Skip to main content
SpringerLink
Log in

Modifiable Determinants of Satisfaction with Intravitreal Treatment in Patients with Neovascular Age-Related Macular Degeneration

  • Original Research Article
  • Published:
Drugs & Aging Aims and scope Submit manuscript

Abstract

Background

The success of intravitreal treatment for neovascular age-related macular degeneration (nAMD) depends on maximal adherence to treatment, which in turn requires patient satisfaction.

Objective

The aim of this study was to assess the factors associated with nAMD patient satisfaction to implement actions to improve treatment experiences and increase adherence.

Design

This was a prospective, observational, analytical, cross-sectional study.

Subjects

Our study included 100 consecutive nAMD patients under intravitreal treatment for at least 1 year.

Methods

Patients completed the Macular Disease Treatment Satisfaction Questionnaire (MacTSQ) and the EuroQol Visual Analog Scale (EQ VAS). A logistic regression was estimated to model the low values of the satisfaction score (MacTSQ < 50).

Results

The mean age of patients was 82.1 ± 7.8 years and 62% were female. Males (p = 0.002) and patients who improved their visual acuity (p = 0.004) were more satisfied, while patients who received a higher number of injections (p = 0.036) and treatment in both eyes (p = 0.001) were less satisfied. Higher health-related quality of life was related to higher satisfaction. The sensitivity and specificity of the predictive model were 75.8% and 76.1%, respectively. Factors independently associated with low satisfaction were female sex (odds ratio [OR] 6.84), going to the clinic alone (OR 8.51), longer duration of treatment (OR 0.62), receiving treatment in both eyes (OR 3.54), and suffering a decline in visual acuity (OR 3.30). The questionnaire revealed patients’ needs for more information and injection points closer to their homes.

Conclusions

Well-defined areas for improvement were identified, i.e. to improve the information offered to each patient, to incorporate new long-acting drugs, and to establish locations for injection services in peripheral areas.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Kaplan RS, Jehi L, Ko CY, Pusic A, Witkowski M. Health care measurements that improve patient outcomes. NEJM Catal Innov Care Deliv. 2021. https://doi.org/10.1056/CAT.20.0527.

    Article  Google Scholar 

  2. Patient Engagement: Technical Series on Safer Primary Care. Licence: CC BY-NC-SA 3.0 IGO. Geneva: World Health Organization; 2016. https://apps.who.int/iris/bitstream/handle/10665/252269/9789241511629-eng.pdf. Accessed 29 Dec 2021.

  3. American Academy of Ophthalmology. Age-related macular degeneration PPP-Updated 2019. https://www.aao.org/preferred-practice-pattern/age-related-macular-degeneration-ppp. Accessed 29 Dec 2021.

  4. Friedman DS, O’Çolmain BJ, Muñoz B, et al. Eye Diseases Prevalence Research Group. Prevalence of age-related macular degeneration in the United States. Arch Ophthalmol. 2004;122(4):564–72. https://doi.org/10.1001/archopht.122.4.564.

    Article  PubMed  Google Scholar 

  5. Spanish Eyes Epidemiological (SEE) Study Group. Prevalence of age-related macular degeneration in Spain. Br J Ophthalmol. 2011;95(7):931–6. https://doi.org/10.1136/bjo.2010.187773.

  6. Mitchell P, Liew G, Gopinath B, Wong TY. Age-related macular degeneration. Lancet. 2018;392(10153):1147–59. https://doi.org/10.1016/S0140-6736(18)31550-2.

    Article  PubMed  Google Scholar 

  7. Ferris FL, Wilkinson CP, Bird A, et al. Beckman Initiative for Macular Research Classification Committee. Clinical classification of age-related macular degeneration. Ophthalmology. 2013;120(4):844–51. https://doi.org/10.1016/j.ophtha.2012.10.036.

    Article  PubMed  Google Scholar 

  8. Bhutto I, Lutty G. Understanding age-related macular degeneration (AMD): relationships between the photoreceptor/retinal pigment epithelium/Bruch’s membrane/choriocapillaris complex. Mol Aspects Med. 2012;33(4):295–317. https://doi.org/10.1016/j.mam.2012.04.005.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Erke MG, Bertelsen G, Peto T, Sjølie AK, Lindekleiv H, Njølstad I. Prevalence of age-related macular degeneration in elderly Caucasians: the Tromsø Eye Study. Ophthalmology. 2012;119(9):1737–43. https://doi.org/10.1016/j.ophtha.2012.03.016.

