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Assessing Impact of COVID-19 Lockdown on Patients with Neovascular AMD
EUROCOVCAT study shows decline in care with corresponding loss of vision. Cheryl Guttman Krader reports from the 2022 ESCRS Virtual Winter Meeting
The early days of the COVID-19 pandemic in Europe saw a significant drop in intravitreal injections and follow-up visits among patients with neovascular age-related macular degeneration (nAMD).
New data from the nAMD EUROCOVCAT study indicates a slow return to care by six months after the first lockdown. But it did not recover to the pre-lockdown levels, and mean BCVA at six months post-lockdown was significantly lower than at six months before lockdown.
“Intravitreal anti-VEGF injections are an effective treatment for nAMD, but any delay or suspension of the injections can lead to significant and rapid vision impairment that may be irreversible,” said Julia Cañas Martín MD, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain.
“Because six months is a very short follow-up period, further studies will be necessary to better understand the amount of visual recovery of this patient population,” Dr Cañas reported in a moderated poster session.
The retrospective multicentre observational study analysed data from patients under routine clinical care for nAMD receiving anti-VEGF injections during the three to six months before lockdown. It included 546 patients seen at six centres in Italy, Poland, Spain, Russian Federation, Switzerland, and Turkey. Almost all patients were white/Caucasian. They had a mean age of 79.4 years, were predominantly female (55%), and the majority had type 1 choroidal neovascularisation (71.5%).
Almost two-thirds of the patients discontinued followup care during the lockdown, either not attending a visit or failing to return for treatment. Twelve percent of the initial cohort still discontinued visits and treatment at six months post-lockdown. Mean BCVA was 60.7 letters at both three- and six-months pre-lockdown and fell to 57.0 letters at six months post-lockdown.
The mean number of intravitreal injections decreased from 2.65 during the six months pre-lockdown to 0.38 during the lockdown and rose to 1.84 at six months post-lockdown. The mean number of injections per month was 1.18 during the six months pre-lockdown, 0.18 during lockdown, and 0.84 at six months post-lockdown; corresponding values for mean number of visits per month were 1.40, 0.12, and 1.05, respectively.
Analyses comparing patients who continued with care during lockdown and those who did not showed no differences between the two groups with respect to age, sex, duration of the lockdown, or having only one functional eye. However, the group that continued follow-up during lockdown had a significantly higher mean BCVA at six months before lockdown and included a significantly higher percentage of patients with active CNV lesions.
“There was no statistically significant difference in the mean change in BCVA after the lockdown comparing patients who continued follow-up care during the lockdown and those who did not. However, it is important to note the number of both intravitreal injections and visits was significantly higher in the group that maintained their scheduled visits and injections during the lockdown,” Dr Cañas said.
Julia Cañas Martín MD practices at the University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain. julia.cmartin93@gmail.com
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