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Wijeyanthy Wijeyakumar, Thomas Hong, Geoffrey Broadhead, Haitao Li, Meidong Zhu, Andrew Alexander Chang, Sydney Institute of Vision Science; Changes in Quality of Life Among Patients Treated with Aflibercept for neovascular Age-related Macular Degeneration (nAMD). Invest. Ophthalmol. Vis. Sci. 2014;55(13):3945.
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To assess vision related quality of life (VR-QoL) in patients with refractory neovascular age-related macular degeneration (nAMD) treated with intravitreal Aflibercept over 12 months.
A total of 49 patients with nAMD who were resistant to previous anti-vascular endothelial growth factor (anti-VEGF) therapy were prospectively treated with 3 loading doses of intravitreal Aflibercept 4 weeks apart followed by injections every 8 weeks across 48 weeks. Full ophthalmic examinations including best corrected visual acuity (BCVA) in Early Treatment of Diabetic Retinopathy Study (ETDRS) letters, and central macular thickness (CMT) assessed by spectral domain optical coherence tomography (SD-OCT) were conducted. The VR-QoL measured with the National Eye Institute Visual Functioning Questionnaire-25 (NEI VFQ- 25) was compared between baseline and week 48. Patients were grouped into “Good” responders (BCVA>5 letter improvement) and “Poor” responders (BCVA ≤ 5 letter improvement). Changes in NEI VFQ-25 scores and correlations with BCVA and CMT were analysed using Student’s paired t-test and Pearson’s correlation.
BCVA improved by an average of 4.7 letters and mean CMT decreased by 97.2 µm at week 48 compared to baseline (p<0.001 for both). Overall NEI-VFQ25 composite scores improved at week 48 compared to baseline (73.5 versus 69.5, p=0.009). With the exception of general health (which was stable) and driving, all subscales including general vision, mental health, role difficulties, near and distance activities showed significant improvement by week 48 (p<0.05 for all of these). Good responders (43%) showed a significant increase in QoL composite score by 7.1 points (p=0.003), whereas poor responders (57%) did not show any significant improvement at week 48 (2.5 points, p=0.31). No significant differences in improvement were found between the good and poor responder groups (p=0.15). No correlations were observed between changes in NEI VFQ- 25 scores and changes in BCVA or CMT (r = 0.26 and r = -0.11 respectively)
Overall VR-QoL improved among patients with refractory nAMD following Aflibercept treatment over 48 weeks compared to baseline. Patients with greater visual gain (good responders) experienced a greater improvement in VR-QoL. Changes in VR-QoL did not correlate with changes in BCVA or CMT.
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