Lifestyle intervention study to promote health behavior changes in AMD patients

Abstract

Purpose : Lifestyle is an important player in Age-related Macular Degeneration (AMD). Despite the high risk of blindness, adherence to current clinical recommendations tends to be low. An important reason for ophthalmologist, is the lack of trust that transition of lifestyle will be feasible in persons of advanced age, and lack of methodology to measure lifestyle or its biological effects. AMD-Life is a still ongoing, randomized controlled intervention study designed to provide evidence that adherence to lifestyle changes can be improved by offering patients feedback of the benefits of their behavioral change.

Methods : 150 AMD patients were randomized into three arms: (A) merely standard recommendations; (B) as A, plus personalized risk profiling based on genetics and lifestyle; (C) as B, plus coaching based on behavioral change technique (BCT) and motivational interviewing (MI). For group C, we developed a coaching model reflecting an upwards spiral to learn from each relapse. This model included elements from the Transtheoretical Model of Change for BCT and the DARN-CAT model for MI. To quantify lifestyle change and to enhance adherence during the coaching sessions, we developed a 13-point lifestyle score form which provided points for not smoking, BMI <25; dietary intake according to Mediterranean Diet food groups, and physical exercise. Genetic risk is based on poly genetic risk score and rare variants in complement genes. Paired t-tests were used to assess whether the change in total AMD-Lifestyle score (TLS) between both visits was statistically significant.

Results : From 22 participants, data from both baseline and 12-month examinations were available for preliminary analysis. Baseline TLS was on average 7; 12-month TLS on average 9, an increase by 2.0 points (p<0.001). Especially patients assigned to group B who received personal risk assessments (mean difference of 1.70, p<0.05) and group C who additionally received coaching (mean difference of 3.0, p<0.001) managed to improve their overall lifestyle.

Conclusions : The preliminary findings of AMD-Life provide evidence that lifestyle changes in AMD patients are feasible and that they are most successful when engagement is stimulated by personalized risk assessment and coaching. AMD-Life strategies may guide ophthalmologists in promoting risk-reducing behavior in AMD-patients.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.