Age-Related Macular Degeneration

The VEHSS team conducted a review of published literature on examination-based population studies reporting the prevalence of age-related macular degeneration (AMD).

Age-related macular degeneration (AMD) is a disorder of the macula that may cause severe loss of central vision. There are three stages of AMD: Early, intermediate, and advanced/late. Although some variation in stage classification exists, in general early stage AMD (also referred to as Age-Related Maculopathy [ARM]) is described as having numerous small drusen (<63 μm) (lipid deposits) and fewer medium drusen (63–125 μm) under the retina, or mild hypo- or hyperpigmentation of the retinal pigment epithelium (RPE) in at least one eye.(AAO, 2015) Intermediate AMD is distinguished by large drusen (> 125 μm), retinal pigment changes, or geographic atrophy of the RPE not in the center of the fovea.(AOA, 2015) AMD with the presence of drusen is also known as dry AMD. The Age-related Eye Disease Study (AREDS) simple classification system defined four stages of early/intermediate AMD, on the basis of the cumulative number of risk factors evident (consisting of large drusen and/or RPE abnormalities) across both eyes.

There are two types of advanced or late stage AMD, thatare the vision-threatening stages of AMD: neovascular/exudative AMD (also known as wet AMD) and pure geographic atrophy.(NEI, 2015) Neovascular/exudative AMD is indicated by the development of choroidal neovascularization (CNV).  CNV is the growth of new blood veins under the macula that could potentially leak.(NEI, 2015) Pure geographic atrophy is the degeneration of the RPE in the foveal center, causing scars in the foveal area and a loss of central vision. AMD is generally diagnosed through fundus photography.(Klein R, 1991) The photographs image the retina and optic nerves and can be examined for signs of AMD and other eye conditions.(Klein R, 1991)

Age-Related Macular Degeneration Literature Review Results

There were 23 studies published between 1993 and 2016 that examined the prevalence of AMD:

Table 1. Age-Related Macular Degeneration Prevalence Sources.

