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Visual functioning and health-related quality of life in diabetic patients about to undergo anti-vascular endothelial growth factor treatment for sight-threatening macular edema
Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.ORCID iD: 0000-0001-7721-8794
Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.ORCID iD: 0000-0002-5892-9897
Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.ORCID iD: 0000-0001-8682-2045
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2015 (English)In: Journal of diabetes and its complications, ISSN 1056-8727, E-ISSN 1873-460X, Vol. 29, no 8, p. 1183-1190Article in journal (Refereed) Published
Abstract [en]

Purpose

To examine patient-reported outcome (PRO) in a selected group of Swedish patients about to receive anti-vascular endothelial growth factor (VEGF) treatment for diabetic macular edema (DME).

Material and methods

In this cross-sectional study, 59 patients with diabetes mellitus, who regularly visited the outpatient eye-clinics, were included. Sociodemographic and clinical data were collected and the patients completed PRO measures before starting anti-VEGF treatment. PRO measures assessed eye-specific outcomes (NEI-VFQ-25) and generic health-related quality of life (SF-36).

Results

The participants consisted of 30 men and 29 women (mean age, 68.5 years); 54 (92 %) patients had type 2 diabetes; Five (9%) patients had moderate or severe visual impairment; 28 (47 %) were classified as having mild visual impairment. Some of the patients reported overall problems in their daily lives, such as with social relationships, as well as problems with impaired sight as a result of reduced distance vision.

Conclusions

Further studies are needed to investigate PRO factors related to low perceived general health in this patient population. It is important to increase our understanding of such underlying mechanisms to promote improvements in the quality of patient care.

Place, publisher, year, edition, pages
2015. Vol. 29, no 8, p. 1183-1190
Keywords [en]
Patient-reported measurements; health-related quality of life; visual function; diabetic macula edema; anti-VEGF treatment
National Category
Endocrinology and Diabetes
Research subject
Health and Welfare
Identifiers
URN: urn:nbn:se:du-19091DOI: 10.1016/j.jdiacomp.2015.07.026ISI: 000366884900036PubMedID: 26318959OAI: oai:DiVA.org:du-19091DiVA, id: diva2:848524
Available from: 2015-08-25 Created: 2015-08-25 Last updated: 2020-05-11Bibliographically approved
In thesis
1. Anti-VEGF treatment of patients with diabetic macular edema: Studies of visual acuity, macular edema and patient-reported outcomes
Open this publication in new window or tab >>Anti-VEGF treatment of patients with diabetic macular edema: Studies of visual acuity, macular edema and patient-reported outcomes
2016 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this thesis was to describe and evaluate visual acuity, macular edema and patientreported outcomes (PRO) following anti-VEGF treatment of diabetic macular edema (DME) patients in a real-world setting. Using a longitudinal study design, a cohort of DME patients was followed from baseline to 1 year after treatment start. Data were collected from two eye clinics at two county hospitals. Social background characteristics, medical data and PRO were measured before treatment initiation, at four month and after 1 year. A total of 57 patients completed the study. Mean age was 69 years and the sample was equally distributed regarding sex. At baseline, the patients described their general health as low. One year after treatment initiation, 30 patients had improved visual acuity and 27 patients had no improvement in visual acuity. The patients whose visual acuity improved reported an improvement in several subscales in patient-reported outcome measures (PROM), which was in contrast to the group that experienced a decline in visual acuity, where there was no improvement in PROM. Outcomes from the study can be useful for developing and providing relevant information and support to patients undergoing this treatment.

Place, publisher, year, edition, pages
Uppsala: Uppsala universitet, 2016. p. 38
National Category
Endocrinology and Diabetes
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-22715 (URN)
Supervisors
Available from: 2016-08-18 Created: 2016-08-18 Last updated: 2016-09-26Bibliographically approved
2. Patient-reported and medical outcomes in patients treated for diabetic macular edema: A real-world longitudinal study
Open this publication in new window or tab >>Patient-reported and medical outcomes in patients treated for diabetic macular edema: A real-world longitudinal study
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background Diabetes mellitus can lead to complications, when the complication affects the eyes it is called retinopathy. This can affect the macula and lead to severe loss of vision, diabetic macular edema (DME). This condition has traditionally been treated with laser. However, in 2011, anti-vascular endothelial growth factor (anti-VEGF) injections in the eye were approved as a treatment for diabetic macular edema, and started to be used in eye clinics.

Aim The overall aim of this thesis was to describe patient-reported outcomes and medical outcomes (PRO) in people treated for diabetic macular edema in a real-world setting in a long-time follow-up study in Sweden.

Methods Participants were enrolled at two eye clinics at two county hospitals in Sweden between 2012 and 2014. Patient-reported outcomes were measured using a vision-specific questionnaire, the 25-question National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) and a generic questionnaire, the Short Form-36 Health Survey (SF-36). Completed questionnaires, medical data such as visual acuity (EDRS), macula swelling (OCT) and social background characteristics were collected before treatment start, at one-year and four-year follow up points. The data was analyzed, descriptive statistics developed and comparative analyses were performed. Interviews were performed before treatment start and were analyzed using qualitative content analysis.

Results A total of 59 participants were included at baseline. The mean age was 69 years, with an equal gender distribution. At baseline, the participants scored a low general health with the vision-specific questionnaire. In total, 21 participants were interviewed, and a theme emerged of ‘being at a crossroads and a crucial phase in life with an uncertain outcome’. The participants expressed thoughts and concerns at different levels, including practical concerns about the treatment procedure and more existential thoughts about hope for improved visual acuity or fear of deterioration. The results at the one-year follow up showed that 30 patients had improved visual acuity and reported an improvement in several subscales in the NEI VFQ-25. The remaining 27 participants had no improvement in visual acuity or in the vision specific questionnaire. The four-year follow-up involved 37 people, and the result showed significant improvement in subjective near-vision activities and improved distance visual acuity.

Conclusion: Before treatment, the participants reported low general health and expressed concerns about the injection treatment and their vision. One year after treatment started, the results showed significant improvement in several NEI VFQ-25 subscales, decreased macula swelling and improved visual acuity. These positive results remained at the four-year follow-up point.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2020. p. 68
Keywords
Diabetes mellitus, Patient-reported outcomes, Retinopathy, Macular edema, Anti-VEGF treatment
National Category
Endocrinology and Diabetes
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-32652 (URN)978-91-513-0896-8 (ISBN)
Public defence
2020-04-28, Aula Gunnesalen, Ingång 10, Psykiatrins hus. Akademiska sjukhuset Uppsala., 13:00 (Swedish)
Opponent
Supervisors
Available from: 2020-05-11 Created: 2020-05-11 Last updated: 2020-05-11Bibliographically approved

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Granström, ThereseForsman, HenriettaLeksell, Janeth

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