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Scheffer M, Menting J, Boeije H, van Nispen R, van Dulmen S. Understanding healthcare communication in age-related macular degeneration care: A mixed-methods review of patients' perspectives. Surv Ophthalmol 2024; 69:646-660. [PMID: 38499047 DOI: 10.1016/j.survophthal.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 03/01/2024] [Accepted: 03/11/2024] [Indexed: 03/20/2024]
Abstract
Age-related macular degeneration (AMD) is the most common cause of irreversible visual impairment among people aged 50 years and older. Earlier research has indicated that the communication process between patients and healthcare professionals (HCPs) leaves considerable room for improvement in AMD care. Effective communication is essential to enhance trust in the professional and understanding of the diagnosis and treatment, and decrease anxiety and stress related to illness. We review patients' experiences, needs and preferences regarding information provision, communication style of the HCP and shared decision-making. We conducted a systematic search in PubMed, Embase, PsycINFO, CINAHL and Web of Science. Study quality was assessed using standard checklists of quality measures. Our search returned 31 eligible articles. Findings indicated current deficits in information provision for people with AMD. Patients were often ill-informed regarding the chronic character of the condition, treatment duration, nutrition, and visual aids and low vision rehabilitation. Many patients were not actively involved during the decision-making process. Altogether, patients with AMD are faced with challenges in terms of patient-HCP communication. Methods of providing information and discussing possible options for care need to be further investigated and improved for this patient group.
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Affiliation(s)
- Mariska Scheffer
- Nivel (Netherlands Institute for Health Services Research), Utrecht, Netherlands; Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, Netherlands.
| | - Juliane Menting
- Nivel (Netherlands Institute for Health Services Research), Utrecht, Netherlands
| | - Hennie Boeije
- Nivel (Netherlands Institute for Health Services Research), Utrecht, Netherlands
| | - Ruth van Nispen
- Ophthalmology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, Netherlands
| | - Sandra van Dulmen
- Nivel (Netherlands Institute for Health Services Research), Utrecht, Netherlands; Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, Netherlands; Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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Thinggaard BS, Pedersen M, Sorensen TL, Grauslund J, Stokholm L. Patient perspectives and barriers in the treatment of neovascular age-related macular degeneration in Denmark: a qualitative study. BMJ Open 2023; 13:e077175. [PMID: 38016793 PMCID: PMC10685919 DOI: 10.1136/bmjopen-2023-077175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/14/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVES This qualitative study aims to identify patient-reported barriers to treatment for neovascular age-related macular degeneration (nAMD) and investigate their impact on quality of life. DESIGN Using a qualitative explorative design. SETTING Semi-structured individual or dyadic interviews were conducted with patients and their relatives. PARTICIPANTS Twenty-one patients completed the interview, with four of them having a relative present. INTERVENTIONS Gadamer's hermeneutics guided the epistemological approach, and maximum variation sampling was employed to capture diverse patient experiences. An advisory board consisting of patients, relatives and ophthalmologists ensured the relevance of the study. Thematic analysis was conducted using NVivo software. PRIMARY AND SECONDARY OUTCOME MEASURES To investigate patient-reported barriers to the recommended treatment for nAMD and impact on quality of life. RESULTS The study included 21 patients with nAMD, with a median age of 79 years. Five themes emerged: (1) good compliance with intravitreal treatment, (2) the dual role of relatives, (3) treatment commute, (4) hospital barriers, (5) preventive health literacy. CONCLUSION This study highlights the resilience and adherence of patients with nAMD in Denmark to their treatment despite various barriers. While the therapy may have negative effects on their well-being, patients do not opt out of treatment. These findings underscore the importance of personalised treatment plans that provide, for example, convenient access to care and clear future agreements at the hospital. By adopting more patient-centred approaches, healthcare providers can enhance patient satisfaction and improve treatment adherence, ultimately leading to better patient outcomes and quality of life.
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Affiliation(s)
- Benjamin Sommer Thinggaard
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- OPEN Data Explorative Data Network, Odense University Hospital, Odense, Denmark
| | - Maria Pedersen
- Department of Nursing and Nutrition, University College Copenhagen, Copenhagen, Denmark
| | | | - Jakob Grauslund
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lonny Stokholm
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- OPEN Data Explorative Data Network, Odense University Hospital, Odense, Denmark
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Enoch J, Ghulakhszian A, Sekhon M, Crabb DP, Taylor DJ, Dinah C. Piloting a forced-choice task to elicit treatment preferences in geographic atrophy. BMC Res Notes 2023; 16:244. [PMID: 37777762 PMCID: PMC10543887 DOI: 10.1186/s13104-023-06531-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 09/21/2023] [Indexed: 10/02/2023] Open
Abstract
OBJECTIVE Geographic Atrophy (GA) is the advanced form of the non-neovascular ('dry') type of age-related macular degeneration (AMD) and responsible for one-quarter of legal blindness in the UK. New therapies delivered by intravitreal injection are in late-stage development, and two such therapies (pegcetacoplan (Syfovre) and avacincaptad pegol (Izervay)) have now been approved for clinical use by the US Food and Drug Administration. These therapies slow down, but do not stop or reverse, progression of GA and they may also increase the risk of developing the neovascular ('wet') type of AMD. Within a larger study exploring the acceptability of these new treatments to people living with GA, we developed a forced-choice exercise to evaluate how participants weigh up benefits and drawbacks of different treatment regimens. This research note reports quantitative and qualitative findings from this exercise. RESULTS Twenty-eight participants took part in this exercise. The exercise demonstrated that participants were generally, although not unanimously, in favour of less frequent treatment for GA that was slightly less efficacious in terms of preserving visual function but presented a lower risk of developing wet AMD. Even among a small sample, the exercise demonstrated the highly personal and idiosyncratic decision-making processes influencing participants' choices of preferred hypothetical GA treatment.
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Affiliation(s)
- Jamie Enoch
- Department of Optometry and Visual Sciences, City, University of London, London, UK
| | - Arevik Ghulakhszian
- Ophthalmology Department, London North West University Healthcare NHS Trust, Central Middlesex Hospital, London, UK
| | - Mandeep Sekhon
- Centre for Applied Health and Social Care Research, Kingston and St George's, University of London, London, UK
| | - David P Crabb
- Department of Optometry and Visual Sciences, City, University of London, London, UK
| | - Deanna J Taylor
- Department of Optometry and Visual Sciences, City, University of London, London, UK
| | - Christiana Dinah
- Ophthalmology Department, London North West University Healthcare NHS Trust, Central Middlesex Hospital, London, UK.
- Department of Brain Sciences, Imperial College, London, UK.
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Yiallouridou C, Acton JH, Banerjee S, Waterman H, Wood A. Pain related to intravitreal injections for age-related macular degeneration: a qualitative study of the perspectives of patients and practitioners. BMJ Open 2023; 13:e069625. [PMID: 37586867 PMCID: PMC10432642 DOI: 10.1136/bmjopen-2022-069625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 08/01/2023] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVES Ocular pain is a commonly reported finding in the intravitreal injection procedure, but post-injection experiences and patient adherence to treatment remain underexplored. We therefore aimed to identify key variations in the intravitreal injection procedure that may influence pain, and to gain insights into the post-injection experience and treatment adherence from the perspective of patients and practitioners. DESIGN Qualitative semistructured interview study using reflexive thematic analysis of transcripts. SETTING Hospital Eye Clinic in Wales, UK. Interviews were conducted between May and September 2019. PARTICIPANTS Purposive sample of patients aged ≥50 years with neovascular age-related macular degeneration and no other retinal pathology who had received at least six intravitreal injections, and practitioners including ophthalmologists, registered nurses and optometrists who performed intravitreal injections at the research site. RESULTS Data saturation was reached with 21 interviews: 14 patients and 7 practitioners. Three main themes were identified from the analysis: fear of losing eyesight and treatment anxiety influence patient adherence to treatment, variability in pain experience during treatment, and post-injection experience and impact on patient recovery. To reassure patients feeling apprehensive about the injections, practitioners promoted safety and trust, and used techniques to manage anxiety. Key variations that may influence pain identified were application of antiseptic or anaesthetic, injecting methods and communication. During injection, patients reported a dull-aching and sharp pain, contrary to practitioners' perspective of feeling a 'pressure'. Patients described prolonged soreness and irritation of up to 36 hours post-injection affecting their sleep and recovery. CONCLUSION Establishing rapport supported patients to recognise the necessity of ongoing treatment to prevent sight loss; however, inadequate pain management led to undesirable outcomes. Practitioners should use pain assessment tools during and immediately after injection and provide ongoing consistent information to help patients manage pain at home.
