Impact of the COVID-19 Pandemic on Visual Outcomes of Diabetic Macular Edema Patients at a Tertiary Care Veterans Affairs Center

Authors

Philip Zhou
Jie Gao
Xiaofan Huang
Kristen A Staggers
Kristin Biggerstaff
Silvia Orengo-Nania
Roomasa Channa

Publication Date

6-1-2022

Journal

Journal of Diabetes & Metabolic Disorders

DOI

10.1007/s40200-022-01049-5

PMID

35582648

PMCID

PMC9098215

PubMedCentral® Posted Date

5-12-2022

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

COVID-19, Pandemic, Macular edema, Diabetic retinopathy, Anti-vascular endothelial growth factor

Abstract

PURPOSE: There are limited studies on factors that impacted retina clinic patient outcomes during the COVID-19 pandemic. We aimed to evaluate visual and anatomic outcomes in patients with diabetic macular edema (DME) requiring anti-VEGF injections at the veterans' affairs tertiary care eye clinic in Houston, TX.

METHODS: Patient volume from April 2020 was compared to that of April 2019 to determine attendance changes. To evaluate outcomes, we reviewed patients with DME who had scheduled appointments during April 2020. We tracked changes in central foveal thickness (CFT) and Snellen visual acuity (VA) measurements. Patient outcomes were classified as poor (defined as worsening VA or CFT at follow-up) or good (no worsening of either at follow-up). Regression analysis identified characteristics associated with poor outcomes.

RESULTS: To prevent the spread of COVID-19, patients were called to reschedule clinic appointments. Attendance frequency decreased from 523 patients in April 2019 to 246 patients in April 2020. 134 patients met inclusion criteria (mean age of 64.7 ± 8.8 years). 19/134 of patients were seen on schedule, 89/134 had delayed appointments (average follow-up interval of 115.2 ± 50.0 days), and 26/134 were lost to follow-up. Patients with delayed appointments had higher odds of poor outcome at follow-up compared to patients seen on schedule (OR = 4.03, 95% CI: 1.14-16.92,

CONCLUSIONS: On average, patients were rescheduled to a visit 2.4 months later than their usual visit. Over half these patients experienced worsening of vision or edema. This demonstrates that lapses in care result in worsening of DME. However, there is no clear association between baseline characteristics and risk of disease progression.