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C. W. Hirneiss, A. Wolf, R. P. Finger, A. Kampik, A. Hoffmann; The Effect of Ranibizumab Treatment on Patients' Preferences and Vision-Related Quality of Life in Neovascular Age Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2010;51(13):545.
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To assess the effect of intravitreal ranibizumab (Lucentis ®) on patient-reported preferences and vision-related quality of life (vr-QoL) in neovascular age-related macular degeneration (AMD).
62 patients (62 eyes) with firstly diagnosed neovascular AMD received monthly intravitreal injections of 0.5 mg ranibizumab for three months. In addition to a full ophthalmological examination, including best-corrected visual acuity, fundus photography, fluorescein angiography and ocular coherence tomography, vr-QoL and patients preferences were recorded at baseline and at follow-up 4 weeks after the last injection. Psychometric instruments included the National Eye Institute Visual Function Questionnaire (NEI VFQ-25), the Euro-QoL (EQ-5D) containing the visual analogue scale (VAS), the time-trade off method (TTO) and the standard gamble (SG). The standard gamble was anchored for two outcomes: blindness and death. Utilities for the EQ-5D were obtained using the database for the European VAS (EQ-5D E-VAS), the German VAS (EQ-5D D-VAS) and the German TTO (EQ-5D D-TTO).
Mean best corrected visual acuity (BCVA) of the treated eye increased from 20/83 at baseline (logMAR 95%CI 0.76-0.48) to 20/70 (0.68-0.43) at last follow-up after three injections (p=0.053). Mean BCVA of the fellow eye was 20/35 (0.37-0.14). The VFQ-25 composite score showed a slight, statistically not significant increase from 73.0+/-16.3 (SD) before to 74.7+/-16.4 after treatment. Creating subgroups by whether the better or worse eye had been treated, no statistically significant differences in the VFQ-25 score was found. Utility assessment pre- and postinterventional gave the following results: SG for blindness 0.94 and 0.96, SG for death 0.94 and 0.96, TTO 0.90 and 0.97, VAS 54.5 and 0.60, EQ-5D E-VAS 0.75 and 0.77, EQ-5D D-VAS 0.78 and 0.80, EQ-5D D-TTO 0.82 and 0.85. Mann-Whitney U testing revealed no significant increase for any utility test.
Patients with neovascular age related macular disease report reduced vr-QoL and utilities. Intravitreal treatment with ranibizumab allows to maintain visual acuity and vr-QoL as measured with the VFQ-25 and SG, TTO and EQ-5D. Significant improvement of VA, VFQ-25 or utilities, independent of better or worse eye treatment, was not observed. However, a trend of increased vr-QoL as assessed with TTO and the VAS is apparent.
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