Investigators Explore the Impact of COVID-19 Lockdowns on Ocular Therapies

Javier Zarranz-Ventura, MD, PhD, MSc

Data presented at the Association for Research in Vision and Ophthalmology (ARVO) Virtual Meeting showed the impacts of the coronavirus disease (COVID-19) lockdowns on treatment outcomes for neovascular age-related macular degeneration (nAMD), diabetic macular edema (DME) and retinal vein occlusion (RVO).

The investigative team was led by Javier Zarranz-Ventura, MD, PhD, MSc, of Hospital Clinic Barcelona, and utilized an international database (Fight Retinal Blindness! Project) to assess patients across 8 countries: Australia, France, Ireland, Italy, Netherlands, New Zealand, Spain, and Switzerland.

Thus, they looked at baseline visits, defined as the most recent visit within 3 months prior to lockdowns, and compared them with follow-up visits post-lockdown. A patient’s pre- and post-lockdown periods were defined up to 6 months before and after baseline visit, respectively.

For their analysis, they collected demographics, visual acuity in logMAR ETDRS letters at baseline and pre- and post-baseline visits, and number of injections.

A total of 5271 eyes from 4288 patients were assessed. Of this amount, 4240 eyes had nAMD, 605 eyes had DME, and 426 eyes had RVO. Patients used ranibizumab (33.5%), aflibercept (50.9%), and/or bevacizumab (15.5%).

Among eyes with nAMD, the mean change in visual acuity post-lockdown ranged from -0.3 to -3.3 letters. Furthermore, the median number of injections decreased from 4-5 (pre-lockdown) to 2-4; the median number of visits decreased from 4-7 to 2-4.

As for eyes with DME, mean visual acuity change ranged between -4 and +2.3 letters, with the median number of injections decreasing from 2-5 to 1-3, and the median number of visits decreasing from 4-6.5 to 2-3.

And finally, in RVO eyes, the mean change in visual acuity ranged from -2.4 to +3 letters. The median number of injections decreased from 3-7 to 1-6, and the median number of visits decreased from 4-7.5 to 2.5-6 post-lockdown.

Zarranza-Ventura and colleagues also reported dropout rates in the 6-month post-lockdown period, noting a 34% rate for nAMD, 43% for DME, and 44% for RVO.

“The data reported in this study may serve clinicians to prepare strategies to mitigate vision loss in future scenarios of the COVID-19 pandemic evolution,” wrote the investigators.

A study that was presented yesterday at the conference similarly noted that delaying anti-VEGF treatment for DME can lead to worse outcomes in affected patients. Those who had gone longer than 12 weeks experienced a worsening of disease course, and few patients experienced a progression of their diabetic retinopathy to the proliferative stage.

As such, in both cases, delaying of treatment across ocular conditions was suggested to be potentially harmful for visual outcomes.

The study, “COVID-19 pandemic lockdown international impact on nAMD, DME and RVO intravitreal therapy outcomes: Fight Retinal Blindness International registry,” was presented at ARVO 2021.