Impact of the COVID-19 Pandemic on Diabetic Macular Edema Patient Outcomes at a Tertiary Care Veterans Affairs Hospital

ABSTRACT

Purpose: Retina clinic volumes declined during the COVID-19 pandemic, and there have been limited studies on how this impacted patient outcomes. Optimal management of diabetic macular edema (DME) requires adherence to regular treatment schedules. We aimed to evaluate the impact of the pandemic on visual and anatomic outcomes in patients with DME requiring anti-VEGF injections at our institution. Methods: Data was collected from the retina clinic at the Michael E. DeBakey VA Medical Center in Houston, Texas. Patient charts from April 2020 were compared to April 2019 to determine changes in attendance. To evaluate outcomes, we reviewed DME patients with appointments scheduled from April 1 - 30, 2020. Data from the last visit prior to April 1, 2020 was compared to the first follow-up visit between April 1, 2020 to December 1, 2020. Ocular surgery or absence of injections within the 3 months prior to scheduled appointment excluded patients from this study. Central foveal thickness (CFT) was measured from optical coherence tomography images and Snellen visual acuity (VA) measurements were obtained from the medical record. Poor outcome was defined as VA decrease of one or more lines or a CFT increase of 10% or more. Analysis included the eye with the worse VA from each patient. Results: Total visits to the retina injection clinic decreased by 54% from 533 patient visits in April 2019 to 247 visits in April 2020. Of 562 unique patients scheduled for April 2020, 185 patients were on anti-VEGF injection schedules for DME treatment. 51 patients were excluded. Of the remaining 134 patients, the mean age was 64.7 ± 8.8 years. 86% (115/134) were rescheduled, and of these, 26/115 were lost to follow-up until the end of our study period. The remaining 89/115 were seen with an average follow-up interval of 115.2 ± 50.0 days. At follow-up, 37/89 (42%) had worsened vision, 24/89 (27%) had worsened edema, and 54% (48/89) had a poor outcome of either worsened vision or worsened edema. Conclusions: Pandemic related rescheduling of patients with DME delayed follow-up care and treatment. On average, patients were rescheduled to a visit that was 2.4 months later than their usual visit and about half the patients experienced worsening of vision or edema. Additional studies are needed to identify patients at highest risk of vision loss so that those patients can be triaged and evaluated appropriately.