AMD Treatment Still Brings Anxiety, Depression Despite Visual Improvements

Reassurance should focus on success rates and low risk of serious problems.

In one of the largest and most detailed observational studies of how patients with “wet” or neovascular age-related macular degeneration (nAMD) experience intravitreal injections, more than half (132/235, or 56%) of such patients qualitatively assessed with a structured survey at the Manchester Royal Eye Hospital in Manchester, U.K., reported treatment-related anxiety despite improvement in visual outcomes.

In addition, according to results of a standardized, validated questionnaire designed to quantify levels of anxiety and depression, 52 of the 300 patients recruited for the study, or 17%, showed clinically significant levels of anxiety, and 36 patients, or 12%, showed clinically significant levels of depression. Levels of depression but not levels of anxiety were significantly greater in those who got up to 3 anti-VEGF injections compared with those who got 4—12 (ANOVA P = 0.027) or more than 12 (ANOVA P = 0.001).

These findings led the authors of the recently published report on the study to conclude that clinical depression seems more frequent in patients who are in the early stages of anti-VEGF treatment than in those who are in its later stages. The authors also concluded that patients receiving anti-VEGF treatment often experience treatment-related anxiety regardless of the number of injections received.

Interestingly enough, the British team discovered that the chief cause of patients’ anxiety was not fear of treatment-related pain. Instead, patients’ anxiety mainly stemmed from fear of going blind because of intravitreal injections and from concerns about the effectiveness of these injections in treating nAMD.

In a press release on the research, study report lead author Tariq Aslam, MD (pictured), senior lecturer in ophthalmology at the University of Manchester, noted that these findings about the cause of the anxiety revealed that to alleviate it, clinicians must enhance patients’ understanding of the benefits and risks of intravitreal anti-VEGF injections for nAMD.

The study report noted that patients might experience less anxiety or depression if clinical staff reassure them about: 1) the success rate of intravitreal anti-VEGF therapy in stopping the progression of nAMD; 2) the ability of anti-VEGF injections to reduce the risk of blindness; and 3) the low risk of serious problems from intravitreal injections of anti-VEGF agents.

The study investigators also determined that nearly 90% of patients who showed clinically significant anxiety or depression in the study were not receiving appropriate psychological and psychiatric treatment. According to the study report’s first author, Hugo Senra, PhD, a clinical psychologist at the University of Manchester’s School of Health Sciences, “This study also highlights the importance of considering specialized counselling for certain wet AMD patients.”

According to lead study author Aslam, who is also consultant ophthalmologist at Central Manchester University Hospitals National Health Service Foundation Trust, the study findings highlight the importance of building strong relationships and opening the lines of communication between healthcare professionals and nAMD patients. Aslam encapsulated the relevance of his team’s findings by emphasizing that, although anti-VEGF therapy has revolutionized nAMD treatment, “we must not forget the human element when applying all this to ensure all our patients can reap the full benefits of cutting-edge science.”

A report on the study, “Experience of anti-VEGF treatment and clinical levels of depression and anxiety in patients with wet age-related macular degeneration,” appeared online in mid-March in the American Journal of Ophthalmology.

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