Improving Outcomes for Patients with Age-Related Macular Degeneration and Cataracts: The Importance of Including an Assessment of Activities of Daily Life (ADL)

Abstract

Age-related macular degeneration (AMD) is the leading cause of blindness in the developing world. AMD causes a substantial burden on patients, reducing independence, their ability to conduct daily activities, and increasing rates of cognitive decline and depression. There is a significant unmet need for patients with AMD, which will grow as the population ages and rates of disease increase. In the past, many studies have demonstrated a benefit when coexisting cataract formation is treated by removing the cloudy lens. AMD-lenses are intraocular implants designed to improve visual acuity in patients with AMD, avoiding the need for cumbersome manual vision aids and magnifiers. Many IOLs have been investigated in AMD, with differing mechanisms aimed at overcoming visual impairment. Most AMD studies use Early Treatment Diabetic Retinopathy Study (ETDRS) chart-based assessments of vision, but BCVA does not correlate with lesion size or pattern, especially in geographic atrophy, and may not be the most appropriate measure to effectively assess vision defects in AMD before or after a cataract surgery. One option is a simple functional assessment of vision related to activities of daily living (ADL), based on a reproducible, task-based questionnaire. The test consists of 6 assessments of ADL to be completed by patients before and after cataract surgery. Experiences highlight the importance of including an assessment of ADL in patients receiving an implant, which gives an effective measure of patient satisfaction. We would welcome the use of similar questionnaires in larger studies of patients, to validate its utility in a broader patient population. In this review article, we (Scandinavian-Austrian-cooperation) summarize lenses designed for implantation in patients with AMD, and how best to improve outcomes through proper patient selection, appropriate vision evaluation using quality-of-life related assessment, and pre- and post-operative care.

Testing Activities of Daily Living (ADL) in Patients with Age-Related Macular Degeneration Undergoing Cataract Surgery: Lessons Learned from the Past and Development of a New Quality of Life (QOL) Test

“…This could be proven in our clinical case series as well as experienced in conventional cases when caring for visually impaired patients. [12][13][14] There are multiple intraocular vision-improving devices available for intervention in patients with moderate-to-severe AMD. While these advances in technology can offer hope to many patients, it is difficult to predict how well the results in the clinical literature will generalize to actual practice, thus limiting the number of surgical cases.…”

“…The items in the performance-based measure include ADL tasks considered to be visually demanding such as reading, writing and measuring. 12,15,16 The examiner provides the items needed for the test to ensure standardization of performance and the tasks are scored using standardized descriptive criteria.…”