The following article presents an interesting study on how various chronic diseases were affected by the COVID-19 pandemic, especially diabetic eye disease, and how this situation was and continues to be managed for the benefit of patients.
The increase in the proportion of patients with diabetes has been significant in recent years.
In 2019 it was estimated that 9.3% of the world's population aged 20-79 years had diabetes, a total of 463 million people. In adults with diabetes, the prevalence of diabetic retinopathy is approximately 35%, while that of diabetic macular edema is 7%, and extrapolating this rate of diabetes to the global population suggests that there are 32.4 million people worldwide with diabetic macular edema. Of these, approximately 39% of patients with diabetic macular edema aged 12 years and older will have vision problems associated with their condition. Diabetic macular edema commonly occurs in the population with an average age of diagnosis of 50 years. As Prof. Ramin Tadayoni states «Diabetic macular edema does not come alone, despite their relatively young age, these patients often present with a complex comorbidity profile, including stroke, retinopathy, cardiovascular problems (including coronary artery disease, myocardial infarction, heart failure and hypertension), kidney disease, dyslipidemia and neuropathy.
The main risk factors for the development of diabetic macular edema are high levels of glycosylated hemoglobin (HbA1c), high systolic blood pressure, elevated total serum cholesterol, long duration of diabetes and the use of certain medications (e.g., glitazones).
The COVID-19 pandemic has had a significant impact on global healthcare and particularly on diabetic patients. In an international survey of 202 healthcare providers, over 98% of respondents
said that changes in healthcare services since the pandemic outbreak had affected patients with chronic conditions, with over 20% stating that the impact was severe. The chronic condition reported to have been most affected by the reduction in healthcare resources due to the pandemic was diabetes. Nearly 80% of healthcare providers reported deterioration of mental health in some or most of their patients during the pandemic. The majority of respondents reported changes in routine patient care from face-to-face testing to telephone or online communication. Indeed, the pandemic has led to a rapid expansion of telemedicine, which is changing the way healthcare is delivered. As Prof. Tadayoni says, «With all these challenges, we have things to learn and progress is being made. We have seen how quickly telehealth and telemedicine have evolved at this time and we are certainly learning things that will be useful in the future.».
Despite this innovation, the pandemic has undoubtedly had a significant negative impact on anti-VEGF therapy in ophthalmological patients. An analysis of patients at a single hospital in northern China showed that the number of Anti-VEGF injections decreased by 70% during the pandemic compared to 2019. Deferred Anti-VEGF treatment can lead to poor visual outcomes, particularly in young patients.
To address this issue, alternative treatment strategies may be considered, such as continuous intravitreal injection of corticosteroid implants that require less frequent injections than anti-VEGF therapy. However, intravitreal corticosteroid therapy is associated with other risks, including increased intraocular pressure (IOP), the development of glaucoma, and the development of premature cataracts. For patients continuing anti-VEGF therapy, treatment intervals and regimens should be maintained appropriately and accurately in those who respond to them to limit the need for additional monitoring. For this reason, stable treatment regimens with reduced monitoring should be considered.
