Table 2.
The global timeline of when changes to intravitreal injection therapy (IVT) practices were instituted during the COVID-19 pandemic, in the context of the magnitude of the COVID-19 problem in various countries
| Country (city) | Estimated date the changes started | Number of cases of COVID-19 in the country on that datea | Other restrictions within the country at that date | Main reasons for the change in practice | Changes in practice patterns during the COVID-19 pandemic with regards to various chronic macula diseases receiving IVT | ||
|---|---|---|---|---|---|---|---|
| nAMD | DME | ME-RVO | |||||
| Asia and Pacific Region | |||||||
| China (Guangzhou) | 1/2/2020 | 14,380 | Travel ban, lockdown | High risk of hospital transmitted infections | All IVT postponed in February, given in March | All IVT postponed in February, given in March | All IVT postponed in February, given in March |
| Israel (Tel Aviv) | 17/3/2020 | 337 | Travel ban, close borders, lockdown | High risk of hospital transmitted infections | No IVT injections postponed, some loading doses could be extended | No IVT injections postponed, some loading doses could be extended | No IVT injections postponed, some loading doses could be extended |
| Malaysia (Kuala Lumpur) | 18/3/2020 | 790 | Travel ban, lockdown | High risk of hospital transmitted infections | All IVT postponed with exceptions | All IVT postponed with exceptions | All IVT postponed with exceptions |
| Singapore | 7/4/2020 | 1418 | Travel ban, close borders, partial lockdown | High risk of hospital transmitted infections | All IVT postponed for 4 weeks except patients with only 1 seeing eye can receive IVT | All IVT postponed for 4 weeks exceptions based on clinician discretion | All IVT postponed for 4 weeks exceptions based on clinician discretion |
| Thailand (Bangkok) | 23/3/2020 | 721 | Travel ban, partial lockdown | High risk of hospital transmitted infection, Lack of resources | Some IVT postponed except those based on individual clinician’s discretion | All IVT postponed for 2–3 months | Some IVT injections postponed based on individual clinician’s discretion |
| Europe | |||||||
| France (Paris) | 16/3/2020 | 6663 | Complete lockdown, travel ban | High risk of hospital transmitted infections | No IVT injections postponed | All postponed for 2/3 months except in single eye patients or threatening situations | All postponed for 2/3 months except in single eye patients or threatening situations |
| Germany (Berlin) | 23/3/2020 | 29056 | Travel ban Reduce close contacts, schools closed | High risk of hospital transmitted infection | No IVT injections postponed | No IVT injections postponed | No IVT injections postponed |
| Germany (Munich) | 16/3/2020 | 7272 | Travel ban, Reduce close contacts, schools closed | High risk of hospital transmitted infection | No IVT injections postponed | No IVT injections postponed | No IVT injections postponed |
| Greece (Athens) | 17/3/2020 | 387 | Travel ban, Lockdown, schools closed | High risk of hospital transmitted infection | All IVT injections postponed, exceptions allowed based on clinician’s discretion | All IVT injections postponed | All IVT injections postponed, exceptions allowed based on clinician’s discretion |
| Italy (Rome) | 16/3/2020 | 27980 | Travel ban, Lockdown, Close borders | Hospital policy, High risk of hospital transmitted infection | All IVT postponed except patients with only 1 seeing eye can receive IVT | All IVT postponed | All IVT postponed |
| Italy (Milan) | 9/3/2020 | 9172 | Travel ban, Lockdown, Close borders | High risk of hospital transmitted infection | All IVT postponed except patients with only 1 seeing eye can receive IVT | All IVT postponed | All IVT postponed except patients with neovascular glaucoma |
| Switzerland (Lucerne) | 16/3/2020 | 2353 | Travel ban, Lockdown, Close borders | High risk of hospital transmitted infection | No IVT injections postponed | No IVT injections postponed | No IVT injections postponed |
| United Kingdom (London) | 19/3/2020 | 3269 | Travel ban, Lockdown, Close borders | High risk of hospital transmitted infection | No IVT injections postponed but to continue on a fixed treatment regiment | All IVT postponed for 6 months | All IVT postponed for 6 months for BRVO, IVT given to CRVO based on clinician discretion |
| United Kingdom (Wales) | 30/3/2020 | 22,141 | Travel ban, Lockdown, Close borders | High risk of hospital transmitted infection | No injections postponed – Extended by 4 weeks rather than 2 where needed | No injections postponed – Extended by 4 weeks rather than 2 where needed | No injections postponed – Extended by 4 weeks rather than 2 where needed |
| North and South America | |||||||
| Brazil (Recife) | 20/3/2020 | 640 | Travel ban, quarantine | High risk of hospital transmitted infectionFlatten the curve | IVT injections postponed in elderly and high-risk patients if vision and OCT were stable on last visit | Some IVT injections postponed in elderly and high-risk patients if vision and OCT were stable on last visit | Some IVT injections postponed in elderly and high-risk patients if vision and OCT were stable on last visit |
| Canada (Vancouver) | 20/3/2020 | 1067 | Travel Ban, State of Emergency, Close borders | High risk of hospital transmitted infection | Some IVT injections postponed for 3-month stable patients | All IVT injections postponed | Some IVT injections postponed for 3-month stable patients |
| Colombia (Cali) | 24/3/2020 | 378 | Travel Ban, State of Emergency, Lockdown, Close borders | Hospital policy, High risk of hospital transmitted infection | All IVT injections postponed for at least 1 month, exceptions allowed based on clinician’s discretion | All IVT injections postponed for at least 1 month, exceptions allowed based on clinician’s discretion | All IVT injections postponed for at least 1 month, exceptions allowed based on clinician’s discretion |
| United States of America (Chicago) | 16/3/2020 | 4596 | Travel restriction, lockdown |
High risk of hospital transmitted infection Limited manpower |
Some IVT postponed for patient with long IVT intervals, patients with shorter IVT maintained according to clinician’s discretion | Some IVT postponed for patient with long IVT intervals, patients with shorter IVT maintained according to clinician’s discretion | Some IVT postponed for patient with long IVT intervals, patients with shorter IVT maintained according to clinician’s discretion |
nAMD: neovascular AMD, DME: Diabetic macula edema, ME-RVO: macula edema related to retinal vein occlusion, BRVO: branch retinal vein occlusion, CRVO: central retinal vein occlusion
aData obtained from ref 73: https://www.worldometers.info/coronavirus/ unless specified otherwise