Purchase this article with an account.
A. I. Marinescu, C. Bunce, R. Wormald; Risk Factors for Late Presentation of Age-Related Macular Degeneration. Pilot Case Control Study. Invest. Ophthalmol. Vis. Sci. 2009;50(13):261.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Age-related Macular Degeneration (AMD) is a leading cause of registered legal blindness in the older population in the west. We intend to identify those patients, late presenters, with high risk of failing to seek early medical advice and to determine if common socio-economic factors are present.
This is a hospital based pilot case controlled study. Thirty-four patients were newly diagnosed with AMD having visual acuity checked and a complete eye examination. Sixteen cases (late presenters) were those with advanced AMD having the visual acuity (VA) equal/< 6/36 in the second eye. Eighteen patients considered controls had early AMD with VA > 6/12. The level of maculopathy in each eye is assigned on overall grade base on the CARMS system (Clinical Age-Related Maculopathy Staging system). Patients with possible AMD and/or other severe eye diseases were excluded. A questionnaire for each qualifying patient regarding age, sex, ethnic origin, economic status, education, and employment was completed.
There was a significant difference between median age of the cases (86 years) and controls (72 years). Cases and controls were similar with regards sex, first language spoken and type of housing. Cases were less likely to have access to a car (cases 43.75%, controls 77.78%), probably explained by a decreased VA, older people less likely to have access to cars and other health matters. Cases were more commonly widowed (cases 68.75%, controls 33.33%) and 50% of controls were married. In terms of education, cases had a lower mean of age at leaving education (cases 15.8 years of age, controls 17.2 years of age). These results could be influenced by the school leaving age increasing from 14 to 15 in 1947. Four patients with early AMD stated a family history of AMD with none of those presenting with late AMD. Smoking does appear more common in the controls.
Results indicate a correlation between age & socio-economic status with late presentation of AMD. A full scale study will allow confirmation of these results especially when some questions were raised over factors such as family history (difficult to identify AMD until 1970, and shorter duration of life). The key question is why, perhaps, advanced cases are not diagnosed earlier in older patients. A definitive study may need to be loosely age matched to ensure that age is not a confounder. The study can lend support for additional resources for education of the elderly population to help identify the early signs of AMD.
This PDF is available to Subscribers Only