Abstract
Purpose: :
Age-related macular degeneration (ARMD) is among the most common causes of severe visual impairment and irreversible loss of vision in the elderly. While prevalence and incidence rates have been evaluated in several population-based studies, the natural history and complication rates of individuals newly diagnosed with ARMD have not been examined in a large nationally representative longitudinal sample of elderly patients.
Methods: :
This is a longitudinal analysis (January 1, 1991 to December 31, 2004) of elderly patients diagnosed as having ARMD using a national 5% sample of Medicare claims data. A cohort of Medicare beneficiaries newly diagnosed with ARMD (n=36,005) in 1994 was compared to a matched control group (n=36,005) regarding death, loss of vision, injury, depression, and long term care placement. Beneficiaries were followed from 1994 to 2004 unless mortality or enrollment in a health maintenance organization for 6 months or more in a year.
Results: :
At the end of the follow-up period, the prevalence of blindness in the ARMD group was 2.4% and loss of vision (including blindness, severe vision loss and moderate vision loss) was 11.3%, both appreciably higher than matched controls. Patients with ARMD developed higher prevalence rates of depression (32.2%) and were more likely to have injury (11.8%) than beneficiaries without ARMD after 10-years. Nursing home or skilled nursing facility placement (30.4%) was also more likely in patients in the ARMD group.
Conclusions: :
A representative sample of elderly patients newly diagnosed with ARMD experienced significantly higher rates of depression, injury, and long term care placement across all time points when compared to patients without this condition. These findings reveal the considerable weight that a new diagnosis of ARMD carries on the individual patient and health care system during a 10-year follow-up period.
Keywords: age-related macular degeneration • clinical (human) or epidemiologic studies: natural history • clinical (human) or epidemiologic studies: outcomes/complications