Pseudophakia as a surprising protective factor in neovascular age-related macular degeneration

Age-related macular degeneration (AMD) is the leading cause of visual impairment in western countries, with increasing global incidence [1]. Age-related cataract often coexists with AMD [2], [3], [4], [5]. Anti-vascular endothelial growth factor (VEGF) intravitreal injections for the treatment of AMD are the most commonly performed ophthalmic procedures in the USA, followed by cataract surgery [6]. Although there is no complete consensus regarding the precise treatment protocol for nvAMD patients undergoing cataract surgery, the latter is generally considered a safe and recommended procedure when the patient is symptomatic and the macular condition is stable [7], [8], [9], [10], [11], [12], [13], [14], [15], [16].

Unlike the extensive data available on the safety of cataract surgery in AMD patients, the impact of pseudophakia on the planification of anti-VEGF therapy has not yet been studied for nvAMD patients [3], [17]. By 2019, millions of patients had been regularly receiving intravitreal anti-VEGF injections [18], and many of them had already undergone cataract surgery [19], [20]. The lockdowns and other restrictions associated with the COVID-19 pandemic severely disrupted the provision of retinal care. Patients were unable to visit medical centers or they were fearful of crowding at those institutions. System resources were redirected to delivering emergent sight-saving therapy, and routine eye care was consequently deprioritized. For the first time since the introduction of intravitreal anti-VEGF therapy for nvAMD, long-standing treatment schedules of masses of patients were suddenly disrupted [21].

In Israel, a lockdown was announced from March to April 2020 during what was termed the first wave of COVID-19. The purpose of this study is to assess the impact of the lens status on nvAMD stability when anti-VEGF treatment could not be delivered as scheduled.

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