Visual Acuity, Mental Health, Determine Quality of Life in Neovascular AMD

Visual acuity, medical history, mental health, and functional status are important factors affecting quality of life (QOL) among patients with neovascular age-related macular degeneration (nAMD), according to a study published in Eye.

Investigators recruited patients (N=547) with nAMD receiving anti-vascular endothelial growth factor (VEGF) therapy between 2012 and 2015 for the clinic-based study. Participants underwent eye examinations and spectral domain optical coherence tomography (SD-OCT) and completed the National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25), Short Form-36 (SF-36) and EuroQoL (EQ-5D-5L) surveys to assess QOL. A subset of individuals (n=83) completed follow-up questionnaires at 1 year.

Participants with worsening visual acuity had lower NEI-VFQ-25 scores — those with a lower number of anti-VEGF injections demonstrated the poorest SF-36 scores (P =.0012). Hospitalization also affected SF-36 physical component and EQ-5D-5L scores, revealing values 2.18 and 4.00 points, respectively, less than those exhibited by individuals who had not been hospitalized (P ≤.04 for both). The presence of 3 or more chronic conditions yielded lower SF-36 physical component (P <.0001), visual analogue scale (P =.02), and EQ-5D-5L scores (P =.01) compared with the remainder of the cohort. Impaired ability to perform basic and instrumental activities of daily living (eating, dressing, showering, cooking, and cleaning) was associated with poorer QOL, evidenced by SF-36 physical component, visual analogue and EQ-5D-5L scores that were 4.44, 0.16, and 4.52 points lower compared with the remainder of the cohort (P ≤.03 for all).

In the longitudinal analysis, NEI-VFQ-25 composite scores were higher among individuals without vision impairment (mean, 67.67) compared with participants with mild (mean, 50.77; P =.0010) or moderate (mean, 47.33; P =.0019) visual impairments or blindness (mean, 39.12; P =.0005). 

“We found that the 12-month vision-related and health-related QOL of nAMD patients is affected by not only visual acuity but also the broader physical and mental health indices and patients’ functional status,” according to the researchers. “Overall, our findings are likely to inform clinical practice by emphasizing the need to consider the whole person, rather than simply treating a patient’s macular morphology.”

Study limitations include a small number of individuals participating in the 1-year follow-up analysis.