Are intravitreal injections essential during the COVID-19 pandemic? Global preferred practice patterns and practical recommendations

Tertiary outpatient ophthalmology clinics are high-risk environments for COVID-19 transmission, especially retina clinics, where regular follow-up is needed for elderly patients with multiple comorbidities. Intravitreal injection therapy (IVT) for chronic macular diseases, is one of the most common procedures performed, associated with a significant burden of care because of the vigorous treatment regimen associated with multiple investigations. While minimizing the risk of COVID-19 infection transmission is a priority, this must be balanced against the continued provision of sight-saving ophthalmic care to patients at risk of permanent vision loss. This review aims to give evidence-based guidelines on managing IVT during the COVID-19 pandemic in common macular diseases such as age-related macular degeneration, diabetic macula edema and retinal vascular disease and to report on how the COVID-19 pandemic has affected IVT practices worldwide.

To illustrate some real-world examples, 18 participants in the International Retina Collaborative, from 15 countries and across four continents, were surveyed regarding pre- and during- COVID-19 pandemic IVT practices in tertiary ophthalmic centers. The majority of centers reported a reduction in the number of appointments to reduce the risk of the spread of COVID-19 with varying changes to their IVT regimen to treat various macula diseases. Due to the constantly evolving nature of the COVID-19 pandemic, and the uncertainty about the normal resumption of health services, we suggest that new solutions for eye healthcare provision, like telemedicine, may be adopted in the future when we consider new long-term adaptations required to cope with the COVID-19 pandemic.

Editorial - Suboptimal response to intravitreal anti-VEGF treatment for patients with diabetic macular edema: is there any point in switching treatment?

To investigate if there is any point in switching treatment in patients with diabetic macular edema (DME) showing suboptimal response to anti-vascular endothelial growth factor (anti-VEGF) treatment. The standard of care for DME is anti-VEGF agents. Although anti-VEGF agents seem to be effective for the treatment of DME, there is a proportion of patients, showing a suboptimal response to anti-VEGF treatment. In such patients, switching treatment to another anti-VEGF agent or to intravitreal dexamethasone implant may provide favorable anatomical and functional results. However, without a control group, it is impossible to compare the effect of switching treatment with the effect of continuing the original administered treatment. Switching treatment in patients with DME remains challenging. Further studies with a control group are needed to reach a safe conclusion.