Decision-making in the treatment of subfoveal neovascularization in age-related macular degeneration. An analysis from the patient's perspective.
BACKGROUND
The clinical management of subfoveal neovascularization in age-related macular degeneration remains controversial. Large multicenter clinical trials recommend laser photocoagulation for certain subfoveal membranes, but many ophthalmologists are reluctant to treat patients with such lesions because a substantial initial visual loss may be induced by the treatment itself. Despite these controversies in management, the attitude of patients toward treatment of these lesions has not been assessed systematically.


METHODS
In this article, a newly designed survey containing five hypothetical clinical scenarios was given to 68 patients with age-related macular degeneration to measure their relative preferences for the potential long-term benefits of laser photocoagulation compared with the immediate visual loss induced by laser therapy.


RESULTS
This pilot study reveals a strong preference by these patients for laser intervention, despite the risk of immediate visual loss. On all five questions, the laser treatment outcome was preferred over the natural course of the disease.


CONCLUSIONS
Ophthalmologists, when making clinical recommendations to patients with subfoveal exudative macular degeneration, may wish to consider the results of this survey, which suggest a substantial patient preference for laser treatment versus no intervention.
Bernstein
P S
PS
Retina Service, Massachusetts Eye & Ear Infirmary, Boston 02114, USA.
Seddon
J M
JM
D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D005260:Female; D005584:Fovea Centralis / Q000098:blood supply*; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects; D008028:Light Coagulation / Q000009:adverse effects; D008268:Macular Degeneration / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000209:etiology / Q000601:surgery*; D011795:Surveys and Questionnaires; D014786:Vision Disorders / Q000209:etiology