***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE To describe the effect of subfoveal choroidal neovascularization ( CNV ) from age-related macular degeneration ( AMD ) on health-related quality of life ( HRQOL ) of patients at enrollment in two r and omized clinical trials ; to examine the relation of visual acuity to HRQOL ; to compare HRQOL scores between participants with unilateral and bilateral CNV independent of other characteristics . DESIGN R and omized clinical trials . METHODS Two Submacular Surgery Trials ( SST ) recruited patients with AMD and either new subfoveal CNV ( Group N Trial ) or predominantly hemorrhagic CNV ( Group B Trial ) .  Health-related quality of life interviews  included the  National Eye Institute Visual Function Question naire [ NEI-VFQ ] , the SF-36 Health Survey  , and the  Hospital Anxiety and Depression Scale [ HADS ] .  Linear correlation and regression analyses were used to relate baseline HRQOL scores to visual acuity and bilateral disease . RESULTS Interview data were analyzed for 789 AMD patients : 454 patients in the Group N Trial and 335 patients in the Group B Trial . Participants reported poor vision-related functioning in many domains measured by the NEI-VFQ ( mean overall scores of 65 for Group N and 63 for Group B ) . Visual acuity of the better eye was strongly associated with NEI-VFQ scores but not with SF-36 or HADS scores . After adjusting for visual acuity of the better eye and other factors , bilateral cases had NEI-VFQ overall scores six points lower than unilateral cases in Group N Trial and 10 points lower than unilateral cases in the Group B Trial . CONCLUSIONS Subfoveal CNV profoundly affects vision-related quality of life . The effect is more pronounced with bilateral disease , even after controlling for visual acuity PURPOSE To assess patient perceptions concerning discomfort and changes in vision associated with  intravitreal triamcinolone injections ( IVTA ) .  DESIGN Prospect i ve consecutive case series . METHODS Fifty patients treated with IVTA between June 2003 and February 2005 were interviewed by telephone 10 to 12 weeks after injection . Each question was answered on a 1 to 5 scale . RESULTS There was no significant difference in reported amount of ocular discomfort pre-injection vs post-injection ( 1.0 vs 1.1 , respectively ) . Expected pain level ( 2.9 ) was higher than the actual pain level ( 1.6 ; P < .001 ) . Patients '  self-reported vision improved from 2.7 to 3.7 ( P < .001 ) . Thirty ( 60 % ) patients reported improved vision and 20 ( 40 % ) reported no change . Thirty-three ( 66 % ) patients reported more visual improvement than expected . CONCLUSIONS Patient expectation of discomfort during IVTA was greater than their actual experience ; approximately two-thirds of patients reported improved vision and about one-third reported improved functional status after injection Purpose : To determine factors associated with patients ' comfort during routine in-office intravitreal injection . Methods : Sixty patients receiving intravitreal injections over 15 months for macular edema because of diabetes , age-related macular degeneration , or retinal vein occlusion who were r and omized into 3 groups to receive 1 of 3 commonly used forms of anesthesia — TetraVisc , proparacaine HCl , or tetracaine HCl — before receiving intravitreal injection were studied . Fifteen minutes after injection , patients were asked to rate their pain from 0 ( no pain/no distress ) to 10 ( agonizing pain/unbearable distress ) using a Visual Analog Pain score survey . Self-reported pain scores were stratified by age , gender , diagnosis , injection number , substance injected , needle gauge , and visual acuity improvement . Results : Intravitreal injection was associated with low pain scores . Patients receiving tetracaine reported a statistically significant lower pain score ( 3.05 ± 2.01 ) than patients receiving proparacaine ( 3.17 ± 2.18 ) or TetraVisc ( 3.3 9± 2.26 ; P < 0.01 ) . Other important factors influencing pain score significantly ( P < 0.01 ) included improved vision from previous injection , female sex , and age > 65 years . Pain scores decreased with each consecutive injection . Conclusion : Pain associated with intravitreal injection is generally mild , and may be associated with epidemiologic and environmental factors PURPOSE To determine the quality of life ( QOL ) of patients with bilateral severe age-related macular degeneration ( AMD ) before macular translocation with 360 degrees peripheral retinectomy .  