The negative impact of COVID-19 pandemic on age-related macular degeneration patients treated with intravitreal bevacizumab injections

Abstract

Purpose COVID-19 emerged in the end of 2019 and was declared a worldwide pandemic shortly after. Social distancing and lockdowns resulted in lower compliance in intravitreal injections and office visits. We aimed to assess clinical outcomes among patients who missed these visits compared to those who arrived as planned. Methods Patients who missed or were late to office visits or intravitreal injections were defined as non-adherent and were compared to adherent patients. Our main outcomes were the need for subsequent injections, mean change in best-corrected visual acuity (BCVA), and central macular thickness (CMT). Results This study included 77 patients (24 adherent and 53 non-adherent). The mean BCVA remained stable during the study period for the adherent group ( p = 0.159) and worsened in the non-adherent group ( p < 0.001). Changes in CMT and maximum thickness were not significant for either group. A higher proportion of patients in the non-adherent group needed subsequent intravitreal injections (49% vs 20%, p = 0.014). Conclusion The findings demonstrate the negative implications of the COVID-19 pandemic and the effect of deferring bevacizumab injections among individuals with age-related macular degeneration. This emphasizes the importance of a scheduled follow-up, also during a pandemic. Supplementary Information The online version contains supplementary material available at 10.1007/s10792-022-02337-y.

Non-adherence and non-persistence to intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy: a systematic review and meta-analysis

“…Twenty-one studies assessed patients taking Aflibercept injections [ 15 , 26 , 34 – 36 , 38 , 39 , 41 , 43 , 45 , 49 – 52 , 63 – 66 , 68 , 70 , 71 ]. Seventeen studies included Bevacizumab as the intravitreal drug [ 29 , 32 , 35 , 38 , 39 , 41 , 45 , 46 , 49 – 51 , 57 , 61 , 62 , 69 – 71 ], and three studies looked at patients treated with Pegaptanib sodium, all anti-VEGF agents [ 45 , 48 , 57 ]. Eight studies did not specify the drug used for intravitreal treatment [ 24 , 40 , 42 , 44 , 54 , 59 , 67 , 69 ].…”

“…Seventeen studies included Bevacizumab as the intravitreal drug [ 29 , 32 , 35 , 38 , 39 , 41 , 45 , 46 , 49 – 51 , 57 , 61 , 62 , 69 – 71 ], and three studies looked at patients treated with Pegaptanib sodium, all anti-VEGF agents [ 45 , 48 , 57 ]. Eight studies did not specify the drug used for intravitreal treatment [ 24 , 40 , 42 , 44 , 54 , 59 , 67 , 69 ]. The dosing schedules varied depending on the anti-VEGF agent used and the local protocols.…”

“…Thirty-two studies had a duration of up to 3 years [ 8 , 13 , 15 , 25 – 27 , 31 – 34 , 36 – 38 , 41 – 43 , 45 , 48 , 53 – 60 , 62 , 64 , 67 – 69 , 71 ]. Twenty studies had a duration of over 3 years [ 9 , 15 , 24 , 28 – 30 , 35 , 39 , 40 , 46 , 47 , 49 – 52 , 61 , 63 , 65 , 66 , 70 ].…”

Antiangiogenic therapy for ocular diseases: Current status and challenges

“…Repeated injections cause treatment burden to patients in at least two aspects. First, frequent injections increase patient's stress and make it difficult to adhere to the treatment schedule, thus resulting in undertreatment and incomplete response in the real world 60,61 . Second, repeated injections increase the risk of infection, endophthalmitis, ocular hypertension, retinal detachment, and hemorrhage 62 .…”

“…First, frequent injections increase patient's stress and make it difficult to adhere to the treatment schedule, thus resulting in undertreatment and incomplete response in the real world. 60,61 Second, repeated injections increase the risk of infection, endophthalmitis, ocular hypertension, retinal detachment, and hemorrhage. 62 To address these issues, much effort has been made to increase the half-life of the drugs, improve drug delivery, and continuously produce anti-VEGF drugs in situ.…”