Delayed DME treatment during pandemic resulted in worsening of vision
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Patients with diabetic macular edema who had their treatment delayed during the first months of the COVID-19 pandemic experienced worsening of DME and retinopathy with consequent vision loss, according to a study carried out in the U.K.
As per the Royal College of Ophthalmologists’ guidelines, many of the patients receiving anti-VEGF intravitreal injections had their appointments deferred in order to minimize the risk for infection for both patients and staff in the eye units. Patients with DME were prioritized according to clinical needs.
“Those with lower risk had their treatment postponed for 3 months. Those with severe nonproliferative diabetic retinopathy (NPDR) or proliferative diabetic retinopathy (PDR) were offered ongoing treatment, but many chose not to attend due to concerns relating to COVID-19 and the higher risk to individuals with diabetes,” according to a poster by Abeir Baltmr and colleagues presented at the virtual Association for Research in Vision and Ophthalmology meeting.
In a cross-sectional study of all patients with DME treated with anti-VEGF injections at the University Hospital of Southampton, U.K., between January 2020 and September 2020, the impact of delayed treatment was evaluated. Data were gathered for 276 eyes of 199 patients. The average gap in treatment was 16.5 weeks, and the average reduction of best corrected visual acuity from baseline was –0.15 D. Twenty-seven eyes lost 5 letters or more, six eyes lost 15 letters, and 63 eyes were within ±5 letters of baseline vision. Improvement in DME despite the gap in treatment was reported in 32 eyes, while five eyes progressed from NPDR to PDR.
The authors found that the longer the gap in treatment, the higher was the risk of reporting worsening visual outcomes. The majority of patients who had a treatment gap of more than 12 weeks had worsening in visual acuity.
Overall, no significant deterioration in OCT thickness occurred after the treatment gap. “This needs further investigation and may indicate slow increase in edema, patient selection, or timing and quality of the OCT scans,” the authors wrote.
“This information helps us to inform patients of the risks of not attending for review and treatment,” they wrote.
Responding to a comment to the poster, Baltmr said that the consequences of delayed treatment may be long term.
“We have not yet analyzed what happened after restarting treatment. This study excluded higher-risk patients whose treatment was tried to continue, but we have anecdotal evidence of more severe proliferative presentation in the last few months,” Baltmr wrote.
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Baltmr A, et al. Delaying anti-VEGF treatment for diabetic macular oedema during the pandemic – effect on vision and anatomical outcomes. Presented at: Association for Research in Vision and Ophthalmology annual meeting; May 1-7, 2021 (virtual meeting).
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