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Vision-related quality of life: 12-month aflibercept treatment in patients with treatment-resistant neovascular age-related macular degeneration

  • Retinal Disorders
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Abstract

Purpose

To assess changes in vision-related quality of life (VR-QoL) among patients with treatment-resistant neovascular age-related macular degeneration (nAMD) following intravitreal aflibercept treatment over 48 weeks.

Methods

We conducted a prospective study in which 49 patients with nAMD resistant to anti-vascular endothelial growth factor therapy were switched to intravitreal aflibercept. Patients were treated with three loading doses every 4 weeks followed by injections every 8 weeks, for a total of 48 weeks. Ophthalmic examinations performed at each visit included best-corrected visual acuity (BCVA) and central macular thickness (CMT) measurement. The National Eye Institute Visual Functioning Questionnaire 25 (NEI VFQ-25) was used to assess VR-QoL at baseline and weeks 24 and 48. Changes in NEI VFQ-25 composite and subscale scores were analyzed using paired t tests. The relationship between the change in VR-QoL and changes in BCVA and CMT, and the impact of the better-seeing eye (BSE, defined as the eye reading the greater number of letters at baseline) vs. the worse-seeing eye (WSE, the fellow eye to the BSE) were assessed.

Results

Mean NEI VFQ-25 composite scores improved significantly at weeks 24 and 48 compared to baseline (4.5 ± 9.2 and 4.4 ± 11.8, respectively, all p < 0.01). Among subscales, general vision and near and distance activities showed significant improvements at weeks 24 and 48 (all p < 0.05). Improvement in the NEI VFQ-25 composite score was significantly associated with increased BCVA at week 48 (β coefficient = 0.43, p = 0.029), but not with change in CMT (β coefficient = −0.007, p = 0.631). There was no association between VR-QoL changes and BSE or WSE.

Conclusion

Despite previous anti-VEGF treatment in this cohort, overall VR-QoL improved following aflibercept therapy over 48 weeks. This improvement was related to improved vision in treatment eyes regardless of whether they were the BSE or WSE.

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References

  1. Avery RL, Pieramici DJ, Rabena MD, Castellarin AA, Nasir MA, Giust MJ, Avery RL, Pieramici DJ, Rabena MD, Castellarin AA, Nasir MA, Giust MJ (2006) Intravitreal bevacizumab (Avastin) for neovascular age-related macular degeneration. Ophthalmology 113(3):363–372.e365. doi:10.1016/j.ophtha.2005.11.019

    Article  PubMed  Google Scholar 

  2. Kane RL (2006) Essentials of clinical geriatric. In: D. Vergil Alfaro III (ed) Age-related macular degeneration: a comprehensive textbook. 7th edn. Lippincott Williams & Wilkins McGraw-Hill Education, Philadelphia: New York, p 364

  3. Gordois A, Pezzullo L, Cutle H (2010) The global economic cost of visual impairment. Access Economics Pty Limited for AMD Alliance International, pp 465–481

  4. Suner IJ, Kokame GT, Yu E, Ward J, Dolan C, Bressler NM (2009) Responsiveness of NEI VFQ-25 to changes in visual acuity in neovascular AMD: validation studies from two phase 3 clinical trials. Invest Ophthalmol Vis Sci 50(8):3629–3635. doi:10.1167/iovs.08-3225

    Article  PubMed  Google Scholar 

  5. Yuzawa M, Fujita K, Tanaka E, Wang EC (2013) Assessing quality of life in the treatment of patients with age-related macular degeneration: clinical research findings and recommendations for clinical practice. Clin Ophthalmol 7:1325–1332. doi:10.2147/OPTH.S45248

    Article  PubMed  PubMed Central  Google Scholar 

  6. Chang AA, Li H, Broadhead GK, Hong T, Schlub TE, Wijeyakumar W, Zhu M (2014) Intravitreal aflibercept for treatment-resistant neovascular age-related macular degeneration. Ophthalmology 121(1):188–192. doi:10.1016/j.ophtha.2013.08.035

