Highly effective current treatments for vision loss need to be allied with careful counselling to ensure patients maintain good psychological health as well as good vision, new research recommends. wAMD is the commonest cause of vision loss in the western world, but modern treatments have dramatically improved the level of vision patients can expect to retain. These treatments involve regular injection of vascular endothelial growth factor inhibitors (anti-VEGF) into the eye.
However, a new study conducted at Manchester Royal Eye Hospital and published in the American Journal of Ophthalmology, demonstrates high levels of undiagnosed anxiety and depression persisting in patients receiving treatment, despite their improved visual outcomes.
Manchester researchers say that the study findings demonstrate the value of human interaction between clinician and patient in offering reassurance around the efficacy and safety associated with anti-VEGF injections.
Dr Tariq Aslam, Senior Lecturer in Ophthalmology at The University of Manchester, Consultant Ophthalmologist, at Central Manchester University Hospitals NHS Foundation Trust (CMFT), and lead author of the study, said: "There have been amazing scientific achievements in diagnosing and treating serious eye diseases, such as wAMD, which have revolutionised our ability to reverse life-changing vision loss. However, we must not forget the human element when applying all this to ensure all our patients can reap the full benefits of this cutting-edge science.
"This study represents one of the largest and most detailed examinations of patients undergoing anti-VEGF therapy to date. It helps us understand how factors such as patients' understanding and building strong relationships with healthcare professionals may help alleviate anxiety around receiving injections."
The report suggests that patients may benefit from additional assurances from clinical staff regarding; success rates in halting disease progression with anti-VEGF therapy, how it can reduce the risk of becoming blind in the future, and the low likelihood of serious problems occurring following the injections.
Dr Hugo Senra, the Clinical Psychologist who conducted the study, said: "This study also highlights the importance of considering specialised counselling for certain wAMD patients. Literature has shown that tailored psychological and psychosocial interventions can be effective to reduce anxiety and depression in wAMD patients, and contribute to their adjustment to illness and medical treatments."
The research found as many as 89% of patients who showed anxiety, and 91% who showed depression were not receiving appropriate psychological and psychiatric treatment.
Although levels of depression reduce once anti-VEGF therapy is established, doctors should be vigilant to such symptoms and their potential to impair quality-of-life. Use of standardised tools to screen wAMD patients for symptoms of anxiety and depression in the macular treatment unit could better help identify patients at risk. Further research and controlled trials will be needed to better understand anxiety and depression in wAMD patients and develop new intervention tools at patient and clinical level to reduce symptoms and improve quality-of-life.
This study was supported by the National Institute for Health Research (NIHR). It was also funded by a grant from Bayer, in order to support the ophthalmology community in transforming care and supporting people living with retinal conditions.
Dr Jackie Napier, Medical Director for Ophthalmology at Bayer, said "At Bayer we are dedicated to working in partnership with the ophthalmology community to help transform lives, and an important element of this is working together to improve the holistic support that is provided to patients, carers and their families. We are proud to support this study, which is one of the first of its kind in the UK to investigate the experience of patients with wet AMD receiving anti-VEGF therapy. This type of research can help shape improvements in patient education and support, and thus enable people with wet AMD to get the most from their treatment."
The article is "Experience of Anti-VEGF Treatment and Clinical Levels of Depression and Anxiety in Patients With Wet Age-Related Macular Degeneration," by Hugo Senra, Konstantinos Balaskas, Neda Mahmoodi, Tariq Aslam (http://dx.doi.org/10.1016/j.ajo.2017.03.005). It appears online at Annals of Global Health, published by Elsevier.