ABSTRACT
Background: Intravitreal anti-vascular endothelial growth factor therapy currently represents the treatment standard for vision-threatening macular conditions, while treatment delays cause precipitous vision loss. The COVID-19 pandemic prompted unprecedented delays for patients receiving intravitreal injections (IVI). We aim to provide real-world data on the effects of delayed IVI treatment due to COVID-19 at our center and its associated visual consequences. Method(s): In this retrospective cohort study based at a tertiary hospital in metropolitan Brisbane, medical records were reviewed for consecutive IVI patients within a 6-week interval between March-May 2020. Patients were divided into two groups based on whether they maintained or delayed their follow-up visit. Main outcome measures included best-corrected visual acuity (BCVA), central macular thickness as well as structural findings on OCT suggestive of disease activity. Result(s): A total of 682 patients were scheduled to receive IVI-based care, with treatment delay observed in 123 patients (18.5%) for an average period of 64 days. BCVA worsened in the delayed group by an average of 0.136 letters compared to 0.008 in the control group (p = 0.02), with the most significant change seen in neovascular age-related macular degeneration patients (p = 0.001). Patients on Aflibercept and Ranibizumab were more likely to maintain vision compared to those on Bevacizumab (p = 0.02 and p = 0.07). Retinal vein occlusion patients were most likely to suffer from longterm visual consequences from delayed follow-up. In multivariate linear regression model for risk factor analysis;BCVA, distance from hospital and patient age were all correlated with treatment delays. Conclusion(s): Patients who experienced treatment delays suffered short-term visual decline. However, visual losses were not sustained in majority of patients.
ABSTRACT
Objectives: Cardiac rehabilitation (CR) exercise classes in Singapore were either cancelled or suspended due to the ongoing COVID-19 pandemic. In response, a hybrid CR programme utilising telehealth was created to reduce reliance on in-person sessions. Our study aimed to assess early patients' impressions of this novel CR delivery method. Methods: Each hybrid CR programme comprises: (a) one CR orientation session via the Zoom video conferencing platform where patients interact with CR nurses and physiotherapists, (b) two 6-minute walk test fitness assessments (at baseline and upon completion), (c) five in-person supervised exercise classes and (d) two teleconsultation sessions (scheduled after exercise sessions 2 and 4) where CR physiotherapists review symptoms and discuss exercise prescriptions with patients over the phone. Upon programme completion, patients filled 2 anonymous online questionnaires - one assessing the videoconferencing component and another assessing the teleconsultation component and overall programme. Results: Seven patients underwent the hybrid CR programme. The majority were male (n=6, 86%), aged between 51 to 65 years (n=4, 57%) and had previously used a wide range of mobile applications (n=6, 86%). 100% of patients either agreed or strongly agreed that both videoconferencing and teleconsultation were: (a) easy to use, (b) as valuable as in-person sessions, (c) saved time and (d) had lower infection risk compared to in-person sessions (Figure). The overall ratings for videoconferencing, teleconsultation and the hybrid programme were 9.3, 9.6 and 9.6 (out of 10) respectively. All patients would definitely recommend the programme to others. Conclusion: Responses by participants of a novel hybrid CR programme utilising telehealth are highly encouraging. From a patient perspective, incorporation of telehealth to enable remote CR is feasible, acceptable and should be considered as an alternative CR delivery method.