Quality of life and relative importance: a comparison of time trade-off and conjoint analysis methods in patients with age-related macular degeneration

AIM

To investigate the relative priorities in quality of life (QoL) in patients with age-related macular degeneration (AMD).

METHODS

Measures of visual function, QoL and utility associated with visual loss were obtained from 122 patients with AMD classified according to macular morphology. The two methods of utility assessment were time trade-off (TTO) and conjoint analysis (CA), which have been recommended by the UK's National Institute of Clinical Excellence as techniques for the assessment of healthcare priorities.

RESULTS

Results show that the two methods for assessing utility are poorly related: TTO relates moderately to visual function and disease severity but CA does not. CA identified two different subgroups of patients: one with outdoor mobility and the other with reading as their main priority.

CONCLUSION

Further work is needed and caution required in interpreting data obtained using these methodologies for determining their relative importance in vision-related QoL studies.

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

AIMS

(1) A prospective study to assess visual function measures and quality of life (QoL) in patients with wet age related macular degeneration (AMD) treated with photodynamic therapy (PDT). (2) To assess if PDT prevents severe visual loss (loss of six or more lines of distance visual acuity) in the treated eye.

METHODS

48 of 51 recruited patients with predominantly classic subfoveal choroidal neovascularisation (CNV) secondary AMD who were treated with PDT were followed up for 1 year. Assessment included distance and near visual acuity, contrast sensitivity, vision related quality of life and fluorescein angiography. Photodynamic therapy using Visudyne was carried out according to standard protocol. Patients were followed up every 3 months and treatment repeated if there was significant leakage from CNV.

RESULTS

At the 12 month follow up, 71% (n = 34) of the patients lost less than three lines of best corrected distance visual acuity. Although there were significant decreases in some of the QoL items tested, patients were significantly less anxious and more independent outdoors at the 12 month follow up.

CONCLUSION

This study is in keeping with published literature with PDT preventing severe visual loss in two thirds of treated patients with predominantly classic CNV.

Is cataract surgery justified in patients with age related macular degeneration? A visual function and quality of life assessment

AIMS

To determine whether patients with age related macular degeneration (ARMD) benefit from cataract surgery in terms of visual function and quality of life measures, and to assess the impact of surgery on the progression of ARMD.

METHODS

A prospective study was carried out of patients with and without ARMD undergoing cataract surgery. Data were collected from 187 patients at the Princess Alexandra Eye Pavilion, Edinburgh and the Oxford Eye Hospital, Oxford. The patients were divided into three groups: (1) a control group with ARMD and no surgery (n=41), (2) a study group of patients with ARMD who underwent cataract surgery (n=90), and (3) a second control group of patients without ocular comorbidities who underwent cataract surgery (n=56). Visual function and quality of life assessments were carried out at baseline and 3-5 months after baseline or surgery.

RESULTS

There were significant improvements both in terms of quality of life and visual function measures in the study group. Benefits were greater in patients with moderate cataract irrespective of the degree of ARMD. No increased incidence in progression to the "wet" form of ARMD was found. Improvements in quality of life measures and visual function were more pronounced in patients with no ocular comorbidities.

CONCLUSIONS

Patients with mild and moderate degrees of ARMD do benefit from cataract surgery and the benefits are greater in patients with moderate degrees of lens opacity. Longer follow up is required to assess the risk of increased ARMD progression.