    Article  PubMed  Google Scholar 

  7. Broadhead GK, Hong T, Zhu M, Li H, Schlub TE, Wijeyakumar W, Chang AA (2015) Response of pigment epithelial detachments to intravitreal aflibercept among patients with treatment-resistant neovascular age-related macular degeneration. Retina 35:975–981

    Article  CAS  PubMed  Google Scholar 

  8. Mangione CM, Lee PP, Gutierrez PR, Spritzer K, Berry S, Hays RD, National Eye Institute Visual Function Questionnaire Field Test I (2001) Development of the 25-item National Eye Institute Visual Function Questionnaire. Arch Ophthalmol 119(7):1050–1058

    Article  CAS  PubMed  Google Scholar 

  9. National Eye Institute (2000) The National Eye Institute 25-item visual function questionnaire-25. Version 2000. Scoring Algorithm. http://www.rand.org/health/surveys_tools/vfq.html. Accessed 27 June 2013

  10. Orr P, Rentz AM, Margolis MK, Revicki DA, Dolan CM, Colman S, Fine JT, Bressler NM (2011) Validation of the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25) in age-related macular degeneration. Invest Ophthalmol Vis Sci 52(6):3354–3359. doi:10.1167/iovs.10-5645

    Article  PubMed  Google Scholar 

  11. Heier JS, Brown DM, Chong V, Korobelnik JF, Kaiser PK, Nguyen QD, Kirchhof B, Ho A, Ogura Y, Yancopoulos GD, Stahl N, Vitti R, Berliner AJ, Soo Y, Anderesi M, Groetzbach G, Sommerauer B, Sandbrink R, Simader C, Schmidt-Erfurth U, View GVS (2012) Intravitreal aflibercept (VEGF trap-eye) in wet age-related macular degeneration. Ophthalmology 119(12):2537–2548. doi:10.1016/j.ophtha.2012.09.006

    Article  PubMed  Google Scholar 

  12. Spilker B (1990) Quality of life assessments in clinical trials. Raven, New York

    Google Scholar 

  13. Ferris FL 3rd, Kassoff A, Bresnick GH, Bailey I (1982) New visual acuity charts for clinical research. Am J Ophthalmol 94(1):91–96

    Article  PubMed  Google Scholar 

  14. Copay AG, Subach BR, Glassman SD, Polly DW Jr, Schuler TC (2007) Understanding the minimum clinically important difference: a review of concepts and methods. Spine J 7(5):541–546. doi:10.1016/j.spinee.2007.01.008

    Article  PubMed  Google Scholar 

  15. Dong LM, Childs AL, Mangione CM, Bass EB, Bressler NM, Hawkins BS, Marsh MJ, Miskala P, Jaffee HA, McCaffrey LA, Submacular Surgery Trials Research G (2004) Health- and vision-related quality of life among patients with choroidal neovascularization secondary to age-related macular degeneration at enrollment in randomized trials of submacular surgery: SST report no. 4. Am J Ophthalmol 138(1):91–108. doi:10.1016/j.ajo.2004.02.011

    Article  PubMed  Google Scholar 

  16. Submacular Surgery Trials Research G (2007) Evaluation of minimum clinically meaningful changes in scores on the National Eye Institute Visual Function Questionnaire (NEI-VFQ) SST Report Number 19. Ophthalmic Epidemiol 14(4):205–215. doi:10.1080/09286580701502970

    Article  Google Scholar 

  17. Rosenfeld PJ, Brown DM, Heier JS, Boyer DS, Kaiser PK, Chung CY, Kim RY, MARINA Study Group (2006) Ranibizumab for neovascular age-related macular degeneration. N Engl J Med 355(14):1419–1431. doi:10.1056/NEJMoa054481

    Article  CAS  PubMed  Google Scholar 

  18. Comparison of Age-related Macular Degeneration Treatments Trials Research Group, Martin DF, Maguire MG, Fine SL, Ying GS, Jaffe GJ, Grunwald JE, Toth C, Redford M, Ferris FL 3rd (2012) Ranibizumab and bevacizumab for treatment of neovascular age-related macular degeneration: two-year results. Ophthalmology 119(7):1388–1398. doi:10.1016/j.ophtha.2012.03.053