Table 1. AMD Prevalence Sources
Author Date of Publication Title Date of Data Collection Data Source Sample Size Prevalence Data Stratified by: Stage of AMD
Varma R, Choudhury F, et al. 2016 Prevalence of Age-Related Macular Degeneration in Chinese American Adults: The Chinese American Eye Study 2010–2013 CHES 4,582 Age, Sex, Race Early, Late, Wet, Dry, Any
Park D, Mansberger SL, et al. 2016 Eye Disease in Patients with Diabetes Screened with Telemedicine 2006–2009 Telemedicine Screening Program 424 Not stratified by demographic variables Any
Pedula KL, Coleman A, et al. 2015 Age-Related Macular Degeneration and Mortality in Older Women: The Study of Osteoporotic Fractures 1996–1998 SOF 1,202 Age, Race Early, Late, Any
 Wu EW, Schaumberg DA, et al.  2014 Environmental Cadmium and Lead Exposures and Age-related Macular Degeneration in U.S. Adults: the National Health and Nutrition Examination Survey 2005 to 2008  2005–2008 NHANES 2005–2008  5,390 Age, Sex, Race/Ethnicity  Any
Maa AY, Evans C, et al. 2013 Veteran Eye Disease After Eligibility Reform: Prevalence and Characteristics January 2008–February 2008 Atlanta VA Medical Center Chart Review 658 Not stratified by demographic variables Early, Late, Wet, Dry, Any
Zhang X, Cotch MF, et al.  2012 Vision Health Disparities in the United States by Race/Ethnicity, Education, and Economic Status: Findings from Two Nationally Representative Surveys 20052008; 19881994 NHANES 2005-2008, NHANES III 5,704; 8,208 Race/Ethnicity Any
Klein R, Chou CF, Klein BE, et al. 2011 Prevalence of Age-Related Macular Degeneration in the US Population 20052008 NHANES 2005-2008 5,553 Age, Race/Ethnicity, Sex Early, Late, Wet, Dry, Any
Butt AL, Lee ET, Klein R, et al. 2011 Prevalence and Risks Factors of Age-Related Macular Degeneration in Oklahoma Indians: The Vision Keepers Study 19951998 Vision Keepers Study: Oklahoma Indians 986 Age, Sex Early, Late, Wet, Dry
 VanderBeek BL, Zacks DN, et al.  2011  Racial Difference in Age-Related Macular Degeneration Rates in the United States: A Longitudinal Analysis of a Managed Care Network  20012007  A Longitudinal Analysis of a Managed Care Network  1,772,962  Age, Sex, Race/Ethnicity  Wet, Dry
Klein R, Cruickshanks KJ, Nash SD, et al. 2010 The Prevalence of Age-Related Macular Degeneration and Associated Risk Factors 20052010 Beaver Dam Offspring Study. 2,810 Age Early
Bressler SB, Muñoz B, et al. 2008 Racial Differences in the Prevalence of Age-Related Macular Degeneration 1993 The Salisbury Eye Evaluation  (SEE) Project 2,520 Race Early, Late, Wet, Dry
Klein R, Klein BE, Knudtson MD, et al. 2006 Prevalence of Age-Related Macular Degeneration in 4 Racial/Ethnic Groups in the Multi-Ethnic Study of Atherosclerosis 20002002 Multi-ethnic Study of Atherosclerosis (MESA) 6,176 Age, Sex, Race Early, Late
Mansberger SL, Romero FC, et al. 2005 Causes of Visual Impairment and Common Eye Problems in Northwest American Indians and Alaska Natives Unknown Northwest AIAN 288 Race Early, Late
Munoz B, Klein R, Rodriguez J et al. 2005 Prevalence of Age-Related Macular Degeneration in a Population-Based Sample of Hispanic People in Arizona: Proyecto VER 19971999 Proyecto VER 2,780 Age, Sex, Race/Ethnicity Early, Late
Varma R, Fraser-Bell S, Tan S, et al. 2004 Prevalence of Age-Related Macular Degeneration in Latinos: The Los Angeles Latino Eye Study 20002008 Los Angeles Eye Study (LALES) 5,875 Age, Race/Ethnicity Early, Late, Any
Friedman DS, O’Colmain BJ, Munoz B, et al; 2004 Prevalence of Age-Related Macular Degeneration in the United States. 19851998 EDPRG N/A Age, Race/Ethnicity, Sex Early, Late, Any
Lee PP, Feldman ZW, Ostermann J, et al. 2003 Longitudinal Prevalence of Major Eye Diseases. 1999 National Long-Term Care Survey Various Sex, Age, Race Any, Wet,  Dry
Klein R, Klein BE, Jensen SC, et al. 1999 Age-Related Maculopathy in a Multiracial United States Population: The National Health and Nutrition Examination Survey III. 19881994 NHANES III 8,270 Age, Sex, Race Early, Late, Wet, Dry
Friedman DS, Katz J, et al. 1999 Racial Differences in the Prevalence of Age-related Macular Degeneration 19851988 The Baltimore Eye Survey 5,308 Age, Race Early, Late, Wet, Dry
Klein R, Clegg L, et al. 1999 Prevalence of Age-related Maculopathy in the Atherosclerosis Risk Communities Study 19931995 Atherosclerosis Risk in Communities Study 11,532 Age, Race, Sex Early, Late, Wet, Dry
Cruickshanks KJ, Hamman, RF, Klein, R, et al. 1997 The Prevalence of Age-Related Maculopathy by Geographic Region and Ethnicity: The Colorado-Wisconsin Study of Age-Related Maculopathy 1983; 19881990 The San Luis Valley Diabetes Study; Beaver Dam Eye Study 1,541; 3,999 Age, Sex, Ethnicity Early, Late, Wet, Dry
Klein R, et al. 1995 The Relationship of Age-Related Maculopathy, Cataract, and Glaucoma to Visual Acuity 19881990 Beaver Dam Eye Study 4,886 Age Early, Late
Haronian E, Wheeler NC, et al. 1993 Prevalence of Eye Disorders Among the Elderly in Los Angeles 19821990 UCLA MEC 431 Age, Sex Any

Overall Age-Related Macular Degeneration Prevalence Rates

Figure 1 shows estimated prevalence rates for age-related macular degeneration (AMD) derived from 16 of the studies that reported an overall rate. The high degree of variation among the results in this figure is likely due to in part to methodological, disease definition, and population differences among the studies. This figure excludes studies that did not report an overall rate for the study. The figure is intended to illustrate the range of published prevalence values; direct comparison of the studies is impossible without considering the underlying differences in the studies. Detailed results from each individual study are available in the full report “Published Examination-based Prevalence of Major Eye Disorders.” Most studies provided crude AMD prevalence estimates, while some only provided rates that were adjusted to an intended study population or a national standard. AMD prevalence rates varied widely and ranged from 1.1% in EDPRG to 40.5% in the Study of Osteoporotic Fractures (Figure 1). Although much of this variation is due to differences between study populations, some may also reflect differences in AMD definition, measurement methodology, and reporting. Many studies provided results stratified by age, race/ethnicity, and sex. However, age and race/ethnicity classifications differed across studies: some study populations included one race/ethnicity category, while others included two or three racial and ethnic subgroups. Similarly, age categories varied across studies as did the included age groups: some studies included adults aged 18 years and older, while others included individuals aged 40 or 65 years or older. The data presented for each study in this section focuses on differences by age, sex, and race/ethnicity.

Figure 1.  Overall Prevalence Rates of AMD in Selected Studies.

Tables displays approximate percentages. CHES: 7%. Telemedicine Screening Program: 6%. SOF: 41%. NHANES 2005-2008: 7%. Atlanta VA Chart Review: 4%. Vision Keepers Study: 35%. BDOS: 3%. MESA: 4%. LALES 10%. EDPRG: 2%. National Long-Term Care Survey: 27%. NHANES II: 8%. ARIC Study: 5%. BDES: 14%. UCLA MEC: 5%.

*Adjusted prevalence rate