Researchers led at the Karl Landsteiner Institute for Retinal Research and Imaging, Vienna, Austria, have reported that the discontinuation of treatment on exudative neovascular age related macular degeneration (nAMD) during the COIVID-19 pandemic showed a persistent negative impact on visual acuity (VA). The research group showed that treatment deferral led to significant visual loss after 1 year and, given the necessity of sustaining an anti-VEGF treatment regimen for patients, data should create awareness for regulators across the EU regarding future planning decisions as the vaccination program for Covid19 continues.
In February 2020, the World Health Organization identified a severe acute respiratory coronavirus 2 (SARS-CoV-2) syndrome as the cause of COVID-19. The subsequent global pandemic resulted in multiple country lockdowns around the world and in severe challenges in the clinical support of non-COVID-19 patients requiring continual care and treatment. This was also the case in Austria, where, on March 16th, 2020, restrictions in public spaces were imposed to limit the spread of the infection. To follow-up on a cohort of exudative neovascular age related macular degeneration patients, researchers collated all VA data to assess the impact of the interruption of anti-VEGF treatment.
Retrospective data from 98 patients in Vienna showed that the treatment interval of anti-VEGF doubled to 117.6 ± 31.4 days in the Spring of 2020, leading to patients losing 2.2 ± 4.6 ETDRS letters (p = 0.002) on average, before reinitiating therapy. The study showed that, in total, 4.1 ± 8.1 letters (p<0.0001) were lost despite continuous individual re-treatment over the course of the next year. In an analysis of the data, the extended interval time remained statistically significant (p<0.0001), indicating a larger VA reduction within intervals with increasing interval time in days. In their paper, the researchers commented that, “our findings provide further support for an adequate and permanent therapy of wet AMD and regard intravitreal injections as urgent standard of care. It should be taken into consideration by authorities in future pandemic planning”. In concluding the outcomes of their study, researchers commented that, “this study provides novelty as it supports further evidence for an urgent and ongoing treatment with intravitreal anti-VEGF for MNV (macular neovascularization) secondary to exudative nAMD, regardless of the treatment regimen. Its findings should be taken into consideration by authorities in future pandemic planning. Amidst multiple lockdowns to come, it remains more important than ever to demonstrate the potential damage done when patients are forced to forego therapy”.