Screening for AMD in the Amish Population

Abstract

Abstract: : Purpose:To investigate the extent of retinal changes indicative of age-related macular degeneration (AMD) and of the risk factors predisposing to it among members of the Old order Amish population of Lancaster and Franklin County, Pennsylvania. Methods:All members of this Amish population, aged 50 years and older were invited by mail to undergo a complete dilated ophthalmologic examination. Visual acuity was measured and stereoscopic digital color fundus photographs of the macula and optic nerve regions were taken. The retinal photographs were independently read and categorized according to the AREDS severity scale. Data on sunlight exposure, smoking, hat wearing, and use of sunglasses were obtained on the most recently seen individuals using self-administered questionnaires at the time of the ocular exam. Results:118 people were examined; 109 people had retinal photographs of one (N=5) or both (N=104) eyes; 40 people completed questionnaires. 4 eyes from 2 individuals have advanced AMD bilaterally (AREDS level 4), 34 eyes from 19 individuals have moderate AMD (AREDS level 3), 75 eyes of 48 individuals have early AMD (AREDS level 2) and 100 eyes of 59 individuals had no indications of AMD (AREDS level 1). Cigarette smoking was reported by 7 people; cigar smoking reported by 10 people. 33 people reported at least 3-4 hours of sunlight exposure per day over their lifetime (16 reported 5-6 hours per day). In 5 of the 9 families, chosen randomly from those responding to the initial mailing and each contributing at least 4 people (56 people total), multiple family members had moderate or advanced AMD. Conclusions:These data confirm the existence of AMD in the Amish and document a positive family history of disease.

Keywords: clinical (human) or epidemiologic studies: pre • macula/fovea • drusen