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Affiliation(s)
| | - Jennifer H Acton
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
| | - Sanjiv Banerjee
- Ophthalmology, Cardiff and Vale University Health Board, Cardiff, UK
| | | | - Ashley Wood
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
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Talks SJ, Daien V, Mitchell P, Aslam T, Barratt J, Biberger A, Lamoureux EL, Hirst C, Sylvanowicz M, Finger RP. The Patient Voice in Neovascular Age-Related Macular Degeneration: Findings from a Qualitative Study. Ophthalmol Ther 2022; 12:561-575. [PMID: 36525220 PMCID: PMC9756919 DOI: 10.1007/s40123-022-00631-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Visual impairment resulting from diseases such as neovascular age-related macular degeneration (nAMD) may cause behavioural, environmental, psychological, and logistical challenges that could act as barriers to effective uptake and sustainability of treatment with anti-vascular endothelial growth factor agents (anti-VEGFs). Understanding emotions and experiences of patients with nAMD may help inform the determinants of adherence, and could contribute to improvements in ophthalmic outcomes and quality of life. METHODS Seventeen patients with nAMD receiving anti-VEGF injections were enrolled from three clinics: one each in France (n = 5), Germany (n = 6), and the UK (n = 6). Patients' health information and treatment characteristics were collected. Individual phone interviews were conducted by experienced health care interviewers. Transcripts were analysed thematically. RESULTS Patients (53% female) had a mean age of 77 years. Bilateral anti-VEGF injections were received by 24% (n = 4); and most (76%, n = 13) were adherent to their treatment. Patient emotions at diagnosis ranged from happiness at learning about the treatment for nAMD to being terrified of receiving an injection in the eye. Most patients mentioned feeling anxious and fearful before their first injection despite receiving reassurance. After the first injection, these feelings and apprehension abated for many, but not all. With the goal of maintaining the best possible vision, few (24%, n = 4) patients reported more than one missed appointment, and most had never considered stopping treatment. No patient reported additional assistance beyond family support; however, many had difficulties with recreational and domestic activities and had developed coping strategies. CONCLUSION This study provides insights on patients' emotions related to their experience of nAMD and its management, highlighting the varying experiences between individuals. It shows the importance of the patient's voice when considering patient care and management, and how the nature and timing of interventions can improve the experience of living with and managing nAMD.
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Affiliation(s)
- S. James Talks
- grid.420004.20000 0004 0444 2244Newcastle Eye Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Vincent Daien
- grid.157868.50000 0000 9961 060XDepartment of Ophthalmology, University Hospital of Montpellier, Montpellier, France
| | - Paul Mitchell
- grid.1013.30000 0004 1936 834XUniversity of Sydney (Westmead Institute for Medical Research), Sydney, NSW Australia
| | - Tariq Aslam
- grid.416375.20000 0004 0641 2866Manchester Royal Eye Hospital, Manchester, UK ,grid.5379.80000000121662407University of Manchester, Manchester, UK
| | - Jane Barratt
- grid.511577.00000 0001 0942 4326International Federation on Ageing, Toronto, ON Canada
| | | | - Ecosse L. Lamoureux
- grid.272555.20000 0001 0706 4670Singapore Eye Research Institute, Singapore, Singapore ,grid.428397.30000 0004 0385 0924Duke-NUS Medical School, Singapore, Singapore
| | - Ceri Hirst
- grid.483721.b0000 0004 0519 4932Bayer Consumer Care AG, Basel, Switzerland
| | | | - Robert P. Finger
- grid.10388.320000 0001 2240 3300Department of Ophthalmology, University of Bonn, Bonn, Germany
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Scheffer M, Menting J, Roodbeen R, van Dulmen S, van Hecke M, Schlingemann R, van Nispen R, Boeije H. Patients' and health professionals' views on shared decision‐making in age‐related macular degeneration care: A qualitative study. Ophthalmic Physiol Opt 2022; 42:1015-1022. [DOI: 10.1111/opo.13016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 05/08/2022] [Accepted: 05/09/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Mariska Scheffer
- Department of Care and Participation of People with Chronic Conditions Netherlands Institute for Health Services Research (Nivel) Utrecht The Netherlands
| | - Juliane Menting
- Department of Care and Participation of People with Chronic Conditions Netherlands Institute for Health Services Research (Nivel) Utrecht The Netherlands
| | - Ruud Roodbeen
- Department of Research Breuer&Intraval Research and Consultancy Groningen The Netherlands
| | - Sandra van Dulmen
- Department of Communication in Healthcare Netherlands Institute for Health Services Research (Nivel) Utrecht The Netherlands
- Department of Primary and Community Care Radboud University Medical Center Radboud Institute for Health Sciences Nijmegen The Netherlands
- Faculty of Caring Science University of Borås Borås Sweden
| | - Manon van Hecke
- Department of Ophthalmology Elisabeth‐TweeSteden Ziekenhuis Tilburg The Netherlands
| | - Reinier Schlingemann
- Department of Ophthalmology, Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
- Bergman Clinics Ogen Amsterdam The Netherlands
- Department of Ophthalmology, University of Lausanne Jules‐Gonin Eye Hospital, Fondation Asile des Aveugles Lausanne Switzerland
| | - Ruth van Nispen
- Department of Ophthalmology, Amsterdam UMC, Vrije Universiteit Amsterdam Public Health Research Institute Amsterdam The Netherlands
| | - Hennie Boeije
- Department of Care and Participation of People with Chronic Conditions Netherlands Institute for Health Services Research (Nivel) Utrecht The Netherlands
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Thier A, Breuning M, Wolfram C, Zeitz O, Holmberg C. Emotional and physical experiences of people with neovascular age-related macular degeneration during the injection process in Germany: a qualitative study. BMJ Open 2022; 12:e058266. [PMID: 35705348 PMCID: PMC9204446 DOI: 10.1136/bmjopen-2021-058266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 05/20/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES In order to better understand the continued barriers to the provision of vascular endothelial inhibitor therapy, this study aims to investigate patients' experiences with neovascular age-related macular degeneration (nvAMD) in Germany during the injection process and how they deal with it. DESIGN AND PARTICIPANTS This analysis is part of the qualitative arm of a wider mixed-methods study. We recruited participants all over Germany via ophthalmologists, eye clinics, general practitioners, care bases and support groups between June 2018 and December 2020 and selected a subsample of study participants with nvAMD who were either undergoing or had previously undergone vascular endothelial growth factor inhibitor therapy. We conducted narrative, semistructured, face-to-face interviews at the participants' homes, which were audio-recorded. The interviews were thematically analysed. RESULTS Twenty-two participants were included in this analysis. Experiencing neovascular macular degeneration was dominated by the injection experience. Study participants perceived the treatment with vascular endothelial inhibitor injections as uncomfortable, and they described undergoing varying levels of anxiety during the whole injection process. After some years of receiving multiple injections, the pain and not experiencing any positive effects made participants with significant vision loss want to discontinue therapy. Furthermore, they narrated negative injection experiences in association with their interactions with medical staff and doctors. CONCLUSION Although time in the medical setting is limited, efficient and good doctor-patient relationships seem crucial for satisfying care experiences. A respectful and humane relationship may be one key to achieving treatment adherence.