DESIGN Prospect i ve , consecutive , noncomparative case series . METHODS An observational study assessed vision-related and general health QOL using the 25-item National Eye Institute Visual Function Question naire ( NEI VFQ-25 ) and the Medical Outcomes Study 12-item short form ( SF-12 ) surveys , respectively . Mean QOL scores were correlated with patient age , duration of vision loss , and visual function . Mean QOL scores in study patients were compared with mean QOL scores in groups of patients with low vision , patients with AMD of varying severity , and reference population s. MAIN OUTCOME MEASURES National Eye Institute VFQ-25 and SF-12 QOL scores . RESULTS Seventy patients with a mean age of 76.4 years were studied .  Mean distance visual acuity ( VA ) was 62.4 ( Early Treatment Diabetic Retinopathy Study letters ) , mean near VA was 0.81 ( logarithm of the minimum angle of resolution ) , and mean reading speed was 74.9 words per minute . Important NEI  VFQ-25 quality of vision subscales ( general vision , difficulty with distance tasks , difficulty with near tasks ) and vision-specific subscales ( dependency , role difficulties , mental health , social function limitations ) tended to correlate negatively with increasing patient age and duration of vision loss , but correlated positively with better VA and reading speed . The mean QOL scores for these important quality of vision and vision-specific subscales were significantly worse than or similar to mean scores in patients with low vision , and significantly worse than scores in patients with AMD of varying severity and a reference population . The mean SF-12 physical composite score in study patients was similar to that seen in patients with AMD of varying severity , but significantly higher than that in patients with low vision and a reference population . The SF-12 mental composite score in study patients was similar to those of all 3 comparison groups . CONCLUSIONS Patients with bilateral severe AMD have vision-related QOL similar to that of patients with low vision but significantly worse than those of patients with AMD of varying severity and persons without eye disease . This inability to perform vision-related daily tasks is not related to general health problems OBJECTIVE To examine ( 1 ) the prevalence of depressive disorders in community-dwelling adults with advanced age-related macular degeneration ( AMD ) and ( 2 ) the relationship in this population between depression , visual acuity , the number of comorbid medical conditions , disability caused by vision loss as measured by the National Eye Institute-Vision Function Question naire ( NEI-VFQ ) and the  vision-specific Sickness Impact Profile ( SIPV ) , and disability caused by overall health status as measured by the Sickness Impact Profile-68 ( SIP ) . DESIGN Analysis of cross-sectional baseline data from a r and omized clinical trial . PARTICIPANTS Participants were 151 adults aged 60 and older ( mean age , 80 years ) with advanced macular degeneration whose vision was 20/60 or worse in their better eye . METHODS Subjects were interviewed using measures of depression , disability , and chronic medical conditions . Visual acuity was obtained . Nonparametric correlation analyses and linear regression analyses were performed . MAIN OUTCOME MEASURES Structured Clinical Interview for DSM-IV ( SCID-IV ) , Geriatric Depression Scale ( GDS ) , NEI-VFQ , SIPV , and SIP . RESULTS Of the participants , 32.5 % ( n = 49 ) met SCID-IV criteria for depressive disorder , twice the rate observed in previous studies of community-dwelling elderly . Over and above depression ( GDS ) , visual acuity aided in prediction of the level of vision-specific disability ( NEI-VFQ and SIPV ) . CONCLUSIONS Depressive disorder is a significant problem for the elderly afflicted with advanced macular degeneration . Further research on psychopharmacologic and psychotherapeutic interventions for depressed AMD patients is warranted to improve depression and enhance functioning . Over and above depression , visual acuity aided in predicting vision-specific disability . Treatment strategies that teach patients to cope with vision loss should be developed and evaluated Aim : To investigate the effects of an informational video on patient expectations and satisfaction with day-stay cataract surgery .  