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. 2017 Jul 11;17(1):120.
doi: 10.1186/s12886-017-0514-3.

Tracing the natural course of visual acuity and quality of life in neovascular age-related macular degeneration: a systematic review and quality of life study

Mari Elshout  1 , Carroll A Webers  2 , Margriet I van der Reis  2 , Yvonne de Jong-Hesse  3 , Jan S Schouten  2
Affiliations

Tracing the natural course of visual acuity and quality of life in neovascular age-related macular degeneration: a systematic review and quality of life study

Mari Elshout et al. BMC Ophthalmol. .

Abstract

Background: Describing the natural course of neovascular age-related macular degeneration (nAMD) is essential in discussing prognosis and treatment options with patients and to support cost-effectiveness studies.

Methods: First, we performed a literature search in PubMed, Embase, and Cochrane. We included randomized clinical trials and prospective observational studies reporting visual acuity (VA) in non-treated patients, 24 studies in total. We integrated VA data using best fit on Lineweaver-Burke plots and modelled with non-linear regression using reciprocal terms. Second, we performed a quality-of-life (QoL) study in nAMD patients. We measured VA with Radner reading charts and QoL with the Health Utilities Index issue 3 (HUI-3) questionnaire in 184 participants. We studied the relation VA-QoL with linear regression. Third, with Monte Carlo simulation, we integrated the VA model from the literature review and the relation VA-QoL from the QoL study.

Results: Visual acuity was 0.4 and 0.07 after 5 years in the better-seeing, and worse-seeing eye, respectively. After 4.3 years, VA was <0.5 in the better-seeing eye; <0.3 after 7 years; 0.05 after 17 years. QoL score decreased from 0.6 to 0.45 after 10 years.

Conclusions: The natural course of nAMD in both eyes needs to be considered when informing patients. Visual acuity in the best eye decreases to below 0.5 in 4.3 years. This affects QoL significantly.

Keywords: Age-related macular degeneration; Cost-effectiveness; Natural progression; Prognosis; Quality of life; Visual acuity.

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Conflict of interest statement

Ethics approval and consent to participate

Informed consent was obtained from each patient prior to participation in the study. An ethics committee in each center reviewed and approved the study. The study was conducted in accordance with the Declaration of Helsinki for research involving human subjects. The study was approved in the Netherlands by the Medical Ethics Committee of the Maastricht University Medical Center; Catharina Hospital Eindhoven; The ZorgSaam Hospital Zeeuws-Vlaanderen; and the VU University Medical Center Amsterdam.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Visual acuity in eyes with non-treated neovascular age-related macular degeneration. Combined analysis. nAMD neovascular age-related macular degeneration
Fig. 2
Fig. 2
Visual acuity in eyes with neovascular age-related macular degeneration. Separate analysis per lesion type
Fig. 3
Fig. 3
Visual acuity development and benchmarks in neovascular age related macular degeneration. VA Visual acuity
Fig. 4
Fig. 4
Quality-of-life over time in non-treated neovascular age-related macular degeneration
See this image and copyright information in PMC

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