    Article  PubMed  Google Scholar 

  10. Granstam E, Westborg I, Barkander A, et al. Reduced occurrence of severe visual impairment after introduction of anti-Vascular Endothelial Growth Factor in wet age-related macular degeneration—a population- and register-based study from northern Sweden. Acta Ophthalmol. 2016;94(7):646–51. https://doi.org/10.1111/aos.13187.

    Article  CAS  PubMed  Google Scholar 

  11. Chong V. Ranibizumab for the treatment of wet AMD: a summary of real-world studies [published erratum appears in Eye (Lond). 2016 Nov;30(11):1526]. Eye (Lond). 2016;30(2):270–86. https://doi.org/10.1038/eye.2015.217.

  12. Sii S, Aspinall P, Borooah S, Dhillon B. Exploring factors predicting changes in patients’ expectations and psychosocial issues during the course of treatment with intravitreal injections for wet age-related macular degeneration. Eye (Lond). 2018;32(4):673–8. https://doi.org/10.1038/eye.2017.271.

    Article  CAS  Google Scholar 

  13. Prenner JL, Halperin LS, Rycroft C, Hogue S, Williams Liu Z, Seibert R. Disease burden in the treatment of age-related macular degeneration: findings from a time-and-motion study. Am J Ophthalmol. 2015;160(4):725-31.e1. https://doi.org/10.1016/j.ajo.2015.06.023.

    Article  PubMed  Google Scholar 

  14. Boyle J, Vukicevic M, Koklanis K, Itsiopoulos C. Experiences of patients undergoing anti-VEGF treatment for neovascular age-related macular degeneration: a systematic review. Psychol Health Med. 2015;20(3):296–310. https://doi.org/10.1080/13548506.2014.936886.

    Article  PubMed  Google Scholar 

  15. Gohil R, Crosby-Nwaobi R, Forbes A, Burton BJ, Hykin P, Sivaprasad S. Treatment satisfaction of patients undergoing ranibizumab therapy for neovascular age-related macular degeneration in a real-life setting. Patient Prefer Adherence. 2016;10:949–55. https://doi.org/10.2147/PPA.S105536.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Marakis TP, Koutsandrea C, Chatzistefanou KI, Tountas Y. Treatment satisfaction of patients with neovascular age-related macular degeneration treated with anti-vascular endothelial growth factor agents. Int Ophthalmol. 2018;38(2):565–76. https://doi.org/10.1007/s10792-017-0492-8.

    Article  PubMed  Google Scholar 

  17. McClard CK, Wang R, Windham V, et al. Questionnaire to Assess Life Impact of Treatment by Intravitreal Injections (QUALITII): Development of a patient-reported measure to assess treatment burden of repeat intravitreal injections. BMJ Open Ophthalmol. 2021;6(1): e000669. https://doi.org/10.1136/bmjophth-2020-000669.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Thiedke CC. What do we really know about patient satisfaction? Fam Pract Manag. 2007;14(1):33–6.

    PubMed  Google Scholar 

  19. Hall JA, Dornan MC. Patient sociodemographic characteristics as predictors of satisfaction with medical care: a meta-analysis [published erratum appears in Soc Sci Med 1990;30(12):following 1368]. Soc Sci Med. 1990;30(7):811–8. https://doi.org/10.1016/0277-9536(90)90205-7.

    Article  CAS  PubMed  Google Scholar 

  20. Instituto Nacional de Estadística de España (INE). Demografía y Población. https://www.ine.es/jaxiT3/Datos.htm?t=2852. Accessed 29 Dec 2021.

  21. The Statistical Office of the European Union (Eurostat). Ageing Europe—statistics on health and disability. https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Ageing_Europe_-_statistics_on_health_and_disability. https://www.ine.es/jaxiT3/Datos.htm?t=2852. Accessed 29 Dec 2021.

  22. Instituto Nacional de Estadística de España (INE). Cifras de población y censos demográficos. https://www.ine.es/jaxi/Datos.htm?path=/t20/e242/p03/a2001/l0/&file=mun34.px. Accessed 27 Jul 2021.

  23. Engelbert M, Zweifel SA, Freund KB. Long-term follow-up for type 1 (subretinal pigment epithelium) neovascularization using a modified “treat and extend” dosing regimen of intravitreal antivascular endothelial growth factor therapy [published erratum appears in Retina. 2011 Jan;31(1):208]. Retina. 2010;30(9):1368-75. https://doi.org/10.1097/IAE.0b013e3181d50cbf.

