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Klin Monbl Augenheilkd 2010; 227(8): 646-652
DOI: 10.1055/s-0029-1245118
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© Georg Thieme Verlag KG Stuttgart · New York

Neue Erkenntnisse zur unterschätzten Beeinträchtigung der Lebensqualität bei altersbedingter Makuladegeneration – ein Literaturüberblick

New Insights into the Underestimated Impairment of Quality of Life in Age-Related Macular Degeneration – a Review of the LiteratureB. Meyer-Ruesenberg1 , G. Richard1
  • 1Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf
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Publication History

Eingegangen: 10.12.2009

Angenommen: 19.12.2009

Publication Date:
06 May 2010 (online)

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Zusammenfassung

Die altersbedingte Makuladegeneration (AMD) führt unabhängig von ihrem klinischen Erscheinungsbild bei den betroffenen Patienten zu erheblichen Visusminderungen bis hin zur Erblindung. Daher hat sie starke Auswirkungen auf das tägliche Leben der Patienten und führt zu massiven Einschränkungen ihrer psychischen Verfassung, Autonomie und Mobilität. Diese Einschränkungen wirken sich auf die Lebensqualität der Patienten aus. Der Begriff der Lebensqualität ist schwierig zu definieren. Er setzt sich aus unterschiedlichen Faktoren zusammen, die verschiedene Testverfahren zu messen versuchen. Neben dem allgemeinen Gesundheitsstatus und dem psychologischen Wohlbefinden spielt hier v. a. die visusabhängige Alltagsfunktionalität eine wichtige Rolle. Um den Einfluss verschiedener Erkrankungen auf die Lebensqualität vergleichen zu können, wurde die sog. Utility Analysis entwickelt. Sie legt eindrucksvoll die häufig unterschätzte Bedeutung der AMD für den Patienten dar und zeigt, dass die Einschränkungen durch die AMD vergleichbar mit anderen schweren Systemerkrankungen wie bösartigen Tumoren oder HIV sind. Gleichzeitig zeigt sich, dass die betreuenden Augenärzte die Beeinträchtigung der Patienten häufig erheblich unterschätzen. Verschiedene Therapieverfahren haben die Lebensqualität der Patienten beeinflusst, jedoch können weiterhin viele Patienten nicht behandelt werden. Sie profitieren von Rehabilitationsmaßnahmen wie der Versorgung mit technischen Hilfsmitteln oder psychosozialen Unterstützungsprogrammen. Weitere klinische Studien von hoher Evidenz unter Verwendung valider und vergleichbarer Testverfahren sind erforderlich, um Therapie und Rehabilitation zu optimieren und die Lebensqualität der Patienten messbar zu steigern.

Abstract

Different forms of age-related macular degeneration (AMD) can lead to massive visual impairment up to blindness. Therefore, AMD has a high impact on patients’ daily life and causes restrictions of their psychological well-being, autonomy and mobility. These restrictions influence their quality of life. It is difficult to define the term ”quality of life”. It consists of different aspects that can be measured with psychometric tests. Besides the general health status and the psychological well-being, the vision-specific functional status plays a central role for determining the quality of life of AMD patients. To compare the impact of different diseases on the quality of life, the utility analysis has been developed. It demonstrates the relevance of AMD for patients and shows that its impact on patients’ life is comparable to those of other systemic diseases like carcinoma or HIV. The impairment of patients’ quality of life by AMD is often underestimated by their attending ophthalmologists. Different medical treatments have influenced the quality of life of AMD patients. However, there is still a large group that cannot be treated. These patients benefit from rehabilitation with low vision aids or psychosocial interventions. Further clinical trials at a high evidence level using valid and comparable psychometric tests are necessary to improve the therapy for and the rehabilitation of AMD patients and to increase their quality of life.

Schlüsselwörter

altersbedingte Makuladegeneration - Lebensqualität - psychologisches Wohlbefinden - Utility Analysis - visusabhängige Alltagsfunktionalität

Key words

age-related macular degeneration - quality of life - psychological well-being - utility analysis - vision-specific functional status

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Dr. Birthe Meyer-Ruesenberg

Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf

Martinistr. 52

20246 Hamburg

Phone: ++ 49/4 07 41 05 23 01

Fax: ++ 49/4 07 41 05 78 03

Email: b.meyer-ruesenberg@uke.de