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Affiliation(s)
- Anne Thier
- Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Martina Breuning
- Self-Help Research Comprehensive Cancer Center Freiburg - CCCF Medical Center -, University of Freiburg, Freiburg im Breisgau, Baden-Württemberg, Germany
| | - Christian Wolfram
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Oliver Zeitz
- Department of Ophthalmology, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Christine Holmberg
- Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Potsdam, Germany
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Evaluating an automated machine learning model that predicts visual acuity outcomes in patients with neovascular age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2022; 260:2461-2473. [PMID: 35122132 PMCID: PMC9325856 DOI: 10.1007/s00417-021-05544-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 11/10/2021] [Accepted: 12/27/2021] [Indexed: 01/01/2023] Open
Abstract
Purpose Neovascular age-related macular degeneration (nAMD) is a major global cause of blindness. Whilst anti-vascular endothelial growth factor (anti-VEGF) treatment is effective, response varies considerably between individuals. Thus, patients face substantial uncertainty regarding their future ability to perform daily tasks. In this study, we evaluate the performance of an automated machine learning (AutoML) model which predicts visual acuity (VA) outcomes in patients receiving treatment for nAMD, in comparison to a manually coded model built using the same dataset. Furthermore, we evaluate model performance across ethnic groups and analyse how the models reach their predictions. Methods Binary classification models were trained to predict whether patients’ VA would be ‘Above’ or ‘Below’ a score of 70 one year after initiating treatment, measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) chart. The AutoML model was built using the Google Cloud Platform, whilst the bespoke model was trained using an XGBoost framework. Models were compared and analysed using the What-if Tool (WIT), a novel model-agnostic interpretability tool. Results Our study included 1631 eyes from patients attending Moorfields Eye Hospital. The AutoML model (area under the curve [AUC], 0.849) achieved a highly similar performance to the XGBoost model (AUC, 0.847). Using the WIT, we found that the models over-predicted negative outcomes in Asian patients and performed worse in those with an ethnic category of Other. Baseline VA, age and ethnicity were the most important determinants of model predictions. Partial dependence plot analysis revealed a sigmoidal relationship between baseline VA and the probability of an outcome of ‘Above’. Conclusion We have described and validated an AutoML-WIT pipeline which enables clinicians with minimal coding skills to match the performance of a state-of-the-art algorithm and obtain explainable predictions. Supplementary Information The online version contains supplementary material available at 10.1007/s00417-021-05544-y.
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Real-life patient journey in neovascular age-related macular degeneration: a narrative medicine analysis in the Italian setting. Eye (Lond) 2022; 36:182-192. [PMID: 33674730 PMCID: PMC8727581 DOI: 10.1038/s41433-021-01470-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 01/20/2021] [Accepted: 02/15/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To investigate the real-life experience of patients affected by neovascular age-related macular degeneration (nAMD), in the healthcare pathway for the management of the disease, using a "patient journey" and narrative method approach. METHODS The patient journey of subjects affected by nAMD was designed using a process-mapping methodology involving a team from 11 Italian centres. Subsequently, narratives were collected from nAMD patients and family members. The interviews were analyzed using the narrative medicine methodology. RESULTS Eleven specialized retina centres across Italy were involved and 205 narratives collected. In 29% of cases, patients underestimated their symptoms or attributed them to non-pathological causes, thus delaying the specialist consultation. The delay in accessing to care was due to a lack of awareness of this disease (50% of the participants didn't know what nAMD is) and to critical issues faced at first visit (long waiting lists, failed diagnosis, underestimation of the problem). Despite anti-VEGF therapies were perceived as effective in improving or stabilizing vision in 91% of narratives collected, 77% of patients still reduced or ceased daily activities such as reading and driving. Within the pathway of care there was not a multidisciplinary approach, and the patients were treated just by the ophthalmologist. CONCLUSIONS nAMD may significantly affect the quality of life of affected patients, both from a functional and psychological point of view. The narrative medicine approach highlights some critical points in the healthcare journey of nAMD patients and represents a useful background in implementing patient management algorithms and pathways of care.
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Giocanti-Aurégan A, García-Layana A, Peto T, Gentile B, Chi GC, Mirt M, Kosmas CE, Lambert J, Lanar S, Lewis HB, Holekamp NM. Drivers of and Barriers to Adherence to Neovascular Age-Related Macular Degeneration and Diabetic Macular Edema Treatment Management Plans: A Multi-National Qualitative Study. Patient Prefer Adherence 2022; 16:587-604. [PMID: 35264847 PMCID: PMC8901255 DOI: 10.2147/ppa.s347713] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/23/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME) patients treated with intravitreally injected anti-vascular endothelial growth factor (anti-VEGF) monotherapies achieve lower vision improvements compared with patients in clinical trials. This qualitative research study aimed to better understand the real-world anti-VEGF treatment experience from nAMD and DME patients', caregivers', and retina specialists' perspectives. METHODS One-time, semi-structured, individual interviews were conducted with adult patients with nAMD or DME treated with anti-VEGF injections for ≥12 months, their caregivers, and experienced retina specialists. Interview transcripts were analyzed qualitatively using a thematic analysis approach. RESULTS A total of 49 nAMD and 46 DME patients, 47 nAMD and 33 DME caregivers, and 62 retina specialists were interviewed in the USA, Canada, France, Germany, Italy and Spain. Most (79%) patients and caregivers reported disruptions to their routine on the day before, the day of, or the day after anti-VEGF injection. Seven nAMD patients (14%) and 14 DME patients (30%) reported having missed an injection visit. The most frequently reported driver for adherence for patients was the doctor-patient relationship (n=66, 70%), whereas for caregivers, it was the ease of booking an appointment (n=25, 32%). Retina specialists reported patient education on the treatment (n=28, 45%) as the most important driver. Treatment barriers could be grouped into four categories: tolerability, clinical factors, logistical parameters and human factors. The most frequently reported barrier to adherence for patients and caregivers was related to side effects (pain/discomfort/irritation: n=63, 67% of patients; n=52, 66% of caregivers), whereas for retina specialists it was logistical parameters (travel logistics: n=44, 71%). CONCLUSION This study highlights the importance of the doctor-patient relationship and patient education as key drivers, and treatment tolerability and logistics as key barriers to treatment adherence. Improved doctor-patient relationship/communication and patient education together with new therapies offering convenience, long-acting effectiveness, and better tolerability may improve treatment adherence.
