Impact of age related macular degeneration on quality of life

AIMS: To describe the impact of age related macular degeneration (AMD) on quality of life and explore the association with vision, health, and demographic variables. METHODS: Adult participants diagnosed with AMD and with impaired vision (visual acuity <6/12) were assessed with the Impact of Vision Impairment (IVI) questionnaire. Participants rated the extent that vision restricted participation in activities affecting quality of life and completed the Short Form General Health Survey (SF-12) and a sociodemographic questionnaire. RESULTS: The mean age of the 106 participants (66% female) was 83.6 years (range 64-98). One quarter had mild vision impairment, (VA<6/12-6/18) and 75% had moderate or severely impaired vision. Participants reported from at least "a little" concern on 23 of the 32 IVI items including reading, emotional health, mobility, and participation in relevant activities. Those with mild and moderate vision impairment were similarly affected but significantly different from those with severe vision loss (p<0.05). Distance vision was associated with IVI scores but not age, sex, or duration of vision loss. CONCLUSION: AMD affects many quality of life related activities and not just those related to reading. Referral to low vision care services should be considered for people with mild vision loss and worse.     

Cataract surgery in patients with age-related macular degeneration: one-year outcomes

PURPOSE: To determine whether patients with age-related macular degeneration (ARMD) benefit from cataract surgery and to assess the risk of progression of preexisting maculopathy 4 and 12 months postoperatively. SETTING: Princess Alexandra Eye Pavilion, Royal Infirmary of Edinburgh, Edinburgh, Scotland. METHODS: Two groups of patients were evaluated prospectively. The study group comprised patients with ARMD scheduled to have cataract surgery (n = 40). The control group comprised patients with ARMD not having cataract surgery (n = 43). Patients were assessed at baseline (preoperatively) and 4 and 12 months postoperatively. Assessment included visual function tests and quality of life (QoL) measures. The mean values for each item tested were obtained for each group at each visit, and comparisons between visits were done using the Wilcoxon signed rank test. RESULTS: There were significant benefits of cataract surgery in terms of visual function and QoL measures at 4 and 12 months. There was no increased risk of progression of maculopathy in the study group. There were no significant differences in the items tested in the control group. CONCLUSIONS: One year postoperatively, QoL benefits were maintained in the study group and there was no increased risk of progression of maculopathy in patients with mild and moderate degrees of ARMD. Larger numbers of patients must be assessed prospectively for longer periods to determine the relative risk of progression of different stages of ARMD after cataract surgery.     

Case selection in macular relocation surgery for age related macular degeneration

BACKGROUND: To date there has been no randomised controlled trial demonstrating the safety and efficacy of macular relocation surgery (MRS) for age related macular degeneration (AMD). Vision can be improved in some patients and made worse in others despite successful surgery or because of complications. PURPOSE: To determine which patients would benefit from MRS. METHODS: Twenty nine patients with exudative AMD took part in a prospective, non-comparative, interventional study. Macular relocation surgery involved phacoemulsification, vitrectomy, 360 degrees retinotomy, excision of choroidal neovascular membrane, and macular relocation using an infusion of 5-fluorouracil and low molecular weight heparin as adjuvant to prevent proliferative vitreoretinopathy. Patients underwent protocol refraction preoperatively and six-monthly postoperatively by designated optometrists. Preoperative fundus fluorescein angiograms were read by masked observers and the lesions were classified according to a set protocol. The main outcome measures were visual improvement, final vision of better than 20/400, reading speed, critical print size. Logistic and multiple stepwise linear regressions were used to identify independent factors which predicted the main outcomes. RESULTS: Preoperative visual acuity (20/120 or worse) and lesion type (predominantly classic or submacular haemorrhage) were significantly associated with visual improvement (coefficient of regression B = 26.8, p<0.001 and B = 14.9 with p = 0.045 respectively). There were no significant independent factors which predicted a final distance logMAR visual acuity of 1.3 (20/400) or any arbitrary definition of blindness. CONCLUSIONS: The study showed that it was possible to select cases that were more likely to experience an improvement in vision following MRS.     

A prospective study of visual function and quality of life following PDT in patients with wet age related macular degeneration

AIMS: (1) A prospective study to assess visual function measures and quality of life (QoL) in patients with wet age related macular degeneration (AMD) treated with photodynamic therapy (PDT). (2) To assess if PDT prevents severe visual loss (loss of six or more lines of distance visual acuity) in the treated eye. METHODS: 48 of 51 recruited patients with predominantly classic subfoveal choroidal neovascularisation (CNV) secondary AMD who were treated with PDT were followed up for 1 year. Assessment included distance and near visual acuity, contrast sensitivity, vision related quality of life and fluorescein angiography. Photodynamic therapy using Visudyne was carried out according to standard protocol. Patients were followed up every 3 months and treatment repeated if there was significant leakage from CNV. RESULTS: At the 12 month follow up, 71% (n = 34) of the patients lost less than three lines of best corrected distance visual acuity. Although there were significant decreases in some of the QoL items tested, patients were significantly less anxious and more independent outdoors at the 12 month follow up. CONCLUSION: This study is in keeping with published literature with PDT preventing severe visual loss in two thirds of treated patients with predominantly classic CNV.     

