Publication date: Feb 01, 2025

To assess the effect of the COVID-19 pandemic on injection intervals among patients treated for neovascular age-related macular degeneration. Retrospective cohort study. Patients treated at a single practice using a treat-and-extend regimen with intravitreal aflibercept between December 2018 and April 2021. The primary outcome was the change in injection intervals. Secondary outcomes included differences in best-recorded visual acuity (BRVA) and central subfield thickness (CST). Associations were evaluated with linear mixed-effects modelling. This study included 1839 injections from 185 eyes (141 patients). The median (interquartile range) injection intervals in the pre-COVID-19 and COVID-19 periods were 60 (42-70) and 70 (49-90) days, respectively. The pandemic was associated with a mean injection interval lengthening of 7. 2 days (P < 0. 001), a decrease in BRVA of 3. 1 Early Treatment Diabetic Retinopathy Study letters (P < 0. 001), and a reduction in CST of 14. 7 μm (P = 0. 003). The presence of exudative intraretinal fluid was associated with a reduction in treatment intervals of 11. 1 days (P < 0. 001), a reduction in BRVA of 1. 9 Early Treatment Diabetic Retinopathy Study letters (P < 0. 001), and an increase in CST of 52. 4 μm (P < 0. 001). The presence of subretinal fluid was associated with a reduction in treatment intervals of 8. 5 days (P < 0. 001) and an increase in CST of 21. 6 μm (P < 0. 001). This real-world study estimated that the severe acute respiratory syndrome coronavirus 2 pandemic resulted in an injection extension of 7. 2 days with associated decreases in BRVA and CST that are unlikely clinically significant on a population basis. This builds on evidence suggesting that long-term vascular endothelial growth factor suppression can facilitate meaningful interval extensions while maintaining visual acuity.

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