title: Experience of Anti-VEGF Treatment and Clinical Levels of Depression and Anxiety in Patients With Wet Age-Related Macular Degeneration.
abstract: OBJECTIVE
  To investigate detailed patient experiences specific to receiving vascular endothelial growth factor inhibitors (anti-VEGF) for wet age-related macular degeneration (wAMD), and to acquire a snapshot of the frequency of clinically significant levels of depression, anxiety, and posttraumatic stress among patients and levels of burden in patients' carers.
  
  
  METHODS
  Observational cross-sectional mixed-methods study.
  
  
  METHODS
  Three hundred patients with wAMD receiving anti-VEGF treatment and 100 patient carers were recruited. Qualitative data on patients' experience of treatment were collected using a structured survey. Standardized validated questionnaires were used to quantify clinically significant levels of anxiety, depression, and posttraumatic stress, as well as cognitive function and carers' burden.
  
  
  RESULTS
  Qualitative data showed that 56% of patients (n = 132) reported anxiety related to anti-VEGF treatment. The main sources of anxiety were fear of going blind owing to intravitreal injections and concerns about treatment effectiveness, rather than around pain. From validated questionnaires, 17% of patients (n = 52) showed clinical levels of anxiety and 12% (n = 36) showed clinical levels of depression. Depression levels, but not anxiety, were significantly higher in patients who received up to 3 injections compared with patients who received from 4 to 12 injections (analysis of variance [ANOVA] P = .027) and compared with patients who received more than 12 injections (ANOVA P = .001).
  
  
  CONCLUSIONS
  Anti-VEGF treatment is often experienced with some anxiety related to treatment, regardless of the number of injections received. Clinical levels of depression seem to be more frequent in patients at early stages of anti-VEGF treatment. Strategies to improve patient experience of treatment and minimize morbidity are suggested.
authors.affiliation: Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom.
authors.forename: Hugo
authors.initials: H
authors.lastname: Senra
authors.affiliation: Manchester Royal Eye Hospital, Central Manchester Foundation Trust, Manchester, United Kingdom.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Balaskas
authors.affiliation: Faculty of Health and Social Sciences, School of Psychology, Leeds Beckett University, Leeds, United Kingdom.
authors.forename: Neda
authors.initials: N
authors.lastname: Mahmoodi
authors.affiliation: Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom; Manchester Royal Eye Hospital, Central Manchester Foundation Trust, Manchester, United Kingdom. Electronic address: Tariq.Aslam@cmft.nhs.uk.
authors.forename: Tariq
authors.initials: T
authors.lastname: Aslam
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D058449:Intravitreal Injections / Q000523:psychology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*; D057135:Wet Macular Degeneration / Q000150:complications / Q000188:drug therapy*
chemical_list: D042461:Vascular Endothelial Growth Factor A