Impact of COVID-19 pandemic on patients with nAMD: Assessing clinical outcomes of patients who underwent four and eight weekly anti-VEGF treatment with no clinic review

Abstract

Purpose : During the COVID-19 pandemic, in line with the UK Royal College of Ophthalmologists’ (RCOphth) guidelines, anti-VEGF treatment regimens for Neovascular Age Related Macular degeneration (nAMD) were adjusted to 8 weekly Aflibercept injections with no clinic review. New patients and those who mentioned a significant drop of vision during their injection visits had OCT and their management adjusted to 4 weekly injections. This work audits our practice at a tertiary university hospital during the 2020 pandemic.

Methods : Retrospective electronic data was collected from the Medisoft ophthalmology database for patients with nAMD, who received Aflibercept over a 5 month period from 01.03.2020 to 01.08.2020.
Best Corrected Visual Acuity (BCVA), Central Macular Thickness (CRT), and number of injections were collected, and compared with our previously published year one data of 225 treatment naïve eyes of 223 patients with nAMD, treated with 8 weekly Aflibercept with mean BCVA of 61 letters & mean CRT of 235 μm at month 5 of therapy. We also assessed the clinical outcomes of our patients who received 4 weekly Aflibercept injections.
Statistical analysis was done using SPSS version 24.

Results : 1778 eyes of 1427 patients met the inclusion criteria and were included in the study. 1338 patients (93.8%) received 8 weekly injections, their mean BCVA ± SD was 59.7 ± 17.3 with CRT of 239.3 μm ± 67.2 SD at baseline and their latest BCVA ± SD was 59.3 ± 17.4, with CRT of 231.8 μm ± 73.8 SD. More than one third of them 618 (43.3%) received three injections during that period.
89 of our patients (6.2%) received 4 weekly injections during our study period. Their mean BCVA ± SD was 60.5 ± 17.6 with CRT of 276.1 μm ± 96.4 SD at baseline and their latest BCVA ± SD was 62.3 ± 15.1, with CRT of 247.8 μm ± 49.0 SD.

Conclusions : Reassuringly, during the COVID-19 pandemic, patients on a fixed 8 weekly Aflibercept pathway maintained their vision. Their mean BCVA & CRT were comparable to our pre-COVID audit outcomes with a treat and extend protocol. Patients on 4 weekly injections also maintained their vision during the pandemic. RCOphth COVID guidelines allowed AMD patients to receive effective therapy whilst minimizing time in hospitals and permitted ophthalmologists to do other COVID related tasks.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.