COVID-19-related treatment delays led to worsening wet AMD


Stone LG, et al. Delayed follow up in wet macular degeneration patients due to COVID-19: Impact on disease activity and visual acuity. Presented at: Association for Research in Vision and Ophthalmology annual meeting; May 1-7, 2021 (virtual meeting).

Stone reports no relevant financial disclosures.

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Patients with neovascular age-related macular degeneration who had treatment delayed due to the COVID-19 pandemic experienced worsening of their disease activity, according to a study.

In her presentation at the virtual Association for Research in Vision and Ophthalmology meeting, Lydia G. Stone, MBBS, said that lockdown in the United Kingdom led to significant delays in anti-VEGF injections and the prioritization of treatment of patients with the highest risk for vision loss.

“Previous research in Newcastle Eye Centre identified that during the first 4 weeks of the United Kingdom lockdown, 67% of booked injection patients were not seen or were delayed,” she said. “This was despite estimates that, following guidelines by the Royal College of Ophthalmologists, only 25% of patients could safely be delayed.”

Researchers analyzed data from 681 eyes that received anti-VEGF injections between Jan. 1, 2020, and March 23, 2020, for the treatment of wet AMD to quantify the effect of treatment delay on visual acuity outcomes and OCT features. They collected data on whether the review was delayed, defined as delayed 8 weeks or more from what was planned, and visual acuity at baseline and follow-up.

Investigators recorded visual acuity at week 20 among patients who were not delayed to provide a control group for the study.

Overall, review was delayed in 194 eyes (28.5%), with a mean delay of 12.7 weeks.

The mean change in visual acuity in the delayed group was 60.1 to 55.2 letters (–4.9) compared with 61.4 to 59.9 letters in the control group (–1.5; P = .001).

Among 161 eyes that had a repeat OCT at their delayed review, mean central macular thickness increased from 311 µm to 342 µm. Additionally, 118 eyes (73.3%) showed evidence of intraretinal fluid or subretinal fluid.

“Delayed appointments due to COVID-19 affected a significant proportion of wet macular degeneration patients receiving intravitreal injections,” Stone said. “Around a third of eyes were dry and maintained their vision despite the delays to treatment. This brings to question whether clinicians could be more bold with treat-and-extend regimens in order to locate those patients who would well tolerate having fewer injections.”