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P. Mitchell, J. J. Wang, A. Kifley, M. J. Karpa, T. Y. Wong, Blue Mountains Eye Study; Five Year Impact of Age-Related Macular Degeneration on Functional Status. Invest. Ophthalmol. Vis. Sci. 2008;49(13):603.
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To evaluate 5-year impact of age-related macular degeneration (AMD) on visual, physical and mental function, falls and fracture risk, and incidence of nursing home placement.
3654 participants of the Blue Mountains Eye Study (BMES), were examined 5 (BMES2) and 10 years (BMES3) after baseline (1992-4). AMD status was determined from retinal photographs at BMES2 and functional outcomes were measured at BMES3, including visual function (NEI-VFQ25), physical and mental function (SF-36), and self-reported occurrence of falls and fractures and nursing home placement since BMES2.
AMD was present in 140 of 1545 participants with data available (118 early, 22 late). Mean age was 67 years among persons without AMD, 74 years for early AMD and 79 years for late AMD. Visual function was significantly lower after 5 years among those with late AMD lesions, and was also slightly lower in participants with early AMD. Age-gender-adjusted mean NEI-VFQ25 scores were 87 in participants without AMD and 83 for early AMD (p=0.0004). It was 63 for unilateral late AMD (p<0.0001) and 44 for bilateral late AMD (p<0.0001). Fracture risk was also significantly higher among persons with than without AMD (22% vs 12% sustained any type of fracture, OR 1.7, 95% CI 1.1-2.7 after adjusting for age, gender, visual impairment attributable principally to other causes, and other confounding factors). Incidence of nursing home placements over the period was significantly higher among persons with than without late AMD (OR 3.7, 95% CI 1.4-9.5 adjusting for age, gender, cognitive impairment, stroke, walking difficulty, living alone, home ownership and self-rated health at BMES2). No statistically significant associations were found between AMD and 5-year risk of falls or performance on the SF-36.
Over a 5-year period, presence of either early or late AMD was associated with significant impacts on subsequent measures of visual function, fracture risk and need for premature nursing home placement. These impacts add to the long-term cost of this disease.
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