• Ei tuloksia

The general aim of this study was to evaluate the neurophysiological changes of wet AMD patients after the anti-VEGF treatment and to assess whether whole-field pattern VEP could be used as a monitoring tool of AMD patients. In addition, the cost-effectiveness of AMD treatment was evaluated.

The specific aims were as follows:

I To identify the possible visual evoked potential changes after the anti-VEGF treatment (Publication I).

II To evaluate if visual evoked potential changes correlate with clinical findings of treated patients (Publication II).

III To study whether binocular face detection is affected by monocular wet AMD (Publication III).

IV To construct a two-eye Markov transition model for the cost-effective analysis of AMD treatment and to identify the most cost-effective treatment protocol and medication for wet AMD (Publication IV).

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9 Conclusions

I In wet AMD VEP is abnormal. The anti-VEGF treatment of wet AMD patients exerts an effect on the neurophysiological responses. VEP amplitudes appear to increase after treatment, suggesting that there is improved visual processing.

II In treated wet AMD patients, the improvement in visual acuity and the increase in VEP amplitude are associated with a decrease in retinal thickness as measured by OCT.

However, there is no evidence from short term follow-up that VEP confers added value in the diagnosis or monitoring of wet AMD.

III Monocular wet AMD clearly influenced face-specific brain electrophysiological components. However, our wet AMD patients had not lost their binocular face detection ability. This supports the view that only the vision of the better seeing eye has a marked influence on every-day life.

IV In the cost-effectiveness analysis of wet AMD treatment, monthly injected bevacizumab is the most cost effective treatment and; monthly treatment with ranibizumab being the least cost effective.

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67

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