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Availability: out of stock. Includes If this item is currently unavailable, enter your e-mail address below to receive an automatic notification when it is back in stock! Overall, however, no major differences between the indications can be observed. The differences in baseline VFQ scores by age are displayed in Fig. A total of There is a tendency towards a decrease in visual function with increasing age. The baseline VFQ scores by gender are shown in Fig.
No major differences between genders are detected. A total of participants A total of patients 9. Overall, no major differences are visible between the health insurance types. The above comparisons of baseline VFQ scores are based on the single parameters indication, age, gender, baseline BCVA and health insurance type. An additional ANOVA including all these parameters except health insurance type , as well as their pairwise interactions was performed for the composite score and for the subscale scores general vision and distance vision.
Results are comparable for the three analysed VFQ scores. The leading cause for giving up driving is mainly eyesight. Age distribution of OCEAN participants who gave up driving generally or mainly due to eyesight issues, by indication. The BCVA is lower in patients who gave up driving mainly due to eyesight issues Furthermore, knowing the impact of different contributing factors to QoL scores allows the medical staff to estimate whether QoL can be influenced by the medical therapy itself or by supporting emotional attention [ 3 ].
For example, if age or gender had a major impact on QoL, these factors would be non-modifiable. On the other hand, if VA was found to be a key factor for QoL scores, there would be a good chance to improve these scores by adequate medical treatment and emotional attention.
The NEI-VFQ measures the influence of visual disability on general health domains such as emotional well-being, social functioning and daily visual function. It allows judgement of the extent to which eye diseases impact anxiety, routine activities and the interaction with family and friends [ 20 ]. Previous research demonstrated a correlation between decreased visual function and depression development, which in turn hampers daily activity [ 23 ].
This was identified as one main reason for the high incidence of depressive disorders in patients with advanced AMD, comparable to patients with life-threatening diseases such as cancer or cerebrovascular diseases [ 24 , 25 ]. In the light of these correlations, baseline VFQ scores can help medical staff to provide patients with optimized medical treatment and emotional attention. In general, patients might be afraid of reporting their significantly reduced QoL and major disease burden to the examining and treating medical staff, especially at a higher age [ 26 ].
It was shown that an impaired QoL is even evident if only one eye is affected by the underlying disease, with unimpaired vision of the BSE [ 27 ]. The same interrelation can be obtained for almost all subscale scores [ 15 ]. The corresponding baseline score of This correlation is seen for almost all subscale scores, especially for social function, mental health and dependency [ 16 ].
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Comparable results are seen for most subscale scores, while dependency, mental health and role limitations have notably higher scores in OCEAN. In summary, these data show that VFQ composite scores and especially emotional well-being as well as social functioning subscale scores e. This could on the one hand reflect the awareness and the increased expectations of patients suffering from neovascular eye disorders with respect to this innovative treatment option.
For instance, VFQ scores were tremendously lower in patients with nAMD when only PDT or macular surgery were available [ 23 ], in patients with diabetes when focal or grid laser treatment were the only options to treat DME [ 31 ], as well as in RVO-affected eyes [ 32 ] when merely laser treatment and surgery for severe cases e.
Thus, intravitreally injected anti-VEGF substances have, besides anatomic and functional considerations, a major impact on social and mental aspect and can distinctly increase patient QoL. All clinical trials mentioned above demonstrated not only medical improvements e. As the indication per se cannot be modified, there is almost no scope for QoL improvement in this respect.
Especially nAMD patients with severe bilateral affection have serious difficulties in performing most vision-dependent daily activities e. This causes distinctly low subscale scores for dependency, role limitations, mental health and social function, all of which demonstrate the potential isolating effect of bilateral severe AMD [ 5 ]. Considering this, medical staff should encourage patients to demand psychological support, if needed, or to attend meetings of specialized support groups, for instance. Patients suffering from DME showed comparable scores to nAMD patients, but a significantly worse VFQ composite score in comparison to glaucoma or cataract patients and in comparison to a healthy reference group [ 20 ].
The severity of peripheral retinal alterations diabetic retinopathy, DR showed an immediate impact on QoL scores. Especially the progression from unilateral to bilateral non-proliferative diabetic retinopathy NPDR caused most substantial decreases [ 34 ]. Finally, lower VFQ scores were independently associated with poorer VA, older age and a history of loss of tactile sensation as a marker of advanced systemic diabetic alterations [ 35 ].
This difference was attributed to the one-sided event in RVO; whereas diabetic changes and nAMD most frequently occur on both sides during the course of disease [ 36 ].
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This observation is supported by previous investigations [ 1 , 5 ], demonstrating a significant age-dependency of VFQ scores by approximately 1. In patients suffering from severe bilateral AMD, QoL tended to correlate negatively with increasing patient age and duration of vision loss, especially for quality of vision and vision-related QoL subscales [ 5 ]. Depression might occur more frequently in older patients and it was formerly demonstrated that depression interferes with VFQ scores, irrespective of VA impairment [ 37 ].
This is of importance because the proportion of older patients will increase in the future [ 38 ]. A tendency towards a more decreased visual function for females is observed. Other investigations reported better VFQ scores in females than in males [ 39 ]. There is a tendency towards a more decreased visual function for patients with a lower baseline VA.
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This observation is in accordance with former findings describing a major impact of BCVA on QoL [ 19 , 30 , 35 , 40 , 41 ]. As BCVA at the beginning of any therapy might only be influenced marginally by the medical staff involved, attention should be shifted towards the following intervention period.
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Former investigations demonstrated that in all neovascular diseases discussed herein, BCVA increased significantly during anti-VEGF treatment [ 42 — 46 ], along with significant improvements in VFQ scores [ 15 — 17 , 19 , 40 , 47 , 48 ]. Treatment outcomes are often less good in routine clinical care than in phase III clinical trials because the treatment population is more diverse and treatment tends to be less intense [ 19 , 30 , 40 , 49 ]. Nevertheless, a strict anti-VEGF treatment, possibly including a treat-and-extend strategy [ 41 , 50 ], has the potential to significantly increase the medical and mental condition of patients, to reduce anxiety, prevent depression development and to support therapeutic compliance.
An analysis of the VFQ changes in OCEAN during and after the treatment period, in relation to therapeutic success, will be reported separately after completion of the ongoing study. Overall, no major differences of VFQ scores are detected in OCEAN with respect to the type of health insurance private versus statutory health insurance.
However, there is a tendency towards a more decreased visual function for statutorily insured patients. However, this could not be demonstrated herein and is only addressable to some extent. The ANOVA analysis shows that, besides age and gender, the eye-specific contributing factors indication, baseline VA, interactions of age and indication as well as baseline VA and indication have a significant impact on the composite as well as on general and distance vision subscale scores.
Remarkably, the percentage of patients who attributed their giving up driving mainly to eyesight issues does not increase as much with age. Here, the question arises which other reasons beside eyesight are responsible for giving up driving.
www.cantinesanpancrazio.it/components/pyfuwyn/291-come-vedere.php Unfortunately, the VFQ questionnaire does not address this issue. Therefore, it seems to be essential that future studies evaluating QoL should focus on this unanswered question. The discrepancy between the overall increasing percentage of subjects who gave up driving and the less increasing percentage of patients relating this mainly to eyesight issues remains unexplained. Picture Information. Mouse over to Zoom - Click to enlarge.
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