Neovascular AMD has substantial psychological impact on patients

Reviewed by Dr Jose Ignacio Fernandez-Vigo

Depression and anxiety are common in patients with neovascular age-related macular degeneration (nAMD). The patient follow-up is affected by long clinic waiting lists, comorbidities and anxiety about injections. 

Investigators at the retinal department of the Hospital Clínico San Carlos, Madrid, Spain, conducted a cross-sectional study of 80 patients with nAMD.

The patients completed a 70-question survey that included the visual functioning questionnaire (VFQ25), which is specific to nAMD and treatment with intravitreal injection, and the hospital anxiety and depression scale (HADS) questionnaire, to determine the impact of visual impairment, visual functioning, emotional well-being and patient-identified barriers that affected follow-up visits for nAMD.

The age and best-corrected visual acuity (BCVA) in the early treatment diabetic retinopathy study (ETDRS) scale were recorded for all patients.

Dr Jose Ignacio Fernandez-Vigo of the Department of Ophthalmology recounted that eighty patients with nAMD were included (mean age, 81.3 ± 10.2 years; range, 68–94). The mean BCVA was 65.8 ± 10.2 ETDRS letters (range, 5–95). The general quality-of-life score was 2.7 ±1.0.

The BCVA in the better eye was associated significantly (p < 0.001) with all three components of the survey. In the VFQ25, the mean general score was 60.6 ± 18.5 out of a range of 0 to 100; the mean score for distance activities was 65.2 ± 13.4.

In the HADS scale, 31% and 22% of patients, respectively, had scores that were classified as depression and anxiety; a score 11 or higher out of 21 indicated abnormal cases and between 8 and 10 out of 21 indicated borderline cases; 25% of cases were considered borderline.

The most common barriers cited that interfered with patient follow-up for nAMD were long waiting times in the clinic (70.4%) followed by other medical conditions (15.9%),and the anxiety score related to the injections was 2.7 ± 1.1 on a scale ranging from 1 to 5.

“This study clarifies the impact of visual impairment and visual functioning in nAMD and describes important rates of depression and anxiety symptoms in addition to the main patient-identified barriers to nAMD follow-up in an urban population,” according to Dr Fernandez-Vigo.