June 2022
Volume 63, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2022
Clinical Outcomes in Exudative Macular Degeneration: A Prospective Study of Patients with Care Delay Due to the COVID-19 Pandemic
Author Affiliations & Notes
  • Timothy Janetos
    Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
  • Roya Zandi
    Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
  • David Younessi
    Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
  • Gina Johnson
    Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
  • Amber Randolph
    Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
  • Manjot Gill
    Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
  • Footnotes
    Commercial Relationships   Timothy Janetos None; Roya Zandi None; David Younessi None; Gina Johnson None; Amber Randolph None; Manjot Gill None
  • Footnotes
    Support  ISPB Grant SP0063493
Investigative Ophthalmology & Visual Science June 2022, Vol.63, 2535 – A0104. doi:
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      Timothy Janetos, Roya Zandi, David Younessi, Gina Johnson, Amber Randolph, Manjot Gill; Clinical Outcomes in Exudative Macular Degeneration: A Prospective Study of Patients with Care Delay Due to the COVID-19 Pandemic. Invest. Ophthalmol. Vis. Sci. 2022;63(7):2535 – A0104.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : During the emergeing COVID-19 pandemic, patient care was delayed due to clinic closures and patient hesitancy in seeking necessary care. We aimed to characterize clinical outcomes of exudative macular degeneration (AMD) patients who had delay in their care. As the uncertainly of the pandemic unfolds, this study aims to inform clinical decision making on future care delay decisions.

Methods : Patients with a chart diagnosis of exudative AMD who had an appointment canceled from 3/16/20 through 5/4/20 were selected. This timeframe encompassed the official clinic closure and a time during which many patients self-delayed care. Patients with concurrent macular disease were excluded. Data from each ophthalmology encounter was collected from 3/1/2019 through 7/1/2021. A linear longitudinal multilevel model was used to model best-corrected visual acuity (BCVA) over time. Time varying covariates included injection at visit, presence of subretinal fluid, intraretinal fluid, geographic atrophy, and macular hemorrhage. Baseline covariates included age, race, sex, treatment interval, treatment vs. observation, delay interval, anti-VEGF agent, baseline subretinal fluid, intraretinal fluid, and geographic atrophy, prior PDT, and smoking status.

Results : 161 eyes encompassing 2,555 ophthalmology encounters were selected. An initial model without addition of time varying or baseline predictors show a daily change in BCVA of 0.00151 logMAR (p = 0.05) over the study period. The pre-closure BCVA daily change was lower than the post-closure suggesting vision dropped at a faster rate after care delay, however this was not statistically significant (Figure 1). With time varying and baseline covariates added, intraretinal fluid status at baseline was the only statistically significant factor that predicted a larger BCVA slope (p=0.05).

Conclusions : Initial data suggests that BCVA fell during the time period, but there was no significant difference between the pre-closure and post-closure data. Patients with intraretinal fluid at baseline may potentially have worse long-term visual outcomes if care is delayed. Further model refinement needs to be undertaken prior to any definite conclusions.

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

 

BCVA (logMAR) plotted over time of each encounter. Timeperiod denotes pre-clinic closure (blue) vs. post-clinic closure (green). Best fit linear trend lines are shown between the two groups.

BCVA (logMAR) plotted over time of each encounter. Timeperiod denotes pre-clinic closure (blue) vs. post-clinic closure (green). Best fit linear trend lines are shown between the two groups.

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