Patients with AMD Receiving Injections Impacted by Expectation, Psychosocial Issues

JANUARY 21, 2018
Jennifer DiSanto
Researchers recently looked into the various issues that can affect treatment compliance in patients with age-related macular degeneration (AMD), which they claim is not only increasing in prevalence as the population ages but is the most common cause of blindness.

Samantha Sii, MD, from the Department of Ophthalmology at the Royal Victoria Hospital, in Belfast, Northern Ireland, and colleagues examined psychosocial issues—such as expectations, pain, and anxiety—thought to decrease patients’ compliance with the necessary long treatment duration for AMD.

“Although there have been qualitative studies exploring patients’ experience of intravitreal therapy (IVT), which have explored levels of anxiety and discomfort, there remains a lack of information investigating patients’ expectations of the IVT given and factors predicting changes in expectations during a course of treatment,” the authors noted.

Fifty patients in the AMD unit at Princess Alexandra Eye Pavilion in Edinburgh, Scotland, were guided through a structured interview and provided a visual analog scale to measure their pain, anxiety, and expectations in relation to their treatment. The research team used multinomial regression analysis to analyze the results.

Patients who participated in the study had all been diagnosed with wet AMD and been through IVT at least once before. Their hearing and sight were also tested to ensure they could complete the required surveys.

According to the published results, more patients (P <.05) experienced diminished expectations while receiving treatment; their reduced expectations were associated with higher expectations at the beginning of treatment (P = .00001), a more significant visual acuity decline (P = .008), and the patients’ “perceived deterioration of vision after starting treatment” (P = .013).

Among those patients, 32% said they were going to stop treatment and decline further injections. Their refusal to continue treatment was associated with a greater decline in visual acuity (P = .026; 95% CI). Patients also reported less pain and anxiety during intravitreal therapy when a friend or relative came with them to treatment (P <.01), as measured by Pearson's correlation (r = .597).
The authors say treatment is “expensive and often prolonged, requiring repeated intra-ocular injections.” To that end, they concluded that patients’ expectations should be managed appropriately at the beginning of and throughout their course of treatment, so it’s less likely they’ll become discouraged and end their treatment, or become non-compliant when it doesn’t meet their initial expectations.

“Pitching starting expectations at the right level by providing appropriate information about disease trajectory is important in order to avoid a fall in expectations along with a course of treatment,” they wrote. “Most important of all, the service implications of our findings are that patients should be provided with the time and space to permit individualized discussion at specified time points in their treatment plan and this should be emphasized when consenting for multiple IVT procedures.”

They concluded by noting that further research will be required to define which factors determine expectation levels and to reveal the most effective approach to standardize realistic expectations for patients with AMD.

The study, “Exploring factors predicting changes in patients’ expectations and psychosocial issues during the course of treatment with intravitreal injections for wet age-related macular degeneration,” was published in Eye (London).

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