Session Title: Vitreoretinal Surgery III
Session Date/Time: Friday 18/09/2015 | 14:30-16:00
Paper Time: 15:34
First Author: : D.Chow CANADA
Co Author(s): : E. Rampakakis H. Hass
PURPOSE:To date, there is a paucity of data regarding the burden of symptomatic vitreomacular adhesion (sVMA). The aim of this study is to determine in the Canadian community, the clinical symptoms and complications of sVMA and its impact on healthcare resource utilization and patient quality of life (QoL).
Retrospective chart review of sVMA patients examined at 11 retina specialist offices. The impact of sVMA on patient QoL was assessed with a parallel cross-sectional survey.
Study eligible patients are adults with a physician-confirmed sVMA diagnosis after January 1st 2010 based on optical coherence tomography (OCT). Furthermore, patients must have been followed by the same physician and have available information for ≥1 year after sVMA diagnosis. QoL was assessed with the National Eye Institute Visual Function Questionnaire (VFQ-25). Descriptive statistics including the mean and standard deviation (SD) for continuous variables and counts and proportions for categorical variables were produced. All proportions were based on the total number of patients/eyes with available data. Time to vitrectomy and relevant predictors were assessed with multivariate Cox regression.
274 patients (chart review: n=200; survey: n=74) were included. Among the former, mean (SD) age at sVMA diagnosis was 69.9 (11.2) years, 67.8% were female, 78.6% were Caucasian, 19.5% had diabetes and 14.2% had cataract surgery. No remarkable differences were observed for survey participants. AMD (19.0%), diabetic retinopathy (12.1%), glaucoma (9.5%) and diabetic macular edema (7.3%) were the most common retinal comorbidities. At diagnosis, visual acuity was 20/63 ft (logMAR=0.5) and 16.0% exhibited bilateral sVMA; blurred vision (61.3%), metamorphopsia (24.7%) and central scotoma (14.7%) were the most common symptoms. On OCT, epiretinal membrane formation was observed in 36.1% (80.5% foveal) of eyes and lamellar hole in 5.6%. Full thickness macular hole (FTMH) was reported in 10.3% of eyes; of which 22.7% were <250 µm, 40.9% were 250-400 µm and 36.4% were >400 µm. Over a mean (SD) of 2.3 (1.1) years, 44.8% of eyes underwent vitrectomy whilst 10.8% exhibited spontaneous sVMA resolution. Significant independent baseline predictors of progression to vitrectomy were higher LogMAR (HR=3.1;P<0.001) and presence of FTMH (HR=5.9,P<0.001) at diagnosis. Patient QoL declined as early as six months from diagnosis [mean (95%CI) VFQ-25: 81.2 (56.2,106.2)] and remained relatively stable over five years.
Patients with sVMA have significant disease burden and lower QoL in Canada. Forty-five percent of eyes underwent vitrectomy and 10.8% exhibited spontaneous sVMA resolution. Worse vision and presence of FTMH at sVMA diagnosis were identified as significant independent predictors of progression to vitrectomy highlighting the need for early diagnosis and intervention in these high-risk patients.