A Follow-Up Survey on the Knowledge of Age-Related Macular Degeneration and its Risk Factors among Singapore Residents after 5 Years of Nation-Wide Awareness Campaigns

Purpose: To re-evaluate the awareness of age-related macular degeneration (AMD) and knowledge of its risk factors among Singapore residents after 5 years of awareness campaigns.

Methods: Cross-sectional, questionnaire-based telephone survey (modified from the AMD Alliance International Global Report), conducted in Singapore in 2011. Participants were randomly selected using the Global Yellow Pages Singapore residential listings 2009/2010. Awareness of AMD and its risk factors was assessed among participants.

Results: Of 1773 Singapore residents contacted over the telephone, 559 participated (31.5% response rate). The mean age of participants was 43.1 years (range 21–85 years). A total of 157 participants (28.1%) were familiar with AMD. Among these, the number who correctly identified the risk factors were: smoking, n?=?132 (84.1%); ageing, n?=?123 (78.3%); lack of vitamins/nutrients, n?=?121 (77.1%); genetics, n?=?101 (64.3%); unprotected light exposure, n?=?100 (63.7%) and; sex, n?=?62 (39.5%). Participants aged >50 years (prevalence rate ratio, PRR 2.23, confidence interval, CI, 1.31–3.81) or who had undergone an eye test within the previous year (PRR 2.61, 95% CI 1.79–3.82) were more familiar with AMD, while females (PRR 0.68, 95% CI 0.47–0.98) were less familiar.

Conclusion: Self-reported awareness of AMD among Singapore residents increased four-fold from 7.3% in 2006 to 28.1% in 2011 following 5 years of awareness campaigns. Participants who were >50 years or had undergone an eye test within the previous year were more aware of AMD while female participants were less aware of AMD.     

Cataract surgery in high-risk age-related macular degeneration: a randomized controlled trial

Background:  To investigate if cataract surgery causes progression, from high-risk early age-related macular degeneration (AMD) to choroidal neovascularization (CNV), in the postoperative period.
Methods:  Randomized controlled trial. Patients, with visually significant cataract and fundus features of early AMD at high risk of progression to CNV, were randomized into two groups and were evaluated at baseline and 6 months. The study patients ( n  = 27) underwent immediate cataract surgery. The control group ( n  = 29) comprised patients who had cataract surgery deferred until after the 6-month visit. Assessment included visual acuity, quality of life (QoL) and fundus fluorescein angiography (FFA).
Results:  Of 68 eligible eyes, 60 participated and 56 completed the study. Three referred eyes (3.2%) were ineligible on the basis of a pre-existing, unsuspected occult CNV that was detected by baseline FFA. All three cases had end-stage exudative AMD in the fellow eye. Of the study eyes in the immediate surgery arm ( n  = 27), one (3.7%) developed CNV compared with none (0/29) in the deferred arm (χ²; P  = 1.0) at 6 months. In the operated group, there was a 2.8-line improvement in logMAR visual acuity and 2.1-fold average gain in QoL at 6 months.
Conclusions:  No increased short-term risk of progression of AMD to CNV in high-risk fundi following uncomplicated phacoemulsification surgery was found. A low threshold for performing preoperative imaging in patients with AMD, especially in those with exudative AMD in the fellow eye, to exclude undetected CNV is recommended. Provided there is no CNV, there are distinct benefits of cataract surgery in people with early AMD.     

