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Patients' preferences in treatment for neovascular age-related macular degeneration in clinical routine
  1. Robert Finger1,2,
  2. Andrea E Hoffmann3,
  3. Eva K Fenwick1,
  4. Armin Wolf3,
  5. Anselm Kampik3,
  6. Marcus Kernt3,
  7. Aljoscha S Neubauer3,
  8. Christoph Hirneiss3
  1. 1Center for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia
  2. 2Department of Ophthalmology, University of Bonn, Bonn, Germany
  3. 3Department of Ophthalmology, Ludwig-Maximilians University, Munich, Germany
  1. Correspondence to Dr Christoph Hirneiss, Augenklinik der Ludwig-Maximilians-Universität, Mathildenstr. 8, D-80336 München, Germany; christoph.hirneiss{at}


Purpose 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.

  • Age related macular degeneration
  • ranibizumab
  • utility
  • quality of life
  • NEI-VFQ-25
  • time trade off
  • angiogenesis
  • rehabilitation
  • epidemiology
  • public health
  • neovascularisation
  • clinical trial
  • low vision aid
  • experimental laboratory
  • retina
  • treatment lasers
  • choroid
  • eye (tissue) banking
  • telemedicine
  • glaucoma
  • imaging

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  • Parts of this study were presented at the annual meeting of the Association for Research in Vision and Ophthalmology, May 2010 in Fort Lauderdale, Florida, USA.

  • Funding This work was supported by Novartis Pharma Germany (grant to CH) and the German Research Council (DFG FI 1540/5-1, grant to RF). CERA receives Operational Infrastructure Support from the Victorian government.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by the Ethics Committee, University of Munich.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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