Characteristics of patients receiving intravitreal injections during COVID-19

ABSTRACT

Purpose: After the Illinois shelter-in-place COVID-19 mandate was instituted on March 16, 2020, outpatient ophthalmology care was limited to patients with vision-threatening conditions. In order to better understand the impact of the mandate on patients receiving intravitreal injections (IVIs), we compared key demographic and clinical features of patients seen before and after quarantine measures. Methods: Retina patients receiving IVIs at Northwestern Medicine sites between 12/1/19 and 6/30/20 were identified and divided into pre-COVID (PC) and Strict-Quarantine (SQ) groups (12/1/19-3/15/20 and 3/16/20-6/30/20, respectively). A subset of patients lost to follow-up (LTFU), defined as having been seen at least once in the PC period but not at all during the SQ period, were also identified. Comparison of primary diagnoses and selfreported demographic data was performed between these three sub-groups. Primary diagnoses necessitating IVIs were identified as age-related macular degeneration (AMD), diabetic retinopathy (DR), retinal vein occlusion (RVO), and other causes of neovascularization (other). Results: 1426 injections were administered to 716 patients during the PC period compared to 1121 injections to 637 patients during the SQ period. More injections per patient were performed in the PC period compared to the SQ period (1.99 ± 1.00 vs 1.76 ± 0.87, p = 5.87E-06). There were no significant differences in primary diagnosis or demographic characteristics between these two groups (p = 0.852, 0.974, respectively). 24.2% of PC patients (173 patients) were identified as LTFU. Of the LTFU patients, a lower percentage identified as White and higher percentages identified as Black, Asian and Other in comparison to the PC (p = 0.0413) and SQ (p = 0.00853) groups. LFTU patients proportionally had a higher percentage of DR (35.88%) and RVO (20.59%) primary diagnoses and a lower proportion of AMD (33.53%) primary diagnoses than patients in the PC (p=0.0011) and SQ (p=0.0014) groups. Conclusions: The COVID-19 pandemic resulted in disruption of normal ophthalmic clinic operations. Because Black and other non-white patients and patients with diabetic retinopathy made up higher percentages of the LTFU group, efforts should be made to understand and address any barriers to medically necessary follow-up during this unprecedented public health crisis.