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Affiliation(s)
- Audrey Giocanti-Aurégan
- Ophthalmology Department, Avicenne Hospital, Bobigny, France
- Correspondence: Audrey Giocanti-Aurégan, Ophthalmology Department, Avicenne hospital, 125 Rue de Stalingrad, Bobigny Cedex, 93009, France, Tel +33 14 895 5815, Fax +33 14 895 5212, Email
| | | | | | | | | | | | | | | | - Sally Lanar
- Patient Centred Outcomes, ICON Plc, Lyon, France
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Yeung L, Hsieh YT, Yang CH, Chen LJ, Chen SJ, Cheng CK, Sheu SJ, Tsai CY, Wu TT, Wu WC, Chen SN. Management of neovascular age-related macular degeneration: Taiwan expert consensus. J Formos Med Assoc 2021; 120:2061-2071. [PMID: 34274193 DOI: 10.1016/j.jfma.2021.06.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 04/20/2021] [Accepted: 06/18/2021] [Indexed: 11/22/2022] Open
Abstract
Neovascular age-related macular degeneration (nAMD) is a leading cause of irreversible vision loss. The present consensus provides suggestions on diagnosis, evaluation, treatment, and follow-up strategies for nAMD from a panel of 11 practicing ophthalmologists. The experts suggest that the baseline visit for nAMD management should include a comprehensive ophthalmologic examination via a multimodal approach consisting of visual and anatomical evaluation. Patients diagnosed with nAMD should be subjected to treatment with the goal of maintaining visual function while diminishing anatomical disease activity and minimizing treatment burden. Currently, anti-VEGF therapy is the main treatment strategy for nAMD, and evaluation involving comprehensive ophthalmologic examination within 1 month of completion of the loading phase comprising three monthly injections is recommended to guide subsequent management. Either a treat-and-extend or pro re nata regimen can be considered for the maintenance phase of anti-VEGF therapy, and the regimen should be chosen and adjusted according to disease activity, reimbursement criteria, financial burden, and patient preferences. In the event of inactive nAMD or poor treatment outcomes, after thorough evaluation and patient education, anti-VEGF therapy may be stopped. The consensus provides practical nAMD management guidelines for ophthalmologists and fellow healthcare professionals.
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Affiliation(s)
- Ling Yeung
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Ting Hsieh
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chang-Hao Yang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan; Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Lee-Jen Chen
- Department of Ophthalmology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Shih-Jen Chen
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Cheng-Kuo Cheng
- Department of Ophthalmology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; School of Medicine, Fu Jen Catholic University, Taipei, Taiwan
| | - Shwu-Jiuan Sheu
- Department of Ophthalmology, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan; Department of Ophthalmology, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Yao Tsai
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan
| | - Tsung-Tien Wu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Wei-Chi Wu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - San-Ni Chen
- Department of Ophthalmology, Changhua Christian Hospital, Changhua, Taiwan; College of Medicine, Chung-Shan Medical University, Taichung, Taiwan; Department of Optometry, College of Nursing and Health Science, Da-Yeh University, Changhua, Taiwan.
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Fenwick EK, Lee EPX, Man REK, Ho KC, Najjar RP, Milea D, Teo KYC, Tan ACS, Lee SY, Yeo IYS, Tan GSW, Mathur R, Wong TY, Cheung CMG, Lamoureux EL. Identifying the content for an item bank and computerized adaptive testing system to measure the impact of age-related macular degeneration on health-related quality of life. Qual Life Res 2021; 31:1237-1246. [PMID: 34562188 DOI: 10.1007/s11136-021-02989-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE We are developing an age-related macular degeneration (AMD) health-related quality of life (HRQoL) item bank, applicable to Western and Asian populations. We report primarily on content generation and refinement, but also compare the HRQoL issues reported in our study with Western studies and current AMD-HRQoL questionnaires. METHODS In this cross-sectional, qualitative study of AMD patients attending the Singapore National Eye Centre (May-December 2019), items/domains were generated from: (1) AMD-specific questionnaires; (2) published articles; (3) focus groups/semi-structured interviews with AMD patients (n = 27); and (4) written feedback from retinal experts. Following thematic analysis, items were systematically refined to a minimally representative set and pre-tested using cognitive interviews with 16 AMD patients. RESULTS Of the 27 patients (mean ± standard deviation age 67.9 ± 7.0; 59.2% male), 18 (66.7%), two (7.4%), and seven (25.9%) had no, early-intermediate, and late/advanced AMD (better eye), respectively. Whilst some HRQoL issues, e.g. activity limitation, mobility, lighting, and concerns were similarly reported by Western patients and covered by other questionnaires, others like anxiety about intravitreal injections, work tasks, and financial dependency were novel. Overall, 462 items within seven independent HRQoL domains were identified: Activity limitation, Lighting, Mobility, Emotional, Concerns, AMD management, and Work. Following item refinement, items were reduced to 219, with 31 items undergoing amendment. CONCLUSION Our 7-domain, 219-item AMD-specific HRQoL instrument will undergo psychometric testing and calibration for computerized adaptive testing. The future instrument will enable users to precisely, rapidly, and comprehensively quantify the HRQoL impact of AMD and associated treatments, with item coverage relevant across several populations.
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Affiliation(s)
- Eva K Fenwick
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Ester P X Lee
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore
| | - Ryan E K Man
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Kam Chun Ho
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore.,UNSW Sydney, Sydney, Australia
| | - Raymond P Najjar
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Dan Milea
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore
| | - Kelvin Y C Teo
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Anna C S Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Shu Yen Lee
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Ian Yew San Yeo
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Gavin S W Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Ranjana Mathur
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Chui Ming Gemmy Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore
| | - Ecosse L Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Level 6, Singapore, 169856, Singapore. .,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore. .,The University of Melbourne, Parkville, Australia.
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13
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Madheswaran G, Ramesh SV, Pardhan S, Sapkota R, Raman R. Impact of living with a bilateral central vision loss due to geographic atrophy-qualitative study. BMJ Open 2021; 11:e047861. [PMID: 34326049 PMCID: PMC8323355 DOI: 10.1136/bmjopen-2020-047861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Geographic atrophy (GA), a type of dry age-related macular degeneration, affects vision as central vision loss (CVL). The challenges faced due to bilateral CVL in activities of daily living and strategies taken to overcome those challenges are not very well understood in the Indian population. This qualitative study aims to understand the impact on everyday life activities and related adaptive and coping strategies in people with long-standing bilateral CVL due to GA in India. DESIGN, PARTICIPANTS, SETTING AND METHODS A qualitative study using a semistructured face-to-face interview was conducted on 10 people with bilateral CVL after obtaining written informed consent. The interviews were audio-recorded, and were transcribed verbatim. Thematic analysis was carried out to understand the challenges faced and adaptive methods due to the impact of CVL. RESULTS Ten participants (50% male) with a median age (IQR) of 72 (70, 74) years were interviewed. All the participants had best-corrected visual acuity of ≤6/60 in the better eye and reported an absolute central scotoma with the home Amsler chart. Qualitative thematic analysis identified four main themes: challenges in everyday living (difficulty in face identification, reading), challenges with lifestyle and socialisation (driving, cooking, reading for a longer duration, watching TV, socially inactive), psychological implications (depression, poor self-esteem, fear due to poor vision) and strategies to overcome the challenges (voice identification, technology support). CONCLUSION GA has a severe negative impact on the quality of life in people with CVL. Inability to recognise faces was the main reason for dependency on others and being socially disconnected. The findings will help clinicians in providing improved rehabilitative care.
