This prospective study, in accordance with the tenets of the Declaration of Helsinki and with the approval of the local ethics committee was performed on the patients who were diagnosed as having AMD and healthy control subjects free of systemic diseases except hypertension agreeing to participate. The Survey was administered using the online survey portal, Google forms® (Online survey services) between 01 and 05 June 2020 during the lockdown. The online link (https://forms.gle/pcFBm51nsHG2dZXj8) through WhatsApp was send to AMD patients and controls which were seen for refractive errors before the pandemic.
Patients with comorbid disorders except hypertension and ocular diseases such as glaucoma, vitreomacular traction, epiretinal membrane, macular hole, diabetic retinopathy, retinal detachment, previous retinal surgery, glaucoma, amblyopia, strabismus, severe media opacities were excluded. In accordance with our inclusion criteria, previously examined age-and sex-matched patients with refractive errors with a range of + 1.00-(-1.00) D were served as controls. The records of patients who met the our inclusion criteria were reviewed for demographic data and ophthalmologic measurements including best-corrected visual acuity, refractive error, slit-lamp evaluation, extraocular movements, intraocular pressure with pneumatic tonometer, and evaluation of macula using OCT.
Patients agreeing to participate were asked to complete the two online questionnaires: the HADS test, the NEI-VFQ-25 test using Google Forms.
HADS has been developed to measure anxiety and depression in the settings of an hospital out patient clinic and the community. It is an easily applicable and reliable self-rating scale that consists of two subscales, one measuring anxiety and an other measuring depression. Although the anxiety and depression items are interspersed with in the scale, these are scored separately. Each subscale has seven items answered by the patient on a four-point Likertscale. 3Total score ranges between 0 and 21 for each of the two subscales. Turkish validity and reliability of the scale was established by Aydemir et al. The cut-offscore of the Turkish version for anxiety subscale is 10 and 7 for depression subscale.4
To asses vision related quality life, we used The National Eye Institute Visual Function Questionnaire (NEI- VFQ-25) of which the validity and reliability in the Turkish population were assessed by Toprak et al9. It depends of 25 questions evaluating general health, general vision, ocular pain, near activities, distance activities, vision-specific social functioning, vision-specific mental health, vision-specific role difficulties, vision-specific dependency, driving, color vision, and peripheral vision.
The AMD group was divided into two subgroups10: dry type and wet type. The dry type group consisted of patients with early- and intermediate-stage AMD ranged from medium-sized drusen or mild RPE abnormalities to large-sized drusen. The wet type group consisted of patients with choroidal neovascularization, serous and/or hemorrhagic detachment of retina or RPE, hard exudates, fibrovascular proliferation, or disciform scar. For distinct analysis AMD group also divided into two subgroups: patients having binocular visual acuity worse than 0.3 and patients having binocular visual acuity equal to or better than 0.3.
SPSS software version 20.0 (SPSS Inc, Chicago, IL) was used for statistical analyses. The descriptive statistics presented include means and standard deviations (SD) for all variables. For comparing differences between groups, The Chi-square test, the Kruskal-Wallis test, and the Mann-Whitney U test with Bonferroni correction were used. Spearman’s correlation analysis was used to examine the relationships between the groups.