Abstract
Background/Objective
Some clinicians may be forced to temporarily extend treatment intervals in neovascular age-related macular degeneration (nAMD) eyes with frequent retreatments to reduce the number of visits during the COVID-19 pandemic. To provide an indication of what these outcomes may be, we studied eyes with active lesions with unplanned treatment interval extensions before the pandemic occurred.
Methods
We compared eyes with active disease despite ≤6 weekly injections whose next injection was extended to ≥7 weeks and those whose intervals were not extended. We identified 1559 (16%) of 9602 eyes from the Fight Retinal Blindness! (FRB!) registry (2013 and 2018) that fit this criteria. Eyes were further stratified into four groups by the mean interval over the following 6 months: (1) ≤6 weeks (81%), (2) 7–9 weeks (9%), (3) 10–12 weeks (5%) and (4) >12 weeks (5%).
Results
There was a significant loss in VA in eyes extended to >12 weeks compared to the non-extended group (adjusted VA change, mean (95% CI): ≤6 weeks, 0.4 (−1.5 to 2.2), versus >12 weeks, −4.7 (−7.4 to −2.1), letters, p = 0.03 and a threefold increase in relative risk of losing ≥15 letters (absolute risk (14% versus 4%, p < 0.01)).
Conclusion
Mean VA remained stable for 6 months in eyes requiring frequent treatment despite retreatment interval extension up to 10–12 weeks. There was a significant short-term risk to vision when retreatment interval was extended beyond 12 weeks, hence extensions to this level should be considered cautiously. These data may be useful for physicians who are considering reducing visits to mitigate the risk of COVID-19.
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Acknowledgements
Fight Retinal Blindness! investigators: Auckland District Health Board, New Zealand (Dr D. Squirrell); Armadale Eye Clinic, Victoria (Dr A. Cohn); Lion’s Eye Institute, Western Australia (Dr F. Chen, Dr T. Isaac, Professor I. McAllister); Auckland Eye, New Zealand (Dr A. McGeorge); Bundaberg Eye Clinic, Queensland (Dr I. McLean); Cairns Eye Surgery, Queensland (Dr A. Field); Canberra Hospital, Australian Capital Territory (Dr C. Dayajeewa, Dr J. Wells); Care Foresight, New South Wales (Dr A. Dunlop); Caulfield Eye Clinic, Victoria (Dr C. Ng); Central Coast Eye Specialist, New South Wales (Dr S. Young); Centre for Eye Research Australia, Victoria (Professor R. Guymer); Coastwide Eye Surgery, New South Wales (Dr R. Ferrier); Crest Eye Associates, New Zealand (Dr J. Ah-Chan); Doncaster Eye Center, Victoria (Dr L. Chow); Dr Alex Amini’s Practice, Victoria (Dr A. Amini); Dr Clarks Practice, New South Wales (Dr G. Clark); Dr Nadia Wittles Practice, South Australia (Dr N. Wittles); Dr Phillip Windle, Queensland (Dr P. Windle); Eye Associates, New South Wales (Dr M. Gillies, Dr A. Hunt); Eye Surgeons Miranda, New South Wales (Dr A. Hunt); Eyemedics (Wayville), South Australia (Dr K. Billing, Dr J. Chen, Dr S. Lake, Dr J. Landers, Dr M. Perks, Dr R. Phillips, Dr N. Saha); Gladesville Eye Specialists, New South Wales (Dr S. Young); Hawthorn Eye Clinic, Victoria (Dr L. Chow); Hornsby Eye Specialists, New South Wales (Dr S. Lal); Les Manning, Queensland (Dr L. Manning); Marsden Eye Specialists, New South Wales (Dr J. Arnold); Midwest Ophthalmology, New South Wales (Dr K. Tang); Mona Vale Eye Centre, New South Wales (Dr C. Lim); Nepean Valley Eye Surgeons, New South Wales (Dr G. Banerjee); North Queensland Retina, Queensland (Dr I. Reddie); Port Macquarie Eye Centre, New South Wales (Dr J. Game); Retina & Macula Specialists (Miranda), New South Wales (Dr M. Chilov); Retina Associates, New South Wales (Dr S. Fraser-Bell, Dr A. Fung, Professor A. Hunyor, Dr C. Younan); Retina Consultants, New South Wales (Dr S. Young); Retina Specialists, New Zealand (Dr R. Barnes, Dr D. Sharp, Dr A. Vincent); Singapore National Eye Centre, Singapore (Dr G. Cheung); Specialist Eye Group, Victoria (Dr L. Chow, Dr A Cohn); Strathfield Retina Clinic, New South Wales (Dr C. Lim); Sydney Eye Hospital, New South Wales (Dr S. Fraser-Bell, Dr J. Wong); University Hospital Zurich, Switzerland (Dr D. Barthelmes); Victoria Parade Eye Consultants, Victoria (Dr M. Daniell, Professor R. Guymer, Dr A. Harper, Dr L. Lim, Dr J. ODay); Victorian Eye Surgeons, Victoria (Dr A. Cohn) and Visionary Eye Specialists, New South Wales (Dr C. Hooper).
Funding
Supported by a grant from the Royal Australian NZ College of Ophthalmologists Eye Foundation (2007–2009), a grant from the National Health and Medical Research Council, Australia, (NHMRC 2010–2012) and a grant from the Macula Disease Foundation, Australia. MCG is a Sydney Medical Foundation Fellow and is supported by an NHMRC practitioner fellowship. DB was supported by the Walter and Gertrud Siegenthaler Foundation Zurich, Switzerland, and the Swiss National Foundation. CMGC is supported grant by a grant from the National Medical Research Council (Open Fund Large Collaborative grant no: NMRC/LCG/0042018).
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Teo, K.Y.C., Nguyen, V., Barthelmes, D. et al. Extended intervals for wet AMD patients with high retreatment needs: informing the risk during COVID-19, data from real-world evidence. Eye 35, 2793–2801 (2021). https://doi.org/10.1038/s41433-020-01315-x
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DOI: https://doi.org/10.1038/s41433-020-01315-x
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