BLOG: Intravitreal injection patterns during COVID-19 pandemic
On March 18, 2020, the American Academy of Ophthalmology issued guidance regarding the emerging COVID-19 pandemic, stating that ophthalmologists should “cease providing any treatment other than urgent or emergent care immediately.”
A rich trove of data sits in the wake of the COVID-19 crisis. One question in particular stuck in our minds: What effect, if any, did the AAO’s guidance to cease all but urgent or emergent cases have on the frequency of anti-VEGF intravitreal injection administration?
To help answer this, the AAO IRIS Registry data curation and analytics partner, Verana Health, retrospectively analyzed deidentified real-world data housed within the IRIS Registry, which is ingested from the electronic health records of approximately 70% of U.S. ophthalmologists. Doing so allowed us to avoid sifting through an amalgam of heterogeneous claims data, providing a cleaner and faster data set to work with.
We compared the period before the AAO’s guidance issue (the pre-guidance period) with a similar length of time immediately after the guidance was issued (the post-guidance period). The cutoff between those two periods was the announcement date, March 18, 2020.
In the pre-guidance period, approximately 214,000 patients visited ophthalmologists per day in the United States. By April 10 — 23 days after the AAO’s recommendation — we saw a dramatic, responsive decline to 34,000 visits per day (approximately an 85% decrease). And although this number has steadily increased, overall daily average patient visits in the post-guidance period has yet to reach 200,000.
In stark contrast, the rates of anti-VEGF intravitreal injections were only minimally affected during the post-guidance period. Although total patient visits fell by 62% from March to April, the number of monthly anti-VEGF injections decreased by only 8% (absolute reduction from 330,000 to 304,000) during the same period.
These data, housed in the IRIS Registry and analyzed with the assistance of Verana Health, suggest several conclusions:
1. Ophthalmologists complied with the AAO’s COVID-19 guidance. The steep drop in patient encounters immediately after the AAO’s March 18 recommendation clearly demonstrates that most ophthalmologists put value in the AAO’s messaging.
2. Most retina patients still received the care required to prevent vision loss. Although the overall number of patient encounters acutely dropped to as low at 34,000 per day, those requiring anti-VEGF therapy were considerably less affected. In other words, patients with retinal conditions needing treatment still received it during this period. Further analysis being conducted will reveal what consequence, if any, this had on patients’ visual outcomes.
3. IRIS Registry’s data insights will continue to help guide discussions about practicing ophthalmology during the COVID-19 era and beyond. Large-scale real-world data curation and analysis born out of the partnership between the IRIS Registry and Verana Health will continue enhancing our understanding of changing practice patterns and clinical outcomes. New, innovative care models have emerged through necessity, and many will have transformational, lasting impact. The IRIS Registry serves an important role as ophthalmic practice paradigms evolve; real-world data can offer unprecedented insights to guide and monitor the quality of patient care and outcomes.
References:
- American Academy of Ophthalmology. Recommendations for urgent and nonurgent patient care. www.aao.org/headline/new-recommendations-urgent-nonurgent-patient-care. Published March 18, 2020. Accessed February 11, 2021.
- Gunasekeran DV, et al. Lancet Digit Health. 2021;doi:10.1016/S2589-7500(20)30287-9.
- Schwartz SD. New insight into real-world U.S. anti-VEGF injection data. Presented at: American Academy of Ophthalmology annual meeting; Nov. 13-15, 2020 (virtual meeting).
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