Did COVID-19 Put a Lockdown on Intravitreal Injection Adherence?

Study shows vision does not suffer with short lapses in care. Cheryl Guttman Krader reports

In-person appointments and treatments met obvious delays and cancellations due to COVID-related lockdowns. A retrospective study of this impact at an intravitreal injection clinic found that while missed appointments were common, the average treatment delay was short and not associated with significant vision loss. However, the analyses did confirm longer lapses in care could potentially compromise outcomes and reinforce racial disparities in healthcare.

“Our study shows that for patients treated with intravitreal injections, enhancing visit adherence can lead to better visual outcomes. Strong patient-provider relationships [that foster] effective communication and patient education are fundamentally important for patient adherence to follow-up,” said Vivian Paraskevi Douglas MD, DVM, MBA, Research Fellow at Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA.

Presented at ARVO 2021, the study included 353 patients with 1,086 visits scheduled from December 1, 2019, through June 10, 2020. The patients in the cohort were predominantly Caucasian, and most were receiving treatment for wet agerelated macular degeneration. A review of appointment status by month showed that the rate of completed visits fell dramatically during the first two months of the lockdown period. Most missed visits were cancellations rather than “no show” patients. Approximately three-fourths of the cancellations during both the lockdown and pre-lockdown periods were patient-initiated rather than provider-initiated. Rates of cancelled and “no show” appointments were higher among African American patients compared to Caucasians.

The researchers noted that the latter finding could be partially explained by African Americans being disproportionately affected by COVID-19. Ensuring minority populations receive education about the importance of visit adherence is instrumental going forward.

Dr Douglas added, “Providing culturally and linguistically appropriate health information and community engagement efforts can lead to health equity promotion and improved health outcomes, including visual outcomes.”

VISION OUTCOMES During the lockdown period, the average delay in care was 2.34 weeks, and it was similar among subgroups classified by indication for intravitreal injection. In the overall cohort, there was no significant visual acuity loss during the lockdown, and the mean change in visual acuity was not significantly different between patients who completed their scheduled appointment and those who missed one or more.

However, plots of individual patient outcomes versus time delay in care showed associations between longer delays and greater visual deficits. The effect was greater in patients with wet age-related macular degeneration or branch or central retinal vein occlusion and more moderate in patients treated for diabetic eye disease.

Vivian Paraskevi Douglas: vivianparaskevi_douglas@meei.harvard.edu

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