Author: Andrew Lotery (United Kingdom)
Co-authors: Paul Donachie, Romi Chabra, Shahram Kashani, Martin McKibbin, Narendra Dhingra, Peter Scanlon
Purpose
Assessing the impact of COVID19 on eyes treated with Aflibercept for neovascular Age-Related Macular Degeneration (nAMD) taking into account the Royal College of Ophthalmologists recommendations.
Setting/Venue
On 30th March 2020, the Royal College of Ophthalmologists published recommendations for AMD treatment to ‘Maintain all patients on 8 weekly anti-VEGF therapy with no clinic review unless they mention a significant drop in vision at their injection visit. Such patients may need OCT and VA assessments and management changed, if deemed appropriate’. Data from 21 UK hospitals through the time period March 2018 to March 2021.
Methods
Anonymised data of patients receiving antiVEGF injections of Aflibercept for nAMD 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 = 4,164 for period 1 and 3,722 for period 2) • Group E: Established: Treatment of between 3 months and 1 year (N = 3,581 for period 1 and 3,264 for period 2) • Group I: Initial phase: Treatment of 3 months or less. (N = 1,224 for period 1 and 1,125 for period 2)
Results
In period 1 the percentage of eyes who received no injections were 32.4%, 19.9% and 10.5%, and the median number of injections was 2, 2 and 3 for groups L, E and I respectively. In period 2 the percentage of eyes who had no injections were 30.1%, 20.4% and 15.7% for groups L, E and I respectively, with a median number of injections of 2 for each group. For period 1, a VA measurement was recorded for both March and October 2020 for 51.8%, 56.7% and 44.7% of eyes in groups L, E and I respectively, where the mean change in vision was -3.0, -2.9 and -0.9 letters for groups L, E and I respectively. For period 2, a VA measurement was recorded for both October 2020 and March 2021 for 46.7%, 47.4% and 52.8% of eyes in groups L, E and I respectively, where the mean change in vision was -0.9, -0.1 and +0.3 letter for group L, E and I respectively.
Conlusions
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 both time periods. 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.
Financial Disclosure
Peter Scanlon has received consulting fees from Boehringer and Bayer and speaker fees from Novartis in the last 3 years.
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