Prevalence and risk factors for depressive symptoms in patients with neovascular age-related macular degeneration who present for anti-VEGF therapy.

PURPOSE: To examine the prevalence and risk factors for depressive symptoms in patients with neovascular age-related macular degeneration (nAMD) presenting for anti-vascular endothelial growth factor (anti-VEGF) therapy. METHODS: In a clinic-based cohort of 547 patients with nAMD who presented for treatment, the Centre of Epidemiological Studies Depression 10-point scale (CES-D-10) and Mental Health Index (MHI) component of the 36-item Short Form Survey were administered to assess for the presence of depressive symptoms. Logistic regression analyses were used to calculate odds ratios and 95% confidence intervals for factors associated with an increased likelihood of depressive symptoms. RESULTS: The prevalence of depressive symptoms was 42.04% and 31.78% as per the CES-D-10 and MHI scales, respectively. Poor self-rated health (SRH) is associated with increased odds of depressive symptoms [multivariable-adjusted OR: 3.00 (95% CI 1.90-4.73) for CES-D-10; OR: 2.67 (95% CI 1.67-4.28) for MHI]. Impaired activities of daily living (ADLs) [multivariable-adjusted OR: 2.62 (95% CI 1.56-4.38) for CES-D-10; OR: 3.59 (95% CI 2.10-6.15) for MHI] and a visual function score within the two lowest quartiles were also associated with increased odds of depressive symptoms using both scales. CONCLUSION: A high prevalence of depressive symptoms was observed among nAMD patients presenting for treatment. Poorer SRH, ADL impairment and reduced visual function were associated with increased odds of depressive symptoms.

Dietary antioxidants are associated with presence of intra- and sub-retinal fluid in neovascular age-related macular degeneration after 1 year.

PURPOSE: To assess whether dietary intake of antioxidants, fruits, vegetables and fish is associated with 12-month treatment outcomes in neovascular age-related macular degeneration (nAMD) patients. METHODS: A total of 547 participants were diagnosed with nAMD at baseline, of whom 494 were followed up after 12 months of antivascular endothelial growth factor therapy. Dietary intakes were determined using a validated food frequency questionnaire. Presence of intra-retinal and sub-retinal fluid (IRF, SRF), pigment epithelial detachment (PED) and central macular thickness (CMT) were recorded from optical coherence tomography images. Best-corrected visual acuity was recorded using log of the Minimum Angle of Resolution (LogMAR) charts. RESULTS: Participants in the upper three quartiles combined compared to those in the first quartile of baseline dietary zinc intake had 49% reduced odds of SRF 12 months later, multivariable-adjusted odds ratio (OR) 0.51 [95% confidence interval (CI) 0.30-0.89]. The upper three quartiles combined compared to the first quartile of ß-carotene intake had 90% greater odds of IRF presence at 12-month follow-up, multivariable-adjusted OR 1.90 (95% CI 1.04-3.46). The highest versus lowest quartile of dietary ß-carotene intake had a nearly twofold greater odds of PED presence, multivariable-adjusted OR 1.99 (95% CI 1.03-3.84). CONCLUSION: A higher intake of dietary zinc was associated with a reduced likelihood of SRF at 1 year. Conversely, a higher intake of dietary ß-carotene was associated with an increased risk of IRF and PED. These findings underscore the importance of ongoing nutritional advice for nAMD patients presenting for treatment.

Dietary zinc intake is associated with macular fluid in neovascular age-related macular degeneration.

IMPORTANCE: Numerous dietary factors have been shown to reduce progression from early to late age-related macular degeneration (AMD), however, little is known on their impact in patients diagnosed with late-stage disease. BACKGROUND: To determine whether a dietary intake high in antioxidants and zinc, fruits, vegetables and fish is associated with favourable clinical outcomes in patients with neovascular AMD (nAMD) undergoing anti-vascular endothelial growth factor therapy. DESIGN: Cross-sectional study carried out at a private ophthalmology clinic. PARTICIPANTS: Five hundred forty-seven participants with nAMD. METHODS: Diet was determined using a validated food frequency questionnaire. Presence of intra-retinal and sub-retinal fluid (IRF, SRF), pigment epithelial detachment and central macular thickness (CMT) were recorded from ocular coherence tomography images. MAIN OUTCOME MEASURES: Fluid presence, mean CMT and visual acuity. RESULTS: Participants with daily zinc intake below (n = 91) vs above (n = 333) 8.1 mg had greater odds of SRF being present, multivariable-adjusted odds ratio (OR) of 0.56 (95% CI 0.36-0.96). This association was stronger in persons with at least 6 months of treatment, OR of 0.32 (95% CI 0.14-0.75). In the entire cohort, participants in the lowest or first quartile compared to those in the upper three quartiles of zinc intake combined had significantly greater mean CMT (254.81 µm vs 232.15 µm, respectively, multivariable-adjusted P = .03). CONCLUSIONS AND RELEVANCE: Low dietary zinc intake was associated with a greater likelihood of SRF presence, particularly in those treated for at least 6 months, and increased macular thickness in treated eyes with nAMD.