Prevalence and Risk Factors for Polypoidal Choroidal Vasculopathy in a General Japanese Population: The Hisayama Study

Purpose: To estimate the prevalence and risk factors for polypoidal choroidal vasculopathy (PCV) in a general Japanese population. Methods: This population-based, cross-sectional study was conducted in 2007 with subjects from the Hisayama Study. Of the 3,648 residents in Hisayama, Japan, 2,663 who were ≥ 50 years old were enrolled in this study. The characteristics of PCV were determined by fundus examination or based on indocyanine green and fluorescein angiographic findings. We evaluated the contributions of the risk factors for PCV. Results: Among the 207 participants with age-related macular degeneration (AMD), 174 (6.5%) had early AMD, and 33 (1.2%) had late AMD, including 10 participants with PCV (0.4%). Male and smoking habit were significant risk factors for the development of PCV. Conclusions: The prevalence of PCV is higher among Japanese subjects than Caucasians in Western countries. Male gender and smoking habit were significant risk factors for PCV in a general Japanese population.     

Prevalence and risk factors of ocular trauma in an urban south-east Asian population: the Singapore Malay Eye Study

Purpose:  To describe the prevalence and risk factors of ocular trauma in an urban Asian population.
Methods:  A population-based survey of 3280 (78.7% response rate) Malay people aged 40–80 years residing in Singapore was conducted in 2004–2006. Interviewer-administered questionnaire was used to ascertain a history of ocular trauma, defined as any eye injury requiring medical attention from a doctor.
Results:  Of the 3264 participants, 149 (5.0%, 95% confidence intervals [CI] 4.1–6.0%) reported a history of ocular trauma. Of those, 30.2% had trauma from a blunt object, 33.6% from a sharp object, and 22.1% from chemical burns. After adjusting for age and sex, men had a higher prevalence of ocular trauma than women (8.3% vs. 2.1%, age-adjusted odds ratio [OR] 4.7, CI 3.1–7.1), and younger persons had a higher risk of ocular trauma (per year increase in age, OR 0.98, CI 0.96–0.99). Consumption of alcohol was associated with higher likelihood of having ocular injury (OR 4.3, CI 2.2–8.4).
Conclusions:  One in 20 persons in this urban south-east Asian population had a history of ocular trauma. Younger persons, men and consumption of alcohol were risk factors for ocular trauma.     

Correlation between CFH Y402H and HTRA1 rs11200638 genotype to typical exudative age-related macular degeneration and polypoidal choroidal vasculopathy phenotype in the Japanese population

Background:  Typical exudative age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV) are two of the major macular diseases found in Asians. Although genomic studies have shown a contribution by CFH and LOC387715/ HTRA1 polymorphisms to the development of these two diseases, the correlation of the clinical phenotypes to these genotypes has not been determined in Asian patients.
Methods:  The prevalence of the CFH Y402H and HTRA1 rs11200638 genotypes was determined in 116 patients with typical exudative AMD and in 204 patients with PCV. Potential correlations of these polymorphisms were tested retrospectively and cross-sectionally for bilaterality of the disease, final visual acuity and the greatest linear dimension of the choroidal neovascular (CNV) lesion.
Results:  There was no significant difference in the incidence of CFH Y402H ( P  = 0.598) and HTRA1 rs11200638 ( P  = 0.290) between eyes with typical exudative AMD and with PCV. There was a significant association between the lesion size and HTRA1 rs11200638. For eyes with typical AMD, the size of the lesion (6363 ± 2837 µm) was significantly larger in the high-risk homozygous group (AA), than in the low-risk homozygous group (GG) (3866 ± 1947 µm; P  = 0.0003). The same tendency was observed for the size of the lesion in PCV cases (homozygous group: 6347 ± 2673 µm, non-risk homozygous group: 4405 ± 2066 µm, P  = 1.3 × 10⁻⁵).
Conclusions:  A common genetic background may exist between typical exudative AMD and PCV patients. Among the patients with these two clinical entities, those with a homozygous HTRA1 rs11200638 risk allele had larger CNV lesions.     

