ABSTRACT
Purpose : During the emergeing COVID-19 pandemic, patient care was delayed due to clinic closures and patient hesitancy in seeking necessary care. We aimed to characterize clinical outcomes of exudative macular degeneration (AMD) patients who had delay in their care. As the uncertainly of the pandemic unfolds, this study aims to inform clinical decision making on future care delay decisions. Methods : Patients with a chart diagnosis of exudative AMD who had an appointment canceled from 3/16/20 through 5/4/20 were selected. This timeframe encompassed the official clinic closure and a time during which many patients self-delayed care. Patients with concurrent macular disease were excluded. Data from each ophthalmology encounter was collected from 3/1/2019 through 7/1/2021. A linear longitudinal multilevel model was used to model best-corrected visual acuity (BCVA) over time. Time varying covariates included injection at visit, presence of subretinal fluid, intraretinal fluid, geographic atrophy, and macular hemorrhage. Baseline covariates included age, race, sex, treatment interval, treatment vs. observation, delay interval, anti-VEGF agent, baseline subretinal fluid, intraretinal fluid, and geographic atrophy, prior PDT, and smoking status. Results : 161 eyes encompassing 2,555 ophthalmology encounters were selected. An initial model without addition of time varying or baseline predictors show a daily change in BCVA of 0.00151 logMAR (p = 0.05) over the study period. The pre-closure BCVA daily change was lower than the post-closure suggesting vision dropped at a faster rate after care delay, however this was not statistically significant (Figure 1). With time varying and baseline covariates added, intraretinal fluid status at baseline was the only statistically significant factor that predicted a larger BCVA slope (p=0.05). Conclusions : Initial data suggests that BCVA fell during the time period, but there was no significant difference between the pre-closure and post-closure data. Patients with intraretinal fluid at baseline may potentially have worse long-term visual outcomes if care is delayed. Further model refinement needs to be undertaken prior to any definite conclusions. (Figure Presented).