnic groups except patients identifying as Hispanic/Latino at a Veterans Affairs Hospital in Los Angeles County. 15 In our study, we investigated the effects of nonophthalmic factors on visit adherence for patients with nAMD having intravitreal injections.…”

“…15 This study found that compared with 2019, there was a drop in visit adherence in all racial and ethnic groups except patients identifying as Hispanic/Latino at a Veterans Affairs Hospital in Los Angeles County. 15 In our study, we investigated the effects of nonophthalmic factors on visit adherence for patients with nAMD having intravitreal injections. We retrospectively reviewed the medical charts of all patients scheduled to have an injection appointment during the initial wave of the COVID-19 pandemic at Boston Medical Center, the largest urban safety-net hospital in New England, or its 2 affiliated suburban eye clinics.…”

Effects of COVID-19 on Intravitreal Injection Clinic After Lockdown

“…Interestingly, our previous study demonstrated a significant rise in the Latino/Hispanic proportion of patients in injection clinic during the lockdown, which was not true after restrictions were lifted. 14 Our previous theory was that Hispanic patients tend to live in multigenerational housing and have a higher proportion of essential workers, which would increase the exposure risk to COVID-19. Though we cannot exactly determine why there was such a difference, we speculate that much higher COVID-19 infection and death rates in the Latino/Hispanic population during March and April 21 may have caused this vulnerable population to take more precautions and stay at home in May and June even after the lockdown was lifted.…”

“…13 We previously investigated both ophthalmic and non-ophthalmic factors during the COVID-19 lockdown period in Los Angeles County and found a decrease in patient volume by 50% along with an increased proportion of Hispanic patients, systemically healthier patients, and patients with a diagnosis of AMD compared with the year prior. 14 In this current study, we sought to study similar factors in the intravitreal injection clinic in the period immediately after lockdown to identify ophthalmic trends in the post-lockdown era.…”

Real-World Evidence for Treat-and-Extend Regimen of Ranibizumab Therapy for Macular Oedema Secondary to Branch Retinal Vein Occlusion

“…In addition, non-ophthalmologic factors have also been shown to have an impact on ophthalmic injections during the COVID-19 pandemic [20]. The T&E regimen responds to the needs of a public health system and to the new scenario generated by the COVID-19 pandemic, optimizing hospital visits and minimizing the number of injections as it is an individualized regimen.…”