Knowledge and beliefs about common eye diseases

Purpose: To ascertain the level of knowledge of common causes of blindness in an adult Australian population and to relate this to use of eye care services.
Methods: A population-based study of common eye diseases in an urban population aged 49 years or older was conducted. The questions were concerned with the awareness and knowledge of and the ability to describe three common eye diseases, namely cataract, glaucoma and agerelated macular degeneration (AMD).
Results: Awareness of cataract (98%) and glaucoma (93%) were high in this population, but awareness of AMD was low (20%). Among people who were aware of the target eye disease, only 29% showed some knowledge of glaucoma, 26% showed some knowledge of AMD and 20% showed some knowledge of cataract; this was also low in people who had previous eye treatment, such as cataract surgery. Knowledge was related to education level, occupational prestige and knowledge of other eye diseases. After excluding people with a previous eye disease diagnosis, those people who were aware and had some knowledge of eye disease accessed eyecare services more frequently.
Conclusions: Knowledge of common eye diseases is generally lacking. Age-related macular degeneration is the leading cause of blindness in Australia, yet only 20% of the present study population had heard of it. As there are often no early symptoms for glaucoma, community awareness of this disease and the need for screening of people at risk may allow timely diagnosis and more effective therapy before advanced visual field loss has occurred. An informed public is more likely to present earlier with visual symptoms before irreversible visual loss has occurred and is more likely to comply better with recommended therapy.     

Factors affecting awareness and knowledge of glaucoma among patients presenting to an urban emergency department

Background:  Until advanced, glaucoma is asymptomatic. For early diagnosis to occur, patients may need to be aware of it and seek assessment regularly. People who have risk factors for glaucoma may have a greater awareness of the disease.
Methods:  Patients presenting to an urban hospital emergency department were surveyed with a brief questionnaire to assess their knowledge of glaucoma. Data was collected about their gender, age, family history of glaucoma and presence of systemic hypertension, diabetes, Raynaud's phenomenon, migraines and myopia.
Results:  Women (Odds ratio 2.3; 95% CI 1.4−3.7; P  < 0.01), people who were 40 years or older (Odds ratio 2.2; 95% CI 1.1−4.4; P  < 0.05) and those who were aware of a family history of glaucoma (Odds ratio 15.7; CI 5.5−45.3; P  < 0.01) knew significantly more about the disease than others. People with other risk factors did not demonstrate significantly greater knowledge despite 89% of all participants having had a previous eye examination.
Conclusion:  This information may be useful to predict which patients may know about glaucoma when they present for an eye examination and who should be targeted in public health campaigns.     

Asian age-related macular degeneration phenotyping study: rationale, design and protocol of a prospective cohort study

Background: Current knowledge of the phenotypic characteristics (e.g. clinical features, risk factors, natural history and treatment response) of age-related macular degeneration (AMD) in Asians remains limited. This report summarizes the rationale and study design of a prospective observational study of Asian neovascular AMD, including polypoidal choroidovasculopathy variant. Design: The Asian AMD phenotyping study is a prospective, observational clinical study of Asian patients with neovascular AMD or polypoidal choroidovasculopathy in three tertiary eye centres in Singapore. Participants: The study aims to recruit 500 consecutive patients from the retinal clinics of three tertiary eye centres in Singapore. Methods: Standardized examination procedures include interviews, a comprehensive eye examination, digital photography of the retina, fundus fluorescein and indocyanine green angiography and spectral domain optical coherence tomography using a standardized protocol. Blood samples were collected for biochemical analyses and stored for genetic and proteomic studies. Main Outcome Measures: The aim of the study was to build a comprehensive database of clinical, angiographic, functional and natural history data of Asian AMD over a 12-month follow-up period. Results: This article discusses the methodology and design of this prospective multi-centred study. Conclusion: This study will provide in-depth longitudinal data of the evolution of clinical features, risk factors, natural history and treatment pattern and response of Asian AMD and polypoidal choroidovasculopathy, allowing unique insights into pathogenesis and the design of new treatment strategies.     

