Quality of Life and Anxiety in Age Macular Degeneration Patients: A Cross-Sectional Study

Relationships between Patient-Reported Outcome Measures and Clinical Measures in Naïve Neovascular Age-Related Macular Degeneration Patients Treated with Intravitreal Ranibizumab

Our objective was to evaluate changes in patient-reported outcome measures using the NEI-VFQ 25 questionnaire during a treat and extend regimen in naive neovascular Age-Related Macular Degeneration patients, and its correlation with anatomical and functional data. We conducted a prospective observational study. Patients underwent a treat and extend regimen with intravitreal ranibizumab for neovascular Age-Related Macular Degeneration. Initial response was evaluated at 4th month, and subsequently in every follow-up visit. If a clinical response was achieved, the injection interval was extended in two-week increments, up to a maximum of 12 weeks. Quality of life was assessed using the NEI-VFQ 25 questionnaire at baseline, 4th months, and 12th months. Patients were categorized as good or poor responders based on Best corrected visual acuity, central foveal thickness, intraretinal fluid, or subretinal fluid. Treatment with ranibizumab led to a significant improvement in quality of life, with a mean increase in NEI-VFQ 25 score of 4.27 points in the 12th month. No significant differences in improvement were observed between good and poor responders. Quality of life scores in neovascular Age-Related Macular Degeneration patients improved with intravitreal treatment regardless of the clinical response. The early response following the loading phase could indicate better quality of life after one year of treatment, with Best corrected visual acuity being the clinical parameter with the greatest influence on quality of life.

10q26 - The enigma in age-related macular degeneration

Despite comprehensive research efforts over the last decades, the pathomechanisms of age-related macular degeneration (AMD) remain far from being understood. Large-scale genome wide association studies (GWAS) were able to provide a defined set of genetic aberrations which contribute to disease risk, with the strongest contributors mapping to distinct regions on chromosome 1 and 10. While the chromosome 1 locus comprises factors of the complement system with well-known functions, the role of the 10q26-locus in AMD-pathophysiology remains enigmatic. 10q26 harbors a cluster of three functional genes, namely PLEKHA1, ARMS2 and HTRA1, with most of the AMD-associated genetic variants mapping to the latter two genes. High linkage disequilibrium between ARMS2 and HTRA1 has kept association studies from reliably defining the risk-causing gene for long and only very recently the genetic risk region has been narrowed to ARMS2, suggesting that this is the true AMD gene at this locus. However, genetic associations alone do not suffice to prove causality and one or more of the 14 SNPs on this haplotype may be involved in long-range control of gene expression, leaving HTRA1 and PLEKHA1 still suspects in the pathogenic pathway. Both, ARMS2 and HTRA1 have been linked to extracellular matrix homeostasis, yet their exact molecular function as well as their role in AMD pathogenesis remains to be uncovered. The transcriptional regulation of the 10q26 locus adds an additional level of complexity, given, that gene-regulatory as well as epigenetic alterations may influence expression levels from 10q26 in diseased individuals. Here, we provide a comprehensive overview on the 10q26 locus and its three gene products on various levels of biological complexity and discuss current and future research strategies to shed light on one of the remaining enigmatic spots in the AMD landscape.

Positive feedback loop between vision-related anxiety and self-reported visual difficulty

BACKGROUND

Patients with Inherited Retinal Diseases typically experience progressive, irreversible vision loss resulting in low vision and blindness. As a result, these patients are at high risk for vision-related disability and psychological distress, including depression and anxiety. Historically, the relationship between self-reported visual difficulty (encompassing metrics of vision-related disability and quality of life, among others) and vision-related anxiety has been regarded as an association and not a causal relationship. As a result, there are limited interventions available that address vision-related anxiety and the psychological and behavioral components of self-reported visual difficulty.

MATERIALS AND METHODS

We applied the Bradford Hill criteria to evaluate the case for a bidirectional causal relationship between vision-related anxiety and self-reported visual difficulty.

RESULTS

There is sufficient evidence to satisfy all nine of the Bradford Hill criteria of causality (strength of association, consistency, biological gradient, temporality, experimental evidence, analogy, specificity, plausibility, and coherence) for the relationship between vision-related anxiety and self-reported visual difficulty.

CONCLUSIONS

The evidence suggests that there is a direct positive feedback loop-a bidirectional causal relationship-between vision-related anxiety and self-reported visual difficulty. More longitudinal research on the relationship between objectively-measured vision impairment, self-reported visual difficulty, and vision-related psychological distress is needed. Additionally, more investigation of potential interventions for vision-related anxiety and visual difficulty is needed.

