title: Patients' preferences in treatment for neovascular age-related macular degeneration in clinical routine.
abstract: OBJECTIVE
  To assess the effect of ranibizumab treatment for neovascular age-related macular degeneration (nvAMD) on patients' preferences and vision-related quality of life (VRQoL) in a routine clinical setting.
  
  
  METHODS
  55 treatment naïve patients were examined before and after the initial upload of three monthly injections of 0.5 mg ranibizumab. VRQoL was assessed using a Rasch-adjusted NEI-VFQ-25. Time trade-off (TTO), standard gamble, a visual analogue scale and the European Quality of Life Questionnaire (EQ-5D) were used to calculate utilities, and multiple logistic regression models were conducted to determine independent factors associated with utilities.
  
  
  RESULTS
  Mean ± SD age was 75 ± 7 years, and 40 patients (73%) were female. Mean ± SD best-corrected visual acuity of the treated eye increased from 20/80 at baseline (logMAR 0.60 ± 0.35) to 20/63 (logMAR 0.52 ± 0.36; p=0.020) at follow-up after three injections. Utility score increases ranged from 2 utils (standard gamble anchored for death) up to 6.6 utils (EQ-5D German TTO, p=0.023) and visual functioning improved (Rasch adjusted composite NEI-VFQ score 50 ± 21 to 54 ± 21, p=0.042). Whether the worse or better eye was treated was not significantly associated with improvements in utility or VRQoL, whereas VA improvement in the treated eye was associated with an increase in utility (TTO, p=0.020).
  
  
  CONCLUSIONS
  TTO performed best in this sample of elderly nvAMD patients undergoing anti-VEGF therapy. Better or worse eye treatment was not associated with a change in reported utilities or visual functioning in patients with newly diagnosed nvAMD. Directly elicited, vision-specific utilities gained with TTO seem to be sensitive to a change in vision status.
authors.affiliation: Center for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Finger
authors.forename: Robert
authors.initials: R
authors.lastname: Finger
authors.forename: Andrea E
authors.initials: AE
authors.lastname: Hoffmann
authors.forename: Eva K
authors.initials: EK
authors.lastname: Fenwick
authors.forename: Armin
authors.initials: A
authors.lastname: Wolf
authors.forename: Anselm
authors.initials: A
authors.lastname: Kampik
authors.forename: Marcus
authors.initials: M
authors.lastname: Kernt
authors.forename: Aljoscha S
authors.initials: AS
authors.lastname: Neubauer
authors.forename: Christoph
authors.initials: C
authors.lastname: Hirneiss
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D058449:Intravitreal Injections; D007802:Language; D008297:Male; D057240:Patient Preference / Q000523:psychology*; D017060:Patient Satisfaction; D011594:Psychometrics; D011788:Quality of Life / Q000523:psychology*; D000069579:Ranibizumab; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology*; D057135:Wet Macular Degeneration / Q000188:drug therapy* / Q000523:psychology
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000069579:Ranibizumab