AMD treatment delay for 20% of Hong Kong elderly during pandemic; Vision deteriorated in 35% of patients

Age-related macular degeneration (AMD or ARMD), a common eye disease in older people, is classified into DRY and WET. Wet macular degeneration or neovascular AMD can also cause vision loss.

A survey of a patient organization found that almost 20% of patients with wet macular degeneration of the elderly had their follow-up diagnosis delayed by an average of two months due to the fifth wave of the pandemic.

While a third of those surveyed said their eyesight had declined by 30% during the pandemic, some people’s condition got even worse.

Retina Hong Kong (RHK), formerly known as the Hong Kong Retinitis Pigmentosa Society, is a non-profit patient mutual aid charity. RHK commissioned the Hong Kong Health Care Alliance to conduct a survey from May to June 2022 and successfully interviewed 200 patients in Hong Kong.

The results showed that during the fifth wave of the pandemic, 18% of patients had follow-up delays due to the pandemic, with an average delay of 61 days; 35 percent of patients had vision loss, with an average decline of 30 percent, of which about 30 percent of these respondents cited their doctors the cause of their vision loss was due to delayed treatment. In addition, 37% of patients surveyed presented with worsening neovascular macular leakage.

At present, there are 50,000 wet macular degeneration patients in Hong Kong.

Age-related macular degeneration is the second leading cause of visual impairment among Hong Kongers. If neovascular AMD conditions are not properly managed, intraocular vascular endothelial growth will lead to leaking and bleeding, which can cause permanent damage to central vision. The condition is irreversible.

In severe cases, patients can go blind within days. Ophthalmologist Lee Ka-yau said, “There is no cure for wet age-related macular degeneration. It is necessary to receive rapid and continuous treatment to control the condition and stabilize the patient’s vision with treatment mainly by intraocular injection.

According to RHK, it is difficult for outpatients to arrange continuous and frequent treatment while waiting for follow-ups and treatment at the Hospital Authority.

Additionally, some patients might need to use the newer generation of vascular endothelial growth factor inhibitors that are not currently registered in the public hospital drug formulary.

As a result, RHK launched the Intraocular Injection Drug Subsidy Scheme, which allows eligible outpatients from hospital authorities to receive treatment at private clinics for up to four injections per year, while the cost of drugs, injections and preoperative examinations for patients is the same sum as public hospital costs.

According to RHK statistics, more than 2,100 patients have benefited from the program since its launch in 2019. The program also started to cover a new generation of drugs for intraocular injection at the end of 2021. The average time for participating patients receive their first dose of intraocular drug injection treatment was only 12.6 days, while the average time to first HA treatment was 2 months. The result was significantly shortened by the new RHK scheme.

RHK urges all eligible HA patients to participate in the intraocular injection subsidy program and receive appropriate treatment as soon as possible, to avoid blindness due to delayed treatment.

Mr Choi, a 68-year-old patient, said he was diagnosed with wet age-related macular degeneration in his right eye in September 2021. Doctors recommended intraocular injection as a treatment. However, during his treatment period, Hong Kong was hit by the fifth wave of the coronavirus outbreak.

Mr. Choi suspected that the two-week delay in treatment had made his condition worse. Fortunately, the resumption of treatment improved the deterioration and his condition.

Mr. Choi said that by joining the drug subsidy scheme, he could receive treatment as quickly as he did. Even with the ongoing outbreak of the pandemic, there were no delays in follow-ups or treatments at the private clinic.

Choi was grateful for the grant program, which helped him get prompt eye treatment and maintain the condition of his age-related macular degeneration.

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