The Effect of Delay in Care among Patients Requiring Intravitreal Injections

Song, Weilin; Singh, Rishi P.; Rachitskaya, Aleksandra

doi:10.1016/j.oret.2020.12.020

Cited by 36 publications

(42 citation statements)

References 22 publications

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“…Clinic restrictions, closure of private clinics, resource shortages, travel restrictions, lack of public transport facilities, and patient concerns were all factors that contributed to the decrease in intravitreal injections [24,25,29]. Younger patients and those with worse visual acuity in the fellow eye were more likely to adhere to anti-VEGF treatment [23,30]. As a result of the decreased clinic visits and intravitreal injections, several studies have investigated the impact of delayed care on functional and anatomic outcomes in patients with DR in recent months.…”

Section: Real-world Impact On Practice Patternsmentioning

confidence: 99%

“…Retrospective analyses comparing best-corrected visual acuity (BCVA) before and after the onset of the COVID-19 pandemic have shown a variable impact of treatment delay on BCVA in patients with DR. Several institutions noted the negative impact of delayed treatment on visual acuity. In a retrospective analysis of patients receiving intravitreal injections at the Cole Eye Institute in the USA from March 14 to May 4, 2020, patients with DME and/or PDR whose appointments were delayed lost 3.48 ± 1.95 ETDRS letters compared to patients who completed their scheduled appointment (gained 2.71 ± 1.75 ETDRS letters, p = 0.0203) [30]. The average delay in care for all patients with missed appointments was 5.34 weeks.…”

Section: Impact Of Delayed Care On Visual Outcomesmentioning

confidence: 99%

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The Impact of COVID-19 on Diabetic Retinopathy Monitoring and Treatment

Ahmed

Liu

2021

Curr Diab Rep

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Purpose of Review Diabetic retinopathy (DR) is one of the leading causes of vision loss worldwide. Although screening and early treatment guidelines for DR have significantly reduced the disease burden, restrictions related to the COVID-19 pandemic have changed real-world practice patterns in the management of DR. This review summarizes evolving guidelines and outcomes of the treatment of DR in the setting of the pandemic. Recent Findings Intravitreal injections for DR have decreased significantly globally during the pandemic, ranging from approximately 30 to nearly 100% reduction, compared to corresponding timepoints in 2019. Most studies on functional outcomes show a decrease in visual acuity on delayed follow-up. Summary Changing practice patterns in the management of DR has led to fewer intravitreal injections and overall reduction in visual acuity on follow-up. As COVID variants emerge, it will be necessary to continue evaluating practice guidelines.

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Section: Real-world Impact On Practice Patternsmentioning

confidence: 99%

Section: Impact Of Delayed Care On Visual Outcomesmentioning

confidence: 99%

The Impact of COVID-19 on Diabetic Retinopathy Monitoring and Treatment

Ahmed

Liu

2021

Curr Diab Rep

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“…To our knowledge, to date, there are only a few studies analyzing the early impact of the COVID-19 outbreak on BCVA changes, due to the delay or block in retinal diseases treatments. Additionally, these studies have potential bias and limitations, such as a heterogeneous study cohort or a limited number of patients enrolled, and the different protocols adopted in countries and periods of lockdown [ 27 , 28 , 29 ].…”

Section: Introductionmentioning

confidence: 99%

Impact on Visual Acuity in Neovascular Age Related Macular Degeneration (nAMD) in Europe Due to COVID-19 Pandemic Lockdown

Arruabarrena

Toro

Önen

et al. 2021

JCM

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This is a retrospective, multicenter study of consecutive patients with nAMD scheduled for a visit and/or a treatment with an intravitreal injection (IVI) during the 3 months before lockdown in the Ophthalmology Departments of six centers of Europe.The study was conducted on 546 patients, of which 55.13% were females, almost 100% of the patients were White/Caucasian race, and 71.53% of the patients presented a type 1 macular neovascularization (NVM). A total of 62.82% of patients (343 patients) that were on scheduled clinic visits and/or intravitreal injection treatment during the 3 months before the quarantine did not attend either to visit or for treatment during the lockdown. The mean number of injections during the lockdown was significantly reduced. This was followed by a significant reduction in the mean best-corrected visual acuity (BCVA) between the 3 months before the lockdown (mean BCVA of 60.68 ± 19.77 letters) and 6 months after lockdown (mean BCVA of 56.98 ± 22.59 letters). Patients with better BCVA before the lockdown and the ones showing neovascular activity were more likely to attend their scheduled visits and/or IVI treatments. The COVID-19 pandemic and the lockdown have led to a decrease in the number of IVI treatments in patients with nAMD, evidencing a significant vision loss at 6 months.

