Short term visual and structural outcomes of anti-VEGF treatment delay during the first COVID-19 wave: a pilot study

Abstract

Purpose : Anti-VEGF injections are essential to maintaining and/or improving ocular conditions including neovascular age-related macular degeneration (nAMD) and diabetic retinopathy. This study aims to assess the effect of unintended delays in anti-VEGF treatment during the first wave of the COVID-19 pandemic.

Methods : This retrospective case series identified patients receiving regularly scheduled anti-VEGF injections from two practices in Minnesota. Diagnoses were limited to nAMD, DME, proliferative diabetic retinopathy, and RVO. Patients were grouped based on whether they maintained or delayed their ‘post-lockdown follow-up visit’ by more than two weeks during the COVID-19 lockdown. The COVID-19 lockdown was declared on March, 28th, 2020 in Minnesota. Visual acuity and structural changes to the retina using ocular coherence tomography (OCT) were assessed to determine whether delayed treatment resulted in worse visual outcomes.

Results : A total of 167 eyes from 117 patients met criteria for inclusion in this study. In the delayed group, the average BCVA at the pre- and post-lockdown visits were 0.614 and 0.715 (logMAR) respectively (p=0.007). Treatment intervals were shortened in 21% of patients delayed by 2-4 weeks, 68% of patients delayed by 5-8 weeks, and 42% of patients delayed greater than 9 weeks. Central subfield thickness (CST) increased from 341 to 447 in the DME delayed group (p=0.03) and from 301 to 314 (p=0.4) in the nAMD delayed group.

Conclusions : These results suggest that treatment delays may negatively impact the visual and anatomic outcomes of patients with nAMD and DME. Further investigation with a larger sample size is ongoing.

This is a 2021 ARVO Annual Meeting abstract.

 

Example of nAMD disease progression on OCT in the delayed and non-delayed groups. Patient presented for pre-lockdown visit (A) and returned for 6 week follow up (B) with stable disease. Another patient presented for pre-lockdown follow-up with stable disease (C) and delayed follow-up by 6 weeks. OCT shows accumulation of subretinal fluid (D).

 

Example of DME disease progression on OCT in the delayed and non-delayed groups. Patient presented for pre-lockdown visit (A) and returned for 10 week follow-up (B) with a stable degree of intraretinal fluid. Another patient presented for a pre-lockdown visit with stable disease (C) and delayed follow-up by 6 weeks. OCT shows accumulation of intraretinal and subretinal fluid (D).