a Department of Community & Clinical Allied Health , La Trobe University , Melbourne , Australia.
b Eye Surgery Associates , Cabrini Medical Hospital , Malvern , Australia.
Psychol Health Med. 2018 Feb;23(2):127-140. doi: 10.1080/13548506.2016.1274040. Epub 2017 Jan 9.
Current therapy to slow disease progression in patients with neovascular age-related macular degeneration (AMD) entails regular intravitreal anti-vascular endothelial growth factor (VEGF) injections, often indefinitely. Little is known about the burden imposed on patients by this repetitive treatment schedule and how this can be best managed. The aim of this study was to explore the psychosocial impact of repeated intravitreal injections on patients with neovascular AMD. Forty patients (16 males, 24 females) with neovascular AMD undergoing anti-VEGF treatment were recruited using purposive sampling from a private ophthalmology practice and public hospital in Melbourne. Patients were surveyed using the Macular Disease Treatment Satisfaction Questionnaire (MacTSQ; Bradley, Health Psychology Research Unit, Surrey, England) and underwent semi-structured, one-on-one interviews. Interview topics were: treatment burden and satisfaction; tolerability; barriers to adherence; treatment motivation; and patient education. Interviews were audio recorded and thematic analysis performed using NVivo 10 (QSR International, Doncaster, Australia). Patients recognised the importance of treatment to preserve eyesight, yet experienced significant psychosocial and practical burden from the treatment schedule. Important issues included treatment-related anxiety, financial considerations and transport burden placed on relatives or carers. Many patients were restricted to sedentary activities post-injection owing to treatment side effects. Patients prioritised treatment, often sacrificing family, travel and social commitments owing to a fear of losing eyesight if treatment was not received. Whilst anti-VEGF injections represent the current mainstay of treatment for neovascular AMD, the ongoing treatment protocol imposes significant burden on patients. An understanding of the factors that contribute to the burden of treatment may help inform strategies to lessen its impact and assist patients to better manage the challenges of treatment.
目前，治疗与年龄相关的湿性黄斑变性（AMD）相关的新生血管的方法是定期进行玻璃体内抗血管内皮生长因子（VEGF）注射，通常是无限期的。对于这种重复治疗方案给患者带来的负担以及如何最好地管理这些负担，我们知之甚少。本研究旨在探讨反复玻璃体内注射对新生血管性 AMD 患者的心理社会影响。通过在墨尔本的一家私人眼科诊所和公立医院进行目的性抽样，招募了 40 名接受抗 VEGF 治疗的新生血管性 AMD 患者（16 名男性，24 名女性）。使用黄斑疾病治疗满意度问卷（MacTSQ；Bradley，英国萨里健康心理学研究小组）对患者进行调查，并进行了半结构化的一对一访谈。访谈主题包括：治疗负担和满意度；耐受性；坚持治疗的障碍；治疗动机；和患者教育。访谈进行了录音，并使用 NVivo 10（QSR International，澳大利亚唐卡斯特）进行了主题分析。患者认识到治疗对保持视力的重要性，但治疗计划给他们带来了重大的心理和实际负担。重要的问题包括与治疗相关的焦虑、经济考虑以及给亲戚或照顾者带来的交通负担。许多患者由于治疗的副作用，在注射后只能进行静坐活动。患者重视治疗，往往因为担心不接受治疗会导致视力丧失而牺牲家庭、旅行和社交活动。虽然抗 VEGF 注射是新生血管性 AMD 的当前主要治疗方法，但持续的治疗方案给患者带来了巨大的负担。了解导致治疗负担的因素可能有助于制定减轻其影响的策略，并帮助患者更好地应对治疗带来的挑战。
