Short term visual and structural outcomes of anti-vascular endothelial growth factor (anti-VEGF) treatment delay during the first COVID-19 wave: A pilot study

Ameay V. Naravane, Rusdeep Mundae, Yujia Zhou, Christopher Santilli, Frederik J.G.M. van Kuijk, Hossein Nazari, Justin Yamanuha, Geoffrey G Emerson, Dara D. Koozekanani, Sandra R. Montezuma

Research output: Contribution to journalArticlepeer-review

26 Scopus citations


Regularly scheduled intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections are essential to maintaining and/or improving many ocular conditions including: neovascular age-related macular degeneration (nAMD), diabetic retinopathy, and retinal vein occlusions with macular edema (RVO). This study aims to assess the effect of unintended delays in anti-VEGF treatment during the first wave of the COVID-19 pandemic. This retrospective case series identified patients receiving regularly scheduled anti-VEGF intravitreal injections based on current procedural terminology (CPT) code at two practices in Minnesota. Diagnoses were limited to nAMD, diabetic macular edema (DME), proliferative diabetic retinopathy, and RVO. Patients were divided into two groups based on whether they maintained or delayed their follow-up visit by more than two weeks beyond the recommended treatment interval during the COVID-19 lockdown. The ‘COVID-19 lockdown’ was defined as the period after March, 28th, 2020, when a lockdown was declared in Minnesota. We then compared the visual acuity and structural changes to the retina using ocular coherence tomography (OCT) to assess whether delayed treatment resulted in worse visual outcomes. A total of 167 eyes from 117 patients met criteria for inclusion in this study. In the delayed group, the average BCVA at the pre- and post-lockdown visits were 0.614 and 0.715 (logMAR) respectively (p = 0.007). Central subfield thickness (CST) increased from 341 to 447 in the DME delayed group (p = 0.03) while the CST increased from 301 to 314 (p = 0.4) in the nAMD delayed group. The results of this pilot study suggests that treatment delays may have a negative impact on the visual and anatomic outcomes of patients with nAMD and DME. Future studies with larger sample sizes are required for further investigation.

Original languageEnglish (US)
Article numbere0247161
JournalPloS one
Issue number2 February
StatePublished - Feb 2021

Bibliographical note

Publisher Copyright:
© 2021 Naravane et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


  • Adult
  • Aged
  • Aged, 80 and over
  • Angiogenesis Inhibitors/therapeutic use
  • COVID-19/epidemiology
  • Diabetic Retinopathy/drug therapy
  • Female
  • Humans
  • Macular Edema/drug therapy
  • Male
  • Middle Aged
  • Minnesota/epidemiology
  • Pandemics/statistics & numerical data
  • Pilot Projects
  • Quarantine/methods
  • Retinal Diseases/drug therapy
  • Retinal Vein Occlusion/drug therapy
  • Retrospective Studies
  • SARS-CoV-2/isolation & purification
  • Time-to-Treatment/statistics & numerical data
  • Vascular Endothelial Growth Factors/antagonists & inhibitors
  • Visual Acuity/drug effects

PubMed: MeSH publication types

  • Research Support, Non-U.S. Gov't
  • Journal Article


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