Communicating with patients requiring anti-VEGF intravitreal injections and their families during the COVID-19 pandemic: an update

Abstract

Dear Editor, In Spring 2020, with our colleagues at The Vision Academy [1], we identified the need for clinician guidance on how best to communicate with patients and caregivers to ensure crucial eye care appointments and services were continued during the current COVID-19 pandemic. At that time, we noted, in particular, heightened anxiety levels among patients, receiving intravitreal injections of anti-vascular endothelial growth factor (VEGF) for neovascular age-related macular degeneration (nAMD), who need to attend regular ophthalmology appointments to maintain their vision. We therefore published guidance for managing such patients during the acute phase of the COVID-19 pandemic [2] and supported this with a patient communication template. The communication could be sent via e-mail, post, or text messages ahead of appointments to reassure patients and caregivers that their safety and eye health remained a priority [3]. Since then, the COVID-19 pandemic has escalated: clearly, it is not going to disappear quickly, and we need to make the necessary adjustments to establish a routine of safely treating patients while the pandemic is ongoing. Evidence has emerged that people with moderate/severe visual impact are significantly more likely to experience worsened mental health because of COVID-19-related restrictions than those with mild/no visual impairment [4]. Additionally, a UK study found that approximately 50% of patients with nAMD failed to attend a scheduled hospital or clinic appointment [5]. Of those non-attendees, 85% said they were fearful of contracting COVID-19, and over 70% would have attended if they had been given clear advance information of adequate infection control measures. These findings are understandable given patients with nAMD are at increased risk of COVID-19related complications, hospitalization, and mortality because of increased age with comorbid conditions. They also reinforce the need for patient information tools. We now provide greater detail about the implementation of patient guidance according to the local epidemic situation, based on three (risk) tiers, until such time that long-term solutions (e.g., effective vaccine) are available [6]: