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R.R. Buggage, X. Xu, A.F. Cruess, G. Zlateva, T. Knight, T.F. Goss; Clinical Characteristics and Impact of Neovascular Age–Related Macular Degeneration on Medical Status, Daily Living, Functioning, and Health Resource Utilization: A Survey of Five Countries . Invest. Ophthalmol. Vis. Sci. 2006;47(13):2208.
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Limited research has been conducted to evaluate the humanistic and economic burden of age–related macular degeneration (AMD). A multi–country, cross–sectional study was conducted to examine the burden of bilateral subfoveal, neovascular AMD on visual impairment, vision–related functioning, comorbid medical conditions, and health resource utilization (HRU).
A total of 834 patients were surveyed in Canada, France, Germany, Spain, and the United Kingdom with 365 bilateral neovascular AMD patients from retina clinics and 469 elderly non–AMD (control) patients from general medical practices. Patients completed a telephone assessment of accidents and related injuries, HRU, and assistance with activities of daily living in the past 12 months. Physicians provided patients’ comorbid medical conditions, visual impairment status, diagnosis and treatment history. Impact of AMD on daily living, functioning, HRU and comorbidities were evaluated using analysis of variance models and chi–square tests.
AMD patients had a mean (sd) age of 77.9 (6.8) years and mean visual acuity (VA) of 20/80 in better seeing eye. About two thirds were female (66%) and had better eye VA of 20/80 or worse (64%). Worse VA was significantly associated with older age (p<0.001). Physicians reported AMD patients having significantly more comorbid medical conditions than controls [mean (95% CI): 2.5 (2.3, 2.7) vs. 2.2 (2.0, 2.3), p=0.005] with significantly (p<0.002) higher proportions having had cancer (9% vs. 4%), stroke (4% vs. 1%), and ocular diseases (40% vs. 7%). In the past 12 months, on average, AMD patients visited ophthalmologists/optometrists 3 times for visual impairment management and were prescribed 2 devices for vision enhancement. Over half (51%) were referred for low–vision rehabilitation. Among patients who fell in the past 12 months (17% in AMD and 8% in controls, p<0.001), the mean number of fall–related hospital emergency room visit was 1.3 and 1.1, respectively, and specialist visit was 4.3 and 2.4, respectively. Significantly more AMD patients received assistance for daily activities than controls (27% vs. 6%, p<0.001).
Bilateral AMD requires substantial HRU and assistance with activities of daily living. AMD patients have significantly higher number of comorbid medical conditions compared to a control group of elderly subjects without AMD.
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