Visual function quality of life measure changes upon conversion to neovascular age-related macular degeneration in second eyes

Abstract

Purpose: To determine changes in quality of life measures when choroidal neovascularization (CNV) developed in the second eye of patients with initially unilateral neovascular age-related macular degeneration (AMD).

Methods: We analyzed responses to the 39-item National Eye Institute Visual Function Questionnaire (NEI-VFQ), 36-item Short Form Health Survey (SF-36), and Hospital Anxiety and Depression Scale (HADS) at baseline, and prior to and following second eye CNV diagnosis in 92 participants enrolled in two Submacular Surgery Trials. Paired t-tests for sample sizes over 30 and Wilcoxon signed-rank tests for sample sizes <30 were performed to compare scores.

Results: CNV development resulted in statistically and clinically significant changes in responses to 20 of 39 NEI-VFQ items, indicating visual function decline during a mean interval of 25 months. Little difference was noted between baseline scores and prior to CNV diagnosis, which averaged 8.9 months duration. Subscales demonstrated a statistically significant decline in general vision, near activities, distance activities, social functioning, role difficulties, dependency, and driving. There were minimal changes in the HADS and SF-36 scales.

Conclusion: CNV development in the second eye had a dramatic effect on visual functioning based on patient responses to the NEI-VFQ questionnaire. Our investigation is believed to be the first study using data collected prospectively to demonstrate vision-related quality of life changes that resulted from development of CNV in AMD patients.

Keywords: Age-related macular degeneration; Choroidal neovascularization; National Eye Institute Visual Function Questionnaire; Quality of Life; Second eyes; Submacular Surgery Trials.

Figure 1

Flow diagram demonstrating the inclusion of patients in the analysis population. A total of 790 patients with choroidal neovascularization (CNV) secondary to age-related macular degeneration enrolled in the Submacular Surgery Trials. Of 380 SST participants without bilateral CNV at time of SST enrollment, 98 developed CNV in the second eye; of whom 92 were included in the analysis population after 6 participants were excluded due to CNV diagnosis at the last SST follow-up examination and thus inability to assess visual function after CNV diagnosis.