Understanding of Age-Related Macular Degeneration Diagnosis

Understanding of Age-Related Macular Degeneration Diagnosis and Patient Use of Computers
Tina Saparia1, AC Roch-Levecq2, BL Broday2
Age-related macular degeneration (AMD) is the leading cause of irreversible vision
loss and decreased visual acuity among the elderly in industrialized countries. It is
rapidly disabling a growing number of elderly persons as societies age. AD is a
degenerative disorder associated with aging that gradually destroys sharp, central
vision. By affecting the macula, which is the part of the eye necessary to see fine
detail1. Oftentimes. AMD progresses so gradually that one may not even notice
change in vision, and other times, it progresses more rapidly and leads to loss of
central vision in both eyes. Although research for treatment of AMD is underway,
including research on laser surgery, injections and vitamin therapy, there is
currently no cure for this disease. For this reason. Patients with AMD often can
have difficulty with various everyday tasks such as reading, driving, and recognizing
University of California, San Diego, School of Medicine; [email protected]
2. Department of Ophthalmology, University of California, San Diego
Of the 132 subjects with AMD, 104 reported to be computer users, whereas the
remaining 28 subjects did not use computers.
In our recent AMD Registry Study. A number of parameters were evaluated on
patients with AMD, including demographic information, computer usage, clinical
characteristics, and knowledge and understanding of AMD, diagnosis validation,
and the psychosocial impact of AMD on their lives5. The present descriptive study
investigates whether people who have access to the computer have an
understanding of their AMD diagnosis.
Materials and Methods
Participants: 132 older subjects (mean age=76.4, SD=7.2, 53.8% female) were
randomly selected from the Shiley Eye Center AMD Assist Registry that serves
San Diego County. The study was carried out at the Shiley Eye Center, UCSD
Department of Ophthalmology. Informed consent was obtained.
Procedure: Subjects were interviewed using a battery of medical and psychosocial questionnaires including the National Eye Institute Vision Function
Questionnaire (NEI-VFQ), AMD Self-Efficacy Questionnaire and the Geriatric
Depression Scale. Fundus photographs of subjects’ dilated eyes e=were also
obtained. Each participant was then examined by an ophthalmologist at the Shiley
Eye Center to assess their disease state using a standardize protocol.
Analysis: Statistical analyses using non-parametric tests were performed to
determine factors involved in computer use, knowledge of care for AMD,
understanding their own diagnosis, and the psycho-social impact of AMD.
While one may assume that computer users, who presumably have access to
the internet, could be better informed of their disease state, the results from
this study showed otherwise. Comparison of the actual stage of AMD with
patient self-reported AMD stage revealed no significant difference in accurate
knowledge of their AMD diagnosis between computer users and non-users.
In previous studies conducted at the Shiley Eye Center, a self-management
program for patients with advanced AMD significantly improved function,
increased self-efficacy, prevented the incidence of depression2 and reduced
depressive symptoms3. The present study, having shown that the majority of
patients with early, intermediate and advance AMD were not well informed
about their disease diagnosis, suggest that self management programs also
may be effective in improving patient knowledge of their disease states.
104 (7.8%) (mean age=75.6, SD=6.7) subjects reported having computers with 80
(76.9%) using the computer at least weekly to access the internet. Those who
reported having a computer were more likely to be younger (<75 years of age),
p=0.01, to have a better vision, (Best LogMar Mean=0.26 vs. 0.52), and more years
of education, P=0.01, M=15.8 years (SD=2.9) vs. M=13.9 years (SD-3.1). Those who
reported having a computer also had lower GDS scores, p-0.08, (Total GDS Score=
1.63 Vs. 2.79) better NEI-VFQ scores, p=0.003, (Total NEIVFQ Score=80.0 vs. 68.5),
and higher AMD self-efficacy scores, p=0.002, (Total AMD Self-efficacy Score=80.4
“Age-Related Macuar Degeneration.” National Eye Institute. Dec 2008. National
Institutes of Health http://www.nei.nih.gov/health/maculardegeneration/index.asp
Brody BL, Roch-Levecq A-C, Thomas RG, Kaplant RM, Brown SI: Self-Management
of Ate-Related Macular Degeneration at the 6-month Follow-up. Archives of
Ophthalmology. 123: 46-53, 2005.
Brody BL, Roch-Levecq A-C, Thomas RG, Kaplant RM, Brown SI: Age-Related
Macular Regeneration: Self-Management and Reduction of Depressive Symptoms in
a Randomized, Controlled Study. Journal of American Geriatrics Society.
Spek V, Cuijpers P, Nyklocek I, Smits N, Tiper H, Keyzer J, Pop V: One-Year followup of a randomized controlled clinical trial on internet-based cognitive behavioral
therapy for sub threshold depression in people over 50 years. Psychological
Medicine. 2008: 38(5):635-9.
Special thanks to Linda Field for her continued support and encouragement
throughout this project.
This works was supported, in part, by the National Institute of Aging Gran
T35AG026757 and the Sam and Rose Stein Institute for Research on Aging at the
University of California, San Diego.

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