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Maxwell S Stem, Danny Mammo, Yoshihiro Yonekawa, Bozho Todorich, Benjamin J Thomas, George A. Williams; Centenarians with Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1514.
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The clinical findings in patients ≥ 100 years old with age-related macular degeneration (AMD) have not been described previously. We report the characteristics of a series of centenarians with AMD seen at our institution.
We conducted a billing search to identify all patients ≥ 100 years old who carried a diagnosis of non-neovascular AMD (ICD-10-CM H35.31), neovascular AMD (ICD-10-CM H35.32), or both. Demographic and clinical data from the patient’s last office visit were recorded and analyzed.
62 patients met the study inclusion criteria. The majority of patients were white (n = 51, 82%) women (n = 50, 81%) and had at least one eye affected by neovascular AMD (n = 55, 89%). The average age was 102 ± 1.4 years (mean ± SD). A minority of patients (n = 27, 44%) were taking AREDS vitamins. Every patient had at least one ocular comorbidity such as dry eye syndrome. Nearly all of the patients (n = 60, 97%) were taking medications to treat a systemic comorbidity. The average Snellen visual acuity (VA) among eyes with neovascular AMD was worse than the average VA for eyes with non-neovascular AMD (20/600 (range 20/40 – HM) vs. 20/250 (range 20/20 – HM), respectively, p < 0.05). Many patients (n = 36, 58%) met the legal definition for blindness with VA in both eyes ≤ 20/200. A smaller number of patients (n = 12, 19%) had a VA of 20/50 or better in at least one eye. A majority of eyes with neovascular AMD (n = 64, 67%) and non-neovascular AMD (n = 20, 71%) had some amount of geographic atrophy in the macula. Among the 95 eyes with neovascular AMD, 22 (23%) received an injection of anti-VEGF within three months of the last recorded examination date. Eleven eyes had received anti-VEGF within three months of the last follow-up while their fellow eyes remained untreated. Average Snellen VA in the treated eyes was 20/320 vs. 20/630 in the untreated fellow eyes (p = 0.3).
Most centenarians with AMD have the neovascular form, and these individuals tended to have poorer vision than those with non-neovascular AMD. However, most centenarians will have some form of geographic atrophy regardless of whether they have neovascular or non-neovascular AMD, and the majority of centenarians in our cohort met the legal definition for blindness. Nevertheless, centenarians with neovascular AMD may continue to be treated with anti-VEGF medications in order to preserve vision.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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