How COVID Has Changed Wet AMD Treatment

Find out how retina specialists have adjusted their practices in the pandemic to continue wet AMD treatment.

An eye doctor examines a patient's eye during an appointment. Eye doctors have instituted a number of safety measure to protect against COVID-19.

If you have wet age-related macular degeneration (wet AMD), you know how important regular check-ins with your retina specialist are.

AMD begins as “dry,” where the retina (the inside lining of the eye, which is sensitive to light) deteriorates due to deposits under the macula (located in the center of the retina and responsible for clear vision). Although vision loss may still occur with dry AMD, it doesn't cause eye leakage. And some people don’t experience any vision loss with dry AMD. “If you're lucky enough to be in that group, then your eye exam can often be once every six months,” says Timothy G. Murray, MD, MBA, president of the American Society of Retina Specialists Foundation and the CEO of Murray Ocular Oncology and Retina in Miami, Florida.

Treating Wet AMD

But when the condition progresses to “wet” AMD, abnormal blood vessels grow under the macula and retina, which can bleed and leak fluid—potentially leading to rapid vision loss. This requires closer monitoring and in-office visits for anti-VEGF eye injections, which help to stabilize the eye’s blood vessels, and in some cases, can improve vision. “Some people have to get injected every three weeks and some will get injected every three months,” says Dr. Murray. “So this is a condition that's incredibly individual.”

Because of the need for frequent injections, telemedicine isn’t a good option for wet AMD. “There’s no telemedicine component to treatment,” says Murray. “All the current injections are delivered by retina specialists within a very controlled office environment.”

The hybrid visit

But with the increasing popularity of telemedicine visits due to the COVID-19 pandemic, retina specialists have made some adjustments to their practice. One such change has been what's called a "hybrid" visit, where you can go to your eye doctor’s office to get quickly screened by a technician. The technician will take eye photographs and optical coherence tomography (OCT) images, which your eye doctor will review separately. "In some offices, you have the option to speak to your doctor remotely while you're actually in the office, or you can go home and at your convenience, speak with your doctor," Murray says. However, this type of visit is used mostly for dry AMD, which requires more monitoring than treatment.

If you do have a hybrid visit, Murray says it’s best to prepare just as you would for an in-office appointment. So when you log in for your virtual visit with your doctor, be ready to share any changes in symptoms or vision since your last visit. In addition, he suggests using a larger computer screen if possible, and making sure to have the camera set so your doctor can see your face well. This will help your doctor see you (and your eyes) clearly.

Making in-office visits safer

During the pandemic, retina specialists have also worked to make in-office treatment safer for patients with wet AMD. “The two things that people are really associating with COVID transmission are contact distance and contact time,” Murray notes. “So the suggestion is that if you can move a person rapidly from space to space, they have minimal contact time, either in one space or with one person.”

This means you might see a technician in one room for images, then go to a separate room for a quick injection from your doctor, without staying very long. Murray says the approach has worked well in his office, which has not reported COVID infections despite seeing 5,000 patients through the pandemic.

Staying vigilant about your wet AMD treatment and working with your doctor will help you stay healthy and preserve your vision, even in these unusual times.

Article sources open article sources

VMR Institute. "What is the Retina?"
American Academy of Ophthalmology. "Retina."
American Macular Degeneration Foundation. "Dry Macular Degeneration."
American Academy of Ophthalmology. "What is Macular Degeneration?"
BrightFocus Foundation. "The Function of the Normal Macula."
Phone Interview. Timothy G. Murray, MD, MBA.
American Macular Degeneration Foundation. "Wet Macular Degeneration."

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