A Two Year Longitudinal Study of Quality of Life in Patients with Occult Choroidal Neovascularisation

Abstract

Abstract: : Purpose:Quality of life measurement in patients with age related macular degeneration (ARMD) has only been investigated to date in cross-sectional studies. Here we present the first two year follow up of a longitudinal study of health-related quality of life (HRQOL) using the National Eye Institute Visual Function Questionnaire (NEI-VFQ) to assess self-reported visual impairment and general functioning Methods: In a prospective study we included patients with occult choroidal neovascularisation (CNV) secondary to ARMD and visual acuity (VA) of 0.25 or better and no other ocular disease. Examinations included ETDRS visual acuity, binocular ophthalmoscopy, fluorescein and ICG angiography, color fundus photography and the German versions of the SF-36 and NEI-VFQ. The NEIVFQ has 12 subscales: General health and General Vision, Pain, Near-, Peripheral-, Colour and Distance vision, Driving: and including those vision- specific: Role difficulties, Dependency, Social function, Mental health. Higher scales are more favourable (10-100 scale). All examinations were performed at baseline, 6 weeks, 3, 6, 12, 18 months and 24 months thereafter. Results:Sixty patients (32 female, 28 male) were included into the "natural history study of occult CNV". Age ranged from 52-88 years (mean: 71 ± 8,1 years). Visual acuity ranged from 20/80 to 20/20 at baseline. Within 24 months 13 patients experienced a moderate visual loss (>=3 ETDRS lines) and 17 patients experienced a severe visual loss (>=6 ETDRS lines). Overall NEIVFQ score dropped from 76.8 at baseline steadily down to 66.0 in all patients. The subgroup that experienced visual loss had an overall score of only 45 after 24 month. The scales for general vision (GV), near activity (NA), mental health (MH) and driving (D) were the most informative with a mean score of 37.1 (GV); 20.1 (NA); 53.8 (MH) and 0.0 (D) at 24 month in patients who lost vision compared to 52.7 (GV); 80,4 (NA); 69.2 (MH) and 55 (D) in all patients at baseline (P-value < 0,05). Conclusions: A loss of three and six EDTRS lines results in a measurable and significant loss in HRQOL. The German version of the NEIVFQ appears to be a reliable instrument for the measurement of health related quality of life in ARMD over time; subscale analysis indicates that it should be part of a comprehensive assessment of visual function in ARMD.

Keywords: age-related macular degeneration • clinical (human) or epidemiologic studies: nat • quality of life