Beyond visual acuity: Patient-relevant assessment measures of visual function in retinal diseases

Abstract

Purpose: To identify patient-reported outcomes (PROs) and other clinical outcome measures (contrast sensitivity (CS), low-luminance visual acuity (LLVA) and reading acuity or reading speed (RA-RS)), relevant to patients with age-related macular degeneration (AMD) or diabetic retinopathy (DR), which would be recommended for use in clinical practice. Methods: The RAND/UCLA Appropriateness Method, based on the synthesis of the scientific evidence and the collective judgment of an expert panel using the two-round Delphi method, was applied. The evidence synthesis was performed by searching for articles on outcome measures for AMD and/or DR published between 2005 and 2018 in English or Spanish. The expert panel consisted of 14 Spanish ophthalmologists, who rated the recommendation degree for each outcome measure on a scale of 1 (extremely irrelevant) to 9 (maximum relevance). The recommended outcome measures were established according to the panel median score and the level of the panelists’ agreement. Results: Through the evidence search, 33 PRO-specific questionnaires (21 for visual function, six for AMD, three for DR, one for AMD and DR) and two treatment satisfaction questionnaires (one on AMD and one on DR) were identified. In addition, 21 methods were found for measuring CS, five for LLVA, and nine for RA-RS. According to the panel ratings, 11 of the 64 outcome measures evaluated for AMD, and seven of the 61 evaluated for DR were recommended. Conclusion: The AMD and DR outcome measures recommended will help ophthalmologists choose the outcome measure most appropriate for their patients. Furthermore, the use of PROs will contribute to shifting clinical practice towards patient-centered medicine.

Switching to Brolucizumab in Neovascular Age-Related Macular Degeneration Incompletely Responsive to Ranibizumab or Aflibercept: Real-Life 6 Month Outcomes

“…A correlation of retinal thickness in OCT with reading abilities has been demonstrated in nAMD [ 19 ], but reading tests are not widely adapted in clinical practice and research, and testing is not standardized [ 20 ]. While ETDRS reading scores are standard for functional outcomes in large randomized studies, vision-related quality of life correlates more with contrast sensitivity and binocular reading speed, but ETDRS letter score does not correlate with binocular reading speed [ 16 ].…”

“…The discrepancy of impaired reading with maintained visual acuity is explained in diseases such as nAMD by the many small microlesions of the sensory cells in the center of the macula. To address this problem and achieve a more patient-centered therapy, different visual assessments have been compared [ 20 ]. Our data support the inclusion of reading acuity in the routine assessments of patients with nAMD as it has a greater informative value with regard to vision-related quality of life, as well as pathophysiology.…”