  24. Mitchell J, Bradley C. Design and development of the MacTSQ measure of satisfaction with treatment for macular conditions used within the IVAN trial. J Patient Rep Outcomes. 2017;2(1):5. https://doi.org/10.1186/s41687-018-0031-z.

    Article  PubMed  Google Scholar 

  25. Holladay JT. Visual acuity measurements. J Cataract Refract Surg. 2004;30(2):287–90. https://doi.org/10.1016/j.jcrs.2004.01.014.

    Article  PubMed  Google Scholar 

  26. Hosmer DW Jr, Lemeshow S, Sturdivant RX. Applied logistic regression. Chapter 4. Hoboken: Wiley; 2013. https://doi.org/10.1002/9781118548387

  27. Sanabria MR, Montero JA, Losada MV, et al. Ocular pain after intravitreal injection. Curr Eye Res. 2013;38(2):278–82. https://doi.org/10.3109/02713683.2012.758290.

    Article  CAS  PubMed  Google Scholar 

  28. Shatz W, Aaronson J, Yohe S, Kelley RF, Kalia YN. Strategies for modifying drug residence time and ocular bioavailability to decrease treatment frequency for back of the eye diseases. Expert Opin Drug Deliv. 2019;16(1):43–57. https://doi.org/10.1080/17425247.2019.1553953.

    Article  CAS  PubMed  Google Scholar 

  29. Instituto Nacional de Estadística de España (INE). Productos y Servicios. 2018. https://www.ine.es/ss/Satellite?L=es_ES&c=INESeccion_C&cid=1259944484459&p=1254735110672&pagename=ProductosYServicios%2FPYSLayout&param1=PYSDetalleFichaIndicador&param3=1259937499084. Accessed 29 Dec 2021.

  30. de Boer AG, van Lanschot JJ, Stalmeier PF, et al. Is a single-item visual analogue scale as valid, reliable and responsive as multi-item scales in measuring quality of life? Qual Life Res. 2004;13(2):311–20. https://doi.org/10.1023/B:QURE.0000018499.64574.1f.

    Article  PubMed  Google Scholar 

  31. Al-Jabi SW, Zyoud SH, Sweileh WM, et al. Relationship of treatment satisfaction to health-related quality of life: findings from a cross-sectional survey among hypertensive patients in Palestine. Health Expect. 2015;18(6):3336–48. https://doi.org/10.1111/hex.12324.

    Article  PubMed  Google Scholar 

  32. Schriefer D, Haase R, Kullmann JS, Ziemssen T. Health-Related quality of life and the relationship to treatment satisfaction in patients with multiple sclerosis: insights from a large observational study. Patient Prefer Adherence. 2020;14:869–80. https://doi.org/10.2147/PPA.S248272.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Bamm EL, Rosenbaum P, Wilkins S. Is Health Related Quality Of Life of people living with chronic conditions related to patient satisfaction with care? Disabil Rehabil. 2013;35(9):766–74. https://doi.org/10.3109/09638288.2012.707746.

    Article  PubMed  Google Scholar 

  34. Chakravarthy U, Harding SP, Rogers CA, et al. A randomised controlled trial to assess the clinical effectiveness and cost-effectiveness of alternative treatments to Inhibit VEGF in Age-related choroidal Neovascularisation (IVAN). Health Technol Assess. 2015;19(78):1–298. https://doi.org/10.3310/hta19780.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Mitchell AP, Harrison MR, George DJ, Abernethy AP, Walker MS, Hirsch BR. Clinical trial subjects compared to “real world” patients: generalizability of renal cell carcinoma trials [abstract]. J Clin Oncol. 2014;32(15 Suppl). https://doi.org/10.1200/jco.2014.32.15_suppl.6510

  36. Boyle J, Vukicevic M, Koklanis K, Itsiopoulos C, Rees G. Experiences of patients undergoing repeated intravitreal anti-vascular endothelial growth factor injections for neovascular age-related macular degeneration. Psychol Health Med. 2018;23(2):127–40. https://doi.org/10.1080/13548506.2016.1274040.

    Article  PubMed  Google Scholar 

  37. Boulanger-Scemama E, Querques G, et al. Ranibizumab for exudative age-related macular degeneration: a five year study of adherence to follow-up in a real-life setting. J Fr Ophtalmol. 2015;38(7):620–7. https://doi.org/10.1016/j.jfo.2014.11.015.

