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Purpose: The main purpose of the study was to report the estimated incidence, cumulative rate, risk factors and outcomes of submacular haemorrhage (SMH) with loss of vision in neovascular age‐related macular degeneration (nAMD) receiving intravitreal injections (IVT) of vascular endothelial growth factor (VEGF) inhibitor in routine clinical practice. Methods: Retrospective analysis of treatment‐naïve eyes receiving IVTs of VEGF inhibitors (ranibizumab, aflibercept or bevacizumab) for nAMD from 1 January 2010 to 31 December 2020 that were tracked the Fight Retinal Blindness! registry. Estimated incidence, cumulative rate and hazard ratios (HR) of SMH with loss of vision during treatment were measured using the Poisson regression, Kaplan–Meier survival curves and Cox proportional hazard models. Results: We identified 7642 eyes (6425 patients) with a total of 135 095 IVT over a 10‐year period. One hundred five eyes developed SMH with loss of vision with a rate of 1 per 1283 injections (0.08% 95% confidence interval [95% CI] [0.06; 0.09]). The estimated incidence [95% CI] was 4.6 [3.8; 5.7] SMH with loss of vision per year per 1000 treated patients during the study. The cumulative [95% CI] rate of SMH per patient did not increase significantly with each successive injection (p = 0.947). SMH cases had a mean VA drop of around 6 lines at diagnosis, which then improved moderately to a 4‐line loss at 1 year. Conclusions: Submacular haemorrhage (SMH) with loss of vision is an uncommon complication that can occur at any time in eyes treated for nAMD in routine clinical practice, with only limited recovery of vision 1 year later. [ABSTRACT FROM AUTHOR]

Background: Clinical ophthalmological guidelines encourage the assessment of potential benefits and harms when deciding whether to perform elective ophthalmology procedures during the COVID‐19 pandemic, in order to minimize the risk of disease transmission. Method: We performed probability calculations to estimate COVID‐19 infection status and likelihood of disease transmission among neovascular age‐related macular degeneration patients and health‐care workers during anti‐VEGF procedures, at various community prevalence levels of COVID‐19. We then applied the expected burden of COVID‐19 illness and death expressed through health‐adjusted life‐years (HALYs) lost. We compared these results to the expected disease burden of severe visual impairment if sight protecting anti‐VEGF injections were not performed. Results: Our calculations suggest a wide range of contexts where the benefits of treatment to prevent progression to severe visual impairment or blindness are greater than the expected harms to the patient and immediate health care team due to COVID‐19. For example, with appropriate protective equipment the benefits of treatment outweigh harms when the chance of progression to severe visual impairment is >0.044% for all scenarios where COVID‐19 prevalence was 1/1000, even when the attack rate in the clinical setting is very high (5‐43%). Conclusion: Unless COVID‐19 prevalence is very high, the reduced disease burden from avoiding visual impairment outweighs the expected HALYs lost from COVID‐19 transmission. This finding is driven by the fact that HALYs lost when someone suffers severe visual impairment for 5 years are equivalent to nearly 400 moderate cases of infectious disease lasting 2 weeks each. [ABSTRACT FROM AUTHOR]