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Quality of Life Improves in Patients with Macular Degeneration

Quality of Life Improves in Patients with Macular Degeneration
Quality of Life Improves in Patients with Macular Degeneration


Duke Health News Duke Health News

DURHAM, N.C. -- Researchers at the Duke University Eye
have determined that patients with age-related
macular degeneration (AMD) experience significant improvement
in their quality of life following a surgical procedure called
"macular translocation with 360 degree peripheral retinectomy"
(MT360). AMD is an eye disease that may lead to vision loss in
the central region of a person's visual field, a defect that
can seriously impact a patient's quality of life.

The macula -- located at the center of the retina, the
light-sensitive tissue lining the back of the eye -- is
particularly critical for activities that require detail
vision, such as reading or sewing.

Very little data exists regarding quality of life (QOL) of
patients with advanced vision loss from AMD, the researchers
said. For this reason, they chose to compare QOL in their
patients with severe AMD against QOL data from other studies of
people with milder effects of AMD or other eye diseases. From
this data, they determined a baseline reading of their AMD
patients' overall quality of life. Armed with a better
understanding of the QOL issues faced by their patients, they
performed a second study in which they compared quality of life
in patients before and after MT360 surgery for severe AMD. The
findings from both studies appear in the January 2005 issue of Ophthalmology.

"We can now show, scientifically, that our patients have
been able to improve not only their central vision, but their
quality of life as a result of the visual improvements
following MT360," said Cynthia Toth, MD, senior author of both
studies, an associate professor of ophthalmology and an eye
surgeon at Duke. "The data show patients improve not only in
tests of visual acuity done in our office but also in their
everyday lives. Does improving visual acuity improve quality of
life for the patient? Yes, it does, and we didn't know for sure
until now."

MT360 is a two-stage surgery that involves first internally
rotating the retina to shift the degenerating macula to a
healthy area, away from abnormally growing blood vessels and
scar tissue. The surgical shift begins to restore function to
the macula. In the second stage, the eye is rotated to account
for the ensuing tilt in a person's visual field. The research
team had long believed their patients' quality of life would
naturally improve along with improvements to their central
vision. But until now, the researchers said, they have lacked
scientific support outside the realm of in-clinic visual

"As clinicians, we must recognize the importance of
patients' overall quality of life when we speak to them about
what is going on with their vision, because to the patients
this is what is most important," said Toth. "A number that
represents their visual acuity improvement is great for me as a
surgeon, but may be meaningless to my patients. What matters is
how this better number will translate into a better life for
them at home."

In the first set of data collected, the team surveyed 70
patients with severe age-related macular degeneration in both
eyes who were scheduled for MT360 surgery. The responses of the
severe, bilateral AMD group were compared against three other
groups: patients with AMD of varying severity, patients with
low-vision (due to various ocular causes) and a control group
of patients without ocular disease. The research group found
QOL measurements in patients with severe, bilateral AMD to be
similar to patients in the low-vision group but worse than
those with AMD of varying severity and worse than those without
ocular disease.

The most important finding, the researchers said, is the
clear demonstration of the impact of central vision loss on
patients' ability to perform vision-related activities such as
reading the newspaper, seeing well up close and navigating
around their home and neighborhood. Furthermore, patients with
bilateral, severe AMD experience a great deal of isolation,
which is manifested as a loss of independence, increased
problems in social interactions and increased levels of
anxiety, the researchers added. Although patients with
bilateral, severe AMD had general health QOL scores comparable
to their peers, their vision-related quality of life scores
were much lower and were not related to general health

In the second study, the team analyzed data from 50 patients
who had completed questionnaires about QOL both before, and one
year after, MT360 surgery. The research team compared pre- and
post-operative QOL survey results and determined that MT360 is
associated with improvement in vision-related QOL, and that
improvement is not associated with changes in the general
health of the patient. Further, the research team learned that
the greatest improvement in QOL appeared in those with the
greatest improvements in visual function following the

"These findings are very reassuring to me as a surgeon and
caregiver," said Sharon Freedman, MD, associate professor of
ophthalmology at Duke and an author on one of the studies.
"Asking the right questions is important. How do visual
improvements translate into improvements in everyday life for
our patients? MT360 and the subsequent eye muscle surgery
represent an aggressive surgical approach – far more aggressive
than simply providing low-vision aids to our patients with AMD.
A successful surgery is not enough – we continue to manage each
of our patients with a distinct team approach to make sure he
or she can maximize their improvement."

Not all patients with AMD are considered candidates for
MT360, the researchers emphasized. The best candidates are
those who have central vision loss in both eyes and who have
experienced recent vision loss – specifically within the
previous six-months – in their second eye. While vision may be
improved following the surgery, there is no cure for AMD, one
of the leading causes of blindness in Americans over the age of

"We are not done yet," Freedman added. "We continue to
refine our surgical techniques and our understanding of our
patients. Our goal is to maximize not only the quantity of
vision preserved or restored, but also the improvement in our
patients' quality of life."

Research funding for both quality of life studies was
provided by Euan and Angelica Baird and The Andrew Family
Foundation -- all benefactors of Duke University Eye Center.
Additional support was provided by the National Institutes of

Sandra Stinnett, DUEC, and Avie Banks, formerly of DUEC, are
authors on the papers. Mark Cahill, a vitreoretinal surgeon and
former associate at DUEC, is first author of both studies.
Cahill now practices in Ireland.

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