Pandemic Delays Treatment, Threatening Patients and Research

Laird Harrison

October 08, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

The COVID-19 pandemic has taken a severe toll on patients with retina diseases, according to leading European specialists who took stock and exchanged tips on innovative responses to the crisis at the virtual European Society of Retina Specialists 2020 Congress.

The number of new patients with neovascular age-related macular degeneration decreased by an average of 72% after the onset of the pandemic, said Adnan Tufail, MBBS, MD, from Moorfields Eye Hospital in London, citing findings from a survey he and his colleagues conducted at three treatment centers in the United Kingdom.

A delay in treatment initiation of 3 months could cause an increase of more than 50% in the number of eyes with age-related macular degeneration with 6/60 vision or worse, the survey team estimates, and a 25% decrease in the number of eyes with driving vision over a year.

Significant declines in the number of patients presenting to the hospital for retina treatments were also reported in France and Spain.

"The problem was that patients were afraid to go to the hospital for the injections in their eyes," said Cesare Mariotti, MD, PhD, from the University of Ancona in Italy.

The overall drop in patients going to the hospital for treatment — roughly 80% across Asia, Europe, and the United States — posed challenges for research, as well as for patients, said Susanne Diehl, PhD, from Novartis in Bavaria, Germany. "Trials will be delayed, approvals will be delayed, and innovation will come to the market delayed."

Mobile Injection Units

One inventive response to the crisis was to form a mobile intravitreal injection clinic so patients, particularly seniors, could receive treatments in their homes, said Anat Loewenstein, MD, MHA, from Tel Aviv University in Israel.

That service required a lot of infrastructure to set up, and a physician was delegated to review all patient charts to identify those who did not need to be examined before an injection was administered.

It would not be feasible to continue over the long term, but patients loved it, she told Medscape Medical News. "You can't imagine how people were grateful and happy and were begging us to do that."

Crews on the mobile units wore masks, face shields, gowns, and gloves, and were tested periodically for COVID-19, Loewenstein reported.

And an entire floor of an office building that wasn't being used during the pandemic was donated by WeWork, the coworking company, so that Loewenstein and her colleagues could set up a satellite injection clinic, complete with an optical coherence tomography (OCT) machine, for patients not comfortable visiting the hospital.

The strategy in France was to issue a press release and information sheets to reassure patients that they could safely come to the hospital for treatment, said Laurent Kodjikian, MD, PhD, president of the French Society of Ophthalmology.

"Despite that, about 20% to 30% of the patients didn't come," said Jean-Francois Korobelnik, MD, from the University Hospital of Bordeaux in France. "Some were afraid because they were old and felt they were exposed, especially coming to the hospital. And some of them had really big issues with transportation; they couldn't find a driver, family, or someone to bring them to the hospital."

Reducing Number of Visual Acuity Exams

Even before the pandemic, Korobelnik's clinic had reduced the number of visual acuity exams performed, which helped shorten appointments to reduce the risk for infection. "We realized that in many, many cases in AMD and DME patients, visual acuity does not change our decision," he said. "We look at the fundus, we look at the OCT, of course, and we talk to the patients, and that's enough."

The pandemic might accelerate the development of OCT and other monitoring devices that can be used at home, said Tufail. "It's going to be an economic decision to make it cheap enough for deployment, but I'm really hopeful that these devices will come out."

Others at the congress reported that hospitals added appointment slots to spread out patient visits or reduced the number of seats in waiting rooms. "We made sure we found every patient who didn't come, just to reassure them that they weren't at any risk," said Robin Hamilton, MB BS, DM(Dist), from Moorfields.

Loewenstein reports financial relationships with Allergan, Bayer, Beyeonics, Forsightlabs, Notal Vision, Novartis, and Roche.

European Society of Retina Specialists (EURETINA) 2020. Presented October 3, 2020.

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