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G. Zlateva, L. Arias, F. Armadá, J. Donate, J. García-Arumí, B. Pazos, A. Piñero, F. Martínez, J. Mondéjar; Delay in Treating Neovascular Age-Related Macular Degeneration (NV-AMD) in Spain Is Associated With Vision Loss. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4564.
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To assess the impact on visual acuity (VA) of delays between diagnosis and treatment in patients with NV-AMD and to evaluate the emotional status of NV-AMD patients prior to therapy.
This multicenter, retrospective, epidemiological study included patients newly diagnosed with NV-AMD registered in the Spanish national health system and referred to any of 10 regional health centers for evaluation and treatment by a retinal specialist between 09/05 and 03/06. Data were abstracted from records at referring physicians’ offices (diagnosis visit) and regional health centers (treatment visit). VA was measured at both visits (Snellen chart). Treatment decisions were made at physicians’ discretion. At the treatment visit, before therapy initiation, the Hospital Anxiety and Depression Scale (HADS) was administered. VA was categorized as: normal, better than 20/40 (score =1); mildly limited, 20/40 to 20/80 (score=2); moderately limited, 20/80 to 20/200 (score=3); severely limited, 20/200 to 20/400 (score=4); and almost blind, 20/400 or worse (score=5). VA change was measured as treatment visit VA score minus diagnosis visit VA score.
In 100 patients, median time between diagnosis and treatment visits was 2.3 months (95% confidence interval: 0.2-10.8 months). Vision loss had progressed at the treatment visit with a doubling in the percentage of patients with VA of 20/400 or worse (12.4% vs 24.7%). The decrease in VA between visits was highly statistically significant (P<0.0001) as was the correlation between months to treatment and VA change (r=0.5234, P<0.0001). Time between diagnosis and treatment visits was significant predictor of progressive vision loss in analysis controlling for VA at diagnosis and change in lesion size between diagnosis and treatment (P<0.0001). Prior to treatment, patients with more severe vision loss tended to report more depression.
Delayed treatment of newly diagnosed NV-AMD patients is associated with substantial VA loss.
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