    Article  CAS  PubMed  Google Scholar 

  38. Gianniou C, Dirani A, Ferrini W, et al. Two-year outcome of an observe-and-plan regimen for neovascular age-related macular degeneration: how to alleviate the clinical burden with maintained functional results [published erratum appears in Eye (Lond). 2015 Mar;29(3):450-1]. Eye (Lond). 2015;29(3):342–349. https://doi.org/10.1038/eye.2014.258

  39. Kandula S, Lamkin JC, Albanese T, Edward DP. Patients’ knowledge and perspectives on wet age-related macular degeneration and its treatment. Clin Ophthalmol. 2010;6(4):375–81. https://doi.org/10.2147/opths9969.

    Article  Google Scholar 

  40. Müller S, Ehlken C, Bauer-Steinhusen U, et al. Treatment of age-related neovascular macular degeneration: the patient’s perspective. Graefes Arch Clin Exp Ophthalmol. 2017;255(11):2237–46. https://doi.org/10.1007/s00417-017-3739-1.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Chang A, Stokes J, Priestman L, Holmes C, Said P. Impact of a patient support program on patient beliefs about neovascular age-related macular degeneration and persistence to anti-vascular endothelial growth factor therapy. Patient Prefer Adherence. 2021;3(15):511–21. https://doi.org/10.2147/PPA.S293941.

    Article  Google Scholar 

  42. Sixma HJ, Spreeuwenberg PM, van der Pasch MA. Patient satisfaction with the general practitioner: a two-level analysis. Med Care. 1998;36(2):212–29. https://doi.org/10.1097/00005650-199802000-00010.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Ophthalmology Department, San Telmo Hospital, Palencia University Hospital Complex, 34004, Palencia, Spain

    Paola S. Calles-Monar, María R. Sanabria & Ana M. Alonso-Tarancon

  2. Institute of Applied Ophthalmobiology, University of Valladolid, Valladolid, Spain

    Rosa M. Coco-Martin

  3. OFTARED Health Research Thematic Network, Carlos III Health Institute, Madrid, Spain

    Rosa M. Coco-Martin

  4. Department of Statistics and O.R. & IMUVA, University of Valladolid, Valladolid, Spain

    Agustín Mayo-Iscar

Authors
  1. Paola S. Calles-Monar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. María R. Sanabria
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ana M. Alonso-Tarancon
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rosa M. Coco-Martin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Agustín Mayo-Iscar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Paola S. Calles-Monar.

Ethics declarations

Funding

This research was supported by a grant from Gerencia Regional de Salud de Castilla-León (GRS 2111/A/19). Agustín Mayo-Iscar has been partially supported by the Spanish Ministerio de Economía y Competitividad (grant MTM2017-86061-C2-1-P) and by Consejería de Educación de la Junta de Castilla y León and FEDER (grants VA005P17 and VA002G18)

Conflicts of interest

María R. Sanabria has received speaker fees from Bayer and Allergan, as well as congress assistance payments from Novartis, Allergan, and Bayer, and has also participated in Advisory Boards for Novartis. Rosa M. Coco-Martin has received speaker fees from Novartis, Bayer, Allergan, and Bausch & Lomb, as well as congress assistance payments from Novartis, Allergan, and Bayer, and has also participated in Advisory Boards for Ciana and Novartis. Additionally, Novartis funds Professorships that Rosa M. Coco-Martin directs at the University of Valladolid (IOBA) for specific or individual authors. Paola S. Calles-Monar, Ana M. Alonso-Tarancon, and Agustín Mayo-Iscar have no conflicts of interest to declare.

Ethics approval

This research followed the tenets of the Helsinki Declaration of 1964 (last amendment, 2013), and the study protocol was approved by the Palencia University Hospital Complex (CAUPA) Research Ethics Committee with appropriate informed consent from all participants.

Consent

Written informed consent explaining the purpose of the research and describing the voluntary nature of participation was obtained from all study participants.

Data availability statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available because they contain information that could compromise research participant privacy/consent.

Author Contributions

PSCM: Data collection, analysis and interpretation of the data, and writing of the manuscript. MRS: Conception and design, analysis and interpretation of the data, and writing of the manuscript. AMAT: Data collection. RMCM: Analysis and interpretation of the data, writing and review of the manuscript. AMI: Statistical analysis and interpretation of the data.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Calles-Monar, P.S., Sanabria, M.R., Alonso-Tarancon, A.M. et al. Modifiable Determinants of Satisfaction with Intravitreal Treatment in Patients with Neovascular Age-Related Macular Degeneration. Drugs Aging 39, 355–366 (2022). https://doi.org/10.1007/s40266-022-00937-y

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40266-022-00937-y

Search

Navigation