Problem-Solving Therapy Boosts QOL in Age-Related Macular Degeneration

May 14, 2013

By Anne Harding

NEW YORK (Reuters Health) May 14 - Problem-solving therapy improved quality of life in patients with age-related macular degeneration (AMD), in a new randomized trial.

Many AMD patients continue to have disabling vision problems, despite treatment with the vascular endothelial growth factor inhibitors ranibizumab (Lucentis) and bevacizumab (Avastin), as Dr. Robin Casten of Thomas Jefferson University in Philadelphia and her colleagues write in their report.

Low vision rehabilitation, which helps patients make the most of their remaining vision by using environmental modifications, vision-enhancing devices, and more, has helped improve reading and other functional abilities for AMD patients.

In problem-solving therapy, a therapist helps patients identify the problems they face, come up with several possible solutions and choose the best one, make a plan for addressing the problem, and then determine if the problem has been solved.

The primary outcome in the present study was "targeted vision function" (TVF), i.e., the ability to improve valued daily living activities that involved vision. That endpoint didn't improve with problem-solving therapy. Vision-specific quality of life, a secondary outcome, did improve, however.

Dr. Casten and her colleagues compared three months of problem-solving therapy (PST) to three months of supportive treatment (ST) in 241 AMD patients age 65 and older. All study participants had best-corrected visual acuity between 20/70 and 20/400 in their better eye. The average age was 82.

At three months and at six months, TVF had significantly improved in both groups, and there was no significant difference in the degree of improvement between the two groups. At three months, 77.4% of PST patients and 78.6% of ST patients reported having less difficulty performing one of their TVF goals (p=0.83); the proportions were also similar at six months (76.2% and 79.1%, respectively, p=0.61).

However, the PST patients showed greater improvement in vision-related quality of life at three and six months compared to the ST patients, as assessed with the National Eye Institute Vision Function Questionnaire plus Supplement. They also developed more adaptive coping strategies than the ST group.

Dr. Casten said she and her colleagues believe PST improved quality of life both by helping patients to learn healthy strategies for coping with their limitations, and also by helping them to focus their psychological, social and environmental issues toward reaching their goals.

In the real world, she added in an interview with Reuters Health, only a small minority of patients with AMD will receive low vision rehabilitation. She and her colleagues are conducting a trial of low-vision interventions including both rehabilitative and psychological treatments to help prevent depression in AMD patients. Ideally, she said, low-vision treatment would include rehabilitation to help address practical issues and therapy to help patients learn skills to cope psychologically with their vision loss.

The report appeared online May 3rd in Ophthalmology.


Ophthalmology 2013.


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