Pandemic Associated With Reduced Intravitreal Injections in France

Close up of a doctor doing an eye exam on his patient
Across France, fewer patients than expected underwent anti-VEGF treatments during COVID-19 lockdowns.

The onset of the coronavirus disease 2019 (COVID-19) pandemic in France was associated with a reduction in the dispensing of key ophthalmological treatments, including intravitreal anti-vascular endothelial growth factor (VEGF) injections for retinal vascular abnormalities, due to challenges in care access and disease monitoring, according to a research letter published in JAMA Ophthalmology. 

Investigators  seeking to quantify the changes in treatment distribution during the COVID-19 pandemic used data collected from the French National Health Data System. The researchers reviewed anonymized pharmacy claims from the first 23 weeks of 2018, 2019, and 2020 for aflibercept or ranibizumab. 

In total, 33,292 people used intravitreal anti-VEGF drugs during 2020 before lockdowns took effect (60.5% women; mean age, 77.3±11.1 years); 87,316 received treatments during lockdown (60.1% women; mean age, 76.8±11 years), and 63,020 used these drugs upon reopening (61.2% women; mean age, 77.5±11 years). 

Compared with the expected numbers, ophthalmologists saw a 47.1% decrease in patients receiving treatments during the first 5 weeks of lockdown. The number of patients using these drugs remained low until the last week of lockdown (-24.9%), with a decrease of 46,381 injections during the 8-week lockdown period. 

Throughout the first 4 weeks of reopening, the researchers observed a “gradual but incomplete recovery,” with a difference of -21.9% in 20 to -4.2% and -3.5% in weeks 22 and 23. The most marked decrease was for treatment initiations (-65.3%) during lockdown, corresponding to a total of 8169 fewer treatments initiated and a gradual recovery during reopening. 

The investigators noted that extrapolation of these data to the entire French population corresponds to an estimated decrease of 60,000 injections and 10,500 initiations during the 8-week lockdown period relative to the estimated 85,000 injections typically administered per month.

Study limitations include the inability to determine whether the study findings are associated with permanent visual acuity loss. 

“Most anti-VEGF therapies, particular with neovascular AMD, should not be delayed,” the research concludes. “We believe this situation should continue to be monitored closely, to determine if persistent delays result in longer waiting times to obtain appointments for these treatments.” 


Billioti de Gage S, Drouin J, Desplas D, et al. Intravitreal anti-vascular endothelial growth factor use in France during the coronavirus disease 2019 pandemic. JAMA Ophthalmol. Published online December 17, 2020. doi:10.1001/jamaophthalmol.2020.5594