Predictors of health-related quality of life in Chinese patients receiving treatment for neovascular age-related macular degeneration: a prospective longitudinal study

Abstract

Background: Age-related macular degeneration (AMD) is currently the leading cause of irreversible visual impairment in developed countries and seriously affects the health-related quality of life (HRQoL) of patients. However, the majority of the research in this area employs cross-sectional design; longitudinal research investigating changes in HRQoL and influencing factors is limited. The aim of this study was to use a longitudinal study design to investigate descriptive trends in HRQoL and their predictive factors in Chinese AMD patients receiving treatment with vascular endothelial growth factor inhibitors (anti-VEGF) at baseline and follow-ups. Methods: In a sample of 142 AMD patients from the outpatient clinic of the Southwest Eye Hospital, a tertiary major hospital in the southwest of China, each patient completed a self-administered questionnaire assessing demographics, clinical features, HRQoL, depression, anxiety, coping style, social support, and self-efficacy at baseline and at 1-, 3-, 6-, and 12-month follow-up appointments. Results: The total score of HRQoL fluctuated, with the highest score at the 6-month follow-up and the lowest score at baseline. Multivariable linear regression showed the predictors of HRQoL are best-corrected visual acuity (BCVA), income level, depression, and visual acuity (VA) of the treated eye at baseline; BCVA, income, and depression at the 1-month follow-up; duration, area of residence, gender, VA of the treated eye, BCVA, income, anxiety, social support, self-efficacy, and depression at the 3-month follow-up; gender, BCVA, income, anxiety, social support, self-efficacy, depression, negative coping, and positive coping at the 6-month follow-up; and BCVA, social support, self-efficacy, and depression at the 12-month follow-up.

Anxiety levels moderate the association between visual acuity and health-related quality of life in chronic eye disease patients

“…When patients’ levels of anxiety are higher, the negative effect that reduced visual acuity has on health-related quality of life is expected to be stronger. This is consistent with the current state of the art which has highlighted the potential negative and disabling effect of comorbid mental health problems on eye disease patients’ quality of life 21 , 44 , 45 . Furthermore, previous studies have identified common factors of mental health problems among eye disease patients, which help us to understand why anxiety levels might play a key role in patients’ health-related quality of life.…”

The management of neovascular age‐related macular degeneration: A systematic literature review of patient‐reported outcomes, patient mental health and caregiver burden

“…Two studies did not report change in composite NEI VFQ‐25 score, and Schroeder et al only reported composite score change after >3 years' follow‐up (Schroeder et al, 2017 ). For the other nine reports of eight study populations, all except one (Bian et al, 2020 ) described a statistically significant improvement in composite NEI VFQ‐25 score at the earliest time point measured after baseline: 1 month (Finger et al, 2013 ); 3 months (Frennesson et al, 2010 ; Inoue et al, 2014 ; Jelin et al, 2018 ; Jelin et al, 2019 ) and 6 months (Rakic et al, 2013 ; Zhu et al, 2017 ; Gomi et al, 2019 ). In three studies, the early improvement in composite NEI VFQ‐25 score was maintained during longer‐term follow‐up at 12 months (Inoue et al, 2014 ; Gomi et al, 2019 ; Jelin et al, 2019 ); in two other studies, it was not (Finger et al, 2013 ; Rakic et al, 2013 ).…”

“…Bian et al found that both visual acuity in the treated eye and overall best‐corrected visual acuity (BCVA) correlated significantly with the NEI VFQ‐25 composite score at baseline, 1, 3, 6 and 12 months (Bian et al, 2020 ). This was consistent with previous, smaller studies, which reported better visual function scores associated with higher NEI VFQ‐25 scores (Inoue et al, 2014 ; Wang et al, 2015 ; Zhu et al, 2017 ).…”

“…While there was a lack of consistent evidence as to whether depression was a predictor of NEI VFQ‐25 total scores (Casten et al, 2010 ; Bian et al, 2020 ), positive correlations between depression scores on the Geriatric Depression Scale and age, visual acuity of either the treated or better eye, duration of nAMD and the number of previous treatments for nAMD have been found (Lee et al, 2013 ). In several studies, the major sources of anxiety for patients with nAMD were related to fear of losing eyesight because of disease activity and/or prognosis, or concerns about the effectiveness of treatment (Droege et al, 2013 ; Senra et al, 2017 ; Giocanti‐Auregan et al, 2018 ; Yiallouridou et al, 2020 ).…”

“…Only two other studies (Kato et al, 2018;Kuwayama et al, 2019;Bian et al, 2020) assessed whether treatment with anti-VEGF agents had any indirect impact on symptoms of anxiety and depression using instruments other than the NEI VFQ subscale (both used HADS; Table 4). The Japanese study data, reported in two conference HADS: At 1 year (n = 40), the mean HADS anxiety score and mean HADS depression score were decreased from 5.0 to 3.8 and from 4.5 to 3.6 points respectively (p < 0.05).…”