Table 4.

Benefits, risks and recommendations for assessment procedures done prior to administering intravitreal injection treatment

Procedure	Benefits	Risks during COVID-19 pandemic	Risk of deferring procedure	Situations where the procedure is indicated	Situations where the procedure can be deferred	Modifications to the procedure during COVID-19 pandemic
VA testing	Widely accepted functional visual assessment Can be used to determine T&E decisions	Increasing contact time with patient and staff	Patients may not report vision loss Visual outcomes less closely monitored	Treatment naïve patients Patients who complain of visual loss	Patients receiving loading doses Long-term patients with stable disease	Take VA starting from smallest letter and work upwards to save time Pinhole vision may not be necessary
IOP measurement	Monitor glaucoma risk in IVT patients	Increased contact time with patient and staff Aerosolized droplets from non-contact/pneumatic tonometry	Undetected IOP rise	High risk glaucoma patients Cupped disc Post intravitreal steroid injection for the first time	Routine follow up No history of glaucoma or disc cupping Already has separate glaucoma follow-up appointment	Suspend the use of non-contact tonometry, use Goldmann applanation or I-care tonometry
Pupil dilation	Allows the examination of the peripheral retina	Increased contact time with patient and staff; spread of COVID-19 from contaminated eye drops	Risk of missing retinal pathology	Treatment naive High myopia Extra-foveal disease Visual field loss	Long-term patients with stable disease	Dilation eye drops should be administered only once on arrival, if needed patient can be given disposable minims of eye drops for repeated administration
OCT	Objective structural assessment of active disease Can be used to determine T&E decisions	Increased contact time with staff	Undetected Worsening disease activity Early recurrence with no VA loss not detected Missed screening of fellow eye	Treatment naïve 4 weeks after 3rd loading dose	Patients receiving loading doses Long-term patients with stable disease Known maximum treatment interval	Plastic shield in machines where patient faces the technician Keep scanning protocol to a minimum Decentralise imaging service
Slit-lamp examination	Detection on non-retinal pathology Assessment of the retinal periphery Detection of new areas of bleeding	Increased close contact with staff	Undetected Non-retinal pathology and peripheral retinal pathology Undetected new retinal hemorrhages or rubeosis	Treatment naïve cases Patients with worsening visual acuity	Patients receiving loading doses Long-term patients with stable disease	Plastic shield in machines where patient faces the doctor N95 masks and goggles for high risk patients
Ophthalmology consultation	Direct reporting of symptoms Patient doctor rapport	Increased prolonged close contact with doctor	Undetected pathology not picked up by imaging	Treatment naïve cases	Patients receiving loading doses Long-term patients with stable disease	To be replaced by telephone or video consultation

VA: visual acuity, IOP: intra-ocular pressure, OCT: optical coherence tomography, loading doses refer to intravitreal anti-VEGF therapy