Decision-making in the treatment of subfoveal neovascularization in age-related macular degeneration - An analysis from the patient's perspective
ABSTRACT The clinical management of subfoveal neovascularization in age-related macular degeneration remains controversial. Large multicenter clinical trials recommend laser photocoagulation for certain subfoveal membranes, but many ophthalmologists are reluctant to treat patients with such lesions because a substantial initial visual loss may be induced by the treatment itself. Despite these controversies in management, the attitude of patients toward treatment of these lesions has not been assessed systematically.
In this article, a newly designed survey containing five hypothetical clinical scenarios was given to 68 patients with age-related macular degeneration to measure their relative preferences for the potential long-term benefits of laser photocoagulation compared with the immediate visual loss induced by laser therapy.
This pilot study reveals a strong preference by these patients for laser intervention, despite the risk of immediate visual loss. On all five questions, the laser treatment outcome was preferred over the natural course of the disease.
Ophthalmologists, when making clinical recommendations to patients with subfoveal exudative macular degeneration, may wish to consider the results of this survey, which suggest a substantial patient preference for laser treatment versus no intervention.
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ABSTRACT: —Background. The Quality of Life Index for Atopic Dermatitis (QoLIAD) and the Parents' Index of Quality of Life in Atopic Dermatitis (PIQoL-AD) have been developed recently for use in adult patients with atopic dermatits (AD) and parents of pediatric AD patients, respectively. Objective . To assess the psychometric properties of the Spanish versions of both questionnaires. Methods . QoLIAD and PIQoL-AD were administered in an observational, multicentre, prospective (2 visits) study which included adult AD patients (group 1) and parents of pediatric AD patients (group 2). The Dermatology Life Quality Index (DLQI) and Psychological General Well-Being Index (IBP) were also administered. Ceiling and floor effects, internal and test-retest reliability, convergent-divergent validity, and known groups validity were assessed for both questionnaires. Results . Group 1 included 83 patients and group 2 included 153 parents. For both questionnaires, ceiling and floor effects ranged between 0% and 9.2%, Cronbach's alpha values were over 0.87 and Spearman correlation coefficients for test-retest reliability ranged between 0.88 and 0.90. Correlation coefficients among target questionnaires and validated instruments were 0.79 (QoLIAD-IBP), 0.76 (QoLIAD and DLQI) and 0.52 (PIQoL.AD and IBP). QoLIAD scores were lower in patients reporting a worse overall health and self-perceived severity; while PIQoL-AD scores were lower in patients reporting a worse overall health. QoLIAD scores were worse in adult patients whose face were affected; while PIQoL-AD scores were worse in patients whose hands were affected. Conclusions . The Spanish versions of the QoLIAD and PIQoL-AD questionnaires have shown a satisfactory reliability and validity for use in this population.Actas Dermo-Sifiliográficas 01/2003; 94(8):539–548. DOI:10.1016/S0001-7310(03)76741-6
British Journal of Ophthalmology 11/1999; 83(10):1103-4. DOI:10.1136/bjo.83.10.1103 · 2.81 Impact Factor
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ABSTRACT: It has been shown that photoreceptor degeneration can be limited in experimental animals by transplantation of fresh RPE to the subretinal space. There is also evidence that retinal cell transplants can be used to reconstruct retinal circuitry in dystrophic animals. Here we describe and review recent developments that highlight the necessary steps that should be taken prior to embarking on clinical trials in humans.Progress in Retinal and Eye Research 08/2001; 20(4):415-49. DOI:10.1016/S1350-9462(01)00003-9 · 9.90 Impact Factor