Key Takeaways
- Age-related macular degeneration (AMD) affects nearly 11 million people in the United States, making it the leading cause of vision loss and legal blindness among adults aged 50 and older.
- Globally, AMD impacts approximately 196 million individuals as of 2020, with projections estimating an increase to 287.8 million by 2040 due to aging populations.
- In the US, about 1.7% of individuals aged 40 and older have late AMD, rising to 12.4% in those over 80 years old.
- Smoking doubles the risk of developing late AMD, with current smokers having a 3-4 times higher risk than never smokers.
- Age is the strongest risk factor, with risk increasing exponentially after 60, and 30% of those over 75 showing signs.
- Family history increases AMD risk by 2.5 to 4.5 times if a close relative is affected.
- The most common early symptom of AMD is drusen formation, appearing as yellow deposits under the retina visible on fundus exam.
- Patients with dry AMD often experience gradual central vision loss, with straight lines appearing wavy (metamorphopsia).
- Wet AMD causes sudden vision loss due to choroidal neovascularization leaking fluid, affecting 10-15% of cases.
- Amsler grid testing detects metamorphopsia in 50% of early AMD patients.
- Optical coherence tomography (OCT) identifies subretinal fluid in 90% of wet AMD cases.
- Fundus fluorescein angiography (FFA) confirms CNV leakage in wet AMD diagnosis.
- Anti-VEGF injections like ranibizumab improve vision by 2+ lines in 90% of wet AMD patients over 2 years.
- AREDS2 formula reduces progression to late AMD by 25% in intermediate cases over 5 years.
- Pegcetacoplan slows GA growth by 29% over 12 months in phase 3 trials.
A common eye disease called macular degeneration causes severe vision loss worldwide.
Clinical Features
- The most common early symptom of AMD is drusen formation, appearing as yellow deposits under the retina visible on fundus exam.
- Patients with dry AMD often experience gradual central vision loss, with straight lines appearing wavy (metamorphopsia).
- Wet AMD causes sudden vision loss due to choroidal neovascularization leaking fluid, affecting 10-15% of cases.
- Geographic atrophy in late dry AMD leads to irreversible blind spots in central vision, sparing peripheral sight.
- Scotomas (blind spots) in AMD typically start small in the center and enlarge over time.
- Color vision deficiency occurs in 20-30% of advanced AMD patients due to photoreceptor loss.
- Difficulty reading or recognizing faces is reported in 85% of late AMD cases.
- Parafoveal sparing in early AMD allows patients to use eccentric vision initially.
- Retinal pigment epithelium (RPE) atrophy is a hallmark of dry AMD progression.
- Neovascular membranes in wet AMD can cause subretinal hemorrhage, distorting vision rapidly.
- Hyperpigmentation and hypopigmentation around drusen indicate intermediate AMD.
- Visual acuity drops below 20/200 in 20% of untreated wet AMD eyes within 2 years.
- Contrast sensitivity loss precedes acuity decline in 70% of early AMD cases.
- Photopsia (flashing lights) occurs in 15% of wet AMD patients due to CNV activity.
- Bilateral involvement happens in 80% of AMD cases, often asymmetrically.
- Drusen size >125 microns predicts higher progression risk to late AMD.
- Fundus autofluorescence shows hypoautofluorescence in GA lesions.
- Microperimetry reveals absolute scotoma expansion at 1.6mm²/year in GA.
Clinical Features Interpretation
Diagnosis and Screening
- Amsler grid testing detects metamorphopsia in 50% of early AMD patients.
- Optical coherence tomography (OCT) identifies subretinal fluid in 90% of wet AMD cases.
- Fundus fluorescein angiography (FFA) confirms CNV leakage in wet AMD diagnosis.
- AREDS simplified severity scale stages AMD risk from 0 (lowest) to 4 (highest).
- Color fundus photography detects large drusen (>125μm) with 85% sensitivity.
- Indocyanine green angiography visualizes occult CNV in 70% of cases missed by FFA.
- OCT angiography (OCTA) non-invasively detects CNV with 97% sensitivity without dye.
- Visual field testing shows central field loss >5dB in early AMD screening.
- Dark adaptometry reveals prolonged rod recovery time (>6.5 min) in AMD suspects.
- Genetic testing for CFH Y402H variant predicts AMD risk with OR 7.4 for homozygotes.
- Annual screening recommended for those over 65 or with family history per AAO guidelines.
- Multiluminance flicker perimetry detects early functional loss in 80% of intermediate AMD.
- Retinal hyperspectral imaging identifies drusen composition preclinically.
- AI-based OCT analysis predicts progression with 90% accuracy in 2 years.
- Slit-lamp biomicroscopy reveals RPE changes in 60% of at-risk patients.
- Electroretinography (ERG) shows mfERG amplitude reduction in foveal AMD.
- Near-infrared reflectance imaging highlights GA borders accurately.