南充市顺庆区中老年年龄相关性黄斑变性患病率及相关因素分析

目的：了解南充市顺庆区50岁及以上人群年龄相关性黄斑变性(AMD)患病率并探讨影响AMD的相关因素。

方法：以人群为基础的流行病学调查。2013-05/10,采用分层整群随机抽样方法,抽取四川省南充市顺庆区50岁及以上人群共2 242人。调查内容包括一般信息登记,体格检查,实验室检查,眼科检查。AMD的诊断标准采用AMD国际临床分级系统。采用SPSS 13.0统计学软件对结果进行分析。

结果：本研究调查实际有2 097人接受全程检查,受检率为93.53%。检出AMD患者207例(283眼),总患病率为9.87%,标准化后AMD的患病率为9.73%。早期和晚期AMD患病率分别为9.25%和0.62%,其中渗出性AMD患病率为0.14%。50～59、60～69、70～79及≥80岁组的AMD患病率分别为6.38%、9.27%、14.69%、17.39%。AMD导致双侧盲及低视力患病率分别为0.48%和1.45%。晚期AMD患眼视力明显低于早期AMD患眼视力。与AMD相关的影响因素有8个,年龄、收缩压、吸烟、阳光暴露、糖尿病史、白内障手术、血清总胆固醇是AMD发生的危险因素,受教育程度是保护因素。

结论：南充市顺庆区50岁及以上人群AMD患病率为9.87%,AMD患病率随着年龄的增加呈明显增长的趋势; 晚期AMD严重影响视力; AMD致病危险因素包括年龄、收缩压、吸烟、阳光暴露、糖尿病史、白内障手术、血清总胆固醇,保护因素为受教育程度。     

Awareness,knowledge, and practice: A survey of glaucoma in north Indian rural residents

Background:

Studies done on the prevalence of glaucoma have reported a high proportion of undiagnosed patients. Late diagnosis is related to increased risk of glaucoma associated with visual disability. Lack of awareness and non-availability of appropriate screening procedures are among the major reasons for non-diagnosis or late diagnosis of glaucoma. The present study has been undertaken to evaluate the level of awareness about glaucoma among the North Indian rural population.

Materials and Methods:

A group-administered, questionnaire-based survey, involving 5000 rural residents (aged 20 and above) was conducted through random sampling. The questionnaire was structured to evaluate the level of awareness and knowledge about glaucoma and the effect of gender, education status, and glaucoma diagnosis was also studied. The source of awareness about glaucoma was also questioned.

Results:

Of the 5000 individuals enrolled for the survey, responses from 4927 (98.5%; 95% Confidence Interval (CI): 98.2 - 98.9) participants, including 3104 males (63%; 95% CI: 61.7 - 64.3) and 1823 females (37%; 95% CI: 35.7 - 38.3) were evaluated. A total of 409 (~8.3%; 95% CI: 7.6 - 9.14) respondents were aware about glaucoma and only 93 (1.89%; 95% CI: 1.55 - 2.31) were qualified as having knowledge about glaucoma as per the set questionnaire. Education was the only variable significantly correlated (P value < 0.001) with the awareness and knowledge of glaucoma out of the parameters included in this study. Close acquaintance with a glaucoma patient was the most common source of information.

Conclusions:

There is a lack of awareness about glaucoma among the rural residents of North India. The study findings stress the need to spread awareness about glaucoma for prevention of glaucoma-related blindness.     

Moving towards improved evidence for the effectiveness of low vision interventions

