Director of Retina Services, Pepose Vision Institute Chesterfield, Chesterfield, Missouri, USA.
Genentech, South San Francisco, California, USA.
Ophthalmic Res. 2024;67(1):311-321. doi: 10.1159/000538975. Epub 2024 Apr 29.
Understanding patient perspectives of treatment may improve adherence and outcomes. This study explored real-world patient experiences with anti-vascular endothelial growth factor (anti-VEGF) treatment for diabetic macular edema (DME) and neovascular age-related macular degeneration (nAMD).
This multinational, non-interventional, quantitative, cross-sectional, observational survey assessed treatment barriers/burden, patient-reported visual functioning, and treatment satisfaction in DME and nAMD patients in the USA, the UK, Canada, France, Italy, and Spain. Treatment patterns and visual outcomes were extracted from medical charts. Regression models evaluated relationships between adherence, total missed visits, number of anti-VEGF injections, and clinical and patient-reported outcomes for visual functioning. Association between treatment satisfaction and aspects of burden were assessed.
The survey was completed by 183 DME and 391 nAMD patients. Patients had moderately high vision-related functioning (25-item National Eye Institute Visual Functioning Questionnaire score: mean = 74.8) and were satisfied with their current treatment (mean total score: Macular Disease Treatment Satisfaction Questionnaire = 59.2; Retinopathy Treatment Satisfaction Questionnaire = 61.3). Treatment satisfaction scores were worse with higher time-related impacts of treatment (nAMD/DME), higher impacts on finances and daily life (nAMD), negative impacts on employment and lower expectations for treatment effectiveness (DME). Most patients reported ≥1 barrier (66.1% DME, 49.2% nAMD patients) related to treatment (35.0%), clinic (32.6%), and COVID-19 (21.1%). Moreover, 44.9% of patients reported some impairment in activities of daily living. Work absenteeism was observed among >60% of working patients. Nearly one-quarter (24.2%) of patients needed ≥1 day to recover from intravitreal injections; most reported ≥30 min of travel time (73.7%) and clinic wait time (54.2%). In unadjusted univariable analyses, treatment adherence (vs. nonadherence) was related to higher most recent visual acuity (β = 8.98 letters; CI, 1.34-16.62) and lower odds of visual acuity below driving vision (≤69 letters) (OR = 0.50; CI, 0.25-1.00).
More durable treatments with reduced frequency of injections/visits may reduce treatment burden and improve patient satisfaction, which may enhance adherence and visual outcomes.
了解患者对治疗的看法可能会提高治疗的依从性和疗效。本研究旨在探讨接受抗血管内皮生长因子（anti-VEGF）治疗的糖尿病黄斑水肿（DME）和新生血管性年龄相关性黄斑变性（nAMD）患者的真实体验。
这是一项多国家、非干预性、定量、横断面、观察性研究，评估了美国、英国、加拿大、法国、意大利和西班牙的 DME 和 nAMD 患者的治疗障碍/负担、患者报告的视觉功能以及治疗满意度。从病历中提取治疗方案和视觉结果。回归模型评估了依从性、总漏诊次数、抗 VEGF 注射次数以及视觉功能的临床和患者报告结果之间的关系。评估了治疗满意度与负担方面的关联。
本研究共纳入了 183 名 DME 和 391 名 nAMD 患者。患者的视力相关功能处于中等偏高水平（25 项国家眼科研究所视觉功能问卷评分：均值=74.8），对目前的治疗方案较为满意（黄斑疾病治疗满意度问卷总分均值=59.2；视网膜病变治疗满意度问卷总分均值=61.3）。治疗满意度评分随着治疗的时间相关影响（nAMD/DME）、对财务和日常生活的影响（nAMD）、对就业的负面影响以及对治疗效果的期望降低（DME）而变差。大多数患者报告了与治疗（66.1% DME，49.2% nAMD 患者）、就诊（32.6%）和 COVID-19（21.1%）相关的至少 1 个障碍。此外，44.9%的患者报告日常生活活动受到一定程度的影响。超过 60%的工作患者缺勤。近四分之一（24.2%）的患者需要至少 1 天才能从玻璃体内注射中恢复，大多数患者报告每次注射的旅行时间（73.7%）和就诊等待时间（54.2%）超过 30 分钟。在未调整的单变量分析中，与治疗不依从相比，治疗依从性（vs. 不依从）与更好的最近视力（β=8.98 个字母；CI，1.34-16.62）和更低的视力低于驾驶视力（≤69 个字母）的几率相关（OR=0.50；CI，0.25-1.00）。
治疗方案更持久、注射/就诊频率更低可能会降低治疗负担，提高患者满意度，从而提高治疗依从性和视觉疗效。
