AMD patients at higher risk of severe complications including death from COVID-19

By Helen Carter

Journalist

People with age-related macular degeneration are at higher risk of severe complications from COVID-19 including intubation and death, an American study indicates.

The study, published in Nature Medicine, does not indicate however that AMD patients are more at risk of contracting COVID-19.

The greater mortality and intubation rates were not because AMD patients were elderly as neither age nor sex could explain their increased susceptibility to COVID complications. But researchers said there was a suspected link between hyperactive complement system activity and more severe disease progression in COVID patients, and macular degeneration is a disease driven by a hyperactive complement system.

The investigation of 6,398 COVID-19 patients hospitalised at New York-Presbyterian/Columbia University Irving Medical Center during the first wave of the pandemic found that AMD patients succumbed to the disease more rapidly than others, died at three times the rate of COVID-19 patients who did not have AMD, and required intubation in one out of five cases.

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Co-lead author of the research, Dr Sagi Shapira said, in a media release from the American Macular Degeneration Foundation: ‘This does not mean that AMD patients are more likely to become infected with coronavirus.

‘Everyone’s risk of getting infected is entirely dependent on their behaviour. But these findings left no doubt that, once infected, those with macular degeneration are at greater risk of developing catastrophic disease symptoms.’

The study was designed to understand the relationship between COVID-19 and the complement system, a core facet of the body’s immune response to infection. Researchers used AMD as a proxy for complement dysfunction since AMD patients have hyperactive complement activity.

It had previously been demonstrated that coronaviruses engage and activate the body’s immune complement system and the new study further demonstrated this.

The study showed that complement dysfunction is associated with severe disease, affecting a population of patients including those with AMD.

‘We found that AMD and coagulatory dysfunctions predispose patients to poor clinical outcomes following SARS-CoV-2 infection (the virus that causes COVID-19),’researchers wrote.

‘Patients with AMD (a proxy for complement activation disorders) and coagulation disorders (thrombocytopenia, thrombosis and haemorrhage) were at significantly increased risk of adverse clinical outcomes (including mechanical respiration and death) following SARS-CoV-2 infection.

‘Moreover, patients with AMD succumb to disease more rapidly than others. Critically, the contribution of age and sex was not sufficient to explain the increased risks associated with history of macular degeneration or coagulation disorders.’

Dr Shapira suggested those with AMD err on the side of caution and implement recommended practices for avoiding infection including wearing a mask, social distancing, hand sanitation and avoiding gatherings with people whose COVID status they did not know.

Macular Disease Foundation Australia CEO Dee Hopkins said the organisation supported the COVID-19 prevention advice issued by the Australian Government.

‘It is particularly important for people in vulnerable groups to follow the guidelines and wear a mask, practise social distancing and hand hygiene,’ she said. ‘While we understand people are anxious, eye health professionals are taking extra precautions to ensure the safety of patients.

‘Our concern throughout the COVID-19 pandemic is to ensure that people are aware that missing an eye injection – or delaying treatment for an eye emergency – can seriously and permanently compromise their vision.’