Patient Experience with Anti-VEGF Intravitreal Injections in Neovascular Agerelated Macular Degeneration and Diabetic Macular Edema: A Multinational Observational Study

Purpose : Anti-vascular endothelial growth factor (anti-VEGF) intravitreal injections are efficacious treatments for neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME), but optimal real-world outcomes require frequent treatment and monitoring that can be burdensome to patients and hinder their ability or willingness to follow their management plan. This study aimed to understand patient treatment experience with anti-VEGF standard of care. Methods : This observational study employed a cross-sectional quantitative survey comprising de novo questions, patient-reported outcome (PRO) measures and medical chart extraction. Adult patients in the USA, UK and Canada with nAMD or DME, and treated with anti-VEGF injections for ≥12 months, were recruited via 21 (9 USA, 6 UK, 6 Canada) clinical sites. Results : Between January and August 2021, 148 (67 USA, 33 UK, 48 Canada) DME and 219 (98 USA, 54 UK, 67 Canada) nAMD patients completed their surveys. While 159 (43%) patients had a study eye visual acuity at most recent reading >70 approxETDRS letters, PRO scores indicated that patients across the two conditions had relatively high visionrelated functioning (NEI-VFQ-25) and were generally satisfied with their current treatment (MacTSQ and RetTSQ). Eighteen DME patients (12%;12% in the US, 27% in the UK, 2% in Canadian samples) and 9 nAMD patients (4%;3% USA, 3% UK, 4% Canada) missed at least 1 injection visit in the past 12 months. Reported barriers were mainly related to treatment, clinic and appointment factors, and the COVID-19 pandemic. Half of the patients reported some level of impairment in their daily activities due to the treatment. Following treatment, the majority recovered within 1 day;however, a sizable portion (24%;21% USA, 31% UK, 22% Canada) needed >1 day to recover. Among the working patients (N = 55), 34 (62%;58% USA, 67% UK, 65% Canada) reported some level of productivity impairment in the form of absenteeism. Conclusions : Despite high adherence and treatment satisfaction levels, patients reported impairment of daily activities, burden, and barriers related to treatment. In general, more DME patients missed at least 1 visit than nAMD patients. More durable treatments with longer intervals could further reduce treatment burden and address the current barriers faced by patients.

Vision-Specific Quality of Life in Patients with Post-Acute Sequelae of COVID-19 (PASC)

Objective: We sought to describe post-acute symptoms of COVID-19 (PASC)-related visual symptoms in a cohort of non-hospitalized individuals presenting to our outpatient neurology practices and undergoing vision-specific quality of life assessments. Background: Infection with SARS-CoV-2 (COVID-19) involves multiple systems, including those for vision. People with post-acute sequelae of COVID-19 (PASC) have reported many neurological symptoms such as brain fog, memory difficulties, and headache, as well as vision related complaints. Design/Methods: Participants completed standardized and well-validated vision-specific quality of life questionnaires, including the 25-Item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) and the 10-Item Neuro-Ophthalmic Supplement to the NEI-VFQ-25 (NOS). Patient scores were compared to those of disease-free controls within the same age groups. Results: Among 50 participants reporting persistent COVID-related symptoms more than 6 weeks after acute illness, the average age was 49.3 ± 14.6 years;33/50 (65%) were female. Symptoms reported by patients were mostly general and not visual. However, vision-specific quality of life scores were significantly lower than values for normal healthy controls with no history of neurological or ophthalmological disease (p<0.0001 for both the NEI-VFQ-25 and NOS composite scores, two-sample t-tests). Mean NEI-VFQ-25 composite score was 89.5 ± 12.7 compared to 98.2 ± 2.1 for healthy controls. Mean NOS score was 82.7 ± 16.0 compared to 96.5 ± 5.2 for controls. Conclusions: People with post-acute sequelae of COVID-19 (PASC) in a neurology outpatient practice, even among those without visual symptoms that bring them to medical attention, report persistent visual quality of life impairment. These data support the inclusion of vision-specific outcome measures and symptom scales in studies of PASC, and confirm that COVID-19 infection may impair visual function.

Online Learning-Related Visual Function Impairment During and After the COVID-19 Pandemic.

This study aimed to review the consequences of increased online learning, which was precipitated by the coronavirus disease 2019 (COVID-19), on visual function, as well as the methods for preventing the associated visual impairment. The recent finding implies that a higher incidence of myopia may be observed during the pandemic than that before. The myopia prevalence was 59.35% in COVID-19, which was higher than that in the normal period. COVID-19-related influence of developing myopia among students should be addressed and under control. Online learning precipitated by COVID-19 is likely to increase the global burden of visual function impairment. This review highlighted useful measures to prevent online learning-related visual function impairments, including the following: (1) desktop illumination of no >300 lx, online learning time for primary, and middle-school students of no more than 20-30 min per session; (2) daily video time for preschool children not exceeding 1 h, and for school-age children and adolescents not exceeding 2 h; (3) after every 30-40 min of online learning, moving eyes away from the screen or closed for 10 min; (4) engaging in outdoor activities for ≥ 2 h a day; (5) suitable screen and learning environment settings and correct postures for reading and writing; (6) sufficient sleep and proper nutrition. Preventing online learning-related visual impairment during and after this unprecedented pandemic will facilitate future ophthalmic practice.

Impact of the COVID-19 pandemic on eye strain and dry eye symptoms.

PURPOSE: Among adult individuals with dry eye, assess the self-reported impact of the COVID-19 pandemic on (1) dry eye-related visual function, (2) reading efficiency, and (3) dry eye treatments used. METHODS: In June-July 2020, we conducted an online survey of adults with dry eye who spent at least somewhat more time at home during the pandemic than before. Consistent with TFOS DEWS II guidelines, we categorized respondents into mild, moderate, or severe dry eye based on treatment usage. RESULTS: We included 388 respondents: 97 respondents (25%) with mild, 80 (21%) with moderate, and 211 (54%) with severe dry eye. In all three groups, screen/reading time generally doubled during the pandemic. Reduced work-related efficiency was noted by a considerable proportion of respondents (moderate dry eye: 51%, mild: 39%, and severe: 38%). Compared with respondents with mild dry eye, respondents with moderate dry eye were considerably more likely to note worsening symptoms: eye pain (OR = 2.57, 95% CI 1.22-5.41), headache from eye symptoms (OR = 2.34, 95% CI 1.11-4.90), and difficulty concentrating because of eye symptoms (OR = 2.79, 95% CI 1.37-5.66). Respondents with moderate dry eye with Sjögren's syndrome were most likely to note these. Respondents with severe dry eye were more likely than respondents with mild dry eye to report losing access to dry eye-related treatments (OR = 2.62, 95% CI 1.36-5.03). CONCLUSIONS: The COVID-19 pandemic-related eye strain may be impacting symptoms, performance, and ultimately employment, especially for those with moderate dry eye. This may be compounding the already-high dry eye-related societal burden.