The Impact of the COVID-19 pandemic on aflibercept and ranibizumab anti-VEGF Injections

Purpose : The COVID-19 Pandemic resulted in a substantial decrease in outpatient ophthalmology clinic visits due to stay-at-home orders. Retinal vascular diseases and wet age-related macular degeneration require adherence to treatment regimens with antivascular endothelial growth factor (anti-VEGF) injections. The purpose of this study was to assess how the COVID-19 pandemic affected the number of injections compared to prepandemic values. Methods : This retrospective, observational clinical study assessed all anti-VEGF injections of aflibercept and ranibizumab for both 2019 (Jan-Dec) and 2020 (Jan-Nov) at an academic center. The total number of injections for each year was compared, as well as the number of injections for each month in 2020 compared to the average number of monthly injections in 2019. Both 1-sample and 2-sample t-tests were conducted, and a p-value less than 0.05 was considered significant. Results : The total number of aflibercept and ranibizumab injections in 2019 (Jan-Nov) were 4989 and 522 respectively, compared to 4855 and 515 in 2020 (Jan-Nov). No significant difference in injections was noted between 2019 and 2020 for either aflibercept (p=0.31) or ranibizumab (p=0.80). When analyzing each month in 2020 compared to the average number of aflibercept injections per month in 2019, there were significantly fewer aflibercept injections administered in February (p<0.01), August (p=0.03), and November (p<0.01), but significantly higher injections administered in July (p<0.01) and October (p<0.01). For ranibizumab, significantly fewer injections were administered in March (p=0.02), April (p=0.02), and May (p<0.01), but a higher number of injections were administered in September (p<0.01) and November (p<0.01). Conclusions : Despite stay-at-home orders, there was no significant decrease in the overall number of aflibercept or ranibizumab injections during the COVID pandemic compared to the prior year. Although further information is needed to determine if these injections represent both new and return patients, these data suggest that in this specific population, patients still returned to their retina specialist for care despite the ongoing pandemic.