Abstract
Purpose :
Diabetic macular edema (DMO) is a leading cause of visual impairment, affecting more than 20 million people worldwide. Current treatment guidelines advocate the use of intravitreal therapy (IVT) at regular intervals for the management of DMO. The COVID-19 pandemic has caused significant disruption to routine clinical care, including DMO treatment. In this study, we looked at real-world data from individuals whose treatment was deferred due to the pandemic to assess their visual outcomes and predictor factors after 18 months following the disruption of services.
Methods :
Patients scheduled to have either initiation or continuation of IVT with aflibercept for DMO (single center) during the lockdown period in March 2020 were identified and recruited if they consented. Clinical data was collected from 01/01/2019 until 09/30/21. Main outcome measure was level of visual acuity (VA) at the final visit.
Results :
416 eyes of 416 patients were included (one random eye per patient). There was an increase in the mean interval between injections in 2020 and 2021 when compared to 2019 [55 days in 2019 (range 25-302), 86 days in 2020 (range 21-681) and 84 days in 2021 (range 24-885)]. There was a worsening of VA over time (mean VA logMAR was 0.36 in 2019; 0.41 in 2020; and 0.45 in 2021).
Significant predictors for visual acuity at the last follow-up were: VA at time of first injection (for every 0.1 logMAR VA increase, final logMAR VA increased by 0.059, p<0.001); length of follow-up (for every 6 months increase, final logMAR VA increased 0.038, p<0.001); age at first injection (for every decade, final logMAR VA increased by 0.037, p=0.001); Ethnicity (White ethnicity groups had less 0.061 logMAR VA when compared to non-white ethnicity groups, p=0.04).
The number of injections; mean interval between injections; maximum interval between injections; subfoveal thickness at baseline and diabetic retinopathy grade (baseline or final) were not significant predictor variables for final VA.
Conclusions :
Longer intervals between aflibercept IVT during COVID were not associated with visual outcome. Predictor variables for visual outcome present at baseline were VA, age, and ethnicity. Identifying these factors is important to allow for better risk stratification and for the development of strategies to tackle healthcare inequalities.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.