Abstract
Purpose: To investigate visual function and vision-related quality of life (VR-QoL) changes in patients with myopic choroidal neovascularization (mCNV) after ranibizumab treatment.Methods: Quantitatively evaluate the objective tests of visual function (visual acuity, microperimetry, and metamorphopsia by m-Charts) before and after 3+prn (pro re neta) ranibizumab treatment for 1 year. The National Eye Institute 25-Item Visual Function Questionnaire (VFQ-25) was performed to evaluate the VR-QoL.Results: A total of 57 eyes of 57 patients were included in this study. The median average metamorphopsia score was 0.65 before treatment and improved to 0.45 after treatment (p = 0.0003). There was also a significant difference in the average threshold, macular integrity, and proportion of patients with stable fixation by the microperimetry (p < 0.000, p < 0.0001, and p = 0.03, respectively). After treatment, the VR-QoL composite, general vision subscale, and vision-related mental health subscale score were increased with borderline or statistical significance (p = 0.088, p = 0.0038, and p = 0.012, respectively). Subgroup analysis demonstrated parallel improvement of the VR-QoL score, metamorphopsia, average macular threshold, and fixation stability in patients with or without visual acuity increase. By multiple linear regression analysis, the VFQ-25 score after anti-VEGF treatment was only associated with the baseline VFQ-25 score and macular integrity. Improvements in the VFQ-25 score were only associated with changes in the metamorphopsia score.Conclusions: Integral lifting in several aspects of visual function was observed in mCNV after ranibizumab treatment. Macular integrity and metamorphopsia, but not visual acuity, were associated with VR-QoL.
Highlights
Myopic choroidal neovascularization is one of the most common vision-threatening complications of pathological myopia, affecting 5–11% of patients with pathological myopia and 0.04–0.05% of the general population [1]
The inclusion criteria were as follows: [1] unilateral active subfoveal or juxtafoveal CNV associated with high myopia confirmed by fundus fluorescein angiography (FFA) with a hyperfluorescent CNV network on early frames and leakage on late frames; [2] patients with baseline best-corrected visual acuity (BCVA) in the affected eye from 24 to 73 Early Treatment Diabetic Retinopathy Study (ETDRS) letters; and [3] patients who received 3+prn intravitreal ranibizumab treatments for 12 months
The retreatment was administered in patients who met any of the following criteria: (a) reduction of BCVA > 5 letters from the previous visit; (b) increase in central retinal thickness (CRT) > 50 μm from the previous visit; new or persistent cystic retinal changes, subretinal fluid or pigment epithelial detachment; and (c) new or persistent bleeding or leakage in FFA or fundus examination
Summary
Myopic choroidal neovascularization (mCNV) is one of the most common vision-threatening complications of pathological myopia, affecting 5–11% of patients with pathological myopia and 0.04–0.05% of the general population [1]. It is prevalent among young and middle-aged Asians [2]. Vision-related quality of life (VR-QoL) is significantly compromised in mCNV patients [3, 4], probably caused by the decrease in visual acuity (VA) and the presence of metamorphopsia, scotomata, and fixation ability [5, 6]. VR-QoL and other aspects of visual function, including the fixation ability, metamorphopsia, and scotomata, are barely studied
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