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Affiliation(s)
- Gopinath Madheswaran
- Department of Optometry, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - S Ve Ramesh
- Department of Optometry, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shahina Pardhan
- Vision and Eye Research Institute (VERI), School of Medicine, Anglia Ruskin University, Cambridge, UK
| | - Raju Sapkota
- Vision and Eye Research Institute (VERI), School of Medicine, Anglia Ruskin University, Cambridge, UK
| | - Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamilnadu, India
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Enoch J, Ghulakhszian A, Crabb DP, Dinah C, Taylor DJ. Acceptability of intravitreal injections in geographic atrophy: protocol for a mixed-methods pilot study. BMJ Open 2021; 11:e049495. [PMID: 33895721 PMCID: PMC8074551 DOI: 10.1136/bmjopen-2021-049495] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Age-related macular degeneration (AMD) is a common cause of visual impairment, affecting central vision. Geographic atrophy (GA) is an advanced form of the non-neovascular (dry) type of AMD. Late-stage clinical trials suggest that intravitreal injections of novel therapeutics may slow down the rate of GA progression by up to 30% in 1 year, thus allowing people with GA to preserve central vision for a longer period. While intravitreal injections have become an established treatment modality for neovascular (wet) AMD, it is unknown whether patients with (more gradually progressing) GA would accept regular injections that slow down, but do not stop or reverse, vision loss. Therefore, this mixed-methods pilot study will aim to explore whether regular intravitreal injections will be acceptable as treatment for patients with GA, and the factors that may affect treatment acceptability. METHODS AND ANALYSIS A mixed-methods survey has been designed in collaboration with a GA patient advisory group. The survey comprises of structured questionnaires, semi-structured interview questions regarding patients' perceptions of intravitreal injections and the burden of treatment, and a task eliciting preferences between different potential treatments. Due to COVID-19 restrictions, this study will be conducted remotely by telephone. Thirty individuals will be recruited from NHS Medical Retina clinics at Central Middlesex Hospital, London. Half of the participants will be naïve to intravitreal injections, while half will have previous experience of intravitreal injections for neovascular (wet) AMD. Qualitative data analysis will be conducted using the Framework Method of analysis to identify key themes from participants' accounts. ETHICS AND DISSEMINATION The study received Health Research Authority approval on 23 March 2021 (IRAS Project ID: 287824). Findings will be disseminated through peer-reviewed publications and conference presentations to the medical retina community, as well as through dialogue with patients and macular disease charities.
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Affiliation(s)
- Jamie Enoch
- Optometry and Visual Sciences, City University of London, London, UK
| | - Arevik Ghulakhszian
- Ophthalmology Department, London North West University Healthcare NHS Trust, Central Middlesex Hospital, London, UK
| | - David P Crabb
- Optometry and Visual Sciences, City University of London, London, UK
| | - Christiana Dinah
- Ophthalmology Department, London North West University Healthcare NHS Trust, Central Middlesex Hospital, London, UK
| | - Deanna J Taylor
- Optometry and Visual Sciences, City University of London, London, UK
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15
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Pina Marín B, Gajate Paniagua NM, Gómez-Baldó L, Gallego-Pinazo R. Burden of disease assessment in patients with neovascular age-related macular degeneration in Spain: Results of the AMD-MANAGE study. Eur J Ophthalmol 2021; 32:385-394. [PMID: 33719641 DOI: 10.1177/11206721211001716] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND/AIMS The present study evaluates the burden of neovascular age-related macular degeneration (nAMD) to Healthcare System and patients, describing the management and treatment effectiveness in routine clinical practice in Spain. METHODS Observational, non-interventional, cross-sectional, retrospective (24 months), multicentre study including patients who started treatment with licensed vascular endothelial growth factor inhibitors (anti-VEGF) for nAMD with a minimum follow up of 24 months. RESULTS 126 evaluable patients were included with mean (SD) age of 79.1 (7.5) years. From diagnosis, it took a mean (SD) of 0.5 (0.5) months for the first treatment. Throughout 24 months, mean (SD) number of visits per patient was 16.0 (5.0), 9.4 (4.3) associated intravitreal injection. There were 1186 injection visits, 53.6% of them only with injection and 46.3% with injection and tests. After loading phase, preferred treatment regimens were T&E (46.0%), PRN (44.4%), fixed regimen (4.0%), and others (5.6%). Total number of visits in patients with T&E and PRN were 16.5 (5.7) and 15.5 (4.7), respectively. After complete loading phase, mean (SD) time between two consecutive treatment injections was 2.2 (1.6) months. 27.8% patients underwent a treatment change, being lack of response the most frequent reason to change (43.2%). Mean (SD) best-corrected visual acuity change was 2.1 (15.9) letters at 24 months. CONCLUSION This study showed an important burden to Healthcare System and patients related to monitoring visits. More efficacious and longer lasting treatments could be useful to increase treatment intervals, thus reducing the burden of patients and caregivers and the use of healthcare resources.
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16
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Patient-Perceived Benefit of Treatment in Polypoidal Choroidal Vasculopathy: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176378. [PMID: 32887213 PMCID: PMC7504237 DOI: 10.3390/ijerph17176378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 12/26/2022]
Abstract
Polypoidal choroidal vasculopathy (PCV), a subtype of neovascular age-related macular degeneration, requires repeated treatment. The objective of this pilot study was to evaluate and compare vision-targeted quality of life (QOL) at baseline and after 6 months of treatment in patients with PCV. Naive PCV patients were recruited. Visual functions assessed were distance visual acuity (DVA), near visual acuity (NVA), contrast sensitivity (CS), reading speed (RS), and QOL at baseline and after 6 months of treatment. Thirty patients (average age of 67.62 ± 8.05 years) revealed mean DVA and NVA improvements of 0.24 logMAR and 0.30 logMAR, respectively. Mean CS and RS improved by 0.39 log contrast and 25.58 words per minute, respectively. The National Eye Institute Visual Function Questionnaire 25 (NEI-VFQ-25) composite score significantly increased from a baseline of 66.73 ± 13.74 to 73.54 ± 14.26. Twenty-eight of the patients showed overall improvement in QOL score by 5 units or more or remained stable. Subscales of NEI-VFQ-25 significantly improved, with general vision, mental health, and role difficulties improving by 10 or more units. The present pilot study reports a significant improvement of QOL in PCV patients after 6 months of treatment, with mental health, role difficulties, social functioning, and distance vision activities being the most improved subscales.
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17
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Thier A, Holmberg C. The patients' view: age-related macular degeneration and its effects - a meta-synthesis. Disabil Rehabil 2020; 44:661-671. [PMID: 32574120 DOI: 10.1080/09638288.2020.1775901] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Aim: The aim of this meta-synthesis is to find out what it means for patients with age-related macular degeneration to live with visual impairment, how they cope with the illness and how they experience their medical care, including vascular endothelial growth factor inhibitor therapy.Method: Inclusion criteria: qualitative studies exploring patients' experiences with age-related macular degeneration in their daily lives and with medical care, published in journals in English or German. The included studies were analysed following the rules and principles of grounded theory.Results: For the analysis, twenty-four articles matching the inclusion criteria were identified. Three main analytic themes emerged from the included studies: (i) a life shaped by losses; (ii) the burden of medical treatment; and (iii) coping with vision loss. For patients, visual impairment/vision loss means living with multiple losses in various domains of life. With the introduction of vascular endothelial growth factor inhibitor therapy, patients with neovascular age-related macular degeneration have a good chance of slowing down the disease progression; therapy does, however, also represent a major burden.Conclusion: New strategies need to be conceived to reduce the burden of medical treatment and to improve the dissemination of information about age-related macular degeneration.IMPLICATIONS FOR REHABILITATIONMost of the people with age- related macular degeneration seem to adapt to visual impairment.Medical treatment implies a great physical and psychological burden for patients with neovascular (wet) age- related macular degeneration.The physical and psychological burden needs to be recognized and addressed in the management of patients with neovascular (wet) AMD in medical facilities.More research is needed on how rehabilitation services may support the adaptation process of patients in the different stages of AMD.
