AMD Management During the COVID‐19 Pandemic

Editor,

At the end of 2019, a novel betacoronavirus (SARS‐CoV‐2) was identified and subsequently led to the ongoing COVID‐19 pandemic. This respiratory virus, leading to pneumonia, severe acute respiratory syndrome (SARS) and even death, has emerged in Wuhan, China, and then spread worldwide at tremendous speed (Ashour et al., 2020), becoming in March 2020 a public health problem even in France. The novel coronavirus appears to be highly contagious, particularly by respiratory droplets, the major mode of diffusion besides discharges and conjunctival secretions (Wang et al., 2020).

Ophthalmologists are a high‐risk category, for the daily close contact with a high volume of patients.

Our department is a tertiary reference centre for the diagnosis and treatment of age‐related macular degeneration (AMD). Hence, given the higher mortality of the disease in the elderly population or in people with several comorbidities such as high blood pressure and diabetes (Chen et al., 2020), our AMD patients are particularly at risk in terms of both vital and functional prognosis. Therefore, given the importance of carry on the cares for AMD, which is one of the leading causes of central vision loss and requires periodic checks and treatments, the activity was rigorously and carefully reorganized to assure protection of both physicians and patients.

According to recommendations of national (Société française d'ophtalmologie, 2020) and international (American macular degeneration foundation, 2020) ophthalmology societies, a strengthening of patient’s triage was put into place. Instructions over COVID‐19’s symptoms and prophylactic measures were introduced in waiting areas. The waiting room itself was reorganized, by positioning chairs 2 m apart from each other. Only one visitor accompanying each patient was allowed. Sanitation was enhanced with a careful and regular disinfection of surfaces. All healthcare workers were asked to wear masks, gloves and ocular shields.

Concerning specifically AMD patients, there was a reorganization of the cares according to the subtype of AMD. General routine intermediate or dry AMD patient visits were rescheduled, and home monitoring (checking at least once a week Amsler grid) and healthy lifestyle choices (controlling diet and eventually continuing taking supplements) were recommended. Patients were also reassured by the fact that urgent care for AMD was assured during all the pandemic.

For patients with neovascular AMD, considering that many studies have shown that maintaining a regular schedule of eye anti‐VEGF injections (IVI) is indispensable in retaining vision, the treatment was guaranteed.

Therefore, a fixed treatment regimen was set up for the next 4 months both for the patients previously undergoing pro re nata (PRN) regimen, and for that having undergone Treat‐and‐Extend (T&E) regimen, after careful analysis of all the records. For T&E patients, the longest possible interval between injections (up to 12 weeks) were settled, also inviting them to perform home monitoring. Before IVI, best‐corrected visual acuity assessment, optical coherence tomography (OCT) and fundus ocular examination were avoided if not strictly necessary. Patients were informed that the doctor would have spoken as little as possible during parts of the examination, requesting them to also refrain from talking during the examination. Each patient was provided with a surgical mask before IVI.

Furthermore, a retina specialist was daily available by phone in order to be able to answer all the doubts or questions that patients may have regarding their case. Despite the fear this outbreak has generated throughout the world, our patients were reassured by the fact that ophthalmological activity was continued, by the implementation of protective measures and by the presence of retina specialists ready to take care of them even in this difficult context. Given that the quality of life depends so much on preserving vision, our AMD patients should not have to choose between preserving their vision and preserving their life.