Exploring patient acceptability of emerging intravitreal therapies for geographic atrophy: A mixed-methods study

• Published in: Eye (London) Vol. 37; no. 17; pp. 3634 - 3642
• Main Authors: Enoch, Jamie, Ghulakhszian, Arevik, Sekhon, Mandeep, Crabb, David P., Taylor, Deanna J., Dinah, Christiana
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.12.2023; Nature Publishing Group
• Subjects: 692/700/228; 692/700/784; Acuity; Age; Angiogenesis Inhibitors - therapeutic use; Atrophy; Decision making; Female; Geographic Atrophy - drug therapy; Humans; Intravitreal Injections; Laboratory Medicine; Macular degeneration; Male; Medicine; Medicine & Public Health; Ophthalmology; Patients; Pharmaceutical Sciences/Technology; Surgery; Surgical Oncology; Vascular Endothelial Growth Factor A - therapeutic use; Visual Acuity; Wet Macular Degeneration - complications; Wet Macular Degeneration - drug therapy
• ISSN: 0950-222X; 1476-5454; 1476-5454
• DOI: 10.1038/s41433-023-02571-3

Background/Objectives The acceptability of emerging intravitreal therapies for patients with Geographic Atrophy (GA) is currently unknown. This study therefore aimed to investigate the extent to which regular intravitreal injections may be acceptable to GA patients. Subjects/Methods Thirty UK-based individuals with GA secondary to age-related macular degeneration (AMD), recruited from two London-based hospitals, were interviewed in April-October 2021 regarding acceptability of new GA treatments. Participants responded to a structured questionnaire, as well as open-ended questions in a semi-structured interview. The Theoretical Framework of Acceptability (TFA) informed framework analysis of the qualitative data. Results Twenty participants (67%) were female, and median (interquartile range (IQR)) age was 83 (78, 87) years. 37% of participants had foveal centre-involving GA, and better eye median (IQR) logMAR visual acuity was 0.30 (0.17, 0.58). Data suggested that 18 participants (60% (95% CI: 41–79%)) would accept the treatment, despite awareness of potential drawbacks. Eight participants (27% (95% CI: 10–43%) were ambivalent or undecided about treatment, and four (13%) (95% CI: 0–26%) would be unlikely to accept treatment. Reducing the frequency of injections from monthly to every other month increased the proportion of participants who considered the treatments acceptable. Conversely, factors limiting acceptability clustered around: the limited magnitude of treatment efficacy; concerns about side effects or the increased risk of neovascular AMD; and the logistical burden of regular clinic visits for intravitreal injections. Misunderstandings of potential benefits indicate the need for appropriately-designed patient education tools to support decision-making. Conclusions Our study suggests a majority of participants would be positive about intravitreal treatment for GA, in spite of potential burdens.