title: Vision-related quality of life: 12-month aflibercept treatment in patients with treatment-resistant neovascular age-related macular degeneration.
abstract: OBJECTIVE
  To assess changes in vision-related quality of life (VR-QoL) among patients with treatment-resistant neovascular age-related macular degeneration (nAMD) following intravitreal aflibercept treatment over 48 weeks.
  
  
  METHODS
  We conducted a prospective study in which 49 patients with nAMD resistant to anti-vascular endothelial growth factor therapy were switched to intravitreal aflibercept. Patients were treated with three loading doses every 4 weeks followed by injections every 8 weeks, for a total of 48 weeks. Ophthalmic examinations performed at each visit included best-corrected visual acuity (BCVA) and central macular thickness (CMT) measurement. The National Eye Institute Visual Functioning Questionnaire 25 (NEI VFQ-25) was used to assess VR-QoL at baseline and weeks 24 and 48. Changes in NEI VFQ-25 composite and subscale scores were analyzed using paired t tests. The relationship between the change in VR-QoL and changes in BCVA and CMT, and the impact of the better-seeing eye (BSE, defined as the eye reading the greater number of letters at baseline) vs. the worse-seeing eye (WSE, the fellow eye to the BSE) were assessed.
  
  
  RESULTS
  Mean NEI VFQ-25 composite scores improved significantly at weeks 24 and 48 compared to baseline (4.5 ± 9.2 and 4.4 ± 11.8, respectively, all p < 0.01). Among subscales, general vision and near and distance activities showed significant improvements at weeks 24 and 48 (all p < 0.05). Improvement in the NEI VFQ-25 composite score was significantly associated with increased BCVA at week 48 (β coefficient = 0.43, p = 0.029), but not with change in CMT (β coefficient = -0.007, p = 0.631). There was no association between VR-QoL changes and BSE or WSE.
  
  
  CONCLUSIONS
  Despite previous anti-VEGF treatment in this cohort, overall VR-QoL improved following aflibercept therapy over 48 weeks. This improvement was related to improved vision in treatment eyes regardless of whether they were the BSE or WSE.
authors: Sydney Retina Clinic & Day Surgery, Level 13, Park House, 187 Macquarie Street, Sydney, NSW, 2000, Australia.|Sydney Institute of Vision Science, Sydney, Australia.|Save Sight Institute, The University of Sydney, Sydney, Australia.
authors: Meidong
authors: M
authors: Zhu
authors: Sydney Retina Clinic & Day Surgery, Level 13, Park House, 187 Macquarie Street, Sydney, NSW, 2000, Australia.|Sydney Institute of Vision Science, Sydney, Australia.|Save Sight Institute, The University of Sydney, Sydney, Australia.
authors: Wijeyanthy
authors: W
authors: Wijeyakumar
authors: Sydney Retina Clinic & Day Surgery, Level 13, Park House, 187 Macquarie Street, Sydney, NSW, 2000, Australia.|Sydney Institute of Vision Science, Sydney, Australia.|Save Sight Institute, The University of Sydney, Sydney, Australia.
authors: Adil R
authors: AR
authors: Syed
authors: Sydney Retina Clinic & Day Surgery, Level 13, Park House, 187 Macquarie Street, Sydney, NSW, 2000, Australia.|Sydney Institute of Vision Science, Sydney, Australia.
authors: Nichole
authors: N
authors: Joachim
authors: Sydney Retina Clinic & Day Surgery, Level 13, Park House, 187 Macquarie Street, Sydney, NSW, 2000, Australia.|Sydney Institute of Vision Science, Sydney, Australia.
authors: Thomas
authors: T
authors: Hong
authors: Sydney Retina Clinic & Day Surgery, Level 13, Park House, 187 Macquarie Street, Sydney, NSW, 2000, Australia.|Sydney Institute of Vision Science, Sydney, Australia.|Save Sight Institute, The University of Sydney, Sydney, Australia.
authors: Geoffrey K
authors: GK
authors: Broadhead
authors: Sydney Retina Clinic & Day Surgery, Level 13, Park House, 187 Macquarie Street, Sydney, NSW, 2000, Australia.|Sydney Institute of Vision Science, Sydney, Australia.
authors: Haitao
authors: H
authors: Li
authors: Department of Statistics, Faculty of Science and Engineering, Macquarie University, Sydney, Australia.
authors: Kehui
authors: K
authors: Luo
authors: Sydney Retina Clinic & Day Surgery, Level 13, Park House, 187 Macquarie Street, Sydney, NSW, 2000, Australia. achang@sydneyretina.com.au.|Sydney Institute of Vision Science, Sydney, Australia. achang@sydneyretina.com.au.|Save Sight Institute, The University of Sydney, Sydney, Australia. achang@sydneyretina.com.au.
authors: Andrew
authors: A
authors: Chang
mesh_terms: D000368:Aged; D004305:Dose-Response Relationship, Drug; D004351:Drug Resistance; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D005654:Fundus Oculi; D006801:Humans; D058449:Intravitreal Injections; D008266:Macula Lutea / Q000473:pathology*; D008297:Male; D011446:Prospective Studies; D011788:Quality of Life; D040262:Receptors, Vascular Endothelial Growth Factor / Q000008:administration & dosage*; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage*; D011795:Surveys and Questionnaires; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity; D057135:Wet Macular Degeneration / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology
chemical_list: D011993:Recombinant Fusion Proteins; D042461:Vascular Endothelial Growth Factor A; C533178:aflibercept; D040262:Receptors, Vascular Endothelial Growth Factor
keywords: Anti-vascular endothelial growth factor (anti-VEGF); Intravitreal aflibercept; Neovascular age-related macular degeneration (nAMD); Prospective clinical trial; Treatment resistant; Vision-related quality of life (VR-QoL)