Short term visual and structural outcomes of anti-vascular endothelial growth factor (anti-VEGF) treatment delay during the first COVID-19 wave: A pilot study.

Ameay V Naravane,Justin Yamanuha,Dara D Koozekanani,Christopher Santilli,Yujia Zhou,Geoffrey G Emerson,Frederik J G M Van Kuijk,Hossein Nazari,Rusdeep Mundae,Sandra R Montezuma

doi:10.1371/journal.pone.0247161

Ameay V Naravane, Justin Yamanuha + Show 8 more

Open Access

https://doi.org/10.1371/journal.pone.0247161

Copy DOI

Abstract

Regularly scheduled intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections are essential to maintaining and/or improving many ocular conditions including: neovascular age-related macular degeneration (nAMD), diabetic retinopathy, and retinal vein occlusions with macular edema (RVO). This study aims to assess the effect of unintended delays in anti-VEGF treatment during the first wave of the COVID-19 pandemic. This retrospective case series identified patients receiving regularly scheduled anti-VEGF intravitreal injections based on current procedural terminology (CPT) code at two practices in Minnesota. Diagnoses were limited to nAMD, diabetic macular edema (DME), proliferative diabetic retinopathy, and RVO. Patients were divided into two groups based on whether they maintained or delayed their follow-up visit by more than two weeks beyond the recommended treatment interval during the COVID-19 lockdown. The ‘COVID-19 lockdown’ was defined as the period after March, 28th, 2020, when a lockdown was declared in Minnesota. We then compared the visual acuity and structural changes to the retina using ocular coherence tomography (OCT) to assess whether delayed treatment resulted in worse visual outcomes. A total of 167 eyes from 117 patients met criteria for inclusion in this study. In the delayed group, the average BCVA at the pre- and post-lockdown visits were 0.614 and 0.715 (logMAR) respectively (p = 0.007). Central subfield thickness (CST) increased from 341 to 447 in the DME delayed group (p = 0.03) while the CST increased from 301 to 314 (p = 0.4) in the nAMD delayed group. The results of this pilot study suggests that treatment delays may have a negative impact on the visual and anatomic outcomes of patients with nAMD and DME. Future studies with larger sample sizes are required for further investigation.

Highlights

As of December 4th, 2020 there were 14 million confirmed cases and 275,000 deaths due to the novel Coronavirus Disease 19 (COVID-19) in the United States [1]
In response to the COVID-19 pandemic, on March 27th, 2020, the American Academy of Ophthalmology (AAO) published a list of emergent and urgent procedures performed in an operating room or ambulatory center that should not be postponed
If an ocular coherence tomography (OCT) was required for a treatment decision, appropriate measures were taken to ensure the safety of patients and clinic staff

Summary

Introduction

As of December 4th, 2020 there were 14 million confirmed cases and 275,000 deaths due to the novel Coronavirus Disease 19 (COVID-19) in the United States [1]. In response to the COVID-19 pandemic, on March 27th, 2020, the American Academy of Ophthalmology (AAO) published a list of emergent and urgent procedures performed in an operating room or ambulatory center that should not be postponed. Many clinics continued to perform intravitreal injection with each developing its own protocols for anti-VEGF office procedures balancing vision-saving therapy with the risk of COVID-19 exposure [5, 6]. Retina specialists modified clinical practice to either order fewer OCT images or plan for injection only visits. Some retinal specialists even modified protocol to only perform intravitreal injections in the operating room (OR) on one eye at a time [6, 8]

Objectives

Methods

Results

Conclusion