Subfoveal neovascular AMD takes toll on quality of life

About one out of every six people had some anxiety that appeared to be associated with their retinal disease.

Quality-of-life assessments included the vision-targeted National Eye InstituteVisual Function Questionnaire (NEI-VFQ) and the Hospital Anxiety and Depression Scale (HADS) for symptom-specific assessment. In addition, patients were asked to assign preference values to their health and vision status. All of the data were collected over the telephone by trained interviewers prior to random treatment assignment.

"These data suggest that we have to be able to identify neovascularization in a first eye very early and treat it effectively to prevent vision loss or prevent it from developing in the first place," said Dr. Bressler, professor of ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore. "Recognizing that the number of people with AMD is expected to double over the next 20 years, these data also confirm why a lot of public and private money is being spent to pursue more effective prevention and treatment options.

"Furthermore, the very low preference value of affected patients suggests that even the expensive medical or surgical treatments being considered for AMD prevention and treatment are cost-effective from the patient's point of view, although whether society can afford it is another question. However, as we continue to learn more about these issues, it will help us decide what to treat and how and where to spend our resource dollars in the future," he added. He spoke during the conference, sponsored by Johns Hopkins University School of Medicine, and Ophthalmology Times.

The quality-of-life analyses were based on data from 790 participants in SST Group N (n = 454) and SST Group B (n = 356). Group N participants had new subfoveal CNV and patients recruited for the Group B trial had predominantly hemorrhagic CNV.

The patients in each group were about equally divided as to whether they had unilateral or bilateral CNV. About 15% to 20% of persons with unilateral CNV had relatively poor vision in the uninvolved eye whereas about 10% of those with bilateral CNV had vision of 20/40 or better in their better eye.

The patients had an average age of about 80 years, about half were women, and they were predominantly white. Comorbid medical conditions were common. About half had hypertension and overall, 90% had some other coexisting medical problem.

"Concomitant conditions are important to note because of their potential to influence a person's general state of being or their anxiety or depression," Dr. Bressler said.

Possible scores on the NEI-VFQ range from 0 (lowest) to 100 (highest). Mean NEI-VFQ scores were 65 and 63 for Group N and Group B, respectively. In Group N, there was an 8-point difference between patients with unilateral and bilateral subfoveal CNV (68 versus 60, respectively). The mean NEI-VFQ score of the subgroup with unilateral disease was 9 points better than the subgroup with bilateral disease in group B. Overall, the NEI-VFQ scores were mostly influenced by the effects of vision on driving skills, distance activities, and dependence on others.