Anti-VEGF Improves Quality of Life in Macular Degeneration

Beth Skwarecki

July 06, 2014

Treating neovascular age-related macular degeneration with anti-vascular endothelial growth factor (VEGF) drugs such as ranibizumab not only increases patients' visual acuity but also improves their vision-related quality of life, according to a new study that uses a rigorously tested quality-of-life questionnaire. The study was published online February 10 and in the June issue of Ophthalmology.

"Against this background, patients' managing retinal physicians should aim for the best possible outcomes even if the worse eye is treated," write Robert P. Finger, PhD, from the Center for Eye Research Australia at the Royal Victorian Eye and Ear Hospital in Melbourne, Australia, and colleagues, as any loss in visual acuity results in a lowered vision-related quality of life.

Ranibizumab's own phase 3 trial had reported an increase in vision-related quality of life with treatment, but later studies found mixed results. Dr. Finger and colleagues suspected that a better questionnaire could assess quality of life more accurately, so instead of the 25-item National Eye Institute Visual Functioning Questionnaire, they used the Impact of Vision Impairment tool and performed a Rasch analysis to validate it. In this analysis, they tested whether the variation in patients' scores supports the idea that the questionnaire is measuring a single trait (quality of life), rather than a mixture of different factors, and whether the test can differentiate reliably between different levels of quality of life.

The researchers recruited participants from outpatient clinics at the Royal Victorian Eye and Ear Hospital in Melbourne, Australia; the researchers believe they were representative of patients seeking treatment for this condition at public Australian hospitals. The participants all had newly diagnosed neovascular age-related macular degeneration and had not yet undergone treatment. Although they were free to seek treatment elsewhere (which resulted in some patients being lost to follow-up), the treatment they received in the study was 3 monthly injections of 0.5 mg ranibizumab, followed by either continued monthly injections or an inject-and-extend protocol. The researchers tested patients' visual acuity with the logarithm of minimum angle of resolution chart, and they also conducted optical coherence tomography.

Of the 169 participants, 56% were women; mean age was 79 years. At the 12-month mark, 120 patients were still enrolled, and those who had been lost were similar in age, sex, and baseline visual acuity to those who remained.

At the 6-month mark, 26% had improved their visual acuity by at least 2 lines, and 8% had lost acuity. At 12 months, 24% had gained letters, and 11% had lost. In the untreated eye, patients lost a mean of 2 letters by both the 6- and 12-month visits.

A loss in visual acuity of more than 2 lines on the logarithm of minimum angle of resolution chart corresponded to a decreased vision-related quality of life in the Accessing Information (P = .007) and Mobility (P = .050) categories on the Impact of Vision Impairment. Patients who gained at least 2 lines of visual acuity saw an improved quality of life in the Accessing Information (P = .009) and Emotional Well-Being (P = .008) categories. Patients whose visual acuity did not change did not report any change in quality of life.

The results held regardless of whether the better or worse eye was treated, leading the investigators to write that "even worse eyes should receive treatment" and that any treatment should aim to improve or at least maintain visual acuity, because any loss seems to translate directly to a lowered quality of life.

Supported in part by the National Health and Medical Research Council, Novartis Australia, a German Research Council grant, and the National Health and Medical Research Council Centre for Clinical Research Excellence. The Centre for Eye Research Australia receives Operational Infrastructure Support from the Victorian Government. The authors have disclosed no relevant financial relationships.

Ophthalmology. 2014;121:1246-1251. Abstract

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