Author: Peter Scanlon (United Kingdom)
Co-authors: Paul Donachie, Raj Mukherjee, Haralabos Eleftheriadis, Tunde Peto, James Talks, Salim Natha
Assessing the impact of COVID19 on eyes treated with Aflibercept for Diabetic Macular Oedema (DMO) taking into account the Royal College of Ophthalmologists recommendations.
On 30th March 2020, the Royal College of Ophthalmologists published recommendations for DMO treatment to ‘defer anti-VEGF injections and review in clinic after 4 months. Exceptions are eyes with severe NPDR and active PDR that may require anti-VEGF agents and PRP.’ Data from 21 UK hospitals through the time period March 2018 to March 2021.
Anonymised data of patients receiving antiVEGF injections of Aflibercept for DMO were extracted from a dedicated ophthalmology electronic patient record system in March 2021. Eligible for analysis are eyes who started treatment with Aflibercept between 01/03/2018 and 17/03/2020 and who had clinical data beyond 17/03/2020. Results are reported for two time periods, where ‘period 1’ is the first 6 months (18/03/2020 to 01/10/2020) and ‘period 2’ is the second 6 months (02/10/2020 to 17/03/2021). The number of injections and change in visual acuity (VA) are reported for three groups depending on their time of treatment on 17/03/2020; • Group L: Long established: treatment of over 1 year (N = 1,787 for period 1 and 1,572 for period 2) • Group E: Established: Treatment of between 5 months and 1 year (N = 1,191 for period 1 and 1,027 for period 2) • Group I: Initial phase: Treatment of 5 months or less. (N = 1,011 for period 1 and 894 for period 2)
In period 1 the percentage of eyes who received no injections were 47.0%, 41.4% and 22.7%, and the median number of injections was 1, 1 and 2 for groups L, E and I respectively. In period 2 the percentage of eyes who had no injections were 43.6%, 36.8% and 31.8% for groups L, E and I respectively, with a median number of injections of 1 for each group. For period 1, a VA measurement was recorded for both March and October 2020 for 44.7%, 49.8% and 50.1% of eyes in groups L, E and I respectively, where the mean change in vision was -2.8, -2.7 and -1.6 letter for groups L, E and I respectively. For period 2, a VA measurement was recorded for both October 2020 and March 2021 for 40.5%, 40.8% and 45.3% of eyes in groups L, E and I respectively, where the mean change in vision was +0.2, +0.5 and +0.6 letters for groups L, E and I respectively.
For newly diagnosed patients COVID19 appears to have impacted less on the administration of injections than for more established patients during the year of COVID19 restrictions in the UK. For newly diagnosed patient COVID19 appears to have impacted any initial increase in vision with some signs of improving vision in the second 6 months. For established patients vision was lost in the first 6 months with signs of recovery in the second 6 months. Approximately 50% of patients had no VA measurement recorded and further work is needed to see if their vision dropped at next attendance in the group with no recorded vision at these time periods.
I have received consulting fees from Boehringer and Bayer and speaker fees from Novartis in the last 3 years.