    Article  Google Scholar 

  19. Schmidt-Erfurth U, Kaiser PK, Korobelnik JF, Brown DM, Chong V, Nguyen QD, Ho AC, Ogura Y, Simader C, Jaffe GJ, Slakter JS, Yancopoulos GD, Stahl N, Vitti R, Berliner AJ, Soo Y, Anderesi M, Sowade O, Zeitz O, Norenberg C, Sandbrink R, Heier JS (2014) Intravitreal aflibercept injection for neovascular age-related macular degeneration: ninety-six-week results of the VIEW studies. Ophthalmology 121(1):193–201. doi:10.1016/j.ophtha.2013.08.011

    Article  PubMed  Google Scholar 

  20. Brown GC (1999) Vision and quality-of-life. Trans Am Ophthalmol Soc 97:473–511

    CAS  PubMed  PubMed Central  Google Scholar 

  21. Brown GC, Sharma S, Brown MM, Kistler J (2000) Utility values and age-related macular degeneration. Arch Ophthalmol 118(1):47–51

    Article  CAS  PubMed  Google Scholar 

  22. Brown GC, Brown MM, Brown HC, Kindermann S, Sharma S (2007) A value-based medicine comparison of interventions for subfoveal neovascular macular degeneration. Ophthalmology 114(6):1170–1178

    Article  PubMed  Google Scholar 

  23. Leys A, Zlateva G, Shah SN, Patel M (2008) Quality of life in patients with age-related macular degeneration: results from the VISION study. Eye 22(6):792–798. doi:10.1038/sj.eye.6702900

    Article  CAS  PubMed  Google Scholar 

  24. Bressler NM, Chang TS, Suner IJ, Fine JT, Dolan CM, Ward J, Ianchulev T, Marina GAR (2010) Vision-related function after ranibizumab treatment by better- or worse-seeing eye: clinical trial results from MARINA and ANCHOR. Ophthalmology 117(4):747–756. doi:10.1016/j.ophtha.2009.09.002, e744

    Article  PubMed  Google Scholar 

  25. Brown MM, Brown GC, Sharma S, Busbee B, Brown H (2001) Quality of life associated with unilateral and bilateral good vision. Ophthalmology 108(4):643–647, discussion 647–648

    Article  CAS  PubMed  Google Scholar 

  26. Finger RP, Fenwick E, Hirneiss CW, Hsueh A, Guymer RH, Lamoureux EL, Keeffe JE (2013) Visual impairment as a function of visual acuity in both eyes and its impact on patient reported preferences. PLoS ONE 8(12), e81042

    Article  PubMed  PubMed Central  Google Scholar 

  27. Hirneiss C, Neubauer AS, Gass CA, Reiniger IW, Priglinger SG, Kampik A, Haritoglou C (2007) Visual quality of life after macular hole surgery: outcome and predictive factors. Br J Ophthalmol 91(4):481–484

    Article  PubMed  Google Scholar 

  28. Finger RP, Guymer RH, Gillies MC, Keeffe JE (2014) The impact of anti-vascular endothelial growth factor treatment on quality of life in neovascular age-related macular degeneration. Ophthalmology 121(6):1246–1251. doi:10.1016/j.ophtha.2013.12.032

    Article  PubMed  Google Scholar 

  29. Hirneiss C (2014) The impact of a better-seeing eye and a worse-seeing eye on vision-related quality of life. Clin Ophthalmol 8:1703–1709

    Article  PubMed  PubMed Central  Google Scholar 

  30. Rovner BW, Casten RJ, Tasman WS (2002) Effect of depression on vision function in age-related macular degeneration. Arch Ophthalmol 120(8):1041–1044

    Article  PubMed  Google Scholar 

  31. Williams RA, Brody BL, Thomas RG, Kaplan RM, Brown SI (1998) The psychosocial impact of macular degeneration. Arch Ophthalmol 116(4):514–520