Vision-Related Quality of Life in Patients With Keratoconus: A Nationwide Study in Saudi Arabia

PURPOSE

To evaluate the impact of keratoconus (KC) on quality of life and assess visual performance via the National Eye Institute Visual Functioning Questionnaire-25 (NEI-VFQ-25) in the Saudi population.

PATIENTS AND METHODS

A descriptive cross-sectional study was conducted using the NEI-VFQ-25 to evaluate the vision-related quality of life among previously diagnosed KC patients. An online questionnaire was used to distribute the validated survey through various social media networks. The data were extracted, reviewed, coded, and then analyzed using the Statistical Package for Social Sciences (SPSS) version 26 (IBM Corp., Armonk, NY).

RESULTS

A total of 429 patients completed the questionnaire. The overall score of NEI-VFQ-25 was 58.6 (SD: 18.0). The visual performance was worse in females than males (with a score of 55.1), especially in patients aged less than 30 years. Visual function improved with the use of low-vision aids (spectacles and contact lenses) compared with those who did not use them.

CONCLUSION

Our study confirms the functional impairment in patients with KC, especially in females, patients aged less than 30 years, and those with no low-vision aids. Moreover, it suggests a significant role of these vision aids (spectacles and contact lenses) in improving the quality of life in patients with KC.

Microbiota mitochondria disorders as hubs for early age-related macular degeneration

Age-related macular degeneration (AMD) is a progressive neurodegenerative disease affecting the central area (macula lutea) of the retina. Research on the pathogenic mechanism of AMD showed complex cellular contribution governed by such risk factors as aging, genetic predisposition, diet, and lifestyle. Recent studies suggested that microbiota is a transducer and a modifier of risk factors for neurodegenerative diseases, and mitochondria may be one of the intracellular targets of microbial signaling molecules. This review explores studies supporting a new concept on the contribution of microbiota-mitochondria disorders to AMD. We discuss metabolic, vascular, immune, and neuronal mechanism in AMD as well as key alterations of photoreceptor cells, retinal pigment epithelium (RPE), Bruch's membrane, choriocapillaris endothelial, immune, and neuronal cells. Special attention was paid to alterations of mitochondria contact sites (MCSs), an organelle network of mitochondria, endoplasmic reticulum, lipid droplets (LDs), and peroxisomes being documented based on our own electron microscopic findings from surgically removed human eyes. Morphometry of Bruch's membrane lipids and proteoglycans has also been performed in early AMD and aged controls. Microbial metabolites (short-chain fatty acids, polyphenols, and secondary bile acids) and microbial compounds (lipopolysaccharide, peptidoglycan, and bacterial DNA)-now called postbiotics-in addition to local effects on resident microbiota and mucous membrane, regulate systemic metabolic, vascular, immune, and neuronal mechanisms in normal conditions and in various common diseases. We also discuss their antioxidant, anti-inflammatory, and metabolic effects as well as experimental and clinical observations on regulating the main processes of photoreceptor renewal, mitophagy, and autophagy in early AMD. These findings support an emerging concept that microbiota-mitochondria disorders may be a crucial pathogenic mechanism of early AMD; and similarly, to other age-related neurodegenerative diseases, new treatment approaches should be targeted at these disorders.

Assessing the quality of life in age-related macular degeneration patients: a cross-sectional study in Kazakhstan

AIM

The goal of this study was to assess Vision-Related Quality of Life (VRQoL) in patients with Age-Related Macular Degeneration (AMD) and identify its significant predictors.

METHODS

458 AMD patients from four eye clinics in three major cities of Kazakhstan were recruited for this study. Data were collected using a structured questionnaire on sociodemographic and visual information and the National Eye Institute-Visual Function Questionnaire-39 (NEI-VFQ-39).

RESULTS

The study sample included 181 male patients who were 64.9 years on average (SD±8.4), and 277 female patients who were 68.7 years on average (SD±10.7). The majority of patients had stage 2 (43.7%) or stage 3 (40.2%) AMD according to the Age-Related Eye Disease Study (AREDS) classification. The mean (SD) NEI-VFQ-39 total score was 58.0 (23.8), range (9.8 - 100). The multiple linear regression model showed that the VRQoL of AMD patients correlated with the AMD stage according to the AREDS classification, age of the patients, visual acuity, number of years since the AMD diagnosis, and the city of residence.

CONCLUSIONS

AMD causes severe vision impairment and daily functioning problems, reducing the quality of life of patients. To diagnose and treat degenerative eye disorders at an early stage, it is essential to inform patients about regular ophthalmological checkups to diagnose and treat degenerative eye disorders at an early stage.