Clinic Visits Remain Preference for AMD Monitoring in Event of Home Confinement

PD Dr med Aude Ambresin
Credit: Swiss Medical Network

Most patients with neovascular age-related macular degeneration (nAMD) in a recent study in Switzerland would still prefer a visit to the clinic to receive anti-vascular endothelial growth factor (anti-VEGF) injections in the event of confinement due to the COVID-19 pandemic or similar circumstances.¹

The analysis showed patients who declared non-adherence to their assigned anti-VEGF injection interval during the first period of COVID-19 confinement (group 1) preferred to monitor their wet AMD via telemedicine at greater rates than the group of patients who responded with positive adherence to the assigned injection interval in the same period (group 2).

“The pandemic of COVID-19 that led to the national confinement in Switzerland created a unique circumstance in which a significant percentage of wet AMD patients failed to receive their scheduled treatment, despite the availability of our clinics to perform continuous intravitreal anti-VEGF injections,” investigators wrote. “The results of this study suggest that in the event of another confinement due to COVID-19 or any other similar circumstances, the biggest part of the patients would still rather visit the clinic.”

Led by PD Dr med Aude Ambresin, Faculty of Biology and Medicine, University of Lausanne, the study looked to gauge perspective on the monitoring of nAMD during COVID-19 in Switzerland and the possibility of using telemedical services in the future for nAMD monitoring. The study population was comprised of patients with nAMD who received intravitreal anti-VEGF injections both before and after the first period of COVID-19 confinement in two Swiss ophthalmology clinics (March 2020 – April 2020).

Patient recruitment occurred between September 2020 and June 2021, with each participant asked to complete two questionnaires related to COVID-19 confinement. The first questionnaire evaluated subjective views on adherence to scheduled intravitreal anti-VEGF injections during the period of confinement and the application of telemedicine in the future. The other was a questionnaire adapted from the National Eye Institute Visual Function Questionairre-25 (NEI-VFQ25) focusing on patients’ opinions concerning their visual function change during confinement.

From 185 eligible patients, 130 (70.3%) responded to the questionnaires, with an average age of 80.02 ± 9.81 years. Of the responders, the patients of group 1 (n = 11; 8.5%) declared non-adherence to their assigned injection schedule, while the patients of group 2 (n = 119; 91.5%) responded with adherence.

Upon analysis, among group 1, 37.5% declared non-attendance to their assigned visit because they preferred not to use public transportation, 25.0% based on their family’s advice, and 25.0% because they were not reminded of their scheduled visit or were unaware of the clinic’s availability. Meanwhile, 78.8% of patients in group 2 considered the treatment reception to be of higher importance than the risk of COVID-19 contraction.

Notably, during the pre-lockdown period, patients of group 2 were significantly more likely to rely on help from others than group 1 patients (P = .02) according to the analysis. During the lockdown, the NEI-VFQ25-adapted visual function of the patients in group 1 was not significantly different compared with group 2.

Regarding the potential for a future lockdown, data showed 36.3% of group 1 and 8.7% of group 2 would rather monitor their wet AMD via telemedicine (P = .02), 54.5% and 86.9% would rather visit the clinic (P = .02), and 9.0% and 4.3% would cancel their appointment, respectively. Ambresin and colleagues noted that 70% of group 1 and 33.6% of group 2 would prefer to use the telemedicine service at home, rather than visit a telemedicine center (P = .04).

“More prospective studies evaluating patients’ opinions on telemedicine monitoring of their wet AMD are needed, with patients having the opportunity to use the telemedicine applications for two or three months to do an objective assessment,” investigators wrote.

References

1. Tsiropoulos GN, Vallée R, Calci C, Gallo Castro D, Ambresin A. Patient Perspective on the Monitoring of Their Wet Age-Related Macular Degeneration during Coronavirus Disease 2019: A Retrospective Study. Medicina (Kaunas). 2023;59(3):490. Published 2023 Mar 2. doi:10.3390/medicina59030490