Download AMD patients` reduction in quality of life and vision may be

Retina
AMD patients’ reduction in quality of life
and vision may be underestimated
Roibeard O’hEineachain
in Lisbon
PATIENTS with AMD may have a reduction
in their quality of life that is in excess of their
loss of visual acuity, an international, crosssectional study suggests.
“Limited research has been conducted to
evaluate the humanistic and economic
burden of age-related macular degeneration
(AMD).We conducted this study to examine
the burden of bilateral subfoveal, neovascular
AMD on visual impairment, vision-related
functioning, co-morbid medical conditions,
and health resource utilisation,” Jordi Monés
MD, Instituto de Microcirugia Ocular de
Barcelona, Spain, told the 6th EURETINA
Congress.
The patients in the study were recruited
from Canada, France, Germany, Spain, and the
UK.They included 401 bilateral neovascular
AMD patients from retina clinics and 471
elderly non-AMD patients from general
practices.
Patients completed a telephone
assessment of the prevalence of accidents
and related injuries, health resource
utilisation and assistance with activities of
daily living over the previous 12 months.
Physicians provided information regarding
patients’ co-morbid medical conditions, visual
impairment status, and diagnosis and
treatment history.The questionnaires used
were the National Eye Institute Vision
Functioning Questionnaire (NEI VFQ-25) the
EuroQol (EQ-5D) and the Hospital Anxiety
and Depression Scale (HADS).
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In the AMD patients, visual acuity was
evenly distributed across a range from 20/40
to 20/400.The mean visual acuity was 20/80
in the best eye and 20/250 in the worst eye.
In most AMD patients the visual acuity of the
worse eye was worse than 20/400.The
BCVA for the control patients was 20/20 in
the better eye and 20/25 in the worse eye.
Dr Mones noted that AMD patients
reported significantly worse vision-related
functioning as measured by the NEI VFQ-25
questionnaire.The mean adjusted NEI VFQ
overall scale score (on a scale from 0-100)
was 49 in AMD patients, compared to 89 in
controls (p<0.001).Among AMD patients,
NEI VFQ-25 scores were 33 for near
activities, 40 for distance activities, and 12 for
driving.Among controls the scores were 88,
89 and 82, respectively, he noted.
Vision-related functioning in AMD patients
declined significantly as vision progressed
toward blindness, Dr Mones said.
Furthermore, patients with milder losses in
visual acuity reported losses in visual function
similar to patients who were legally blind.The
NEI VFQ score was 62 among those with a
visual acuity of 20/40 or better, 50 among
those with a visual acuity of 20/80, and 47
among those with a visual acuity of 20/20020/400.
“Surprisingly many AMD patients that had
almost normal visual acuity scored pretty
badly compared to controls and close to
patients that had the worst vision.”
Dr Mones noted that the reduction in
quality of vision among AMD patients
appeared to be independent of age.Among
patients aged 70 years or more the NEI VFQ25 scores were 51 in the AMD group and 92
in the control group, and for those 75 years
or older the scores were almost identical at
50 and 92, respectively, he said.
Reduced quality of life in AMD patients
Quality of life scores on the EuroQol
questionnaire were also significantly worse in
the AMD patients than in the controls, with a
relative difference of 13 per cent (P<0.0001).
The visual acuity of the better eye correlated
with the QOL outcomes, Dr Mones noted.
The proportion requiring assistance was
also significantly higher among patients with
AMD.Assistance with daily activities was
required by 29 per cent of the AMD group
compared to only seven per cent of controls.
In addition, 23 per cent of AMD patients
required homecare, compared to only five
per cent of controls.
Furthermore, the prevalence of falls was
nearly twice as high for AMD patients as it
was for controls (16 per cent vs. 8.3 per
cent, p=0.0006), as was the proportion
requiring treatment for falls (8.2 per cent vs.
4.7 per cent, p=0.0019), while the proportion
with fall-related fractures over twice as high
(3.5 per cent vs. 1.5 per cent, p=0.0019).
AMD patients had substantially higher
annual heath-related costs. For example, in
Germany the mean annual healthcare cost
among patients with AMD was 12,519
compared to only 1,300 for patients
without AMD.
AMD patients had significantly more
anxiety and depression symptoms as
measured by the HADS scale.The relative
difference between the HADS scores of the
two groups was 27 per cent for anxiety and
42 per cent for depression (p<0.0001). In
addition, among those with anxiety or
depression, treatment duration was 9.5
months for those with AMD, compared to
7.8 months for controls (p=0.030).
“We achieved all the primary and
secondary endpoints and our results
supported and quantified our overall study
hypotheses. It was proven that visual
impairment compromises the individual’s
independence and quality of life and that
central vision by itself impacts on the visual
functioning,” he concluded.
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