Evaluación de la calidad de vida en pacientes con DMAE neovascular en tratamiento con antiangiogénicos intravítreos según práctica clínica habitual

Abstract

Background. Age-Related Macular Degeneration (AMD) is the leading cause of irreversible blindness in developed countries and its prevalence is increasing due to rising life expectancy. Neovascular AMD (nAMD) occurs in approximately 15 % of patients and it’s the most aggressive form of the disease, since it produces a rapid deterioration of central vision and therefore, a decrease in vision-related quality of life (VR-QoL). The current treatment of nAMD relies on intravitreal injections of anti-vascular endotelial growth factor (VEGF) drugs that must be administered chronically to maintain visual function. Purpose. To evaluate VR-QoL and its different domains in patients with nAMD with chronic treatment with intravitreal injections of anti-VEGF. To analyze the influence of metamorphopsia, contrast sensitivity and other variables related to the anti-VEGF treatment in the VR-QoL of these patients. Methods. This is an observational and cross-sectional study that includes 88 eyes of 88 Caucasian patients with nAMD receiving anti-VEGF treatment for more than one year following a treat-and-extend (T&E) regimen in real-world settings (study group), and 78 eyes of 78 patients with similar demographic characteristics and without macular alterations or with early or intermediate AMD (control group). At inclusion we determined: distance (ETDRS scale) and near (Jaeger charts) binocular best-corrected visual acuity (BCVA), monocular far BCVA, metamorphopsia (M-CHARTS™), contrast sensitivity (CSV-1000E test), central subfield thickness (CST), global thickness of the peripapillary retinal nerve fiber layer (pRNFL) and VR-QoL (NEI VFQ-25 questionnaire). In addition, the following data were obtained from the electronic health record for the study group eyes: monocular BCVA (baseline BCVA) and subtype of macular neovascularization (MNV) before initiation of the anti-VEGF treatment, drug(s) administered, number of intravitreal injections received during the first year of treatment, total number of intravitreal injections received, duration of treatment and activity or not of the MNV at the time of inclusion (SD-OCT). Results. Monocular and binocular distance BCVA were significantly lower in the study group than in the control group. Metamorphopsia values (horizontal, vertical and total) were significantly higher in the study group. Four spatial frequencies values of contrast sensitivity were significantly lower in the study group. We did not find differences in CST and pRNFL thickness between the groups. The VR-QoL was significantly lower in study group. All the NEI VFQ-25 subscales of the VR-QoL questionnaire were significantly lower in the study group, except those of general health and ocular pain. In the study group, we found that distance binocular BCVA and the number of intravitreal injections received during the first year were directly correlated with the VR-QoL, while age, the total number of intravitreal injections received and the duration of treatment were inversely correlated with the VR-QoL. Patients with intravitreal treatment in their better-seeing eye showed a significantly lower VR-QOL than the patients with treatment in their worst-seeing eye or the patients with similar BCVA in both eyes. The patients who were being treated in their only functional eye had a significantly lower VR-QoL than the rest of the patients. Patients with unilateral or bilateral nAMD and treatment in one or both eyes, respectively, had higher VR-QoL than patients with bilateral nAMD receiving treatment in only one eye. In the study group, we did not find a relationship between metamorphopsia and: the duration of treatment, the number of injections received, the activity of the MNV, the changes in the monocular distance BCVA or the VR-QoL. We also did not find a relationship in the study group between contrast sensitivity and: duration of treatment, total number of injections, changes in monocular distance BCVA or VR-QoL, but we found that contrast sensitivity was significantly lower in eyes with active neovascular lesions. Conclusions. Patients with nAMD receiving chronic intravitreal anti-VEGF treatment have lower VR-QoL, more metamorphopsia, and poorer contrast sensitivity, despite the fact that they have CST and pRNFL thickness similar to that of control patients. The VR-QoL of patients with in nAMD is directly related to the binocular distance BCVA and to the number of intravitreal injections received during the first year of treatment, and inversely to age, total number of intravitreal injections received and duration of treatment. The VR-QoL subscales most affected in nAMD patients are general vision, near vision, driving, role limitations, and distance vision. The VR-QoL of patients with nAMD is not related to other aspects of visual function such as metamorphopsia and contrast sensitivity