Clinical Ophthalmology (Sep 2022)
Effects of COVID-19 on Intravitreal Injection Clinic After Lockdown
Abstract
Terry Hsieh,1 Bradley S Gundlach,2 Sahar Ashrafzadeh,2 David Sarraf,3,4 Irena Tsui3,5,6 1Stein Eye Institute, University of California, Los Angeles, CA, USA; 2David Geffen School of Medicine, University of California, Los Angeles, CA, USA; 3Ophthalmology Department, West Los Angeles Veterans Health Administration, Los Angeles, CA, USA; 4Retinal Disorders and Ophthalmic Genetics - Stein Eye Institute, University of California, Los Angeles, CA, USA; 5Retina Division - Stein Eye Institute, University of California, Los Angeles, CA, USA; 6Doheny Eye Institute, University of California, Los Angeles, CA, USACorrespondence: Irena Tsui, Ophthalmology Department, West Los Angeles Veterans Health Administration, Los Angeles, CA, USA, Tel +1 310 825 7290, Fax +1 310 825 9946, Email [email protected]: To examine the return of patients to intravitreal injection clinic after the COVID-19 lockdown.Patients and Methods: The electronic medical records of all patients who received intravitreal injections at a tertiary care Veterans Health Administration (VHA) clinic 14 weeks post-lockdown (5/9/20-8/13/20) in Los Angeles County were reviewed. Reference groups included injection patients during the 7-week COVID-19 lockdown (3/19/20-5/8/20) and a 7-week pre-pandemic period in 2019 (3/19/19-5/8/19). Clinic volume was compared using a one-way ANOVA. Demographic data, medical and psychiatric co-morbidities, injection diagnoses, visual acuities, and clinic volumes were compared between the 3 periods using a generalized estimating equation multivariate analysis.Results: The post-lockdown period group averaged 25.1 visits per week, compared with 12.3/week during lockdown and 25.4/week pre-COVID in intravitreal injection clinic. In the post-lockdown period, the VHA injection clinic returned closer to the pre-lockdown volume compared to the VHA comprehensive clinic (98.9% vs 57.4%, p < 0.001). Post-lockdown, COPD patients and organ transplant patients were less likely to receive injections compared to 2019 (OR 0.76 p = 0.008, OR 1.37 p < 0.0001, respectively). Patients with a diagnosis of cancer increased in proportion between the pre-pandemic and the post-lockdown periods (OR 1.31, p = 0.007). No differences were found, according to psychiatric co-morbidities. After lockdown, the proportion of patients receiving injections for diabetic macular edema (DME) increased (OR 1.11, p = 0.01).Conclusion: Injection volume returned to pre-pandemic levels immediately after lockdown ended. However, patients with high-risk comorbidities did not return to intravitreal injection clinic post-lockdown. These results can inform medical organizations, which groups may need increased safety measures and targeted outreach to address their ophthalmic needs.Keywords: age-related macular degeneration, anti-vascular endothelial growth factor, coronavirus, co-morbidities, diabetic retinopathy, retina
