Department of Ophthalmology, Research Unit of Clinical Medicine and Medical Research Center, University of Oulu, P.O.Box 21, Oulu, OYS, 90029, Finland.
Oulu University Hospital, Oulu, Finland.
J Patient Rep Outcomes. 2024 Aug 12;8(1):89. doi: 10.1186/s41687-024-00775-z.
Neovascular age-related macular degeneration (nAMD) is a common cause of visual impairment and blindness in the elderly with globally increasing prevalence. Vascular endothelial growth factor inhibitor (anti-VEGF) treatment has improved visual prognosis of nAMD, but continuous treatment may cause anxiety and stress, although increase in visual acuity (VA) may also have positive effects on patients' quality of life. The health care burden due to frequent treatment and monitoring is apparent, but the effect of anti-VEGF treatment on patients' quality of life is not fully understood. We evaluated the overall impact of nAMD and its treatment on newly diagnosed patients' health-related quality of life (HRQoL) in real-world setting.
The present prospective cohort study included newly diagnosed nAMD patients treated with anti-VEGF injections at Oulu University Hospital during 2019-2020. Data included parameters from comprehensive ophthalmic examination and fundus imaging, age at diagnosis, sex, comorbidities, visual acuity, and frequency of anti-VEGF injections. HRQoL was assessed by 15D questionnaire at diagnosis, 6 months, and 12 months.
95 nAMD patients were included. They were 78 ± 8 years old, 56 (59%) were female, and 74 (78%) had more than one comorbidity. The patients received 8 ± 3 anti-VEGF-injections. Visual acuity (VA) improved from 56 ± 18 to 61 ± 24 Early treatment diabetic retinopathy study (ETDRS) letters in 12 months. VA improved > 5 ETDRS letters in 45 (47%), remained stable in 30 (32%) and decreased > 5 letters in 17 (18%) eyes. The mean total 15D score reflecting overall HRQoL decreased from 0.850 ± 0.104 to 0.834 ± 0.103 in 12 months. Decreased HRQoL was associated with baseline best-corrected VA (BCVA) ≥ 70 ETDRS letters (p = 0.023) and more than one comorbidity (p = 0.034). HRQoL regarding visual function increased from 0.765 ± 0.194 to 0.789 ± 0.184 during the 12-month follow-up.
In real world setting, HRQoL regarding visual function improved in anti-VEGF-treated nAMD patients during the first 12 months after the diagnosis and treatment initiation. Good baseline VA or several comorbidities were associated with decreased overall HRQoL during the follow-up. Despite the effectiveness of anti-VEGF treatment on visual function, several other aspects affecting elderly patients' everyday life should be considered when nAMD treatment is implemented.
新生血管性年龄相关性黄斑变性（nAMD）是老年人视力障碍和失明的常见原因，其全球患病率呈上升趋势。血管内皮生长因子抑制剂（抗 VEGF）治疗改善了 nAMD 的视觉预后，但持续治疗可能会引起焦虑和压力，尽管视力提高（VA）也可能对患者的生活质量产生积极影响。由于频繁的治疗和监测带来的医疗保健负担是显而易见的，但抗 VEGF 治疗对患者生活质量的影响尚不完全清楚。我们评估了 nAMD 及其治疗对新诊断患者在真实环境中的健康相关生活质量（HRQoL）的整体影响。
本前瞻性队列研究纳入了 2019-2020 年在奥卢大学医院接受抗 VEGF 注射治疗的新诊断 nAMD 患者。数据包括全面眼科检查和眼底成像参数、诊断时的年龄、性别、合并症、视力和抗 VEGF 注射频率。在诊断时、6 个月和 12 个月时使用 15D 问卷评估 HRQoL。
95 名 nAMD 患者入选。他们的年龄为 78±8 岁，56 名（59%）为女性，74 名（78%）有多种合并症。患者接受了 8±3 次抗 VEGF 注射。12 个月时，视力（VA）从 56±18 提高到 61±24 早期治疗糖尿病视网膜病变研究（ETDRS）字母。45 只眼（47%）VA 提高超过 5 个 ETDRS 字母，30 只眼（32%）VA 稳定，17 只眼（18%）VA 下降超过 5 个字母。反映整体 HRQoL 的平均 15D 总分从 12 个月时的 0.850±0.104 降至 0.834±0.103。HRQoL 下降与基线最佳矫正视力（BCVA）≥70 ETDRS 字母（p=0.023）和多种合并症（p=0.034）相关。在 12 个月的随访期间，视觉功能相关的 HRQoL 从 0.765±0.194 增加到 0.789±0.184。
在真实环境中，抗 VEGF 治疗的 nAMD 患者在诊断和治疗开始后的前 12 个月内，视觉功能相关的 HRQoL 得到改善。良好的基线 VA 或多种合并症与随访期间整体 HRQoL 下降有关。尽管抗 VEGF 治疗对视功能有效，但在实施 nAMD 治疗时，还应考虑影响老年患者日常生活的其他几个方面。
