title: Improving function in age-related macular degeneration: a randomized clinical trial.
abstract: OBJECTIVE
  To compare the efficacy of problem-solving therapy (PST) with supportive therapy (ST) to improve targeted vision function (TVF) in age-related macular degeneration (AMD).
  
  
  METHODS
  Single-masked, attention-controlled, randomized clinical trial with outcome assessments at 3 months (main trial endpoint) and 6 months (maintenance effects).
  
  
  METHODS
  Patients with AMD (n = 241) attending retina practices.
  
  
  METHODS
  Whereas PST uses a structured problem-solving approach to reduce vision-related task difficulty, ST is a standardized attention-control treatment.
  
  
  METHODS
  We assessed TVF, the 25-item National Eye Institute Vision Function Questionnaire plus Supplement (NEI VFQ), the Activities Inventory (AI), and vision-related quality of life (QoL).
  
  
  RESULTS
  There were no between-group differences in TVF scores at 3 (P = 0.47) or 6 (P = 0.62) months. For PST subjects, mean ± standard deviation TVF scores improved from 2.71±0.52 at baseline to 2.18±0.88 at 3 months (P = 0.001) and were 2.18±0.95 at 6 months (change from 3 to 6 months, P = 0.74). For ST subjects, TVF scores improved from 2.73±0.52 at baseline to 2.14±0.96 at 3 months (P = 0.001) and were 2.15±0.96 at 6 months (change from 3 to 6 months, P = 0.85). Similar proportions of PST and ST subjects had less difficulty performing a TVF goal at 3 months (77.4% vs 78.6%, respectively; P = 0.83) and 6 months (76.2% vs 79.1%, respectively; P = 0.61). There were no changes in the NEI VFQ or AI. Vision-related QoL improved for PST relative to ST subjects at 3 months (F(4, 192) = 2.46; P = 0.05) and at 6 months (F(4, 178) = 2.55; P = 0.05). The PST subjects also developed more adaptive coping strategies than ST subjects.
  
  
  CONCLUSIONS
  We found that PST was not superior to ST at improving vision function in patients with AMD, but that PST improved their vision-related QoL. Despite the benefits of anti-vascular endothelial growth factor treatments, AMD remains associated with disability, depression, and diminished QoL. This clinical reality necessitates new rehabilitative interventions to improve the vision function and QoL of older persons with AMD.
  
  
  BACKGROUND
  The authors have no proprietary or commercial interest in any of the materials discussed in this article.
authors: Departments of Psychiatry and Neurology, Jefferson Medical College, Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania 19107, USA. barry.rovner@jefferson.edu
authors: Barry W
authors: BW
authors: Rovner
authors: Robin J
authors: RJ
authors: Casten
authors: Mark T
authors: MT
authors: Hegel
authors: Robert W
authors: RW
authors: Massof
authors: Benjamin E
authors: BE
authors: Leiby
authors: Allen C
authors: AC
authors: Ho
authors: William S
authors: WS
authors: Tasman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015928:Cognitive Behavioral Therapy; D005260:Female; D006304:Health Status; D006801:Humans; D008268:Macular Degeneration / Q000503:physiopathology* / Q000628:therapy; D008297:Male; D011340:Problem Solving; D011788:Quality of Life; D018434:Sickness Impact Profile; D016037:Single-Blind Method; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014786:Vision Disorders / Q000503:physiopathology* / Q000628:therapy; D014792:Visual Acuity / Q000502:physiology*
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