OBJECTIVE/PURPOSE: To examine the effect of delay in care on visual acuity in patients requiring intravitreal injections. DESIGN: Retrospective cohort study. SUBJECTS: Patients aged 18 or older with DME and/or PDR, nAMD, or RVO scheduled to be seen by a retina specialist during the mandated lock down period from March 14 - May 4, 2020 (COVID-19 period) and who had received an intravitreal injection in the 12 weeks prior. METHODS: Chart review was performed and demographics, ophthalmic diagnoses, procedures performed, and visual acuity at all visits were recorded. MAIN OUTCOME MEASURES: Visual acuity in patients who completed, canceled, and no-showed for the COVID-19 period visit. RESULTS: Of the 1,041 total patients in this study, 620 (60%) completed the scheduled visit, while 376 (36%) canceled and 45 (4%) were no-shows. In patients who missed the scheduled visit, the average delay in care was 5.34 weeks. In those who missed a visit, the visual acuity was assessed at the subsequent visit. Patients who canceled a visit were older, and patients who no-showed had lower baseline vision [mean EDTRS letters (±SE); no-show: 53.27 (±3.21), canceled: 60.79 (±1.11), completed: 62.81 (±0.84), p=0.0101] and were more likely to have DME and/or PDR [no-show: 13 (29%), canceled: 56 (16%), completed: 81 (13%), p=0.0456]. Patients who missed a visit lost more vision as compared to the patients who completed the scheduled visit [no-show: -5.024 (±1.88), canceled: -1.633 (±0.65), completed: 0.373 (±0.50), p=0.0028]. In particular, patients with DME and/or PDR [- 3.48 (±1.95) vs 2.71 (±1.75) letters, p=0.0203] and RVO [-3.22 (±1.41) vs 0.95 (±1.23) letters, p=0.0230], and to lesser degree with nAMD [-1.23 (±0.70) vs -0.24 (±0.56) letters, p=0.2679], lost vision compared to patients with same diagnoses who completed the scheduled visit. CONCLUSIONS: In patients requiring intravitreal injections, a delay in care of 5.34 weeks resulted in vision loss. It was seen in all patients but was more prominent in DME and/or PDR and RVO patients. Further studies are necessary to examine whether these vision changes persist over a longer duration of time.
The Effect of Delay in Care Among Patients Requiring Intravitreal Injections