Significant improvements in near vision, reading speed, central visual field and related quality of life after ranibizumab treatment of wet age‐related macular degeneration

Abstract

ABSTRACT.Purpose: To investigate the effects on near visual acuity, reading speed, central visual field and related quality of life of ranibizumab treatment of wet age-related macular degeneration (AMD). Methods: The study was a prospective, non-comparative consecutive case series, followed for 3 months and investigator-driven. Thirty eyes of 30 patients with wet AMD were included, mean age 75 years (range 69-95 years). In addition to a full ophthalmological examination -including best-corrected visual acuity (BCVA; Early Treatment Diabetic Research Study chart), fundus biomicroscopy, fundus photography, fluorescein angiography, indocyanine green angiography (occult cases) and ocular coherence tomography -near visual acuity, reading speed, central visual field and quality of life for related activities were also investigated at baseline and at 3 months after ranibizumab treatment. Results: Mean BCVA increased from 62 ± 11 to 66 ± 14 letters at 3 months (7%; p = 0.018). Near vision improved from 9 ± 5 to 6 ± 3 points (33%; p = 0.0006) and reading speed increased from 59 ± 40 to 85 ± 50 words ⁄ min (44%; p < 0.0001). The mean deviation from normal of the visual field improved from )9 ± 7 to )6 ± 5 dB (33%; p < 0.0001). Quality of life improved for distance activities from 54 ± 28 to 63 ± 28 points (17%; p < 0.0001) but significantly (p = 0.024) more for near activities, from 49 ± 26 to 63 ± 26 points (29%; p < 0.0001). Reading newspaper text in the group in which the better eye was treated showed the highest increase in quality of life score of all: 116%. Conclusion: The increase in BCVA after ranibizumab treatment is well established.The present study also showed significant improvements in other important visual qualities, such as near visual acuity, reading speed, central visual field and several activities influencing quality of life. The improvement was greater for near activities than for distance activities. Therefore, the beneficial effects of ranibizumab treatment shown here are more extensive than those reported previously.

Therapeutic Interventions for Macular Diseases Show Characteristic Effects on Near and Distance Visual Function

“…12 While this difference diminished during therapy, there was still a difference of 0.3 logMAR units at the last visit. This indicates that reading acuity is more impaired in active disease and that under therapy, reading acuity improves relatively more than distance acuity, which is concordant to the findings of Frennesson et al 2 These findings suggest that reading acuity might be a more sensitive marker for disease activity than dVA. A previous study found a 0.3 log unit between dVA and reading performance in eyes with dry age-related macular degeneration, but it was assumed that there is a linear correlation between these 2 parameters.…”

“…1,2 An accurate assessment of visual function therefore requires more than distance visual acuity (dVA) measurement alone. 3 Unfortunately, in daily practice and in pivotal clinical trials, visual function is usually only assessed by measuring dVA.…”

Subjective perception versus objective outcome after intravitreal ranibizumab for exudative AMD

“…In other words, patients needed less magnification of the text content for effortless reading. Our data are thus consistent with the finding of increasing reading speed following intravitreal ranibizumab treatment reported by Frenneson et al [21].…”

“…An early study treating patients with a single injection of bevacizumab for CNV found an objective mean improvement of +3.1 ETDRS letters and a subjective improvement of vision in 50% of these patients after 1 month, which is comparable to our findings [27]. Besides this, several studies can be found assessing operational aspects of visual function using questionnaires like the National Eye Institute 25-item Visual Function Questionnaire (NEI VFQ-25) [21,28,29]. However, rather than focusing on patient-perceived visual quality of one specific treated eye, these questionnaires aim to evaluate patients' overall vision-related quality of life (QOL).…”

“…Using VFQ-25 questionnaires, it has been shown that vision-related QOL differs between patients having their better-seeing or their worse-seeing eye treated [21,30]. According to that, treatment of the worse-seeing eye at baseline has a smaller impact on self-reported vision-related QOL.…”