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Affiliation(s)
- Anne Thier
- Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Christine Holmberg
- Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany.,Faculty of Health Sciences, joint Faculty of the Brandenburg University of Technology Cottbus-Senftenberg, the Brandenburg Medical School Theodor Fontane and the University of Potsdam
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18
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Taylor DJ, Jones L, Binns AM, Crabb DP. 'You've got dry macular degeneration, end of story': a qualitative study into the experience of living with non-neovascular age-related macular degeneration. Eye (Lond) 2020; 34:461-473. [PMID: 31118490 PMCID: PMC7042256 DOI: 10.1038/s41433-019-0445-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 03/25/2019] [Accepted: 04/04/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND/OBJECTIVES To investigate the impact of non-neovascular (dry) age-related macular degeneration (AMD) on the person with respect to diagnosis, vision loss and coping strategies. SUBJECTS/METHODS Volunteers with dry AMD with a range of disease severity were given an eye examination and asked to describe aspects of their experience with dry AMD in a semi-structured interview. Interviews were audio-recorded, transcribed, and subjected to Framework analysis. Overarching themes were pre-defined, whilst subthemes were derived from the data. RESULTS Twenty-seven participants (81% female), with early (n = 3), intermediate (n = 16) and advanced dry AMD (GA; n = 8) were interviewed. Median (interquartile range) age (years), logMAR binocular visual acuity and Pelli-Robson contrast sensitivity were 76 (71, 80), 0.2 (0.18, 0.40) and 1.65 (1.35, 1.93), respectively. Overarching themes (and subthemes) were: diagnosis (relationship with healthcare professional, psychological impact of diagnosis, and knowledge of AMD, both pre- and post-diagnosis), impact of visual loss (functional and psychological) and coping strategies (help from others and personal strategies). Many participants reported feelings of distress at the time of diagnosis and, particularly noteworthy, several reported a constant fear of their condition worsening. CONCLUSIONS Dry AMD, for which there is currently no treatment, can have a significant impact on individuals, even in its early stages, before significant functional vision loss is manifest, as well as in its intermediate and advanced stages. Results from this study offer important insight into the experience of living with dry AMD not previously explored. Moreover, the results have the potential to serve as an educational resource for eyecare professionals.
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Affiliation(s)
- Deanna J Taylor
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB, UK
| | - Lee Jones
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB, UK
| | - Alison M Binns
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB, UK
| | - David P Crabb
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB, UK.
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Baek SK, Kim JH, Kim JW, Kim CG. Increase in the Population of Patients with Neovascular Age-Related Macular Degeneration Who Underwent Long-Term Active Treatment. Sci Rep 2019; 9:13264. [PMID: 31519960 PMCID: PMC6744448 DOI: 10.1038/s41598-019-49749-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/24/2019] [Indexed: 02/03/2023] Open
Abstract
To investigate changes in the size of the population of patients who are receiving long-term, active treatment for neovascular age-related macular degeneration (AMD). This retrospective, observational study included 3,380 patients who received anti-vascular endothelial growth factor injections (3,974 eyes). The injections performed were divided into the following three groups: group 1, injections performed right after the initial diagnosis; group 2, injections performed <24 months; and group 3, injection performed ≥24 months. Time-dependent changes in the proportion of injections in each group were analyzed. The total number of injections markedly increased from 431 in the 1st quarter of 2014 to 1,323 in the 4th quarter of 2018. There were significant changes in the proportion of injections in each group over time (P < 0.001). The proportions of group 1, group 2, and group 3 in the 1st quarter of 2014 were 17.4%, 65.4%, and 17.2%, respectively. The proportions changed to 10.6%, 50.2%, and 39.5% in the 4th quarter of 2018, respectively. The marked increase in the proportions of group 3 may suggest an increase in the patient population that underwent long-term active treatment. The socioeconomic influence of this trend should be considered when establishing future strategies for neovascular AMD.
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Affiliation(s)
- Seung Kook Baek
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, South Korea
| | - Jae Hui Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea.
| | - Jong Woo Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
| | - Chul Gu Kim
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, South Korea
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20
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Visual Prognosis in the Better-seeing Eyes of Patients with Unilateral Polypoidal Choroidal Vasculopathy. Optom Vis Sci 2019; 96:686-694. [PMID: 31479024 DOI: 10.1097/opx.0000000000001419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
SIGNIFICANCE In patients initially diagnosed as having unilateral polypoidal choroidal vasculopathy, the visual prognosis of the better-seeing eye is highly favorable. If patients are overly pessimistic regarding their vision in the future, physicians can encourage patients by informing them of the small possibility for visual deterioration in the better-seeing eye. PURPOSE The purpose of this study was to investigate the long-term changes in the visual acuity of the better-seeing eyes in patients with unilateral polypoidal choroidal vasculopathy. METHODS This retrospective, single-institution study was performed with 221 patients who were diagnosed as having unilateral polypoidal choroidal vasculopathy and who were treated with intravitreal anti-vascular endothelial growth factor. Only patients with an initially uninvolved eye best-corrected visual acuity (BCVA) of 20/40 or better and who were followed up for at least 24 months were included. The changes in the BCVAs of the initially involved and uninvolved eyes as well as the better-seeing eyes were measured. For patients with three or more lines of uninvolved eye visual deterioration, the cause for the visual deterioration was identified. RESULTS Patients were followed up for a mean of 43.1 ± 11.8 months after diagnosis. During the follow-up period, three or more lines of deterioration in the BCVA were noted in 61 initially involved eyes (27.6%) and 11 uninvolved eyes (4.9%). The reasons for uninvolved eye visual deterioration were neovascularization (n = 8), retinal vein occlusion (n = 2), and posterior capsule opacification (n = 1). At diagnosis, the BCVA of the better-seeing eye was 0.05 ± 0.08 (Snellen equivalents, 20/22). During the follow-up period, three or more lines of deterioration in the BCVA for the better-seeing eye were noted in eight patients (3.6%). CONCLUSIONS Visual acuity of the better-seeing eye over time remained stable in most patients who were initially diagnosed as having unilateral polypoidal choroidal vasculopathy. As a result, the visual prognosis of the better-seeing eye is highly favorable in this condition.
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21
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Senra H, Macedo AF, Nunes N, Balaskas K, Aslam T, Costa E. Psychological and Psychosocial Interventions for Depression and Anxiety in Patients With Age-Related Macular Degeneration: A Systematic Review. Am J Geriatr Psychiatry 2019; 27:755-773. [PMID: 31005495 DOI: 10.1016/j.jagp.2019.03.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 03/01/2019] [Accepted: 03/01/2019] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To review the current literature on psychosocial and psychological interventions to prevent and treat depression and anxiety in patients with age-related macular degeneration (AMD). METHODS The authors conducted a systematic review of literature evaluating psychosocial and psychological interventions for depression and anxiety in patients with AMD. Primary searches of PubMed, Cochrane library, EMBASE, Global Health, Web of Science, EBSCO, and Science Direct were conducted to include all articles published up to April 21, 2018. RESULTS Of a total of 398 citations retrieved, the authors selected 12 eligible studies published between 2002 and 2016. The authors found nine randomized controlled trials (RCT), and three non-randomized intervention (NRI) studies. RCT studies suggested that interventions using group self-management techniques and individual behavioral activation plus low vision rehabilitation can be effective to treat and prevent depression in patients with AMD, and one study suggested that a stepped-care intervention using cognitive-behavioral techniques can be effective to manage anxiety and depression over time. NRI studies highlighted a positive effect of self-help and emotion-focused interventions to reduce depression. CONCLUSION Clinical practice with patients with AMD can rely on some tailored cognitive-behavioral therapeutic protocols to improve patients' mental health, but further clinical trials will generate the necessary evidence-based knowledge to improve those therapeutic techniques and offer additional tailored interventions for patients with AMD.
