Pandemic-Associated Delays in Intravitreal Injections Linked to Lost Visual Acuity

Woman ophthalmologist checking eyesight of elderly man
Female ophthalmologist examining eye of a mature patient in her clinic. Woman ophthalmologist checking eyesight of elderly man looking into tonometer.
Patients who delayed intravitreal injection treatments due to the pandemic experienced worsening vision, a study shows.

COVID-19 emergency response resulted in a nearly 3-month suspension of injections treatment for patients with neovascular age-related macular degeneration (AMD) at a tertiary center in Bergamo, Italy. Researchers assessed the clinical outcomes that followed in a case study published in Clinical Ophthalmology.

“While decisions amid a crisis are always difficult and complex, a retrospective evaluation of the adopted strategies could provide insight on the impact and efficacy of our choices,” the report says. “In particular, we decided to carry out a new loading phase of bevacizumab, one injection per month for 3 months before starting back with the previous regimen.”

The 39 patients (median age 76.2 years, 15 men, right eye 21) included in the study received at least 3 injections in January or February 2020, before the lockdown. They had been scheduled to receive an injection in March or April 2020.

The researchers utilized a mixed effect model with random intercepts to compare best corrected visual acuity (BCVA) in post lockdown period with the prediction from the central macular thickness (CMT) and analyze any change in choroidal neovascularization (CNV) maximum height and width over the course of the study.

Controlling for CMT, the researchers found that BCVA significantly decreased between pre- and post-lockdown (P =.0201). BCVA values were lower than the researchers had predicted based on CMT values.

Maximum height and width of pigmented epithelium detachment (PED) did not significantly change between pre- and post-lockdown. Sixteen patients developed fibrosis during follow-ups (16 before lockdown, 9 after lockdown).

In mixed effect logistic regression, there was no significant change in frequency of observed subretinal fluid (SRF) and intraretinal cysts (IRC) pre- and post-lockdown.

Patients did not report adverse events, according to the researchers.

“Different guidelines indicated the necessity of continuing intravitreal injections, in the forecast of future measures to control COVID-19 pandemic waves we warn about the risks of suspending anti-VEGF therapy and highlight the importance of treatment consistency,” the research says. “Indeed, despite our efforts to minimize the impact of interruption, we could still detect a significant loss in visual function, despite good structural recovery. The magnitude of the average loss was, however, small and this can be viewed as a partially successful outcome.”

Limitations of the study include the confounder of lockdown vs. natural evolution of the disease, small sample size, reliability of CNV measurement, and lack of control group.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.  


Allegrini D, Raimondi R, Montesano G, et al. Short-term outcomes after COVID-19-related treatment interruption among patients with neovascular age-related macular degeneration receiving intravitreal bevacizumab. Clin Ophthalmol. 2021;15:4073-4079. doi:10.2147/OPTH. S323058