Abstract
Purpose :
The coronavirus pandemic has prompted unprecedented delays to treatment with anti-VEGF intra-vitreal injections due to the need to reduce hospital attendances and prioritize the patients at highest risk of vision loss. This study aims to quantify the effect of these delays on visual acuity (VA) outcomes and optical coherence tomography (OCT) features for patients receiving treatment for neovascular age-related macular degeneration (nAMD).
Methods :
A retrospective data analysis of an electronic medical record was performed on a random sample of 681 eyes receiving anti-VEGF injections between 1 January and 23 March 2020 for nAMD. Data collected included whether the review was delayed (defined as delayed by 8 weeks or more from planned) and the VA at baseline and follow up. For those eyes not delayed, a VA at 20 weeks was recorded to provide a control group, as this was the mean number of weeks until the delayed group was seen. For the delayed group, the OCT features at follow up were also noted.
Results :
The sample of 681 eyes was analysed, of which 194 (28.5%) had been delayed by 8 weeks or more. The mean number of weeks delay was 12.7. Mean change in VA for eyes in the delayed group was significantly worse compared to those not delayed. VA change in the delayed group was 60.1 to 55.2 (-4.9) letters and VA change in the non-delayed group was 61.4 to 59.9 (-1.5) letters (p = 0.001). 161 eyes that were delayed had a repeat OCT at their delayed review; mean CMT (µm) had increased from 311 to 342 and 118 eyes (73.3%) showed evidence of intraretinal and/or subretinal fluid. By November 2020, 25.1% of eyes had not returned to within 5 letters of their baseline vision.
Conclusions :
Delayed appointments due to COVID-19 affected a significant proportion of nAMD patients receiving intra-vitreal injections. nAMD eyes which were delayed experienced significant visual loss compared to those who were not delayed. This was associated with worsening of disease activity on OCT.
This is a 2021 ARVO Annual Meeting abstract.