The importance of monitoring wet age-related macular degeneration patients during Coronavirus disease 19 pandemic: A retrospective study of assessment of functional and structural outcomes

Abstract

Objectives: Intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections are the gold standard treatment for wet age-related macular degeneration (wet AMD). Coronavirus disease 2019 (COVID-19) has led to the cancellation of many scheduled intravitreal anti-VEGF injection visits. We compared the functional and structural visual outcomes of wet AMD patients who did not adhere to their planned intervals (group 1) with those who did (group 2).

Methods: Wet AMD patients of Swiss Visio Montchoisi and RétinElysée were included. Best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) changes between their first visit after the end of the first national lockdown in Switzerland (27 April 2020, first post-lockdown visit) and their last visit before the beginning of the first national lockdown in Switzerland (13 March 2020, last pre-lockdown visit) were assessed. The BCVA outcome was defined as unfavorable when there was a loss of≥5 ETDRS letters in the first post-lockdown visit compared to the BCVA at last pre-lockdown visit. The OCT outcome was defined as unfavorable when there was an increase in at least one of the parameters, intraretinal fluid (IRF), subretinal fluid (SRF), or pigment epithelial detachment (PED), at the first post-lockdown visit compared to the last pre-lockdown visit.

Main results: Group 1 (89 patients, 109 eyes) had a 13.41% greater rate of unfavorable BCVA outcomes and a 38.27% greater rate of unfavorable OCT outcomes than group 2 (96 patients, 122 eyes) (P=0.04, P<0.0001, respectively). Multivariate analysis showed that the more the patients deviated from their programmed injections and the higher the BCVA pre-lockdown, the higher the rate of unfavorable BCVA outcomes (P=0.03 and P=0.02, respectively). OCT outcomes were not a predictive factor for an unfavorable BCVA outcome.

Conclusions: The cancellation of many intravitreal anti-VEGF injection appointments resulted in worse functional and structural outcomes in wet AMD patients. The COVID-19 pandemic led many patients to refrain from their routine intravitreal anti-VEGF injection appointments, allowing us to analyze the role of designated intervals in the treatment of wet AMD. During any future lockdown due to COVID-19 or similar circumstances, continuity of care for wet AMD patients should be maintained.

Keywords: Anti-VEGF; Anti-facteur de croissance endothélial vasculaire; Anti-vascular endothelial growth factor; COVID-19; Coronavirus disease 2019; DMLA; Dégénérescence maculaire liée à l’âge humide; Maladie à coronavirus 2019; Wet AMD; Wet age-related macular degeneration.

Figure 1

The difference between the assigned and real injection intervals was significant for group 1 (P < 0.0001) but not significant for group 2 (P = 0.75). The mean real injection interval was significantly higher than the mean assigned injection interval for group 1 (P < 0.0001).

Figure 2

Group 1 had 58.7% favourable and 41.3% unfavourable best-corrected visual acuity (BCVA) outcomes, while group 2 had 72.1% and 27.9% favourable and unfavourable BCVA outcomes, respectively. Group 1 had a 13.4% greater rate of unfavourable BCVA outcome than group 2 (P = 0.04).

Figure 3

Group 1 had 48.6% favourable and 51.4% unfavourable optical coherence tomography (OCT) outcomes, while group 2 had 86.9% and 13.1% favourable and unfavourable OCT outcomes, respectively. Group 1 had a 38.3% greater rate of unfavourable OCT outcome than group 2 (P < 0.0001).