Methods : 141 patients undergoing day-stay cataract surgery were r and omised into one of two video groups , explaining either what to expect from the cataract surgery or the anatomy of cataract . Patients were surveyed as to their expectations for visual outcome , anxiety , risk , and discomfort result ing from the surgery . After the operation , patients were again asked to rate their experience of anxiety , discomfort , risk , comprehension , overall satisfaction , and comparison with expectations . Results : 84 % of patients already thought they received enough or too much information . The expectations video group expected more risk and discomfort than the anatomy video group . Yet , after the surgery , the expectations video group was significantly more satisfied , understood better what was happening to them , and felt less anxious . There was no difference in the discomfort or risk actually experienced , or the expected visual outcomes .  Patients with previous cataract surgery experience expected less anxiety and discomfort , and found the surgery closer to their expectations . None the less , previous cataract surgery experience did not negate the effects of the video . Conclusions : This study demonstrates that a simple , inexpensive videotape showing patients what to expect from cataract surgery results in significant increases in patient underst and ing of and satisfaction with the cataract surgery , as well as a decrease in anxiety . These effects were independent of patients ’ expected outcomes or previous experience with cataract surgery , and despite the fact that patients generally thought they had already received enough information PURPOSE To compare the anesthetic effectiveness of 3 topical agents used for intravitreal injections . DESIGN R and omized , triple-armed , double-blinded , prospect i ve , single-centered trial in patients receiving intravitreal ranibizumab for neovascular age-related macular degeneration . METHODS Patients were r and omized 1:1:1 to receive 0.5 % tetracaine hydrochloride drops and a 4 % lidocaine pledget ( n = 31 ) , 0.5 % tetracaine hydrochloride drops alone ( n = 31 ) , or 4 % cocaine ( + epinephrine 1/100,000 ) drops alone ( n = 31 ) . Patients were asked to score their pain experience using a visual analogue scale ( VAS ) immediately following and 15 minutes after their injection . The average of these scores was used as the primary outcome . The physician performing the procedure separately scored his perception of the patients ' pain using the Wong-Baker FACES scale . RESULTS Means of the averaged VAS pain score for Groups 1 , 2 , and 3 were : 19 ( 95 % confidence interval [ CI ] 12 - 26 ) , 21 ( 95 % CI 13 - 29 ) , and 21 ( 95 % CI 16 - 27 ) respectively . Mean Wong-Baker pain scores for Groups 1 , 2 , and 3 were 1.9 ( 95 % CI 1.3 - 2.6 ) , 2.1 ( 95 % CI 1.4 - 2.7 ) , and 2.3 ( 95 % CI 1.6 - 3.1 ) respectively . There was no significant difference ( P = .549 ) between groups for average VAS pain score . Similarly , there was no significant difference ( P = .790 ) for the physician-perceived pain score between groups . CONCLUSIONS There was no clinical difference in  patient pain experience between the 3 anesthetic options tested . The addition of a 4 % lidocaine pledget offered no clinical advantage in pain relief compared to 0.5 % tetracaine or 4 % cocaine ( + epinephrine 1/100,000 ) drops alone Purpose : To compare the effectiveness of four different anesthetic methods for intravitreal injection . Methods : Twenty-four patients each received four  intravitreal injections using each of four types of anesthesia ( proparacaine , tetracaine , lidocaine pledget , and subconjunctival injection of lidocaine ) in a prospect i ve , masked , r and omized block design . Pain was grade d by the patient on a 0 to 10 scale for both the anesthesia and the injection . Results : The average combined pain scores for both the anesthesia and the intravitreal injection were 4.4 for the lidocaine pledget , 3.5 for topical proparacaine , 3.8 for the subconjunctival lidocaine injection , and 4.1 for topical tetracaine . The differences were not significant ( P = 0.65 ) . There were also no statistical differences in the individual anesthesia or injection pain scores . Subconjunctival lidocaine injection had the most side effects . Conclusion : Topical anesthesia is an effective method for limiting pain associated with intravitreal injections 
    Output:
    
These studies have focused primarily on patients ' experiences of the injection procedure with respect to pain and anxiety .
Anticipated discomfort is often greater than actual discomfort experienced during intra-vitreal injection .
However , different stages of the treatment procedure produce varying levels of patient discomfort .
No one method of anaesthesia has consistently been shown to be more effective in reducing discomfort associated with treatment .
Common reasons underlying patient apprehension surrounding treatment include the thought of having an injection , fear of losing eyesight and fear of the unknown .