The effect of treatment delay on exudative age-related macular degeneration patients due to the COVID-19 Pandemic

ABSTRACT

Purpose: Due to the Coronavirus Disease 2019 (COVID-19) pandemic, the AAO announced guidelines which recommended the cessation and postponement of all routine and nonurgent clinic visits and elective surgeries. While this decision was important for the public health effort to mitigate the COVID-19 pandemic, the effect this decision had on patients with exudative age-related macular degeneration (AMD) requiring frequent visits for treatment and monitoring is unknown. This retrospective observational study evaluates the effect that the delay in these visits and treatments had on this patient population.Methods: This study identified patients with exudative AMD undergoing active treatment who had at least one appointment rescheduled due to the COVID-19 pandemic from March to May 2020 at a single institution. Data was collected from the last appointment prior to March 2020, and the first appointment following delay, and compared to agematched controls from 2019 with the same diagnosis. Average length of time from postponement to follow-up was calculated. Patient demographics, visual acuity (LogMAR), and central macular thickness (CMT) on spectral-domain optical coherence tomography (OCT) were documented. Statistical analysis was conducted using t-tests with a two-tailed hypothesis. Results: 69 patients (96 eyes) with exudative AMD met inclusion criteria. The mean (SD) age was 83.7 (8.3) years and 74% of patients were female. The mean (SD) number of days of treatment delay was 45.9 (38.6) days. Mean (SD) increase in CMT was 23.84 (82.71) μm for the eye that had delayed treatment, which was statistically significant (t=2.49, p=0.01). Mean (SD) change in visual acuity was +0.11 (0.32) LogMAR, which was significantly worse (t=3.42, p=0.001). Conclusions: Central macular thickness and visual acuity of treatment eyes were significantly worse as a result of the delay secondary to the COVID-19 pandemic. Further data collection over time is required to determine whether changes in CMT and VA are reversible over time. Further analyses of sequelae of delayed injections may reveal unique insights into subgroups which may be more tolerant of extended injection schedules.