ABSTRACT
Purpose : Assessing the impact of COVID-19 on visual acuity (VA) in eyes treated for Diabetic Macular Edema. Methods : Anonymized data from 21 UK centers were extracted from Medisoft for eyes receiving treatment with aflibercept and with VA data in the pre-COVID baseline period (01/10/19 to 30/03/20, N=3,248). Comparisons for period 1 (01/04/20 to 30/09/20, N=2,077)-lockdown following RCOphth Medical Retinal Management Plan, period 2 (01/10/20 to 30/03/21, N=1,850)-intermittent lockdown and period 3 (01/04/21 to 30/09/21, N=1,111;20 centers)-easing of COVID-19 restrictions. VA change was compared for baseline VA, <7 vs. ≥7 injections before period 1 and for eyes losing ≥5 ETDRS letters in period 1. Results : The mean change in VA for eyes with a baseline VA of ≤35 letters, was +4.9, +2.5 and +1.7 letters from baseline to period 1, period 1 to 2 and period 2 to 3, respectively. For baseline VA of 36-55 letters, +0.6, +1.7 and -0.2 letters, from baseline to period 1, period 1 to 2 and period 2 to 3, respectively. For baseline VA of 56-75 letters, +1.9, zero and -0.5 letters, from baseline to period 1, period 1 to 2 and period 2 to 3, respectively. For baseline VA of >75 letters, -4.3, -0.5 and zero letters, from baseline to period 1, period 1 to 2 and period 2 to 3, respectively. For eyes receiving <7 injections before period 1, the mean change in VA was -1.9 letters (N=1,335) from baseline to period 1, +0.5 letters (N=992) from period 1 to 2 and +0.1 letters (N=592) from period 2 to 3. For ≥7 injections before period 1, the mean change in VA was -3.4 letters (N=742) from baseline to period 1, -0.4 letters (N=515) from period 1 to 2 and -1.1 letters (N=303) from period 2 to 3. For eyes losing ≥5 letters before period 1, the mean change in VA when receiving ≥1 injection in period 2 was +3.9 letters (N=283) from period 1 to 2 and -0.1 letters (N=140) from period 2 to 3. For eyes not retreated in period 2, the mean change in VA was -2.9 letters (N=162) from period 1 to 2 and zero letters (N=73) from period 2 to 3. Conclusions : Visual gain between time periods was more likely for lower baseline vision. For eyes with <7 or ≥7 injections before period 1, the mean VA change was a loss in vision in the first period with little change in later periods. For eyes with ≥5 letter loss in period 1, subsequent visual gain was more likely if treatment continued.
ABSTRACT
Purpose : During the COVID-19 pandemic, in line with the UK Royal College of Ophthalmologists' (RCOphth) guidelines, anti-VEGF treatment regimens for Neovascular Age Related Macular degeneration (nAMD) were adjusted to 8 weekly Aflibercept injections with no clinic review. New patients and those who mentioned a significant drop of vision during their injection visits had OCT and their management adjusted to 4 weekly injections. This work audits our practice at a tertiary university hospital during the 2020 pandemic. Methods : Retrospective electronic data was collected from the Medisoft ophthalmology database for patients with nAMD, who received Aflibercept over a 5 month period from 01.03.2020 to 01.08.2020. Best Corrected Visual Acuity (BCVA), Central Macular Thickness (CRT), and number of injections were collected, and compared with our previously published year one data of 225 treatment naïve eyes of 223 patients with nAMD, treated with 8 weekly Aflibercept with mean BCVA of 61 letters & mean CRT of 235 μm at month 5 of therapy. We also assessed the clinical outcomes of our patients who received 4 weekly Aflibercept injections. Statistical analysis was done using SPSS version 24. Results : 1778 eyes of 1427 patients met the inclusion criteria and were included in the study. 1338 patients (93.8%) received 8 weekly injections, their mean BCVA ± SD was 59.7 ± 17.3 with CRT of 239.3 μm ± 67.2 SD at baseline and their latest BCVA ± SD was 59.3 ± 17.4, with CRT of 231.8 μm ± 73.8 SD. More than one third of them 618 (43.3%) received three injections during that period. 89 of our patients (6.2%) received 4 weekly injections during our study period. Their mean BCVA ± SD was 60.5 ± 17.6 with CRT of 276.1 μm ± 96.4 SD at baseline and their latest BCVA ± SD was 62.3 ± 15.1, with CRT of 247.8 μm ± 49.0 SD. Conclusions : Reassuringly, during the COVID-19 pandemic, patients on a fixed 8 weekly Aflibercept pathway maintained their vision. Their mean BCVA & CRT were comparable to our pre-COVID audit outcomes with a treat and extend protocol. Patients on 4 weekly injections also maintained their vision during the pandemic. RCOphth COVID guidelines allowed AMD patients to receive effective therapy whilst minimizing time in hospitals and permitted ophthalmologists to do other COVID related tasks.
ABSTRACT
Purpose : To assess the impact of COVID-19 on eyes treated for neovascular AMD. Methods : Anonymized data from 21 UK centers were extracted from Medisoft for patients receiving treatment with aflibercept and VA data in the pre-covid baseline (01/10/19 to 31/03/20 n=8,313). Comparisons were made for period 1 (01/04/20 to 30/09/20 n=4,011)-lockdown following RCOphth Medical Retinal Management Plan during COVID-19, period 2 (01/10/20 to 31/03/21 n=4,551)-intermittent lockdown following updated RCOphth COVID-19 guidelines, and period 3 (01/04/21 to 30/09/21 n=2,630)-easing COVID-19 restrictions. VA change was compared for baseline VA, <7 vs. ≥7 injections before period 1 and for eyes losing ≥5 letter in period 1. Results : The mean change in VA for eyes with a baseline VA of ≤35 ETDRS letters was +0.7, +0.1 and -1.6 letters, 36-55 letters was -3.0, -1.2 and -1.3 letters, 56-75 letters was -2.1, -1.1 and -1.5, and >75 letters was -4.3, -0.7 and -0.4 letters in periods 1, 2 and 3 respectively. The median VA change was zero letters for all baseline VA groups and time periods except for the >75 letter group in period 1 (median 2 letter loss). The mean change in VA from baseline for eyes with <7 injections before period 1, was -2.0, -0.6 and -1.2 letters from 2,083, 2,465 and 1,420 eyes in periods 1, 2 and 3, and ≥7 injections before period 1, was -2.9 from 1,928 eyes in period 1 and -1.3 letters from 2,086 and 1,210 eyes in periods 2 and 3. For both groups and time periods the median VA change was zero letters. For eyes that lost ≥5 ETDRS letters before period 1 the mean change in VA for eyes receiving no injections was +2.3 letters (n=155) and -3.5 letters (n=107), 1-3 injections was +1.4 letters (n=740) and -1.3 letters (n=340), and >3 injections was +2.3 letters (n=199) and -0.8 letters (n=122) in periods 2 & 3 respectively. The median VA change was zero letters for all time periods and injection number groups except for >3 injection eyes in period 2 (median 3 letter gain) and no injection eyes in period 3 (median 1 letter loss). Conclusions : In period 1, a small VA loss was experienced by many eyes dependent on baseline VA. Similar VA changes were present for eyes receiving <7 and ≥7 injections before period 1. For eyes that lost ≥5 ETDRS letters during period 1, many had visual gain with more improvement linked to receiving more injections in period 2, falling back in period 3.