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Aneesha Ahluwalia, Liangbo Linus Shen, Lucian V Del Priore; Natural History of Vision-related Quality of Life in Advanced Age-related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2020;61(7):1937.
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Vision-related quality of life (VRQoL) is an important patient-centered metric that is utilized increasingly to evaluate disease progression. However, longitudinal data examining VRQoL in advanced age-related macular degeneration (AMD) is limited. We analyzed data from the Age-Related Eye Disease Study (AREDS) to describe the natural progression of VRQoL in patients with neovascular age-related macular degeneration (nAMD) and central geographic atrophy (GA), as well as to determine factors associated with VRQoL decline.
We used data from the National Eye Institute Visual Function Questionnaire (NEI-VFQ) that was administered to 643 patients with nAMD and 259 patients with central GA in the AREDS cohort. We estimated the rate of change in VRQoL as the slope of the NEI-VFQ score over time for each individual. We performed Kaplan-Meier analysis to determine the time until clinically meaningful decrease in VRQoL (loss of 5 NEI-VFQ points). We conducted multivariate regressions to identify clinical and demographic factors associated with cross-sectional VRQoL score and with experiencing a decline in VRQoL during the study period.
The median time until clinically significant loss of VRQoL in this cohort was 4.0 years (95% CI 3.4-4.9) for nAMD patients versus 4.2 years (95% CI 3.0-5.7) for central GA patients (P = 0.95). The mean rate of decline of VRQoL in patients with nAMD was greater than the rate in central GA patients (3.30 ± 6.16 vs. 1.68 ± 4.65 NEI-VFQ units/year; P = 0.012). In a multivariate regression analysis, female gender (Odds ratio (OR) 1.21, 95% CI 1.08-1.36; P = 0.004) and higher baseline VRQoL score (OR 1.01, 95% CI 1.002-1.01; P = 0.006) were independently associated with experiencing a longitudinal decline in VRQoL. Better eye best-corrected visual acuity (BCVA) was independently associated with cross-sectional VRQoL (OR 2.03, 95% CI 1.85-2.23; P<.001).
After developing advanced AMD, individuals continued to experience a decline in VRQoL, and female patients and those with a higher baseline VRQoL were more likely to experience a decline in VRQoL over time. BCVA in the better eye was independently associated with VRQoL, whereas BCVA in the worse eye was not. These findings may help guide future clinical trials with VRQoL endpoints, as well as recommendations for counseling patients with advanced AMD.
This is a 2020 ARVO Annual Meeting abstract.
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