Background:  Two recently published Manchester trials have provided evidence on the effectiveness of specific low vision rehabilitation (LVR) interventions.
Methods:  In RCT 1, we compared enhanced LVR (supplementary home visits) and conventional LVR for people with AMD. In RCT 2, we evaluated the effectiveness of prism relocation spectacles in people with central scotomas due to AMD. RCT methodology was employed in each trial on large samples of subjects ( n  > 200), using a wide range of outcomes.
Results:  For RCT 1, arms did not differ significantly for any outcome. At 12 months, 94% of participants reported using at least one LVA. For RCT 2, there was no significant effect of treatment group (prism or placebo) on any of the outcomes.
Conclusions:  While these specific LVR interventions did not prove to be effective, they were not designed to address the effectiveness of LVR in general. A LVR vs no-LVR trial is proposed.
References:  Reeves, B.C., Harper, R.A. and Russell, W.B. (2004) Enhanced low vision rehabilitation for people with age-related macular degeneration: a randomised controlled trial. Br J Ophthalmol 88 , 1443–1449.
Smith, H.J., Dickinson, C.M., Cacho, I., Reeves, B.C., Harper, R.A. (2005) A randomized controlled trial to determine the effectiveness of prism spectacles for patients with age-related macular degeneration. Arch Ophthalmol 123 , 1042–1050.     

Survey of practice preference pattern in antibiotic prophylaxis against endophthalmitis after cataract surgery in Singapore

To determine practice preference of prophylaxis against post-cataract surgery endophthalmitis in Singapore. Prospective nationwide survey of all registered ophthalmologists through telephone, e-mail or postal questionnaires. A response rate of 76.6% was obtained from 121 out of 158 eligible ophthalmologists. Awareness of the recommendations made by the European Society of Cataract and refractive surgeons (ESCRS) endophthalmitis study was noticed in 98 (81.0%) respondents. Out of the 121 respondents, 85 (70.2%) do not use intracameral antibiotic prophylaxis. Of the 36 respondents using intracameral antibiotics, 34 (94.4%) used cefazolin. The reasons cited for not adopting intracameral antibiotic prophylaxis included financial costs, the relatively low risk of endophthalmitis after cataract surgery, the burden of dilution and the fear of toxic anterior segment syndrome. More than half (65, 53.7%) of respondents would use intracameral antibiotic prophylaxis if it were available commercially. The most commonly practiced prophylaxis (94, 77.7%) was preoperative topical antibiotics. The majority of ophthalmologists in Singapore have not adopted the use of intracameral antibiotics, with most preferring the use of pre- and postoperative prophylactic topical antibiotics, despite knowledge of the ESCRS endophthalmitis study.     

Current trends in photodynamic therapy

Background:  Patients with wet age-related macular disease (AMD) and subfoveal choroidal neovascular membrane (CNV) may be offered photodynamic therapy (PDT). Currently, Visudyne (Verteporfin) is the only photosensitizer approved by the FDA and randomized trials have shown that treatment can prevent severe vision loss. Combination therapy with Visudyne PDT and intravitreal triamcinolone may be additionally beneficial. In an effort to develop a more effective therapy, we have undertaken studies in primates and in patients with advanced AMD using a new photosensitizer, talaporfin sodium. Following dose-ranging work in the normal primate retina, a study in humans investigated the safety and effectiveness of this drug.
Methods:  Eleven patients with vision of <6/60 and persistent leakage from CNV were recruited. Following talaporfin sodium injection of 0.5 mg kg⁻¹ bodyweight, a light dose of between 24 and 48 J cm⁻² was given with a 664 nm laser. Fluorescein angiography and visual acuity (VA) were performed before and after therapy. Adverse events were recorded. Follow-up was for 14 days, but informal review was longer (in some cases ≥ 40 weeks).
Results:  All patients showed evidence of decreased leakage from CNV. No re-opening of closed choroidal vessels was observed during extended follow-up. At the last follow-up, VA was stable in seven patients, improved in three and decreased in one (using >0.1 logMAR). Three adverse events were reported; two related to photosensitivity of the skin and one patient had closure of a branch retinal vein.
Conclusion:  Talaporfin sodium PDT showed extended closure of CNVs and therefore has potential for treating exudative AMD and other choroidal vascular anomalies.     

