Vision-related quality of life: Impacts of advanced AMD

Why progression to advanced disease may have a more dramatic impact on patients with neovascular AMD compared with those with central geographic atrophy.

AMD screening

This article was reviewed by Lucian V. Del Priore, MD, PhD.

The natural progression of vision-related quality of life (VRQoL) in individuals with age-related macular degeneration (AMD) who develop advanced disease may differ between those with central geographic atrophy (GA) versus those with neovascular disease, according to a study presented at ARVO 2020 by Yale University researchers.

Performed using data from the Age-Related Eye Disease Study, the study included 206 participants with central GA and 198 subjects with neovascular AMD (nAMD) who completed the National Eye Institute Visual Function Questionnaire (NEI-VFQ). The study findings could have potential implications for the design of future VRQoL research and for patient counseling, said Aneesha Ahluwalia, medical student, Yale University School of Medicine, New Haven, Connecticut.

“While previous work has demonstrated that there is a significant decrease in VRQoL when patients progress from early to advanced AMD, there is a paucity of literature exploring longitudinal trends before and after this transition and little is known about patient characteristics associated with changes in VRQoL. Additionally, prior VRQoL studies have either examined advanced AMD as a single group or focused on nAMD, despite the fact that advanced AMD can refer to either central GA or nAMD. As the number of individuals with AMD continues to increase and new treatments are being assessed for efficacy, it is important to understand the impact of both forms of advanced AMD on VRQoL,” she said. “Our findings suggest that future studies examining VRQoL in patients with advanced AMD may want to consider separately examining the central GA and nAMD cohorts.”

Analyses of change in VRQoL before and after the transition to advanced disease within each advanced AMD cohort showed that among participants with nAMD, the rate of decline of VRQoL was significantly greater after neovascularization occurred than it was before. However, there was no significant change in the rate of VRQoL decline after the development of central GA.

“When we grouped both cohorts together, we found that the rate of VRQoL decline significantly increased after the development of advanced disease, which was likely being driven by the nAMD cohort,” Ahluwalia said. “These results suggest that the progression to advanced disease may have a more dramatic impact on VRQoL in patients with nAMD compared to those with central GA.”

Ahluwalia noted that these data mirror the clinical experience that nAMD patients generally maintain good visual function until the onset of neovascularization, whereas as GA develops, patients often experience a slower, steadier deterioration in visual function that allows them to adapt.

The investigation also determined that women and individuals with higher baseline VRQoL were more likely to experience a longitudinal decline in VRQoL over the study period. The gender association is consistent with reports of lower cross-sectional VRQoL scores among women with various ophthalmic conditions, including AMD. Previous studies have also shown that BCVA decline over time is greater in individuals who start with a higher baseline level, Ahluwalia said.

“Simply put, individuals who begin with a higher baseline VRQoL may have more to lose, while the finding that longitudinal VRQoL decline in more likely in women could be related to gender differences in the impact of visual impairment on daily activities and warrants further investigation,” Ahluwalia said.

Lucian V. Del Priore, MD, PhD
Aneesha Ahluwalia
Ahluwalia conducted the study with Lucian V. Del Priore, MD, PhD, Robert R Young Professor and Chair, Department of Ophthalmology and Visual Science, Yale University School of Medicine, and fellow medical student, Linus Shen, BS.
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