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 |