Influence of photodynamic therapy for age related macular degeneration upon subjective vision related quality of life

Background Photodynamic therapy (PDT) has been used in the treatment of choroidal neovascularisation secondary to age-related macular degeneration (AMD). This study prospectively investigated patients’ subjective change in visual function following PDT as treatment for AMD.Methods Eighty-two consecutive patients receiving PDT in Tasmania, Australia, between May and November 2003 were recruited. In conjunction with a comprehensive clinical examination, the Visual Function-14 (VF-14) questionnaire was administered. Final follow-up occurred between February and March 2005. The VF-14 was scored by traditional summary scoring and by Rasch analysis.Results Five of the 82 (6.1%) subjects recruited were excluded from analysis. PDT was performed on average 5.7±2.6 times per patient. Raw VF-14 scores tended towards being significantly lower at follow-up than at baseline (67.6±27.2 against 64.5±27.7; P=0.052), and did significantly deteriorate using a collapsed Rasch analysis (P=0.0102). Following treatment, 38 (47.5%) eyes had lost three or more Snellen lines of best-corrected visual acuity.Conclusion Patients undergoing PDT typically report reasonable visual function. In parallel with visual acuity, self-reported visual function may deteriorate slightly after PDT for AMD, but not as much as reported in untreated AMD.The authors have no commercial interest or conflicts of interest in this publication     

Cataract surgery in cases of age-related macular degeneration

It has been noted for some time that cataract surgery in the presence of retinal comorbidity such as diabetic macular edema may generate a progression of macular changes and result in a poor visual outcome. Recent findings show that adverse events may also occur in the presence of age-related macular degeneration (AMD). Therefore, when indicating cataract surgery the surgeon needs to consider the risks both for progression of early into late stages of AMD or further deterioration of late manifestations of AMD. Furthermore, in the presence of advanced atrophic or neovascular AMD the question arises whether or not the patient may benefit from cataract surgery in spite of an already existing central visual loss. Here we critically review results from recent studies.     

老年性黄斑变性锥细胞运动觉功能的变化

目的　观察干性型老年性黄斑变性（ａｇｅ－ｒｅｌａｔｅｄ ｍ ａｃｕｌａｒｄｅｇｅｎｅｒａｔｉｏｎ,ＡＭＤ）患者三种视锥细胞视觉运动觉的变化。　方法　通过随机点运动觉检查方法,分别应用蓝、绿、红视标显示在黄、紫及青色背景,保持视标与背景间等亮度以排除亮度因素的影响,从而分离检查２０只眼ＡＭＤ三种视锥细胞视觉运动觉功能的变化。　结果　ＡＭＤ三种视锥细胞的感觉位移和方向位移阈值,与正常人相比明显受损,发生了弥漫性的损害。　结论　视锥细胞的视觉运动觉,是能够反映干性型ＡＭＤ视功能损害的一个新的测试指标。     

老年性黄斑变性锥细胞运动觉功能的变化

目的 观察干性型老年性黄斑变性(age-related macular degeneration,AMD)患者三种视锥细胞视觉运动觉的变化。 方法 通过随机点运动觉检查方法,分别应用蓝、绿、红视标显示在黄、紫及青色背景,保持视标与背景间等亮度以排除亮度因素的影响,从而分离检查20只眼AMD三种视锥细胞视觉运动觉功能的变化。 结果 AMD三种视锥细胞的感觉位移和方向位移阈值,与正常人相比明显受损,发生了弥漫性的损害。 结论 视锥细胞的视觉运动觉,是能够反映干性型AMD视功能损害的一个新的测试指标。 (中华眼底病杂志, 1999, 15: 219-221)     

玻璃体视网膜手术治疗老年黄斑变性的疗效评价

为探讨玻璃体切除术及视网膜下手术治疗湿性型老年黄斑变性（ＡＭＤ）的疗效和估价，对２６眼因ＡＭＤ玻璃体出血混浊施玻璃体切除术；６眼黄斑中心凹处新生血管膜形成、出血行视网膜下手术。结果为玻璃体切除术组，术后全部看清眼底，发现黄斑区视网膜下出血１３眼，有新生血管膜及疤痕１０眼，两者同时存在３眼，术后视力提高２２眼，不变及减退各２眼，视力在０．０５以上仅８眼；视网膜下手术组，成功取出视网膜下新生血管膜３眼，出血冲洗干净３眼，术后视力进步４眼，不变及减退各１眼。结论：玻璃体切除术虽然能清除玻璃体出血及混浊，但不能阻止ＡＭＤ病变的发展和治疗视网膜下病变及恢复视功能；视网膜下手术能清除部分视网膜下病灶，亦不能恢复色素上皮和感光细胞功能。因此，视网膜移植可能是治疗湿性型ＡＭＤ的新途径     

Impact of cataract surgery on quality of life in patients with early age-related macular degeneration.

