Exploring the Experiences of Newly Certified Midwives and Women's Health Nurse Practitioners in Medically Underserved Populations.

With the rise in life expectancy and the aging of the global population, maintaining independency in daily living activities in older adults is a major challenge for our societies. Vision being involved in most activities of daily living (shopping, using transportation, dressing, using the telephone, managing medications…), visual impairment is associated with an increased risk of disability, in particular in individuals with visual acuity below 20/40 (Daien et al., ; Nael et al., ; Peres et al., ). Visual impairment is also associated with falls and fractures (Lamoureux et al., ; Patino et al., ; Yip et al., ), as well as mood disorders, especially depression (Chou, ; Cosh et al., , ; Evans et al., ; Zhang et al., ), which may further increase the risk of disability. Advanced AMD (atrophic and/or neovascular) is naturally associated with major visual impairment and a leading cause of blindness in industrialized countries (GBD 2019 Blindness, ). However, since their first authorization in 2007, treatments with intravitreal anti‐vascular endothelial growth factor (VEGF) agents have profoundly changed the visual prognostic of neovascular AMD (nAMD). Indeed, they result in a mean gain of about 7 ETDRS letters at 2 years, compared with a mean loss of 15 ETDRS letters in the placebo arm in the pivotal trials (Rosenfeld et al., ; Schmidt‐Erfurth et al., ). Real‐world studies confirmed the initial gain in vision with anti‐VEGF therapy, with about half of the patients attaining a best‐corrected visual acuity (BCVA) of at least 20/40 at 2 years (Barthelmes et al., ; Fu et al., ). However, visual impairment cannot always be avoided over the long run, because of insufficient treatment efficacy and/or the occurrence of retinal atrophy in one or both eyes, although half of the patients retained a BCVA greater than 20/200 after 8 years in a retrospective study (Fu et al., ). A few studies from the pre‐anti‐VEGF era have shown a major increased risk of disability in patients with advanced AMD and in particular nAMD. In an international case–control study performed in 2005, assistance in activities of daily living was 4 times more frequent in patients with bilateral nAMD than in controls (Soubrane et al., ). The rate of falls was also twice as high in cases, and scores of anxiety and depression were 30% and 42% higher (Soubrane et al., ). In the Blue Mountains Eye Study, advanced AMD at baseline (2002–2004) was associated with a 13‐fold increased risk of incident disability at 5 years (2007–2009). However, there is a lack of recent data in nAMD treated with anti‐VEGF agents.