Assessment of Mental Burden of Patients with Neovascular Age-Related Macular Degeneration Treated by Treat-and-Extend Regimen with Intravitreal Ranibizumab

Abstract

Purpose : A treat-and-extend (TAE) regimen is a scheduled regimen to arrange the intervals of intravitreal injections according to the treatment response of eyes with neovascular age-related macular degeneration (AMD) and beneficial to provide both sufficient and necessary treatments. The purpose of this study is to investigate one-year visual outcomes and psychological impacts of the TAE regimen using Hospital Anxiety and Depression Scale (HADS).

Methods : In this prospective, multicenter, nonrandomized trial, patients diagnosed neovascular AMD at Nagoya City Hospital and Sugita Eye Hospital and treated with intravitreal ranibizumab were enrolled. Immediately before each injection, best-corrected visual acuity (BCVA) was measured and fundus examination and optical coherence tomography (OCT) were performed. Then the next visit was extended step by step as 4, 6, 8, 12, and 16 weeks if exudative changes were resolved and shortened again if exudative disease was persistent or relapsed. Visual outcomes were assessed with BCVA and the central retinal thickness (CRT) on OCT at week 52. HADS test was performed at baseline and at week 52.

Results : Forty eyes of 40 patients were enrolled. Twenty patients were diagnosed typical AMD and 20 patients polypoidal choroidal vasculopathy. The mean age was 72.3 years. The mean BCVA was improved from 65.1 letters to 71.6 letters at week 52. BCVA was improved by 15 letters or more in 9 patients (22.5%), stabilized within 15 letters in 30 patients (75.0%), and deteriorated by 15 letters or more in 1 eye (2.5%). The mean CRT was significantly improved from 311 µm to 256 µm (P<0.01) at week 52. The mean injection number of ranibizumab was 6.9 (ranging 5-12). In 27 patients (67.5%), exudative changes were not observed at week 52. The mean HADS anxiety and HADS depression score were decreased from 5.0 point to 3.8 point and 4.5 point to 3.6 point, respectively (p<0.05). Eight patients had anxiety at baseline, 4 of those patients them became free from anxiety at week 52. Nine patients had depression at baseline, 6 of these patients became free from depression and 2 other patients had depression newly at week 52.

Conclusions : This study showed that the TAE regimen of intravitreal ranibizumab may not only preserve vision but also reduce the mental burden of patients with neovascular AMD.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.