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Affiliation(s)
- Hugo Senra
- Institute of Psychiatry, Psychology and Neuroscience (HS), King's College London, London
| | - António Filipe Macedo
- Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden; Low Vision and Visual Rehabilitation Lab, Department and Center of Physics - Optometry and Vision Science, University of Minho, Braga, Portugal
| | - Nuno Nunes
- Centre of Psychology, Faculty of Psychology and Educational Sciences (NN, EC), University of Porto, Porto, Portugal
| | - Konstantinos Balaskas
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Tariq Aslam
- Division of Pharmacy and Optometry (TA), School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester Royal Eye Hospital (TA), Central Manchester Foundation Trust, Manchester, UK
| | - Emilia Costa
- Centre of Psychology, Faculty of Psychology and Educational Sciences (NN, EC), University of Porto, Porto, Portugal
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22
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Sivaprasad S, Tschosik EA, Guymer RH, Kapre A, Suñer IJ, Joussen AM, Lanzetta P, Ferrara D. Living with Geographic Atrophy: An Ethnographic Study. Ophthalmol Ther 2019; 8:115-124. [PMID: 30706242 PMCID: PMC6393253 DOI: 10.1007/s40123-019-0160-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Indexed: 01/20/2023] Open
Abstract
Introduction The specific impact from the patient’s perspective of geographic atrophy (GA), an advanced form of age-related macular degeneration (AMD), is not well understood. Methods An ethnographic study was conducted to understand the impact of bilateral GA secondary to AMD on daily functioning by observing regular activities performed at home and through semi-structured interviews. Eligible subjects had a definitive GA diagnosis, including presence of drusen, GA lesion size of at least one disc area in the better-seeing eye, and no other confounding ophthalmologic diagnosis. Data were collected via video recordings and field notes, and analyzed by coding video transcripts. Results Functional impact domains affecting more than two of the 16 subjects from the United Kingdom, United States, or Germany were activities of daily living (difficulty reading, n = 16; driving, n = 12; and watching movies, television, or theater, n = 11), emotional (frustration, and fear of blindness, n = 7 each), social/leisure (interference with hobbies, n = 8, and diminished social activities, n = 4), physical (n = 4), and financial (n = 10). Subjects with a best-corrected visual acuity (BCVA) of 20/100 or better in the better-seeing eye (n = 10) reported similar functional impacts to those with a BCVA of worse than 20/100 in their better-seeing eye (n = 5). Conclusion This study helps address gaps in patient-focused research into GA, which negatively impacts the day-to-day functioning of patients. Larger qualitative and quantitative studies are needed to quantify patient experiences and assess the correlation between BCVA score and impact of GA. Funding F. Hoffmann-La Roche Ltd.
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Affiliation(s)
| | - Elizabeth A Tschosik
- Department of Patient-Centered Outcomes Research, Genentech, Inc., a Member of the Roche Group, South San Francisco, CA, USA.
| | - Robyn H Guymer
- Centre for Eye Research Australia, The Royal Victorian Eye and Ear Hospital, Melbourne, Australia.,Department of Surgery (Ophthalmology), University of Melbourne, Melbourne, Australia
| | - Audrey Kapre
- Department of Patient-Centered Outcomes Research, Genentech, Inc., a Member of the Roche Group, South San Francisco, CA, USA
| | | | - Antonia M Joussen
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Paolo Lanzetta
- Department of Medicine - Ophthalmology, University of Udine, Udine, Italy.,Istituto Europeo di Microchirurgia Oculare - IEMO, Udine, Italy
| | - Daniela Ferrara
- Clinical Science Ophthalmology, Genentech, Inc., a Member of the Roche Group, South San Francisco, CA, USA
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23
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Exploring factors predicting changes in patients' expectations and psychosocial issues during the course of treatment with intravitreal injections for wet age-related macular degeneration. Eye (Lond) 2017; 32:673-678. [PMID: 29219960 DOI: 10.1038/eye.2017.271] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 10/22/2017] [Indexed: 11/08/2022] Open
Abstract
PurposePatients with wet age-related macular degeneration (AMD) often require long courses of treatment. We investigate the psychosocial issues that could hinder compliance, including patient expectations of treatment. The aims of this study were to explore the factors related to changes in patient expectations, pain, and anxiety during treatment.Patients and methodsA structured interview was carried out among 50 patients selected from the list attending the AMD unit at the Princess Alexandra Eye Pavilion (PAEP). The interview was based on a questionnaire. Additionally, a visual analogue scale was created as a tool for measuring patient expectations, pain, and anxiety. Data were analysed using multinomial regression analysis.ResultsThere were significantly more patients who had a fall in expectations (P<0.05) during the course of treatment. A fall in expectations was found to be predicted by higher starting expectations (P=0.00001), greater decline in visual acuity (P=0.008), and perceived deterioration of vision after starting treatment (P=0.013). Of the patients, 32% planned to stop attending for further injections. Planning to stop attending was correlated with worse final visual acuity (P=0.026, 95% CI). Pain and anxiety with intravitreal therapy (IVT) was significantly reduced when patients were accompanied to the clinic by a friend or relative (P<0.01) using Pearson's correlation (r=0.597).ConclusionPatients require appropriate counselling at the start of a course of treatment to align expectations with perceived treatment outcomes in order to improve adherence. Additionally, a large minority of patients would consider stopping treatment. Patients' expectations should be assessed at relevant time points along a course of treatment.
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Kandel H, Khadka J, Goggin M, Pesudovs K. Impact of refractive error on quality of life: a qualitative study. Clin Exp Ophthalmol 2017; 45:677-688. [PMID: 28370795 DOI: 10.1111/ceo.12954] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 02/27/2017] [Accepted: 03/24/2017] [Indexed: 11/28/2022]
Abstract
IMPORTANCE This study qualitatively explores the impact of refractive error on adults, particularly after correction. BACKGROUND The study aimed to explore the impact of refractive error on quality of life. DESIGN Cross-sectional; in-depth telephone and face-to-face semistructured interviews; qualitative study with inductive and deductive processes. PARTICIPANTS Forty-eight adults with refractive error (including presbyopia) were recruited from the Flinders Vision, the Ashford Advanced Eye Care and among Flinders University staff and students, in South Australia. METHODS The interviews were audio-recorded, transcribed verbatim, coded and analysed using thematic analysis. MAIN OUTCOME MEASURES Themes and categories RESULTS: The median age of the participants was 49 years (min: 22 years; max: 76 years). Most of them were female: (29; 59%). Most of them (36; 75.0%) had myopia followed by hyperopia (12; 25.0%). Twenty-two (45.8%) participants had astigmatism. Similarly, 23 (47.9%) of them were presbyopes. Most of the participants (39; 81.3%) wore glasses; 17 (35.4%) used contact lenses, and 17 (35.4%) had undergone refractive surgery. A total of 2367 comments were coded. Thematic analysis resulted into six themes that informed about quality of life issues in people with refractive error. Concerns about cosmetic appearance, personal health and safety, difficulties in day-to-day activities and inconveniences rendered in daily life were identified as the most important themes. CONCLUSIONS AND RELEVANCE The findings of this study enrich the understanding on the issues important in people with refractive error. The quality of life issues identified will be used to develop a refractive error-specific item bank.
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Affiliation(s)
- Himal Kandel
- NHMRC Centre for Clinical Eye Research, Flinders University of South Australia, Adelaide, South Australia, Australia
| | - Jyoti Khadka
- NHMRC Centre for Clinical Eye Research, Flinders University of South Australia, Adelaide, South Australia, Australia
| | - Michael Goggin
- University of Adelaide/South Australian Institute of Ophthalmology, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Konrad Pesudovs
- NHMRC Centre for Clinical Eye Research, Flinders University of South Australia, Adelaide, South Australia, Australia
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25
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Dean S, Mathers JM, Calvert M, Kyte DG, Conroy D, Folkard A, Southworth S, Murray PI, Denniston AK. "The patient is speaking": discovering the patient voice in ophthalmology. Br J Ophthalmol 2017; 101:700-708. [PMID: 28455280 PMCID: PMC5583687 DOI: 10.1136/bjophthalmol-2016-309955] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 01/31/2017] [Accepted: 02/28/2017] [Indexed: 11/25/2022]
Abstract
Eye disease can be devastating. The most feared impact is sight loss, but in a number of ophthalmic conditions, there can be wide-ranging systemic, psychological, emotional and social effects of both the disease and its treatment. External tests of visual function, such as visual acuity, are inadequate to understand the overall impact of ophthalmic disease on a patient’s functional vision or daily life. This can lead to a discordance between the patient’s priorities and perspective on the one hand and the efforts of clinicians and other stakeholders on the other hand. In this review, we discuss how the patient is uniquely placed to understand the impact of the disease and can use that position to transform ophthalmic care at the individual and collective level, from research to care delivery. We highlight how the “patient voice” can contribute to key areas, including priority setting in the research agenda, communicating the wide-ranging impact of disease and its treatment as assessed through qualitative research, identifying the outcome measures that matter to the patient through core outcome set development and reporting these outcomes through appropriate patient-reported outcome measures. We also consider the increasing power of the patient voice on health institutions, ranging from broadcasting an individual’s experience of care he/she has received to patient societies influencing future health policy. Finally, we reflect on the challenges that need to be overcome for the patient voice to increasingly influence and improve the delivery of eye care in the future.
