The influence of delayed treatment due to COVID-19 on patients with neovascular age-related macular degeneration and polypoidal choroidal vasculopathy

Abstract

Purpose: To explore the impact of coronavirus disease 2019 (COVID-19) on the prognosis of patients with neovascular age-related macular degeneration (nAMD) and polypoidal choroidal vasculopathy (PCV), and share the experience in managing them during pandemics. Method: This is a retrospective study of nAMD and PCV patients treated at Peking Union Medical College Hospital from 31 December 2019 to 1 August 2020. Baseline demographic and clinical characteristics, best corrected visual acuity (BCVA), optical coherence tomography (OCT) features, duration of delayed treatment and number of anti-vascular endothelial growth factor (VEGF) injections were analyzed. Results: A total of 130 nAMD patients (155 eyes) and 76 PCV patients (89 eyes) were identified. Compared to the conditions before COVID-19, the BCVA of delayed cases decreased significantly, and the proportion of patients presenting with sub-macular scar was significantly greater in the delayed treatment group ( p < 0.05). The BCVA of non-delayed cases remained stable, with the percentage of patients with disease activity sub-retinal fluid and hemorrhage at the fovea decreasing significantly ( p < 0.05). The stable cases who did not require anti-VEGF treatment had significantly worse baseline and final BCVA, these patients were likely to be chronic and ‘burnt out’ cases with significantly worse anatomical structures ( p < 0.05). Conclusions: The delayed cases due to the pandemic suffered compromised visual function and a higher rate of sub-macular scar formation, while the visual function of non-delayed cases remained stable with favorable anatomical outcomes, suggesting the importance of regular follow-up for nAMD and PCV patients. Besides, effective measures of hospitals during pandemics are crucial to provide timely treatment for chronic disease.

The Influence of COVID-19 on the Stability of Patients with Neovascular Age-Related Macular Degeneration with Different Treatment Regimens

“…As a result of the sudden epidemic, many medical institutions had to stop clinical work, and the routine treatment of many patients was interrupted, including those receiving anti-VEGF treatment. Untreated disease or delayed treatment with anti-VEGF will result in patients with severe visual impairment during the initial diagnosis of nAMD, and for patients with nAMD who have already begun to receive anti-VEGF treatment, a sudden interruption or delay in treatment secondary to interruptions by the COVID-19 pandemic can also result in decreased visual acuity and a recurrence of the lesions [ 19 , 20 ]. However, it is not clear whether patients with nAMD who have reached a stable state after a course of anti-VEGF treatment will be affected by the COVID-19 pandemic.…”

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 .…”

“… 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. The majority of studies reported worsening of vision due to delays caused by the COVID-19 pandemic with the exception of patients with DME in studies by Bulut and coworkers, Sindal and coworkers, and Elfalah and coworkers, 5 , 8 , 33 as well as patients with RVO in studies by Naravane et al and Sindal et al 24 , 33 These studies reported either no change or minor improvements in vision.…”

“…The references by Song et al and Zhao et al are key references as they are methodologically rigorous articles that report their outcomes clearly and in detail. 34 , 46 …”

COVID-19 and retinal degenerative diseases: Promising link “Kaempferol”

“…In the non-delayed cases, visual function remained constant with favorable anatomical results, highlighting the need for regular follow-up for patients. Furthermore, appropriate hospital procedures during pandemics are critical for prompt treatment for chronic diseases [ 57 ]. Optical Coherence Tomography (OCT) revealed lesions at the inner plexiform and ganglion cell layers post SARS-CoV-2 infection [ 58 ].…”