IMPACT study: Impact of adherence to anti‐VEGF intravitreal injections for macular disease during COVID 19‐related confinement in France

PURPOSE: The aim of this study was to evaluate the impact of adherence to French coronavirus disease 2019 (COVID 19)‐related guidelines for intravitreal injection (IVI) practice on the visual outcomes of patients treated with anti‐vascular endothelial growth factor (VEGF) agents for macular diseases during the first lockdown period. METHODS: Observational multicentre study including all patients from 18 centres with an IVI initially planned during the lockdown. Visual acuity (VA, ETDRS) was recorded at 1 and 4 months after lockdown. French COVID 19‐related guidelines recommended maintaining IVI practice. We defined three groups of patients: A, adherent to guidelines; NA+, non‐adherent with delayed IVIs; and NA−, non‐adherent without IVIs performed during the lockdown. Risk factors for non‐adherence and visual loss were studied. RESULTS: A total of 3020 eyes of 3020 patients, aged 77.8 ± 11.6 years, 59.8% women, were included. 59.3% were non‐adherent(46.7% NA+, 12.6% NA−). A smaller decrease in VA at 4 months was observed in the A group than the NA+ and NA− group (−0.2 ± 6.7, −0.3 ± 6.9 and −1.5 ± 6.9, respectively [p < 0.001]). Factors associated with non‐adherence were in multivariable analysis, older age, hospital practice, low‐density population areas, high viral incidence areas, longer intervals between injection and treat and extent protocol. Factors associated with visual loss at 4 months in multivariable analysis were, being in the NA− group, older age, T&E and fixed regimens. CONCLUSION: Strict adherence to guidelines was associated with better visual outcome, although most of our patients did not attend as planned. Identification of patients at risk could help in the future in case of a new pandemic lockdown.