Three-year follow-up of visual outcome and quality of life in patients with age-related macular degeneration

Abstract

Background: The purpose of this study was to evaluate the visual outcome and self-reported vision-targeted health status in patients treated with intravitreal ranibizumab for wet age-related macular degeneration (AMD).

Methods: A total of 51 eyes from 50 patients aged 76 ± 7 years, with wet AMD not previously treated, were included in this prospective study. Best corrected visual acuity was examined using Early Treatment Diabetic Research Study charts and near vision reading. All patients underwent an ophthalmological examination, including fluorescein and indocyanine green angiography (occult cases) and optical coherence tomography. The Visual Function Questionnaire test was completed before and 37 ± 7 months after the start of intravitreal injections.

Results: The patients received a mean number of 7.8 ± 5.0 (range 2-22) injections. One month after the third intravitreal injection, significant improvement was seen in both visual acuity (53 ± 14 to 61 ± 14 letter, P = 0.001) and near vision (17 ± 9 to 11 ± 8 points, P = 0.001). During follow-up, mean visual acuity decreased from 53 ± 14 to 44 ± 24 letters (P = 0.011), and near vision decreased from 17 ± 9 to 20 ± 11 points (P = 0.048). Despite visual impairment, the quality of life test revealed no significant decrease in mental health (P = 0.529) or ability to read a newspaper (P = 0.21), but a decrease in distance activities (reading street signs, steps, going to the theater) from 57 ± 27 to 46 ± 31 points (P = 0.007) was documented.

Conclusion: Decreased visual acuity was related to a decrease in self-reported visual function for distance activities, while mental health items, such as worrying, were not influenced.

Keywords: age-related macular degeneration; quality of life; visual outcome.

Figure 1

Mean best corrected visual acuity (ETDRS letters) and near vision (points) at baseline, and at 3-month and 37-month follow-up in the better-seeing eye treated and the worse-seeing eye treated. Note: The three columns to the right in each group represent the ETDRS letters and the three to the left represent near vision. Abbreviation: ETDRS, Early Treatment Diabetic Research Study.

Figure 2

Pooled data for near activities (reading newspaper, seeing well at close distance, finding an item on crowded shelf), distance activities (street signs, steps, stairs in dim light), and mental health (worrying, “less control over what I am doing”) items in patients with better-seeing eye treated compared with worse-seeing eye treated. Abbreviation: NEI VFQ-25, National Eye Institute Visual Function Questionnaire.

Figure 3

Pooled data for near activities (reading newspaper, seeing well at close distance, finding an item on crowded shelf), distance activities (street signs, steps, stairs in dim light), and mental health (worrying, “less control over what I am doing”) items in patients with worse visual outcome compared to patients with improved visual outcome. Abbreviations: BCVA, best corrected visual acuity; NEI VFQ-25, National Eye Institute Visual Function Questionnaire.