Senra Hugo, Balaskas Konstantinos, Mahmoodi Neda, Aslam Tariq
Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom.
Manchester Royal Eye Hospital, Central Manchester Foundation Trust, Manchester, United Kingdom.
Am J Ophthalmol. 2017 May;177:213-224. doi: 10.1016/j.ajo.2017.03.005. Epub 2017 Mar 14.
To investigate detailed patient experiences specific to receiving vascular endothelial growth factor inhibitors (anti-VEGF) for wet age-related macular degeneration (wAMD), and to acquire a snapshot of the frequency of clinically significant levels of depression, anxiety, and posttraumatic stress among patients and levels of burden in patients' carers.
Observational cross-sectional mixed-methods study.
Three hundred patients with wAMD receiving anti-VEGF treatment and 100 patient carers were recruited. Qualitative data on patients' experience of treatment were collected using a structured survey. Standardized validated questionnaires were used to quantify clinically significant levels of anxiety, depression, and posttraumatic stress, as well as cognitive function and carers' burden.
Qualitative data showed that 56% of patients (n = 132) reported anxiety related to anti-VEGF treatment. The main sources of anxiety were fear of going blind owing to intravitreal injections and concerns about treatment effectiveness, rather than around pain. From validated questionnaires, 17% of patients (n = 52) showed clinical levels of anxiety and 12% (n = 36) showed clinical levels of depression. Depression levels, but not anxiety, were significantly higher in patients who received up to 3 injections compared with patients who received from 4 to 12 injections (analysis of variance [ANOVA] P = .027) and compared with patients who received more than 12 injections (ANOVA P = .001).
Anti-VEGF treatment is often experienced with some anxiety related to treatment, regardless of the number of injections received. Clinical levels of depression seem to be more frequent in patients at early stages of anti-VEGF treatment. Strategies to improve patient experience of treatment and minimize morbidity are suggested.
调查湿性年龄相关性黄斑变性（wAMD）患者接受血管内皮生长因子抑制剂（抗VEGF）治疗的具体详细经历，并了解患者中具有临床意义的抑郁、焦虑和创伤后应激水平以及患者护理人员的负担水平。
观察性横断面混合方法研究。
招募了300名接受抗VEGF治疗的wAMD患者和100名患者护理人员。使用结构化调查收集关于患者治疗经历的定性数据。使用标准化的有效问卷来量化具有临床意义的焦虑、抑郁和创伤后应激水平，以及认知功能和护理人员的负担。
定性数据显示，56%的患者（n = 132）报告了与抗VEGF治疗相关的焦虑。焦虑的主要来源是因玻璃体内注射而害怕失明以及对治疗效果的担忧，而非疼痛。从有效问卷中可知，17%的患者（n = 52）表现出临床水平的焦虑，12%（n = 36）表现出临床水平的抑郁。与接受4至12次注射的患者相比，接受最多3次注射的患者抑郁水平显著更高（方差分析[ANOVA]P = 0.027），与接受超过12次注射的患者相比也是如此（ANOVA P = 0.001），但焦虑水平并非如此。
无论接受注射的次数如何，抗VEGF治疗常常伴随着与治疗相关的一些焦虑。在抗VEGF治疗早期阶段的患者中，临床水平的抑郁似乎更为常见。建议采取策略来改善患者的治疗体验并将发病率降至最低。