PURPOSE: To investigate if cataract surgery improves overall and specific areas of quality of life (QoL) in patients with early age-related macular degeneration (AMD) using the impact of vision impairment (IVI) questionnaire. METHODS: Patients with visually significant cataract and early AMD, who were being considered for cataract surgery in the study eye, were recruited. Eligible patients were randomized to either "early surgery" or "standard surgery" (standard cataract surgery waiting time of 6 months) groups. The IVI, sociodemographic, and clinical data were collected. Rasch analysis was used to estimate QoL person measures at baseline and follow-up. The data were analyzed using repeated measures ANOVA. Effect sizes were calculated using Cohen's d coefficient. RESULTS: Fifty six patients (mean age = 78.5 years and visual acuity = 6/15) had one eye randomly allocated to either the early surgery (n = 29) or standard surgery (n = 27) groups. At follow-up, significant interaction effects were found for the overall IVI score [F(1,54) = 17.7; p < 0.001], the emotional well-being [F(1,54) = 13.4; p = 0.001], mobility and independence [F(1,54) = 13.4; p = 0.001], and reading and accessing information subscales [F(1,54) = 13.1; p = 0.001]. The standard surgery group systematically recorded worse scores at 6 months on all QoL measures whereas the early surgery group recorded significant gains (p < 0.001; Cohen's d = 0.66 to 0.91) on all of them. Visual acuity in the study eye significantly improved in the early surgery group only (Cohen's d = 1.1; p < 0.05) and improvement in log MAR lines read was identified as the single independent predictor of enhanced QoL explaining between 26 and 34% of the variance in the IVI scores. CONCLUSIONS: Cataract surgery is justified in patients with early AMD. It brings significant improvements in visual acuity, aspects of daily living, and overall QoL.     

Age related macular degeneration surgery

Age related macular degeneration (ARMD) is a disease in which the retinal pigment epithelium (RPE) is damaged in the central retinal area. In the exudative form, the vision loss is due to choroidal neovascularization, while in the nonexudative or atrophic form, there is a vision loss because of the retinal pigment epithelium atrophy. Treatment which proved to be efficient in lowering the risk of severe vision loss in the exudative form includes laser photocoagulation, photodynamic therapy, transpupilary thermotherapy and as surgical treatment, the controversial subretinal membrane extraction. In all these situations the RPE is damaged by the disease itself and by the therapeutic procedure too. Retinal translocation is a surgical procedure that intends to remove the neurosensory retina from an area with damaged RPE to an healthy RPE area, through a 360 degrees retinotomy or through a limited one. This paper present some ARMD cases treated by subretinal membrane extraction and one by limited retinal translocation. The question which is still remaining is which are the risks and benefits for the following treatment procedures: laser photocoagulation, photodynamic therapy, transpupilary thermotherapy and surgical approach?     

Optokinetic nystagmus in patients with central scotomas in age related macular degeneration

BACKGROUND: Reports on the impact of a loss in the central field of vision on optokinetic nystagmus (OKN) are varied. A study was therefore undertaken to reassess the role of the central retina in the generation of OKN in a large group of patients with age related macular degeneration. METHODS: Four groups of 20 patients were examined: a control group without scotoma and three groups with absolute central scotomas measuring 1 degrees--10 degrees, 11 degrees--20 degrees, and 21 degrees--30 degrees. OKN was elicited with black and white stripes moving nasally to temporally or temporally to nasally on a screen subtending 54 degrees x 41 degrees at four velocities (15, 30, 45, and 60 degrees /s). OKN gain was measured using infrared oculography. RESULTS: There was no significant difference in OKN gain between the control group and those with scotomas of 1 degrees--10 degrees and 11 degrees--20 degrees. A significant difference in OKN gain was found between the group with scotomas of 21 degrees--30 degrees and all other groups at stimulus velocities of 30, 45, and 60 degrees/s (p<0.05). OKN gain significantly diminished with increasing stimulus velocity (p<0.05). No statistically significant difference was found in OKN gain between stimuli moving temporally to nasally and nasally to temporally. CONCLUSION: Abnormalities of OKN gain were noted only in patients with large scotomas. An intact macula is therefore not necessary for the generation of OKN.     

年龄相关性黄斑变性眼底血管荧光造影分析

目的:探讨眼底荧光造影(fundus fluorescein angiography,FFA)在老年黄斑变性诊断中的应用价值。方法:用Topocon TRC-NW7SF型眼底照相机对老年黄斑变性(age related macular degeneration,AMD)患者进行FFA检查,并结合临床其他检查进行分析。结果:AMD患者40例62眼中,萎缩型49眼(79%),渗出型13眼(21%)。萎缩型表现均为点状或斑驳样透见荧光,未见荧光素渗漏。渗出型早期可见脉络膜新生血管(choroidal neovascularization,CNV)形态,晚期大量荧光素渗漏,周围有出血者则表现为荧光遮蔽。结论:对AMD患者早期应用FFA检查有助于分析CNV,并显示其范围和部位,为治疗提供依据。