Does Treating Macular Degeneration Lead to Improved Quality of Life? New Research Says Yes

A group of Australian researchers has demonstrated that treating wet age-related macular degeneration with Lucentis, Eylea, or Avastin injections not only increases patients’ visual acuity – it can also improve their vision-related quality of life.

Ophthalmology: the Journal

The research, entitled The Impact of Anti–Vascular Endothelial Growth [i.e., anti-VEGF, explained below] Factor Treatment on Quality of Life in Neovascular Age-Related Macular Degeneration, has been published in the June, 2014 edition of Ophthalmology, the official journal of the American Academy of Ophthalmology. Ophthalmology publishes original, peer-reviewed research in ophthalmology, including new diagnostic and surgical techniques, the latest drug findings, and results of clinical trials.

The authors are Robert P. Finger, PhD; Robyn H. Guymer, PhD; Mark C. Gillies, PhD; and Jill E. Keeffe, PhD, who represent the following Australian institutions: the Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne; and the Save Sight Institute, University of Sydney.

About Wet, or Neovascular, Age-Related Macular Degeneration (AMD)

In wet, or exudative, macular degeneration (AMD), the choroid (a part of the eye containing blood vessels that nourish the retina) begins to sprout abnormal new blood vessels that develop into a cluster under the macula. This process is called choroidal neovascularization or CNV (neo = new; vascular = blood vessels).

The macula is the part of the retina that provides the clearest central vision. Because these new blood vessels are abnormal, they tend to break, bleed, and leak fluid under the macula, causing it to lift up and pull away from its base. This damages the fragile photoreceptor cells, which sense and receive light, resulting in a rapid and severe loss of central vision.

Anti-Angiogenic Drugs and Anti-VEGF Treatments

Angiogenesis is a term used to describe the growth of new blood vessels and plays a crucial role in the normal development of body organs and tissue. Sometimes, however, excessive and abnormal blood vessel development can occur in diseases such as cancer (tumor growth) and AMD (retinal and macular bleeding).

Substances that stop the growth of these excessive blood vessels are called anti-angiogenic (anti=against; angio=vessel; genic=development), and anti-neovascular (anti=against; neo=new; vascular=blood vessels).

The focus of current anti-angiogenic drug treatments for wet AMD is to reduce the level of a particular protein (vascular endothelial growth factor, or VEGF) that stimulates abnormal blood vessel growth in the retina and macula; thus, these drugs are classified as anti-VEGF treatments and include Lucentis, Eylea, and Avastin. They are administered by injection directly into the eye after the surface has been numbed.

More about the Research

From Anti-VEGF Improves Quality of Life in Macular Degeneration, via Medscape (registration required):

[A Phase 3 clinical trial of Lucentis] had reported an increase in vision-related quality of life with treatment, but later studies found mixed results. Dr. Finger and colleagues suspected that a better questionnaire could assess quality of life more accurately, so instead of the 25-item National Eye Institute Visual Functioning Questionnaire, they used the Impact of Vision Impairment (IVI) [questionnaire].

[Editor’s notes: In Phase 3 of a clinical trial, the study drug or treatment is given to larger groups of people (1,000-3,000) to confirm its effectiveness, monitor side effects, compare it to commonly used treatments, and collect information that will allow the drug or treatment to be used safely.

The Impact of Vision Impairment (IVI) scale is a short questionnaire that was developed to measure the impact of vision impairment on participation in activities of daily living. Each questionnaire item is rated on a six-level scale from “no difficulty” to “can’t do because of vision.” The IVI questionnaire measures vision-related quality of life in three main areas: (a) reading and accessing information, (b) mobility and independence, and (c) emotional well-being.]

The researchers recruited participants from outpatient clinics at the Royal Victorian Eye and Ear Hospital in Melbourne, Australia. The participants all had newly diagnosed neovascular [i.e., wet] age-related macular degeneration and had not yet undergone treatment.

They received three monthly injections of 0.5 mg [Lucentis], followed by either continued monthly injections or a treat-and-extend protocol. Of the 169 participants, 56% were women; mean age was 79 years. At the 12-month mark, 120 patients were still enrolled.

More about the Study Results and Quality of Life

From the article abstract:

Purpose: To assess the impact of anti–vascular endothelial growth factor (VEGF) treatment in routine medical practice on vision-related quality of life in neovascular age-related macular degeneration.

Methods: The vision-related quality of life interviews administered at [the beginning, six months, and 12 months]; routine anti-VEGF treatment with up to monthly follow-ups; and re-treatment as indicated. The Impact of Vision Impairment (IVI) questionnaire was subjected to [rigorous] analysis to assess its measurement performance.

Findings: The mean age was 70 years; 56% were female. Visual acuity improved by a mean of eight letters [as measured on a LogMAR eye chart].

Those who lost more than two lines [on the eye chart] (13 persons, or 11%) reported worse vision-related quality of life in the Accessing Information and Mobility areas.

Those who gained more than two lines [on the eye chart] (29 persons, or 24%) reported better vision-related quality of life in the Accessing Information and Emotional Well-being areas.

Patients who did not experience a change in visual acuity reported no change in their vision-related quality of life.

Only a change in visual acuity, but not whether the better or worse eye was treated, predicted a change in vision-related quality of life in the Accessing Information and Emotional Well-being areas.

Conclusions: We confirmed that anti-VEGF treatment for neovascular macular degeneration improves patients’ vision-related quality of life in those who gain vision and maintains vision-related quality of life in those who maintain visual acuity in their treated eye, irrespective of whether the worse or better eye is treated. Against this background, the best possible outcomes should be aimed for, even if the worse eye is treated because a loss of visual acuity in the worse-seeing eye will adversely affect patients’ vision-related quality of life.

As summarized by Medscape, the results remained consistent, regardless of whether the better or worse eye was treated. The investigators wrote that “even worse eyes should receive treatment” and that any treatment should aim to improve, or at least maintain, visual acuity, since any loss of visual acuity seems to translate directly to a reduced quality of life.

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