Review: Age-Related Macular Degeneration
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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.
Download the full report:
Published Examination-Based Prevalence of Major Eye Disorders [PDF – 703 KB]
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.
| 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 | 2005–2008; 1988–1994 | 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 | 2005–2008 | 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 | 1995–1998 | 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 | 2001–2007 | 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 | 2005–2010 | 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 | 2000–2002 | 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 | 1997–1999 | 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 | 2000–2008 | 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. | 1985–1998 | 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. | 1988–1994 | 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 | 1985–1988 | 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 | 1993–1995 | 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; 1988–1990 | 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 | 1988–1990 | 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 | 1982–1990 | 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.
*Adjusted prevalence rate