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“… 38 A USA team recently demonstrated that patients who missed a visit for intravitreal injection lost more vision than patients who completed the scheduled visits (no visit −5.024 ±1.88, canceled visit: −1.633 ±0.65, completed visits 0.373 ±0.50; p = 0.0028) so that a delay in care of even only 5.34 weeks resulted in vision loss (Italian lockdown lasted 9.857 weeks). 39 The population of diabetic subjects treated in Italy with intravitreal injection was estimated, starting from the fact that about 30% of the total intravitreal injections are administered to diabetic patients by an average of eight injections per year. 40 The economic impact related to the reduction of treatment for these patients was then estimated.…”

Section: Methodsmentioning

confidence: 99%

“…37 In addition, a Chinese study showed that interruption of anti-VEGF treatments exposes patients at significative risk for severe adverse visual sequelae. 38 A USA team recently demonstrated that patients who missed a visit for intravitreal injection lost more vision than 39 The population of diabetic subjects treated in Italy with intravitreal injection was estimated, starting from the fact that about 30% of the total intravitreal injections are administered to diabetic patients by an average of eight injections per year. 40 The economic impact related to the reduction of treatment for these patients was then estimated.…”

Section: Effects Of Reduced Hospital and Follow-up Procedures In Patients Atmentioning

confidence: 99%

Economic Impact of COVID-19 Lockdown on Italian NHS: Focus on Diabetes Mellitus

Torre¹,

Colombo²,

Matteo³

et al. 2021

CEOR

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Background In Italy, the adoption of a total lockdown has generated almost total suspension of outpatient visits except for emergencies. Even after lockdown, the pandemic fear created additional barriers to access the health services. The aim of our study is to evaluate the economic impact of the lockdown for COVID-19 on public health in Italy, focusing on its effects on diabetic population. Materials and Methods We analyzed the impact of the lockdown on excess mortality and morbidity in the Italian diabetic population during 2020. The analysis was divided into several steps: a quantification of specialist visit reduction, the calculation of excess mortality in the diabetic population, the economic evaluation of the slowdown in the use of innovative diabetic therapies. Furthermore, the impact of the lockdown on the reduction of procedures and follow-up visits in diabetic population was evaluated. The overall impact of the pandemic and lockdown effects on costs and quality of life was then calculated. Results During 2020, a drop of 28% in patient access has been observed. Diabetic patients recorded a twice higher mortality value compared to general population (20.4% vs 10.2%). The analysis of market data revealed a slowdown in consumption of new antidiabetic therapies (−14%, 27% vs 41%). We estimated an expense of €26.6 million for NHS and a loss of 257 utilities in diabetic population due to the missed benefits related to slowdown in innovative antidiabetic drugs use and non-optimal follow-up and control of diabetes complications. In simulation scenarios, we also estimated an overall expenditure ranging from €38.7 to 94.0 million and a loss of 294–836 utilities. Conclusion Diabetic population paid a high tribute to pandemic and lockdown, both in terms of number of deaths and burden of diabetic complications, together with an overall deterioration of quality of life.

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The Effect of Delay in Care among Patients Requiring Intravitreal Injections

Cited by 36 publications

References 22 publications

The Impact of COVID-19 on Diabetic Retinopathy Monitoring and Treatment

The Impact of COVID-19 on Diabetic Retinopathy Monitoring and Treatment

Impact on Visual Acuity in Neovascular Age Related Macular Degeneration (nAMD) in Europe Due to COVID-19 Pandemic Lockdown

Economic Impact of COVID-19 Lockdown on Italian NHS: Focus on Diabetes Mellitus

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