Real-world short-term outcomes after switching to fixed-interval anti-VEGF therapy for neovascular AMD during the COVID-19 pandemic

To assess short-term real-world visual and anatomic outcomes in patients with neovascular age-related macular degeneration (nvAMD) following a protocol shift from an individualized treat-and-extend (T&E) anti-VEGF regimen to a fixed-interval injection schedule without routine imaging during the early COVID-19 pandemic. This retrospective cohort study included patients with nvAMD undergoing anti-VEGF therapy at a single tertiary academic retina practice. In response to the COVID-19 pandemic, the clinic transitioned from a T&E approach to a fixed 8-week injection schedule without routine OCT imaging between March 25 and July 1, 2020. Eyes with at least two visits and OCT imaging before and after the protocol change were included. Outcomes measured included visual acuity (VA), central macular thickness (CMT), fluid status, appointment adherence, COVID-19 cases, and mortality. Statistical comparisons were performed using paired t-tests and Wilcoxon signed-rank tests. A total of 289 eyes (232 patients) were included. Mean VA before the switch was 20/45 (logMAR 0.35 ± 0.33) and 20/50 (logMAR 0.39 ± 0.33, p = 0.17) after the switch. Mean CMT showed non-significant changes from 292.1 ± 89 μm pre-switch to 298.7 ± 66 μm (p = 0.15) post-switch. COVID-19 affected 11 patients (6 deaths); no cases were linked to clinic visits, and staff remained unaffected. Switching to fixed-interval injections with limited imaging effectively maintained visual and anatomical outcomes while safely reducing COVID-19 transmission risks. These results suggest that fixed-interval regimens may preserve short-term outcomes in established nvAMD patients and could be useful during future care disruptions or protocol changes.