The Impact of COVID-19 on Intravitreal Injection Compliance

Intravitreal injections (IVI) of anti–vascular endothelial growth factor (anti–VEGF) agents have become the most prevalent intraocular procedure as they represent the major therapeutic modality for prevalent retinal conditions such as age-related macular degeneration (AMD) and diabetic retinopathy. Effective therapy requires adherence to a schedule of iterative IVI as well as routine clinic appointments. The ongoing coronavirus disease 2019 (COVID-19) pandemic has resulted in the reduction of attendance at scheduled clinic visits and IVI. In this study, we attempted to analyze the effect of COVID-19 on compliance with anti–VEGF therapy. A total of 636 eyes received injections during a 4-week period of the COVID-19 outbreak in the Retina Clinic. The number of clinic visits for IVI during 1 month from March 15 to April 14 of 2020 was compared to a similar time period in each of the last 4 years. The study demonstrates a decrease in clinic visits for IVI when compared with the same 4-week interval in the four previous years. Based on the trend of the previous 4 years, 10.2% of the year’s total was expected for this time period. Using this model, the 636 reported number of injections for the March–April 2020 period was ~ 5%. This represents a decrease of ~ 50% of the expected IVI for this time period. The COVID-19 outbreak in Israel severely impacted compliance with anti–VEGF treatments.