The impact of COVID-19 on visual acuity for nAMD patients treated with aflibercept in the UK

ABSTRACT

Purpose: To assess the impact of COVID-19 on eyes treated for neovascular AMD. Methods: Anonymized data from 21 UK centers were extracted from Medisoft for patients receiving treatment with aflibercept and VA data in the pre-covid baseline (01/10/19 to 31/03/20 n=8,313). Comparisons were made for period 1 (01/04/20 to 30/09/20 n=4,011)-lockdown following RCOphth Medical Retinal Management Plan during COVID-19, period 2 (01/10/20 to 31/03/21 n=4,551)-intermittent lockdown following updated RCOphth COVID-19 guidelines, and period 3 (01/04/21 to 30/09/21 n=2,630)-easing COVID-19 restrictions. VA change was compared for baseline VA, <7 vs. ≥7 injections before period 1 and for eyes losing ≥5 letter in period 1. Results: The mean change in VA for eyes with a baseline VA of ≤35 ETDRS letters was +0.7, +0.1 and -1.6 letters, 36-55 letters was -3.0, -1.2 and -1.3 letters, 56-75 letters was -2.1, -1.1 and -1.5, and >75 letters was -4.3, -0.7 and -0.4 letters in periods 1, 2 and 3 respectively. The median VA change was zero letters for all baseline VA groups and time periods except for the >75 letter group in period 1 (median 2 letter loss). The mean change in VA from baseline for eyes with <7 injections before period 1, was -2.0, -0.6 and -1.2 letters from 2,083, 2,465 and 1,420 eyes in periods 1, 2 and 3, and ≥7 injections before period 1, was -2.9 from 1,928 eyes in period 1 and -1.3 letters from 2,086 and 1,210 eyes in periods 2 and 3. For both groups and time periods the median VA change was zero letters. For eyes that lost ≥5 ETDRS letters before period 1 the mean change in VA for eyes receiving no injections was +2.3 letters (n=155) and -3.5 letters (n=107), 1-3 injections was +1.4 letters (n=740) and -1.3 letters (n=340), and >3 injections was +2.3 letters (n=199) and -0.8 letters (n=122) in periods 2 & 3 respectively. The median VA change was zero letters for all time periods and injection number groups except for >3 injection eyes in period 2 (median 3 letter gain) and no injection eyes in period 3 (median 1 letter loss). Conclusions: In period 1, a small VA loss was experienced by many eyes dependent on baseline VA. Similar VA changes were present for eyes receiving <7 and ≥7 injections before period 1. For eyes that lost ≥5 ETDRS letters during period 1, many had visual gain with more improvement linked to receiving more injections in period 2, falling back in period 3.