Table 2.

Studies on impact of anti-VEGF treatments on vision-related QoL

Study	Study design	Outcomes measure(s)/definition	Key finding(s)
Impact of anti-VEGF therapy on patient’s quality of life (four studies; five publications)
Zhu et al. [28]  (abstract)	Prospective open-label clinical trial	Patients’ VRQoL using the NEI-VFQ-25 at 6, 12,18, and 24 months	Improvement in VRQoL at 6, 12, 18, and 24 months: Composite score: 4.5 ± 9.2/4.4 ± 11.8/5.6 ± 11.2/4.6 ± 12.4 o Good responder: 4.4 ± 8.9/6.8 ± 10.1 o Poor responder: 4.6 ± 9.6/2.5 ± 12.7 o Mental health: 6.2 ± 13.3/4.3 ± 15.2 o Driving: 1.7 ± 19.8/− 2.1 ± 16.9
Inoue et al. [27]	Observational non-interventional study	NEI VFQ-25 scores preoperatively and postoperatively at 3 months/12 months	Score at baseline: Composite score: 72.3 o Mental health: 68.4 o Driving: 69	Score at 3/12 months: • 75.8/78.5 o 77.2/78.6 o 70.1/69
			IVR treatment resulted in a higher postoperative NEI VFQ-25 score Improved VA at 12 months was associated with a greater improvement in NEI VFQ-25
Finger et al. [25]	Observational, non-interventional study	The VRQoL at 6 and 12 months was measured by the IVI using its three subscales: Accessing information, Mobility, and Emotional well-being	Score at baseline: • Accessing information: − 0.54 ± 2.33 • Mobility: − 0.82 ± 2.68 • Emotional well-being: − 0.97 ± 2.68	Score at 6 months/12 months • –0.67 ± 2.07/− 0.55 ± 2.35 • –0.93 ± 2.53/− 0.69 ± 2.69 • –1.17 ± 2.68/− 1.11 ± 3.06
Finger et al. [26]	Observational, non-interventional study	Patients’ VRQoL using the NEI-VFQ at 12 months	Improvements in VRQoL at 12 months: + 0.73 ± 0.37
Depression and anxiety after anti-VEGF therapy for nAMD (six studies)
Casten et al. [29]	Observational, non-interventional study	• PHQ-9 rating severity of depressive symptoms at baseline and at 3 months • Subjective opinion of how helpful injections and obstacles to treatment	• At 3 months, 20% of patients had clinically significant depressive symptoms (mean [SD] PHQ-9 score, 6.8 [1.6]) • Compared with non-depressed patients, depressed patients had a greater decline in vision over 3 months • Depression was unrelated to changes in NEI-VFQ scores or obstacles to treatment
Cooley et al. [30]  (abstract)	Prospective observational study	PSS, CES-D, IVI; Relationships among changes in VA, IVI, PSS, and CES-D were analyzed using linear regression	• Greater social support at initiation of anti-VEGF treatment was associated with reduced depression at follow-up • Decrease in self-reported visual functioning was related to higher stress level at follow-up, whereas VA change was not
Lee et al. [31]	Cross-sectional study	Prevalence of depression using geriatric depression scale	• The prevalence of depression: 26.2% with AMD; it was suggested that age was the most important factor associated with depression in AMD • With older age, the severity of depression also increases
Segal et al. [32]	Observational non-interventional study	Pre-procedural anxiety using VASA	Positive correlation between increased preprocedural anxiety and perceived pain
		Post-procedural pain using VAS	Correlation between procedure and perceived pain in intravitreal injections
Senra et al. [33]	Observational, cross-sectional study; mixed methods	Qualitative data on patients’ experience with treatment	56% of patients reported anxiety related to anti-VEGF treatment. The main sources of anxiety: fear of going blind due to intravitreal injections and concerns about treatment effectiveness, rather than pain
		Standardized validated questionnaires to quantify clinically significant levels of anxiety (HADS-Α), depression (HADS-D), and posttraumatic stress (patients) (IES-R), cognitive function (MMSE) and caregivers’ burden	• 17% of patients showed clinical levels of anxiety • 12% showed clinical levels of depression • Depression levels, but not anxiety, were significantly higher in patients who received ≤3 injections compared with patients who received 4–12 injections and patients who received > 12 injections
Sloan et al. [23]	Longitudinal	Number of patients newly diagnosed with depression during the follow-up period (measure or method not stated)	A new diagnosis of depression during the follow-up period was found to be 2%; there was no statistical difference between those who had anti-VEGF treatment and those who did not
		Need for admission to a long-term care facility	Receipt of anti-VEGF therapy was associated with a 19% lower probability of entry into a long-term care facility

Abbreviations: AMD age-related macular degeneration, CES-D Center for Epidemiological Studies Depression scale, HADS Hospital Anxiety and Depression Scale, IES-R Impact of Events Scale-Revised, IVI Impact of Vision Impairment scale, IVR intravitreal injection of ranibizumab, MMSE Mini-Mental State Examination, NEI VFQ-25 National Eye Institute Visual Function Questionnaire, PHQ-9 Patient Health Questionnaire 9, PSS Perceived Stress Scale, SD standard deviation, VAS visual analogue scale, VASA visual analogue scale for anxiety, VEGF Vascular endothelial growth factor, VRQoL vision-related quality of life