Experience of Anti-VEGF Treatment and Clinical Levels of Depression and Anxiety in Patients With Wet Age-Related Macular Degeneration

Abstract

Purpose: To investigate detailed patient experiences specific to receiving vascular endothelial growth factor inhibitors (anti-VEGF) for wet Age-Related Macular Degeneration (wAMD), and to acquire a snapshot of the frequency of clinically significant levels of depression, anxiety and post-traumatic stress among patients and levels of burden in patients' carers. Design: Observational cross-sectional mixed-methods study Methods: 300 patients with wAMD receiving anti-VEGF treatment and 100 patient carers were recruited. Qualitative data on patients' experience of treatment were collected using a structured survey. Standardised validated questionnaires were used to quantify clinically significant levels of anxiety, depression, post-traumatic stress, as well as cognitive function and carers' burden. Results: Qualitative data showed that 56% of patients (n =132) reported anxiety related to anti-VEGF treatment. The main sources of anxiety were fear of going blind due to intravitreal injections, and concerns about treatment effectiveness rather than around pain. From validated questionnaires, 17% of patients (n=52) showed clinical levels of anxiety, and 12% (n=36) showed clinical levels of depression. Depression levels, but not anxiety, were significantly higher in patients who received up to 3 injections compared to patients who received from 4 to 12 injections (ANOVA P=.027) and compared to patients who received more than 12 injections (ANOVA P=.001). Conclusions: Anti-VEGF treatment is often experienced with some anxiety related to treatment regardless of the number of injections received. Clinical levels of depression seem to be more frequent in patients at early stages of anti-VEGF treatment. Strategies to improve patient experience of treatment and minimise morbidity are suggested.Key Words: Wet Age-Related Macular Degeneration; Anti-VEGF; Depression; Anxiety; Experience.Abstract (MUST be submitted as a separate file) 1

Development and testing of a patient‐derived questionnaire for treatment of neovascular age‐related macular degeneration: dimensions of importance in treatment of neovascular age‐related macular degeneration

“…Thus, DITAMD should be tested in additional sites, preferably in a multicentre, international setting. However, the strength of the current study is its coherence with previous studies that report similar dimensions of importance in nAMD treatment (Kandula et al 2010(Kandula et al , 2010Boyle et al 2015;Senra et al 2016Senra et al , 2017. Kandula et al reported that the patients felt hopeful about the prospect of receiving intravitreal injections which is similar to one of our most frequently reported dimensions: receive treatment to keep vision.…”

“…Other dimensions included in DITAMD questionnaire such as waiting time, follow up structure, transport/travel, are similar to what has been described as 'treatment burden' in other studies (Droege et al 2014;Boyle et al 2015;Senra et al 2016). Boyle et al 2015;Senra et al 2016Senra et al , 2017. Many of these areas reported in previous studies, including injection technique, the need for information about the disease and progression, and the concern about treatment being effective to keep vision can be recognized in dimensions of the current study (Kandula et al 2010;Tailor et al 2011;Droege et al 2014;Table 4.…”

“…However, the strength of the current study is its coherence with previous studies that report similar dimensions of importance in nAMD treatment (Kandula et al 2010(Kandula et al , 2010Boyle et al 2015;Senra et al 2016Senra et al , 2017. However, the strength of the current study is its coherence with previous studies that report similar dimensions of importance in nAMD treatment (Kandula et al 2010(Kandula et al , 2010Boyle et al 2015;Senra et al 2016Senra et al , 2017.…”

“…Fear of injections is something that patients may experience in intravitreal treatment, not only because of pain or insufficient pain relief, but also because of discomfort, technique (needle entry, insertion of speculum), fear of the unknown and fear of losing their sight, as well as side effects. Many of these areas reported in previous studies, including injection technique, the need for information about the disease and progression, and the concern about treatment being effective to keep vision can be recognized in dimensions of the current study (Kandula et al 2010;Tailor et al 2011;Droege et al 2014; Boyle et al 2015;Senra et al 2016Senra et al , 2017. We chose to limit the number of dimensions to assure brevity (Gossec et al 2009(Gossec et al , 2014Heiberg et al 2013) as lengthy questionnaires may increase missing responses and reduce respondent rates (Labori et al 2006).…”

Cost‐effectiveness of basic vision rehabilitation (The basic VRS‐effect study): study protocol for a randomised controlled trial

“…Each subscale includes seven items, generating scores between 0 and 21, for anxiety (Cronbach's alpha of 0.89) and depression (Cronbach's alpha of 0.91). A score of 8 and above is widely used to indicate the presence of clinical levels of anxiety or depression that may warrant further psychological investigation …”