- Low-luminance visual acuity testing worsens VA by 0.3 logMAR in early AMD.
Diagnosis and Screening Interpretation
Epidemiology
- Age-related macular degeneration (AMD) affects nearly 11 million people in the United States, making it the leading cause of vision loss and legal blindness among adults aged 50 and older.
- Globally, AMD impacts approximately 196 million individuals as of 2020, with projections estimating an increase to 287.8 million by 2040 due to aging populations.
- In the US, about 1.7% of individuals aged 40 and older have late AMD, rising to 12.4% in those over 80 years old.
- Non-Hispanic White Americans have the highest prevalence of AMD at 9.7% among those aged 40+, compared to 2.3% in non-Hispanic Blacks.
- Early AMD prevalence in Europe is around 3.5% in people under 50, increasing to 12.1% in those over 80.
- In Australia, AMD affects 1 in 7 people over 50, with late-stage disease in 1 in 25.
- The incidence of late AMD over 10 years is 2.1% in those aged 55-64, escalating to 13.5% in those over 85.
- Women have a slightly higher lifetime risk of developing late AMD (8.8%) compared to men (7.8%).
- In China, the prevalence of any AMD is 6.8% in those over 50, with early AMD at 6.5% and late at 0.3%.
- AMD accounts for 8.7% of all blindness worldwide and 50% in developed countries among those over 55.
- In the UK, over 700,000 people live with sight loss from AMD, expected to rise to 2.1 million by 2050.
- The prevalence of geographic atrophy (GA), a form of late dry AMD, is 0.36% in the US population aged 50+.
- Neovascular AMD prevalence is higher in Asians (0.21%) than in Whites (0.17%) or Blacks (0.10%).
- In India, AMD prevalence is 1.1% overall, but reaches 4.7% in those over 70.
- Lifetime risk of late AMD in the US is 3.2% for early ARM progressors.
Epidemiology Interpretation
Risk Factors
- Smoking doubles the risk of developing late AMD, with current smokers having a 3-4 times higher risk than never smokers.
- Age is the strongest risk factor, with risk increasing exponentially after 60, and 30% of those over 75 showing signs.
- Family history increases AMD risk by 2.5 to 4.5 times if a close relative is affected.
- Caucasian ethnicity confers the highest risk, with Whites 3-5 times more likely than African Americans.
- Obesity raises late AMD risk by 2.2 times compared to normal weight individuals.
- Hypertension increases AMD risk by 1.4 to 2.0 fold, particularly early AMD.
- High dietary intake of omega-3 fatty acids reduces AMD risk by up to 41%.
- Low antioxidant levels (vitamins C, E, beta-carotene, zinc) increase late AMD odds by 25%.
- Cardiovascular disease history raises AMD prevalence by 1.5-2 times.
- Prolonged exposure to blue light from screens may increase oxidative stress, elevating AMD risk by 20-30%.
- Hyperlipidemia correlates with a 1.3-fold increase in early AMD.
- Female gender slightly elevates risk due to longer lifespan and hormonal factors, with OR of 1.2.
- Chronic kidney disease patients have 2-3 times higher AMD prevalence.
- UV light exposure increases risk by damaging retinal pigment epithelium, with OR 1.5 for high exposure.
- Diabetes mellitus type 2 associates with 1.4-fold higher neovascular AMD risk.
Risk Factors Interpretation
Treatment and Prognosis
- Anti-VEGF injections like ranibizumab improve vision by 2+ lines in 90% of wet AMD patients over 2 years.
- AREDS2 formula reduces progression to late AMD by 25% in intermediate cases over 5 years.
- Pegcetacoplan slows GA growth by 29% over 12 months in phase 3 trials.
- Photodynamic therapy with verteporfin stabilizes vision in 60% of occult CNV cases.
- Laser photocoagulation reduces severe vision loss risk by 50% in classic CNV AMD.
- Aflibercept achieves 95% maintenance of vision (losing <15 letters) at 52 weeks.
- Smoking cessation lowers progression risk by 40% within 5 years post-quitting.
- Low vision rehab improves quality of life scores by 20-30% in AMD patients.
- Bevacizumab (off-label) matches ranibizumab efficacy at lower cost, with 90% stability.
- Gene therapy trials (RGX-314) reduce injection need by 80% over 2 years.
- Stem cell transplants restore RPE in preclinical models, with 70% graft survival.
- Untreated wet AMD leads to legal blindness in 25% of eyes within 2 years.
- AREDS supplements halve neovascular AMD risk in high-risk groups.
- Brolucizumab shows 43% GA reduction risk vs aflibercept at 96 weeks.
- GA untreated expands at 1.66 mm²/year, causing 20/200 VA in 50% over 5 years.
- Faricimab extends injection intervals to 16 weeks in 45% of patients.
Treatment and Prognosis Interpretation
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