    Article  CAS  PubMed  Google Scholar 

  32. Mangione CM, Gutierrez PR, Lowe G, Orav EJ, Seddon JM (1999) Influence of age-related maculopathy on visual functioning and health-related quality of life. Am J Ophthalmol 128(1):45–53

    Article  CAS  PubMed  Google Scholar 

  33. Scott IU, Schein OD, West S, Bandeen-Roche K, Enger C, Folstein MF (1994) Functional status and quality of life measurement among ophthalmic patients. Arch Ophthalmol 112(3):329–335

    Article  CAS  PubMed  Google Scholar 

  34. Brody BL, Gamst AC, Williams RA, Smith AR, Lau PW, Dolnak D, Rapaport MH, Kaplan RM, Brown SI (2001) Depression, visual acuity, comorbidity, and disability associated with age-related macular degeneration. Ophthalmology 108(10):1893–1900, discussion 1900–1891

    Article  CAS  PubMed  Google Scholar 

  35. Mitchell J, Bradley C (2006) Quality of life in age-related macular degeneration: a review of the literature. Health and Quality of Life Outcomes 4:97. doi:10.1186/1477-7525-4-97

    Article  PubMed  PubMed Central  Google Scholar 

  36. Chang TS, Bressler NM, Fine JT, Dolan CM, Ward J, Klesert TR, Group MARINA Study Group (2007) Improved vision-related function after ranibizumab treatment of neovascular age-related macular degeneration: results of a randomized clinical trial. Arch Ophthalmol 125(11):1460–1469

  37. Bressler NM, Chang TS, Fine JT, Dolan CM, Ward J for the Anti-VEGF Antibody for the Treatment of Predominantly Classic Choroidal Neovascularization in Age-Related Macular Degeneration (ANCHOR) Research Group (2009) Improved vision-related function after ranibizumab vs photodynamic therapy: a randomized clinical trial. Arch Ophthalmol 127:13–21

  38. Chang AA, Broadhead GK, Hong T, Joachim N, Syed A, Schlub T, Toth L, Peto T, Zhu M (2015) Intravitreal aflibercept for treatment-resistant neovascular age-related macular degeneration: 12-month safety and efficacy outcomes. Ophthalmic Res 55(2):84–90

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Sydney Retina Clinic & Day Surgery, Level 13, Park House, 187 Macquarie Street, Sydney, NSW, 2000, Australia

    Meidong Zhu, Wijeyanthy Wijeyakumar, Adil R. Syed, Nichole Joachim, Thomas Hong, Geoffrey K. Broadhead, Haitao Li & Andrew Chang

  2. Sydney Institute of Vision Science, Sydney, Australia

    Meidong Zhu, Wijeyanthy Wijeyakumar, Adil R. Syed, Nichole Joachim, Thomas Hong, Geoffrey K. Broadhead, Haitao Li & Andrew Chang

  3. Save Sight Institute, The University of Sydney, Sydney, Australia

    Meidong Zhu, Wijeyanthy Wijeyakumar, Adil R. Syed, Geoffrey K. Broadhead & Andrew Chang

  4. Department of Statistics, Faculty of Science and Engineering, Macquarie University, Sydney, Australia

    Kehui Luo

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  1. Meidong Zhu
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Corresponding author

Correspondence to Andrew Chang.

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Funding

Financial support was provided in part by Bayer Corporation. The sponsor had no role in the design or conduct of this research. The authors have full control of all primary data, and we agree to allow Graefe’s Archive for Clinical and Experimental Ophthalmology to review our data upon request.

Conflict of interest

Dr. Andrew Chang has acted as a consultant for Alcon, Bayer and Novartis. All other authors state that they have no proprietary interests or conflicts of interest related to this submission.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

This manuscript has not been published previously, and it is not simultaneously being considered for any other publication.

The trial was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN 12612000666820).

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Zhu, M., Wijeyakumar, W., Syed, A.R. et al. Vision-related quality of life: 12-month aflibercept treatment in patients with treatment-resistant neovascular age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 255, 475–484 (2017). https://doi.org/10.1007/s00417-016-3477-9

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  • DOI: https://doi.org/10.1007/s00417-016-3477-9

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