Study Participants

Overall, 466 participants were included: participants had a mean age of 68 years and over half of the participants were female (n = 250, 54%). In most participants (n = 335, 72%), unilateral vision was affected.

Treatment for Wet AMD

Overall, participants were receiving intravitreal wet AMD therapy for a mean (standard deviation [SD]) of 3.9 (10) years. Participants received ranibizumab (37%), aflibercept (33%), bevacizumab (23%), or other anti-VEGF agents (7%), and most participants received their treatment in an outpatient setting consisting of a large practice with at least six ophthalmologists (62%, Table 1).

Table 1 Treatment received by patients with wet AMD and treatment settingsPreference Drivers of Patients with Wet AMDAggregated Overall and Country Results

Of all the domains included in the study, treatment effects, vision-related symptom burden, and risk of treatment-related issues were the most important domains, globally and in all included countries. In Germany, psychological burdens were considered significant; however, in the USA and France, impact on daily activities was one of the most important attributes in addition to vision-related symptom burden and treatment effects among the participants with wet AMD. In Canada and Australia, burden of hospital visits was a significant attribute. A similar trend was observed in participants of both genders and laterality.

Treatment Effect

The three attributes within the domain “treatment effect” were treatment effect on symptoms, time to treatment effect, and time to re-administration. Treatment effect on symptoms was the most important attribute followed by time to treatment effect and time to re-administration, across all the countries, both genders, and laterality. Treatment effect on symptoms was not statistically significant as compared with time to treatment effect in participants across Australia, France, and the UK. In Japan and the USA, treatment effect on symptoms was statistically significant compared with time to treatment effect. Time to re-administration was a significant attribute across all the included countries (Fig. 2 and Fig. S1 in the supplementary material).

Fig. 2

Global and country-specific treatment effect. ns non-significant

Vision-Related Symptom Burden

Clarity of vision and quality of vision were the attributes included in this domain (vision-related symptom burden). Clarity of vision was a significant attribute in Australia, Canada, Japan, Taiwan, the UK, and the USA, both genders, and laterality, whereas quality of vision was a significant attribute across all countries (Fig. 3 and Fig. S2 in the supplementary material).

Fig. 3

Global and country-specific vision-related symptom burden. ns non-significant

Burden of Clinic or Hospital Visits

Attributes included within the domain “burden of clinic or hospital visits” were frequency of visits, type of treatment, changing treatment team, treatment provider (i.e. nurse or doctor at the treatment facility), and treatment location. Participants across all the countries ranked the treatment location to be the most important attribute within this domain. Frequency of visits to clinics/hospitals was one of the most significant attributes within this domain across most included countries (except Germany and the UK), both genders, and laterality. Among participants from Japan, type of treatment administration was the most important attribute, whereas in Germany, burden of changing the treatment team was a significant attribute to the participants. In France, the burden associated with treatment provider was considered significant (Fig. 4 and Fig. S3 in the supplementary material).

Fig. 4

Global and country-specific burden of clinic or hospital visits. ns non-significant

Risk of Treatment-Related Safety and Tolerability Issues

Attributes included in the domain “risk of treatment-related safety and tolerability issues” were risk of damage to the treated eye, risk of major side effects immediately after treatment (requiring hospitalization), risk of minor side effects immediately during/after treatment (not requiring hospitalization), and lack of approval from national health authorities for treating wet AMD. Among participants in all the countries except France, risk of eye damage was the most troublesome attribute within this domain. Participants in France considered risk of major side effects immediately after treatment as the most important attribute. Participants in Japan, Germany, and Spain perceived the risk of minor side effects immediately during/after treatment to be more significant than lack of approval from national authorities for treating wet AMD, whereas participants in all other countries perceived these two effects to be similar in burden and the differences were not statistically significant (Fig. 5). Of the four attributes in this domain, risk of damage to the treated eye was the most important attribute, irrespective of the gender and laterality (Fig. S4 and in the supplementary material).

Fig. 5

Global and country-specific risk of treatment-related safety and tolerability issues or events. ns non-significant

Impact of Wet AMD on Daily Activities

In the domain “impact of wet AMD on daily activities”, the four attributes included were impact on work, impact on screen-based activities, impact on hobbies, and impact on independence. Participants across all the countries, both genders, and laterality ranked impact on work as the most significant attribute followed by impact on screen activities, impact on independence, and lastly impact on hobbies. The difference in impact on work and impact on screen-based activities was not significant across most included countries; similarly, difference between impact on screen activities and impact on independence was not significant in 60% of the countries (Fig. 6 and Fig. S5 in the supplementary material).

Fig. 6

Global and country-specific impact on daily activities. ns non-significant

Impact of Wet AMD on Psychological Well-Being

The three attributes included in the domain “impact of wet AMD on psychological well-being” were worry about future health and well-being, impact of wet AMD on emotional well-being, and worry about financial well-being. Worry about future health and well-being was the most important attribute globally, and across both genders, and laterality (Fig. 7 and Fig. S6 in the supplementary material).

Fig. 7

Global and country-specific impact on psychological well-being. ns non-significant

Patient Activation Measure (PAM)

PAM-13 analysis of patient activation showed the proportion of patients with level 1 (n = 116, 25%), level 2 (n = 78, 17%), level 3 (n = 217, 47%), and level 4 (n = 46, 10%) PAM globally. The majority of participants from Taiwan (n = 45, 75%), USA (n = 43, 62%), the UK (n = 22, 56%), Canada (n = 23, 51%), and Australia (n = 21, 51%) were level 3 PAM (Table 2). However, a significant proportion of participants included in the study from Japan (n = 31, 70%) were in level 1 PAM.

Table 2 Global and country-specific Patient Activation Measure-13 (PAM) results