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Wickman I, Lövestam-Adrian M, Granstam E, Kjellström U, Schroeder M. The impact of COVID-19 on aflibercept treatment of neovascular AMD in Sweden - data from the Swedish Macula Register. BMC Ophthalmol 2024; 24:49. [PMID: 38291368 PMCID: PMC10826194 DOI: 10.1186/s12886-024-03326-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/24/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND The purpose of the study was to compare the real-world aflibercept treatment and visual outcomes, and to examine the adherence to pandemic guidelines in two groups of patients with treatment-naïve neovascular age-related macular degeneration (nAMD) before and during the first year of the COVID-19 pandemic in Sweden up to the 1-year follow-up. METHODS This is a retrospective observational study including 2915 treatment naïve eyes with nAMD. Using data from the Swedish Macula Register (SMR), 1597 eyes initiating treatment between 1 July 2018 and 31 January 2019 (pre-pandemic group) were compared with 1318 eyes starting treatment between 1 February and 31 August 2020 (pandemic group). The eyes were then followed for 1 year ± 2 months, hence the first group was unaffected by the pandemic while the second group was affected. The focus was on baseline characteristics, visual acuity (VA) change from baseline, number of injections, treatment regimen, number of appointments and the frequency and length of appointment delays. The Wilcoxon Signed-Rank Test was used to compare baseline VA to follow-up VA within the respective groups. The Mann-Whitney U-test and Fisher's exact test were used to compare outcomes between the groups. RESULTS Baseline characteristics were similar between the two groups. The percentage of eyes with an available follow-up VA after 1 year was 58% in the pre-pandemic group vs. 44% in the pandemic group. VA in the pre-pandemic group had increased significantly after 1 year, from 62.2 ± 14.1 letters to 64.8 ± 16.1 letters (n = 921); p < 0.0001. In the pandemic group, VA increased from 61.1 ± 15.8 to 64.9 ± 16.9 (n = 575); p < 0.0001. There was no significant difference in mean VA change between the groups; p = 0.1734. The pre-pandemic group had significantly more delays than the pandemic group, 45% vs. 36%; p < 0.0001. CONCLUSIONS The pre-pandemic and pandemic groups had similar VA gains at 1-year follow-up, but with a reduced number of available VA in the pandemic group. Clinics were able to implement and prioritize injection visits excluding VA measurements, helping to reduce delays and maintain VA gains during the COVID-19 pandemic.
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Affiliation(s)
- Isac Wickman
- Department of Ophthalmology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
| | - Monica Lövestam-Adrian
- Department of Ophthalmology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Ophthalmology, Skåne University Hospital, Lund, Sweden
| | - Elisabet Granstam
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Ophthalmology, Uppsala University Hospital, Uppsala, 751 85, Sweden
| | - Ulrika Kjellström
- Department of Ophthalmology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Ophthalmology, Skåne University Hospital, Lund, Sweden
| | - Marion Schroeder
- Department of Ophthalmology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Ophthalmology, Skåne University Hospital, Lund, Sweden
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Rego-Lorca D, Valverde-Megías A, Fernández-Vigo JI, Oribio-Quinto C, Murciano-Cespedosa A, Sánchez-Quirós J, Donate-López J, García-Feijóo J. Long-Term Consequences of COVID-19 Lockdown in Neovascular AMD Patients in Spain: Structural and Functional Outcomes after 1 Year of Standard Follow-Up and Treatment. J Clin Med 2022; 11:jcm11175063. [PMID: 36078993 PMCID: PMC9457226 DOI: 10.3390/jcm11175063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 08/20/2022] [Accepted: 08/24/2022] [Indexed: 11/16/2022] Open
Abstract
Consequences of the COVID-19 pandemic on medical care have been extensively analyzed. Specifically, in ophthalmology practice, patients suffering age-related macular degeneration (AMD) represent one of the most affected subgroups. After reporting the acute consequences of treatment suspension in neovascular AMD, we have now evaluated these same 242 patients (270 eyes) to assess if prior functional and anatomical situations can be restored after twelve months of regular follow-up and treatment. We compared data from visits before COVID-19 outbreak and the first visit after lockdown with data obtained in subsequent visits, until one year of follow-up was achieved. For each patient, rate of visual loss per year before COVID-19 pandemic, considered “natural history of treated AMD”, was calculated. This rate of visual loss significantly increased during the lockdown period and now, after twelve months of regular follow-up, is still higher than before COVID outbreak (3.1 vs. 1.6 ETDRS letters/year, p < 0.01). Percentage of OCT images showing active disease is now lower than before the lockdown period (51% vs. 65.3%, p = 0.0017). Although anatomic deterioration, regarding signs of active disease, can be apparently fully restored, our results suggest that functional consequences of temporary anti-VEGF treatment suspension are not entirely reversible after 12 months of treatment, as BCVA remains lower and visual loss rate is still higher than before the COVID-19 pandemic.
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Affiliation(s)
- Daniela Rego-Lorca
- Department of Ophthalmology, San Carlos Clinical Hospital, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
- Correspondence:
| | - Alicia Valverde-Megías
- Department of Ophthalmology, San Carlos Clinical Hospital, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - José Ignacio Fernández-Vigo
- Department of Ophthalmology, San Carlos Clinical Hospital, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
- Centro Internacional de Oftalmología Avanzada, 28010 Madrid, Spain
| | - Carlos Oribio-Quinto
- Department of Ophthalmology, San Carlos Clinical Hospital, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Antonio Murciano-Cespedosa
- Department of Biodiversity, Ecology & Evolution, Faculty of Biology, Complutense University, 28040 Madrid, Spain
- Modeling, Data Analysis and Computational Tools for Biology Research Group, Complutense University, 28040 Madrid, Spain
- Neurocomputing and Neurorobotics Research Group, Complutense University, 28037 Madrid, Spain
- Brain Plasticity Group, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Julia Sánchez-Quirós
- Department of Ophthalmology, San Carlos Clinical Hospital, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Juan Donate-López
- Department of Ophthalmology, San Carlos Clinical Hospital, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Julián García-Feijóo
- Department of Ophthalmology, San Carlos Clinical Hospital, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
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