Estimating excess visual loss with neovascular age-related macular degeneration during COVID-19

During the COVID-19 lockdown people over 70 years old have been told to self-isolate.  This new study led by Darren Thomas (UCL IHI), and published as a pre-print in medRxiv indicates that delayed neovascular age-related macular degeneration (nAMD) treatment will lead to a substantial increase in visual loss  including legal blindness and loss of driving vision, and advises those at risk to seek care in a timely fashion before irreversible vision loss occurs.

The study, a collaboration between UCL, Moorfields, Barts Health NHS Trust and King’s College London, used clinical audit data and developed a simulation model to study the impact on sight loss of elderly patients not seeking help for eye problems during the COVID pandemic.  The authors report a very large decrease (72% reduction) in nAMD referrals during the first month of COVID-19 lockdown  at four UK nAMD treatment centres in April 2020 compared to April 2019, suggesting there is a substantial number of patients with new nAMD who will suffer from delayed treatment.  They then estimated the potential impact of this by simulating one year visual outcomes following various periods of treatment delay and projecting these results to a national level. As a conservative estimate, study findings suggest a treatment delay of 3 months could lead to a >50% relative increase in the number of eyes with vision ≤6/60 and 25% relative decrease in the number of eyes with driving vision at one year. The consequences of untreated nAMD are likely to exacerbate the problems of COVID-19 and non-COVID-19 induced social isolation on the mental and physical health of the elderly.