ABSTRACT
Purpose : The COVID-19 Pandemic resulted in a substantial decrease in outpatient ophthalmology clinic visits due to stay-at-home orders. Retinal vascular diseases and wet age-related macular degeneration require adherence to treatment regimens with antivascular endothelial growth factor (anti-VEGF) injections. The purpose of this study was to assess how the COVID-19 pandemic affected the number of injections compared to prepandemic values. Methods : This retrospective, observational clinical study assessed all anti-VEGF injections of aflibercept and ranibizumab for both 2019 (Jan-Dec) and 2020 (Jan-Nov) at an academic center. The total number of injections for each year was compared, as well as the number of injections for each month in 2020 compared to the average number of monthly injections in 2019. Both 1-sample and 2-sample t-tests were conducted, and a p-value less than 0.05 was considered significant. Results : The total number of aflibercept and ranibizumab injections in 2019 (Jan-Nov) were 4989 and 522 respectively, compared to 4855 and 515 in 2020 (Jan-Nov). No significant difference in injections was noted between 2019 and 2020 for either aflibercept (p=0.31) or ranibizumab (p=0.80). When analyzing each month in 2020 compared to the average number of aflibercept injections per month in 2019, there were significantly fewer aflibercept injections administered in February (p<0.01), August (p=0.03), and November (p<0.01), but significantly higher injections administered in July (p<0.01) and October (p<0.01). For ranibizumab, significantly fewer injections were administered in March (p=0.02), April (p=0.02), and May (p<0.01), but a higher number of injections were administered in September (p<0.01) and November (p<0.01). Conclusions : Despite stay-at-home orders, there was no significant decrease in the overall number of aflibercept or ranibizumab injections during the COVID pandemic compared to the prior year. Although further information is needed to determine if these injections represent both new and return patients, these data suggest that in this specific population, patients still returned to their retina specialist for care despite the ongoing pandemic.
ABSTRACT
Purpose : Inherited Retinal Diseases (IRDs) are a group of rare genetic disorders that require a detailed approach and workflow for diagnosis. To facilitate optimal patient care while minimizing the hazard of direct person-to-person exposure during the COVID-19 pandemic, we developed a telehealth management protocol, or telegenetics, for complete or hybrid virtual visits. Methods : Our telegenetics protocol comprised of three key components: (1) Digitization of diagnostic imaging and electrophysiological testing for review by physicians remotely;(2) Telemedicine video visits performed using MyHealth, a Health Insurance Portability and Accountability Act (HIPAA) compliant platform. (3) Complete shift to remote genetic testing using IRB-approved e-consents (electronic consent forms) and remote genetic testing saliva kits. Results : Telegenetic care was provided for 113 patients, including 3 international patients (age range: 5-99 years). During the first eight months of this program, 25 return and 28 new patient evaluations were completed virtually. Sixty patients were seen in a hybrid manner (45 new and 15 return), where an in-person clinic visit was performed followed by remote consenting, and saliva collection, genetic testing, and genetic counseling. A spectrum of retinal dystrophies were diagnosed and pathogenic mutations were detected in several genes, including genes approved or under-investigation for gene therapy like RPE65, CHM, and RPGR. Four patients with cystoid macular edema were successfully treated with topical dorzolamide, and 26 were referred for low-vision rehabilitation Conclusions : Telegenetic services have proved to be a useful tool during the COVID pandemic. They provide a safer alternative by limiting the exposure of patients and staff to the virus while maintaining the same high quality of care that was provided to patients before the pandemic. With the added efficiency and convenience of virtual patient care, we expect that telegenetics will continue and expand into other medical genetic conditions long after the pandemic.