Effects of anti-VEGF drug therapy on vision-related quality of life in patients with wet age-related macular degeneration: An observational Longitudinal Study
Authors: Luo Mi , Zeng Jihong , Zhang Qi , Mao Junhong , GeRong Xiamu , Han Yanting , Li Ka 
Published: August 2023

Abstract
The objective of this study is to assess the effects of anti-vascular endothelial growth factor (anti-VEGF) drug therapy on the quality of life (QoL) related to vision in patients with wet age-related macular degeneration (AMD), a common eye disease that often leads to central blindness. Anti-VEGF therapy is considered the most promising treatment for wet AMD. Furthermore, this study aims to investigate the factors that influence QoL at different stages of treatment. Methods: This prospective cohort study included patients with wet age-related macular degeneration (AMD) who were recruited from the Department of Ophthalmology at West China Hospital of Sichuan University. The eligible participants were those receiving anti-vascular endothelial growth factor (anti-VEGF) therapy for the first time. Prior to treatment initiation, the researchers collected general information questionnaires, simple disease perception questionnaires, and social support scales from the enrolled patients. The National Eye Institute Visual Function Questionnaire was administered to the participants at baseline (time of recruitment), before treatment, and at 1 month, 3 months, and 9 months post-treatment. Data analysis was conducted using repeated measures analyses and multiple linear models. Results: A total of 115 patients diagnosed with wet age-related macular degeneration (AMD) and undergoing anti-vascular endothelial growth factor (anti-VEGF) therapy were included in this study. Statistically significant findings (P < 0.01) were observed for the vision-related quality of life (QoL) total score and scores for all dimensions, except driving, color vision, and peripheral vision, among patients receiving anti-VEGF treatment. These significant differences were observed before treatment and after 1, 3, and 9 months post-treatment. Notably, the total score of the QoL scale exhibited an increasing trend at 1 and 3 months after treatment, followed by a subsequent decrease at 9 months. Nevertheless, the score remained higher than the pre-treatment level. Multivariate analysis indicated a positive linear relationship (P < 0.01) between visual acuity and QoL scores in patients receiving anti-VEGF treatment for wet AMD. This relationship suggested that higher visual acuity correlated with higher QoL scores. Similarly, a positive linear relationship (P < 0.05) was found between disease perception (cognition) and QoL scores, indicating that higher levels of disease perception were associated with improved QoL. In contrast, subjective and objective support levels (social support) demonstrated a negative linear relationship (P < 0.05) with QoL scores, suggesting that higher levels of support were linked to lower QoL scores. Furthermore, patients with longer disease duration and higher education levels exhibited lower QoL scores compared to those with shorter disease duration and lower education levels, and these differences were statistically significant (P < 0.05). Conclusions: Patients with wet age-related macular degeneration (AMD) have unique healthcare needs at different stages of anti-vascular endothelial growth factor (anti-VEGF) therapy. It is crucial for healthcare professionals to provide customized and targeted treatment and nursing interventions based on these specific stages. Additionally, there is a need for further research to develop assessment tools that capture the quality of life (QoL) in AMD patients, with a particular emphasis on evaluating the changes in QoL among individuals undergoing long-term anti-VEGF injections. This research would contribute to the delivery of continuous and high-quality care for patients, while addressing the specific characteristics of the Chinese population.