Delay No More

The COVID-19 pandemic has not been good for ophthalmologists or patients. We have lamented the immediate effects of repeated lockdowns and elective procedure suspensions on our lives – and now the aftereffects of delaying ophthalmic healthcare are rearing their ugly head.

Researchers from Keimyung University Dongsan Hospital and Keimyung University School of Medicine in Daegu, Korea, found that delayed intravitreal anti-VEGF therapies during the pandemic led to a decline in best-corrected visual acuity (BCVA) and residual subretinal fluid height in neovascular AMD patients (1). Although previous studies have warned of BCVA worsening in AMD patients due to delays in anti-VEGF treatment, there has been limited data to show correlations between visual acuity and anatomical changes – a gap this study aims to bridge.

The study retrospectively used data from 57 neovascular AMD patients whose injections were delayed by at least two weeks. Researchers compared BCVA with anatomical changes, measured using OCT, both before and six months after patients received their anti-VEGF treatment. Through this comparison, they can ascertain that the differences in BCVA were caused by physical progression of the disease.

Interestingly, patients’ AMD prognosis improved in the two to four months after the delayed treatment, yet faltered to below baseline after six-month follow-up. This highlights the importance of adhering to scheduled treatments and appointments and emphasizes the need to avoid delaying anti-VEGF therapy in AMD patients. Understandably, given the primarily elderly demographic of people with AMD, a large proportion of these patients may have been avoiding contact and therefore missed appointments for fear of contracting COVID-19.

Given the huge impact of AMD worldwide, it is clear that the data acquired during the COVID-19 pandemic should be applied to future incidents – and that timely anti-VEGF treatments in AMD patients should be prioritized even in emergency situations.

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