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DE Goldberg, A-C Roch-Levecq, KK Maclean, BL Brody, DE McGuire, MH Goldbaum, RG Thomas, SI Brown, WR Freeman; Psychosocial and Functional Parameters in Patients with Age Related Macular Degeneration and Choroidal Neovascularization with and without Photodynamic Therapy . Invest. Ophthalmol. Vis. Sci. 2002;43(13):597.
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Purpose: To determine in patients with choroidal neovascularization (CNV) from age related macular degeneration (AMD): 1) the effect of photodynamic therapy (PDT) with Verteporphin on visual acuity; 2) the psychosocial and functional status of PDT treated patients compared to untreated controls and 3) the relationship between PDT effect on visual acuity and psychosocial and functional status. Methods: ETDRS visions were recorded in 22 patients at a minimum of 1 year after initial PDT. Psychosocial and functional status were evaluated with tools sensitive to visual disability and depression (Standardized Clinical Interview of depression, AMD Health Impact Questionnaire, Profile of Mood States, National Eye Institute Visual Function Questionnaire, AMD Self Efficacy Questionnaire and Geriatric Depression Scales). Patients were matched on age, sex, race and marital status to 44 untreated AMD patients in whom psychosocial and functional status was identically evaluated. Unbiased assessment of the effect of visual acuity on psychosocial function depended on matching the PDT patients with untreated patients whose visions approximated potential visual outcomes of the PDT patients had they not been treated. Since the Treatment of AMD with PDT (TAP) study found that PDT with Verteporphin reduced visual loss of 15 ETDRS letters over 24 months as compared with untreated controls, each PDT patient was matched against 2 untreated patients whose best corrected visual acuity was worse than the best corrected visual acuity of the treated patient by at least one doubling of the visual angle (15 ETDRS letters). Results: The mean final ETDRS vision in the PDT treated eyes (20/475) did not differ significantly from the mean ETDRS vision prior to initiation of PDT (20/400); p≷0.05 Analysis of psychosocial variables revealed significant depression in both groups and no significant differences between their respective scores of psychosocial and functional status: p≷0.05. Conclusion: In our clinical setting there was no significant change in vision over 1 year in patients treated with PDT and there was no significant difference in psychosocial functioning between such patients and untreated controls. Although PDT has been shown to stabilize visual loss in a small subpopulation of patients with CNV due to AMD, this treatment effect does not appear to have a significant impact on psychological and functional status of such patients.
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