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 retinal vein occlusion (RVO) and diabetic macular oedema (DMO) patients.
Methods :
A retrospective data analysis of an electronic medical record was performed on a random sample of eyes receiving anti-VEGF injections for RVO and DMO between 1 January and 23 March 2020. Patients with RVO and DMO were identified and data collected included whether the review was delayed (defined as delayed by 8 weeks or more from planned) and VA at baseline and follow up. For those patients 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 were seen. For the delayed group, the OCT features at follow up were also noted.
Results :
300 eyes were analysed, of which 176 had RVO and 124 had DMO. 65 out of 176 eyes (36.9%) with RVO and 39 out of 124 eyes (31.5%) with DMO had their review delayed by 8 weeks or more. The mean number of weeks delay was 13.3 and 13.7 weeks for RVO and DMO respectively. Mean change in VA for eyes with RVO where their appointment was delayed was worse compared to those not delayed. For delayed RVO eyes, VA changed from 59.7 to 54.5 (-5.2) letters and for non-delayed RVO eyes VA changed from 63.5 to 61.6 (-1.9) letters (P=0.363). Mean change in VA for eyes with DMO was comparable between delayed (63.0 to 61.1 letters, -1.9) and non-delayed groups (63.7 to 61.0 letters, -2.7). For the delayed group, mean CMT (μm) changed from 374 to 451 (+77) in RVO eyes and 395 to 387 (-8) in DMO eyes. By November 2020, 23.1% of eyes with RVO and 8.6% of eyes with DMO had not returned to within 5 letters of their baseline vision.
Conclusions :
Delayed appointments due to COVID-19 affected a significant proportion of RVO and DMO patients receiving intra-vitreal injections. Delayed reviews in RVO eyes had a greater impact than for DMO eyes, with a higher proportion losing vision both in the short and long term. VA loss was associated with worsening of OCT features in RVO patients.
This is a 2021 ARVO Annual Meeting abstract.