Associations of cardiovascular disease and its risk factors with age-related macular degeneration: the POLA study

The POLA study (June 1995 through July 1997) is a population-based study on cataract and age-related macular degeneration (AMD) and their risk factors in 2584 residents of Séte (South of France), aged 60–95 years. Classification of AMD was performed on 50° fundus photographs, according to an international classification. The presence of cardiovascular disease and its risk factors was determined by interviewer-based questionnaire, clinical examination (anthropometry, blood pressure) and fasting plasma measurements. Using a logistic model adjusted for age and gender, late AMD was not significantly associated with a history of cardiovascular disease, diabetes, use of hypocholesterolemic drugs, hypertension, blood pressure or plasma lipids. Obese subjects (body mass index greater than 30 kg/m 2 ) had a 2.29-fold (95% confidence interval (CI): 1.00–5.23) and 1.54-fold (CI: 1.05–2.26) increased risk of late AMD and pigmentary abnormalities in comparison with lean subjects. Finally, the risk of soft drusen was decreased in those subjects with a history of cardiovascular disease (odds-ratio (OR) = 0.72, CI: 0.54–0.97), and increased with increasing levels of HDL-cholesterol (OR = 1.52, CI: 1.14–2.02). None of these results were modified by further adjustments for smoking, educational level and plasma alpha-tocopherol. These results need to be confirmed by other studies, which ideally should be longitudinal and prospective.     

Gender, oestrogen, hormone replacement and age-related macular degeneration: Results from the Blue Mountains Eye Study

Purpose: To determine whether females have a higher age-specific age-related maculopathy prevalence than males; whether there is an increased risk of age-related macular degeneration (AMD) with early menopause; and whether there is a decreased risk of AMD with use of hormone replacement therapy (HRX). Methods: Pooled data from three study populations that have used similar AMD diagnostic criteria were used to answer the first hypothesis: the Beaver Dam Eye Study (BDES), the Rotterdam study of the elderly, and the Blue Mountains Eye Study (BMES). The BMES population was used to answer the second and third hypotheses. This population included residents aged 49 or older with 2072 women participating, of whom 1899 postmenopausal women answered questions about menopause, menarche and HRT AMD was diagnosed from graded retinal photographs using modified international criteria. Results: The overall pooled odds ratio (OR) for association between sex and AMD revealed a significant increase in AMD prevalence among females compared with males, adjusting for 10-year age categories, OR = 1. 15 (1. 10-1.21), with no significant heterogeneity between studies. A significant decrease in the odds of early AMD with increasing years from menarche to menopause was observed. Conclusions: The results suggest that females may have a higher risk of AMD. The significant decrease in early AMD with increasing years from menarche to menopause supports the concept that a shorter duration of oestrogen production may increase risk of AMD.     

Long-term visual and microperimetry outcomes following autologous retinal pigment epithelium choroid graft for neovascular age-related macular degeneration

Background:  To describe the 2- to 4-year visual and microperimetry outcomes of autologous retinal pigment epithelium (RPE)-choroid graft in patients with neovascular age-related macular degeneration (AMD).
Methods:  In this retrospective cohort study, 12 patients with subfoveal neovascular AMD who had undergone autologous RPE-choroid graft between August 2004 and June 2005 were reviewed. Change in visual acuity (VA), contrast sensitivity (CS), fixation stability and retinal sensitivity on microperimetry after 2–3 years and the rates of late postoperative complications were examined.
Results:  Patients were followed for 26–48 months (mean, 39). Median preoperative VA (logMAR) was 0.87 but declined to 1.43 (1 year), 1.46 (2 years) and 1.38 (3 years), P  = 0.001. Median CS (logCS) was 0.75 preoperatively but declined to 0.45 at 2 years. Six patients had serial microperimetry. Fixation stability declined in 1 but improved in 2 patients. All 6 had decline in retinal sensitivity over the graft during follow up. Retinal detachment did not occur after 12 months but 8 developed epiretinal membrane, 12 had cystic retinal change over the graft and 4 developed recurrent choroidal neovascularization. However, 10 grafts retained autofluorescence signal at 18–48 months of follow up.
Conclusions:  Autologous RPE-choroid graft can maintain VA, stable fixation and retinal sensitivity in some patients for over 3 years. The spatial correlation between graft autofluorescence, outer retinal structures on optical coherence tomography and retinal sensitivity are consistent with photoreceptor cell rescue. However, we caution the use of this technique as there is high complication rate and delayed loss of retinal function.     

