Verteporfin photodynamic therapy cohort study: report 2: clinical measures of vision and health-related quality of life.
OBJECTIVE
To quantify decreases in health-related quality of life (HRQoL) for given deterioration in clinical measures of vision; to describe the shape of these relationships; and to test whether the gradients of these relationships change with duration of visual loss.


METHODS
A prospective, longitudinal study of patients treated with verteporfin photodynamic therapy in the United Kingdom National Health Service.


METHODS
Patients with neovascular age-related macular degeneration (AMD) treated in 18 ophthalmology departments in the United Kingdom with expertise in management of neovascular AMD.


METHODS
Responses to HRQoL questionnaires (Short Form 36 [SF-36] and National Eye Institute Visual Functioning Questionnaire [NEIVFQ]) and clinical measures of vision were recorded at baseline and at follow-up visits. Mixed regression models were used to characterize the relationships of interest.


METHODS
Measures of vision were best-corrected visual acuity (BCVA) and contrast sensitivity (CS). The SF-36 physical and mental component scores (PCS and MCS), SF-6D utility, and distance, near, and composite NEIVFQ scores were derived to characterize HRQoL.


RESULTS
The SF-6D, PCS, and MCS were linearly associated with BCVA; predicted decreases for a 5-letter drop in BCVA in the better-seeing eye were 0.0058, 0.245, and 0.546, respectively (all P<0.0001). Gradients were not influenced by duration of follow-up. Models predicting distance, near, and composite NEIVFQ scores from BCVA were quadratic; predicted decreases for a 5-letter drop in BCVA in the better-seeing eye were 5.08, 5.48, and 3.90, respectively (all P<0.0001). The BCVA predicted HRQoL scores more strongly than CS.


CONCLUSIONS
Clinically significant deterioration in clinical measures of vision is associated with small decreases in generic and vision-specific HRQoL. Our findings are important for further research modeling the cost effectiveness of current and future interventions for neovascular AMD.
Reeves
Barnaby C
BC
The London School of Hygiene and Tropical Medicine, London, England.
Langham
Julia
J
Walker
Jemma
J
Grieve
Richard
R
Chakravarthy
Usha
U
Tomlin
Keith
K
Carpenter
James
J
Guerriero
Carla
C
Harding
Simon P
SP
D000368:Aged; D015350:Contrast Sensitivity / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008268:Macular Degeneration / Q000188:drug therapy* / Q000503:physiopathology*; D008297:Male; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D011166:Porphyrins / Q000627:therapeutic use*; D011446:Prospective Studies; D011788:Quality of Life; D018434:Sickness Impact Profile; D013222:State Medicine; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D006113:United Kingdom; D000077362:Verteporfin; D014792:Visual Acuity / Q000502:physiology*
D017319:Photosensitizing Agents; D011166:Porphyrins; D000077362:Verteporfin