Anti-Vascular Endothelial Growth Factor Drug Adherence During COVID-19 Improved Patient Outcomes

Failure to adhere to intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection regimens during the COVID-19 pandemic resulted in worsened visual and macular structural and functional outcomes in patients with wet age-related macular degeneration (AMD), according to research published in Journal Français d’Ophtalmologie.

Investigators enrolled 185 participants with wet AMD consisting of patients who did not adhere to scheduled intravitreal anti-VEGF injections during the pandemic (group 1; n=89; 109 eyes; mean age, 81.16±6.64 years) and those who did adhere to these treatments (group 2; n=96; 122 eyes; mean age, 82.12±6.99). Patients underwent best corrected visual acuity (BCVA) and optical coherence tomography (OCT) measurements at baseline (prior to the beginning of Switzerland’s lockdown on March 13, 2020) and follow-up (after the end of Switzerland’s lockdown on April 27, 2020). A poor BCVA outcome was defined as a loss of 5 or more Early Treatment Diabetic Retinopathy Study (ETDRS) letters, and poor OCT outcomes were defined by an increase in intraretinal fluid (IRF), subretinal fluid (SRF), or pigment epithelial detachment (PED).

BCVA changes from baseline to follow-up were insignificant in both groups 1 and 2 (66.65±18.04 to 66.38±15.48 and 65.66±19.03 to 66.38±18.32, respectively). However, a higher incidence of unfavorable outcomes was noted in group 1 compared with group 2 (41.3 vs 27.9%; P =.04). Group 1 participants had a 38.27% greater risk of poor OCT outcomes compared with group 2 participants (51.4 vs 13.1%; P <.001). PED and IRF increases obtained during the first post-confinement visit were significantly higher in group 1 than in group 2 (P =.0004 and P =.04, respectively). Overall, there was no correlation between poor BCVA outcomes and poor OCT outcomes.

“The COVID-19 pandemic led many patients to refrain from their routine intravitreal anti-VEGF injection appointments, allowing us to analyze the role of designated intervals in the treatment of wet AMD,” according to the researchers. “During any future lockdown due to COVID-19 or similar circumstances, continuity of care for wet AMD patients should be maintained.”

Study limitations include its retrospective nature, short follow up duration, and the potential for selection and recall bias. 

Reference

Tsiropoulos GN, Vallee R, Gallo Castro D, Ambresin A. The importance of monitoring wet age‐related macular degeneration patients during coronavirus disease 2019 pandemic: a retrospective study of assessment of functional and structural outcomes. J Fr Ophthalmol. Published online July 6, 2022. doi:10.1016/j.jfo.2022.05.005