提高对年龄相关性黄斑变性危险因素的认识

年龄相关性黄斑变性(AMD)是老年人的致盲性眼病,严重影响其独立生活能力.流行病学研究资料显示,AMD存在各种危险因素,除了年龄、遗传、种族等不可改变的因素之外,还包括生活方式、眼部情况、全身疾病等可改变因素.然而,公众对AMD危险因素的了解,甚至广大眼科医师对AMD危险因素的重视程度也不尽如人意.对AMD的危险因素进行了复习,以期提高对AMD致病危险因素的认识,扩展AMD的研究思路及指导临床工作.     

Prevalence of Age-Related Macular Degeneration in Slovakia and Associated Risk Factors: A Mobile Clinic-Based Cross-Sectional Epidemiological Survey

Purpose: Age-related macular degeneration (AMD) is one of the leading causes of blindness in the elderly population. Although there are prevalence studies for AMD in Europe, data are scarce for the Slovakian population. Methods: This was a prospective, multicenter, non-interventional, mobile clinic-based cross-sectional study that assessed age-specific prevalence of AMD in the Slovakian population and risk factors associated with AMD. The type of AMD was graded based on the international age-related maculopathy grading system; optical coherence tomography (OCT) was used for the differential diagnosis. Overall, 3,278 patients were screened; the fundus photographs, OCT scans, and self-reports were collected at the mobile clinic in a single visit. Results: The prevalence of AMD in the study population was 8.99% (wet AMD 1.01%; dry AMD 7.85%), whereas the extrapolated estimate in the entire Slovakian population was 3.3% (wet AMD 0.3%; dry AMD 3.0%). Age, smoking, and hypertension were risk factors associated with AMD; however, contrary to reports in the literature, no gender-specific association was observed. Conclusion: Based on the results of this study, mobile clinics may be an effective way to extend health care access to a larger population. Early diagnosis of AMD will assist in early treatment and effective disease management of the population at risk.     

Dietary and lifestyle risk factors associated with age-related macular degeneration: A hospital based study

Aim:

To establish the frequency, associations and risk factors for age-related macular degeneration (AMD) in hospital population of South India.

Materials and Methods:

In this cross-sectional hospital based study, 3549 subjects (2090 men and 1459 women) above 45 years of age were screened randomly for AMD. Participants underwent ocular evaluation and were interviewed for lifestyle variables and dietary intake of carotenoids by structured food frequency questionnaire. AMD was defined according to the international classifications and grading system.

Results:

Either form of AMD was detected in 77 (2.2%) participants. Of which, early and late AMD was present in 63 (1.8%) and 14 (0.4%) subjects, respectively. Binary logistic analysis showed that the incidence of AMD was significantly higher with increasing age (Odds ratio [OR] 1.17; 95% CI 1.13-1.22) and diabetes (OR 3.97; 95% CI 2.11-7.46). However, AMD was significant among heavy cigarette smokers (OR 5.58; 95% CI 0.88-7.51) and alcoholics (OR 4.85; 95% CI 2.45-12.22). Dietary lutein/zeaxanthin (L/Z) and β-carotene intake were associated (P < 0.001) with the reduction in risk for AMD, with an OR of 0.38 and 0.65, respectively.

Conclusions:

Higher dietary intake of carotenoids, especially L/Z, was associated with lower risk for AMD. Risk of AMD is higher with increasing age and was prevalent among subjects with diabetes. Cessation of smoking and alcohol may reduce the risk of AMD in this population.