Delayed anti-VEGF injections during the COVID-19 pandemic and changes in visual acuity in patients with three common retinal diseases: A systematic review and meta-analysis

Abstract

The COVID-19 pandemic disrupted the regular injections of anti-vascular endothelial growth factor (anti-VEGF) in patients with various retinal diseases globally. It is unclear to what extent delayed anti-VEGF injections have worsened patients' visual acuity. We performed a meta-analysis to assess the impact of delayed anti-VEGF injections on the best-corrected visual acuity (BCVA) in patients with neovascular age-related macular degeneration (nAMD), retinal vein occlusion (RVO), and diabetic macular edema (DME). We searched four computer databases (EMBASE, MEDLINE, Web of Science, Scopus) from inception to January 5, 2022. Data were pooled using the random-effects model. Results were reported by less than 4 months and 4 months or longer for the time period between the first injection during the pandemic and the last pre-pandemic injection. All BCVA measures were converted to the logarithm of the minimum angle of resolution (logMAR) for analyses. Among patients who received injections 4 months or longer apart, the mean difference in BCVA was 0.10 logMAR (or 5 ETDRS letters) (95% confidence interval [CI] 0.06∼0.14) for nAMD patients, 0.01 logMAR (or∼ 1 ETDRS letter) (95% CI -0.25∼0.27) for RVO patients, and 0.03 logMAR (or ∼1 ETDRS letters) (95% CI -0.06∼0.11) for DME patients. These results suggest that patients with nAMD needing scheduled anti-VEGF injections may require priority treatment over those with RVO and DME in the event of disturbed anti-VEGF injections from COVID-19 lockdowns or similar scenarios.

Keywords: COVID-19; Diabetic macular edema; Neovascular age-related macular degeneration; Retinal vein occlusion; Systematic review and meta-analysis.

Fig. 1

Forest plot of mean difference in the best-corrected visual acuity between the first visit during the pandemic and the last pre-pandemic visit among patients with neovascular age-related macular degeneration, retinal vein occlusion and diabetic macular edema stratified by length of time between injections.

Fig. 2

Forest plot of mean difference in the best-corrected visual acuity between the first visit during the pandemic and the last pre-pandemic visit among patients with neovascular age-related macular degeneration stratified by length of time between injections.

Fig. 3

Forest plot of mean difference in the best-corrected visual acuity between the first visit during the pandemic and the last pre-pandemic visit among patients with retinal vein occlusion stratified by length of time between injections.

Fig. 4

Forest plot of mean difference in the best-corrected visual acuity between the first visit during the pandemic and the last pre-pandemic visit among patients with diabetic macular edema stratified by length of time between injections.