Intravitreal Injection Adherence Associated with Better VA During COVID-19 Pandemic

Catherine Creuzot-Garcher

New findings suggest a strict adherence to COVID-19-related guidelines for intravitreal anti-VEGF treatment for macular disease was associated with better visual outcomes.

However, the study based in France reported a relatively low rate of adherence patients (40.7%) to the French Society of Ophthalmology intravitreal injection guidelines during the COVID-19 lockdown.

“Non-adherent patients were at greater risk of visual loss, confirming the need to maintain intravitreal injections in the event of a pandemic,” wrote study author Catherine Creuzot-Garcher, Service d’Ophtalmologie, CHU. “This study gives insight into patient profiles  at higher risk of non-adherence and could help identify the target population for preventive information.”

Due to few patients adhering to guidelines, Creuzot-Garcher and colleagues aimed to evaluate the impact of lockdown on visual outcomes in patients treated with intravitreal injections of anti-VEGF agents for macular diseases, particularly age-related macular degeneration (AMD).

Data from all patients scheduled for intravitreal injections of VEGF inhibitors during the lockdown from March - May 2020 were collected from 18 centers in France. Those who were not scheduled to be injected during this period were not included in the study.

Investigators collected data on the delay between initially planned and the real timing of the injection during the lockdown and visual acuity (VA) at 4-months post-lockdown. They defined three groups according to the guideline-adherence:

• Strict adherence (adherence group, A)
• Non-strict adherence with delayed intravitreal injections (adherence group, NA+)
• Non-adherence without any injection during lockdown (adherence, NA–)

The main objective was to measure the effect of lockdown and society guideline adherence on visual acuity change at 4 months, with secondary objectives assessing the influence of macular disease etiology on the visual outcome and identifying the risk factors for intravitreal injection, poor adherence and visual loss.

The study included a total of 3020 eyes of 3020 patients (59.8%) with a mean age of 77.8 years. Data show the mean visual acuity before the lockdown was 64.5 ± 18.4 ETDRS letters. A total of 2030 eyes (67.7%) were treated for neovascular AMD.

The findings suggest the rate of strict adherence to French guidelines (A) was 40.7% (n = 1230) of patients compared to non-adherence (NA+ and NA–) in 59.3% of patients (n = 1790).

For patients who attended a visit, the mean VA change at 4 months after the lockdown was –0.4 ± 6.8 ETDRS letters with a mean visual acuity at 4 months of 64.7 ± 18.9 ETDRS letters.

Investigators observed a significant difference in absolute visual acuity between groups at 1 and 4 months after lockdown. Data show 64.6 ± 18.9 ETDRS letters for group A versus. 60.4 ± 19.5 for the NA− group at 1 month. At 4 months, the data show 64.9 ±  19.0 vs. 61.4 ± 20.5 at 4 months in each group (P < 0.001, P = 0.03, respectively).

Moreover, the findings suggest the NA– group ​​(−1.5 ± 6.9 letters) had significantly lower mean visual acuity change 4 months after lockdown than the NA+ group (−0.3 ± 6.9 letters) and the A group (−0.2 ±  6.7  letters; P < .001).

Through multivariable analysis, factors associated with non-adherence included older age, hospital treatment, treat-and-extend protocol, high viral incidence areas, and longer intervals between injections, as well as those who lived in densely populated areas.

The study, “IMPACT study: Impact of adherence to anti-VEGF intravitreal injections for macular disease during COVID 19-related confinement in France,” was published in Acta Ophthalmologica.