Sara Nayeem

Date of Award

11-15-2006

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Ron Adelman

Abstract

The purpose of this study was to examine quality of life (QOL) in age-related macular degeneration (AMD), particularly across photodynamic therapy (PDT) and pegaptanib sodium injection treatment groups. Patients with AMD were either mailed or were administered in person a modified version of the Visual Function Questionnaire (VFQ-25). Subgroup analysis of the VFQ-25 was performed per NEI prescribed algorithms and additional analyses regarding questions on treatment side effects were also performed. A two-tailed student t-test and mean were calculated for each treatment group and correlations between visual acuity and subgroup outcomes were calculated. Correlations between the subgroup and treatment-related subgroup outcomes were also calculated to determine which QOL deficits might occur together. Multiple linear regression models were used to estimate the association between the overall QOL score and scaled visual acuity, age, gender, and treatment history. 30 patients were interviewed in person and an additional 41 patients returned the questionnaire by mail. Of these, 37 had been treated with PDT (ten had also received intravitreal triamcinolone acetate (IVTA) injections); 16 had been treated with pegaptanib; seven had been treated with both pegaptanib and PDT (two had also received IVTA); and 25 had not been treated with any of these treatments. The mean age was 79 years. Patients lowest subgroup scores were in perception of general vision (43.2) and in driving (50.8). The ocular pain subgroup yielded a mean score of 82.9 for the PDT group and 87.5 for the pegaptanib group (p = 0.59). The average vision worsening score for the first two weeks following treatment was 87.5 for the PDT group and 77.8 for the pegaptanib group (p = 0.29). The average mental health score for concerns related to treatments was 78.2 for the PDT group and 73.6 for the pegaptanib group (p = 0.61), while the average independence score related to treatment appointments was 86.1 for the PDT group and 87.5 for the pegaptanib group (p = 0.92). Strong positive correlations (> 0.45) were seen between general health and ocular pain; between treatment-related mental health and both overall QOL score and treatment-related vision worsening; and between numerous measures of visual function. The best predictor of overall QOL score was the near activities score. Age was moderately or weakly negatively correlated with multiple measures. Stepwise multiple linear regression analysis demonstrated that the square of SVA provided the most explanatory power for the overall QOL score, implying a non-linear relationship between visual acuity and QOL. None of the treatment modalities added explanatory power to the model when added to the square of SVA. In conclusion, QOL, stress regarding treatment, and ocular pain did not differ between PDT and pegaptanib treatment groups. Decreasing visual acuity was associated most strongly with decreases in ability to perform near and distance activities, overall QOL, driving, and independence. Scales denoting worry and frustration about treatment did not demonstrate a strong relationship to visual function, implying patient concern about treatment across the visual acuity spectrum. A nonlinear relationship was seen between QOL and visual acuity.

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This is an Open Access Thesis.

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