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Affiliation(s)
- Samera Dean
- Health Education England (West Midlands), Birmingham, UK
| | - Jonathan M Mathers
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Melanie Calvert
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
| | - Derek G Kyte
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
| | | | | | - Sue Southworth
- Department of Ophthalmology, University Hospitals Birmingham NHSFT, Birmingham, UK
| | - Philip I Murray
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,Birmingham & Midland Eye Centre, Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Alastair K Denniston
- Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK.,Department of Ophthalmology, University Hospitals Birmingham NHSFT, Birmingham, UK.,Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,Centre for Rare Diseases, Institute of Translational Medicine, Birmingham Health Partners, Birmingham, UK.,NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
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26
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Jones RK, Jefferis JM. Is qualitative research under-represented in ophthalmology journals? Eye (Lond) 2017; 31:1117-1119. [PMID: 28387766 DOI: 10.1038/eye.2017.49] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- R K Jones
- Department of Ophthalmology, Royal Hallamshire Hospital, Sheffiled, UK
| | - J M Jefferis
- Department of Ophthalmology, Royal Hallamshire Hospital, Sheffiled, UK
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27
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Chatard H, Tepenier L, Jankowski O, Aussems A, Allieta A, Beydoun T, Salah S, Bucci MP. Effects of Age-Related Macular Degeneration on Postural Sway. Front Hum Neurosci 2017; 11:158. [PMID: 28408876 PMCID: PMC5374199 DOI: 10.3389/fnhum.2017.00158] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 03/17/2017] [Indexed: 11/25/2022] Open
Abstract
Purpose: To compare the impact of unilateral vs. bilateral age-related macular degeneration (AMD) on postural sway, and the influence of different visual conditions. The hypothesis of our study was that the impact of AMD will be different between unilateral and bilateral AMD subjects compared to age-matched healthy elderly. Methods: Postural stability was measured with a platform (TechnoConcept®) in 10 elderly unilateral AMD subjects (mean age: 71.1 ± 4.6 years), 10 elderly bilateral AMD subjects (mean age: 70.8 ± 6.1 years), and 10 healthy age-matched control subjects (mean age: 69.8 ± 6.3 years). Four visual conditions were tested: both eyes viewing condition (BEV), dominant eye viewing (DEV), non-dominant eye viewing (NDEV), and eyes closed (EC). We analyzed the surface area, the length, the mean speed, the anteroposterior (AP), and mediolateral (ML) displacement of the center of pressure (CoP). Results: Bilateral AMD subjects had a surface area (p < 0.05) and AP displacement of the CoP (p < 0.01) higher than healthy elderly. Unilateral AMD subjects had more AP displacement of the CoP (p < 0.05) than healthy elderly. Conclusions: We suggest that ADM subjects could have poor postural adaptive mechanisms leading to increase their postural instability. Further studies will aim to improve knowledge on such issue and to develop reeducation techniques in these patients.
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Affiliation(s)
- Hortense Chatard
- UMR 1141, Institut National de la Santé et de la Recherche Médicale-Université Paris 7, Robert Debré University HospitalParis, France.,Vestibular and Oculomotor Evaluation Unit, ENT Department, Robert Debré University HospitalParis, France.,Centre Ophtalmologique du Val-d'Oise (OPH95)Osny, France
| | - Laure Tepenier
- Groupe Hospitalier Cochin-Hôtel-Dieu, Department of Ophthalmology, Assistance Publique-Hôpitaux de Paris, Paris Descartes UniversityParis, France
| | | | | | - Alain Allieta
- Centre Ophtalmologique du Val-d'Oise (OPH95)Osny, France
| | - Talal Beydoun
- Groupe Hospitalier Cochin-Hôtel-Dieu, Department of Ophthalmology, Assistance Publique-Hôpitaux de Paris, Paris Descartes UniversityParis, France
| | - Sawsen Salah
- Groupe Hospitalier Cochin-Hôtel-Dieu, Department of Ophthalmology, Assistance Publique-Hôpitaux de Paris, Paris Descartes UniversityParis, France
| | - Maria P Bucci
- UMR 1141, Institut National de la Santé et de la Recherche Médicale-Université Paris 7, Robert Debré University HospitalParis, France.,Vestibular and Oculomotor Evaluation Unit, ENT Department, Robert Debré University HospitalParis, France
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28
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Marakis TP, Koutsandrea C, Chatzistefanou KI, Tountas Y. Treatment satisfaction of patients with neovascular age-related macular degeneration treated with anti-vascular endothelial growth factor agents. Int Ophthalmol 2017; 38:565-576. [PMID: 28285389 DOI: 10.1007/s10792-017-0492-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 03/06/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess the psychometric properties of the Greek Macular Disease Treatment Satisfaction Questionnaire (MacTSQ) and evaluate the factors that influence treatment satisfaction of patients with neovascular age-related macular degeneration (nAMD). METHODS The MacTSQ was translated into Greek and administered to 176 patients. All patients completed the SF-12 Health Survey and the Macular disease Dependent Quality of Life Questionnaire (MacDQoL) and underwent vision measurements. For test-retest reliability, a subset of 19 participants completed the MacTSQ twice, two weeks apart. Stepwise multiple linear regression analyses were performed to identify predictors of treatment satisfaction. Change in MacTSQ scores over time was assessed on 83 patients who completed the MacTSQ at a follow-up visit, one year later. RESULTS The intraclass correlation coefficients between the first and second test-retest administration ranged from 0.88 to 0.98 for the items and total score. Internal reliability of the total score was adequate (Cronbach's a = 0.837). Principal component analysis revealed three subscales (effectiveness, information provision and convenience, impact). The MacTSQ score showed significant correlations with SF-12 summary scales and MacDQoL scores (ρ = 0.16-0.27). The most important factor that determined the satisfaction was mental health. Distance visual acuity (VA) in better eye was the best predictor of the effectiveness subscale, and the total number of injections was a negative predictor for the convenience subscale. Treatment satisfaction increased at one-year follow-up, despite the deterioration in distance VA. CONCLUSIONS The Greek MacTSQ is a reliable and valid instrument for assessing nAMD patients' perceptions of treatment satisfaction, especially using its three new subscales. Treatment satisfaction is multifactorial and was primarily determined by patients' mental health status.
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Affiliation(s)
- Theodoros P Marakis
- First Department of Ophthalmology, University of Athens Medical School, Athens General Hospital "G. Gennimatas", Athens, Greece.
| | - Chrysanthi Koutsandrea
- First Department of Ophthalmology, University of Athens Medical School, Athens General Hospital "G. Gennimatas", Athens, Greece
| | - Klio I Chatzistefanou
- First Department of Ophthalmology, University of Athens Medical School, Athens General Hospital "G. Gennimatas", Athens, Greece
| | - Yannis Tountas
- Department of Hygiene and Epidemiology, Center for Health Services Research, University of Athens Medical School, Athens, Greece
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