Background and Objectives: The purpose was to provide the patients’ perspective on the monitoring of their wet age-related macular degeneration (wet AMD) during coronavirus disease 2019 (COVID-19) and the importance of telemedicine. Materials and Methods: Wet AMD patients that underwent intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections in two Swiss ophthalmology clinics, completed two questionnaires after the first confinement due to COVID-19 in Switzerland. The first evaluated their views concerning their adherence to scheduled injections during the confinement, and the application of telemedicine in the future. The second, adapted from the National Eye Institute Visual Function Questionnaire-25, assessed their opinions on visual function change during confinement. Results: From a total of 130 patients, 8.5% responded they did not respect their assigned schedule (group 1) while 91.5% responded they did (group 2). A total of 78.7% of group 2 considered treatment reception as more relevant compared to the risk of COVID-19 contraction. During the pre-lockdown period, group 2 patients required more help from others than group 1 patients (p = 0.02). In the possibility of another lockdown, 36.3% of group 1 and 8.7% of group 2 would choose telemedicine to monitor their wet AMD (p = 0.02), 54.5% and 86.9% would rather visit the clinic (p = 0.02), while 9.0% and 4.3% would cancel their appointment, respectively. It was found that 70% of group 1 and 33.6% of group 2 would prefer to use the telemedicine services than visiting a telemedicine centre (p = 0.04). Conclusions: During circumstances similar to the COVID-19 confinement, most patients would prefer to visit the clinic. Group 1 would prefer wet AMD monitoring via telemedicine at a higher rate than group 2.
Purpose: To present the patients’ view on the monitoring of their wet Age‐related Macular Degeneration (wet AMD) during Coronavirus disease 2019 (COVID‐19), and the impact that telemedicine could have on it.Methods: Wet AMD patients of Swiss Visio Montchoisi and RétinElysée (Lausanne, Switzerland), who had intravitreal anti‐Vascular Endothelial Growth Factor (anti‐VEGF) injections before and after the first period of the Swiss confinement due to COVID‐19, completed two questionnaires. The first evaluated their view on their adherence to their scheduled injections during the confinement, and on the future use of telemedicine. The second, adapted from National Eye Institute Visual Function Questionnaire‐25, evaluated their opinion on their visual function during the confinement.Results: From a total of 130 patients, 8.5% responded they did not respect their assigned injection interval during the confinement (group 1), while 91.5% responded they did (group 2). The majority of group 1 (37.5%) responded they did not attend their scheduled visit to avoid using public transportation. The majority of group 2 (78.7%) considered the continuation of their treatment more important than the risk of contracting COVID‐19. Before the lockdown, patients of group 2 had more need for help from others than the patients of group 1 (p = 0.02). In a future lockdown, 36.3% of group 1 and 8.7% of group 2 would prefer remote monitoring of their wet AMD via telemedicine (p = 0.02), 54.5% and 86.9% would prefer to visit the clinic (p = 0.02), while 9% and 4.3% would avoid the visit, respectively. 70% of group 1 and 33.6% of group 2 would rather use the telemedicine application in their home than visit a telemedicine center (p = 0.04).Conclusions: Despite our availability to provide continuous intravitreal anti‐VEGF injections during the COVID‐19 confinement, many wet AMD patients did not receive their scheduled treatment. In similar future circumstances, most patients would prefer to visit the clinic. The patients of group 1 would prefer remote monitoring of their AMD via telemedicine at a higher rate than the patients of group 2.Bibliography: Visual Function Questionnaire 25. https://www.nei.nih.gov/learn‐about‐eye‐health/resources‐for‐health‐educators/outreach‐materials/visual‐function‐questionnaire‐25
31 July 2024 in Graefe's Archive for Clinical and Experimental Ophthalmology
Purpose: To highlight the influence of preocular and ocular vascular circulatory dynamics on the vascular density (VD) of retinal capillary plexuses (RCPs) and choriocapillaris (CC) in patients with and without cardiovascular risk (CVR) factors. Methods: A retrospective observational study in patients with and without CVR factors (type 1 and 2 diabetes, arterial hypertension, and hypercholesterolemia). Fluorescein (FA) and indocyanine (ICGA) angiography circulatory times were arterial time (FAAT), start (FAstartLF) and end (FAendLF) of laminar flow, and arterial time (ICGAAT), respectively. OCT angiography VDs were superficial (VDSCP) and deep (VDDCP) RCPs and CC (VDCC) VDs. Correlation and regression analysis were performed after adjusting for confounding factors. Results: 177 eyes of 177 patients (mean age: 65.2 ± 15.9 years, n = 92 with and 85 without CVR) were included. VDSCP and VDDCP were significantly inversely correlated with FAAT, FAstartLF and FAendLF likewise VDCC with ICGAAT. Correlations were stronger in patients without CVR than with CVR. CVR, FAAT, FAstartLF and FAendLF were more strongly correlated with VDDCP than VDSCP. FAAT, FAstartLF and FAendLF significantly impacted VDSCP and VDDCP, likewise ICGAAT impacted VDDCP. VDDCP was most strongly impacted by FAAT and FAstartLF. Conclusion: Ocular and pre-ocular circulatory dynamics significantly impacted RCPs and CC VDs, especially deep RCP.
Purpose: Intravitreal anti‐Vascular Endothelial Growth Factor (anti‐VEGF) injections are the gold standard treatment for wet Age‐related Macular Degeneration (wet AMD). Coronavirus disease 2019 (COVID‐19), and the resulting confinement, led to the cancellation of many programmed intravitreal anti‐VEGF injection visits. We compared the functional and structural visual outcomes of patients that did not respect their intravitreal anti‐VEGF injection intervals during the period of confinement due to COVID‐19 (group 1) and those who respected them (group 2).Methods: Wet AMD patients of Swiss Visio Montchoisi and RétinElysée were included. Best Corrected Visual Acuity (BCVA) and Optical Coherence Tomography (OCT) changes between the first post‐ and last pre‐confinement visit were assessed, with favorable and unfavorable being the possible outcomes for each change.Results: Group 1 (n = 89, 109 eyes) had 13.41% greater rate of unfavorable BCVA outcome and 38.27% greater rate of unfavorable OCT outcome than Group 2 (n = 96, 122 eyes) (p = 0.04, p < 0.0001, respectively). The multivariate analysis showed that the more the patients deviated from their programmed injections and the higher the BCVA pre‐confinement, the higher the rate of unfavorable BCVA outcome (p = 0.03, p = 0.02, respectively). The OCT changes were not a predictive factor for an unfavorable BCVA outcome. The rates of pigment epithelial detachment (PED) and intraretinal fluid (IRF) increase in the first post‐confinement visit were higher in group 1 than in group 2 (p = 0.0004, p = 0.0374, respectively), with a relative increase of unfavorable OCT outcome of 200% and 66.67%, respectively.Conclusions: COVID‐19 pandemic led many patients to refrain from their routine intravitreal anti‐VEGF injection visits, allowing us to analyze the role of designated intervals in the treatment of patients with wet AMD. During a next confinement due to COVID‐19, or circumstances similar to it, ophthalmologists should ensure the continuity of injections for their patients.Bibliography: Fung THM et al. Addressing COVID‐19 fear to improve clinic attendance for patients with wet age‐related macular degeneration. Acta Ophthalmol 99: e285 (2021). Colantuono D et al. AMD management during the COVID‐19 pandemic. Acta Ophthalmol 98, e925–e925 (2020).