• Users Online: 99
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 16  |  Issue : 1  |  Page : 42-46

Clinical study of age-related macular degeneration-incidence, visual acuity assessment, and risk factors


Department of Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India

Date of Submission21-May-2020
Date of Decision18-Dec-2020
Date of Acceptance16-Jan-2021
Date of Web Publication29-Jul-2021

Correspondence Address:
Dr. Sapan Jaiswal
Department of Ophthalmology, Jawaharlal Nehru Medical College, AVBRH, DMIMS Campus, Sawangi (Meghe), Wardha - 442 004, Maharashtra
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1319-4534.322608

Rights and Permissions
  Abstract 


Background: Age-related macular degeneration (AMD) is an eye disease that can blur the sharp, central vision you need for activities like reading and driving. “Age-related” means that it often happens in older people. “Macular” means it affects a part of your eye called the macula. Settings and Design: AMD is a common condition – it's a leading cause of vision loss for people age 50 and older. AMD doesn't cause complete blindness, but losing your central vision can make it harder to see faces, drive, or do close up work like cooking or fixing things around the house. Methods: AMD happens very slowly in some people. Even if you have early AMD, you may not experience vision loss for a long time. For other people, AMD progresses faster and can lead to central vision loss in one eye or both eyes. Conclusion: The present article aims to summarize the current knowledge on AMD its incidence, visual acuity, and risk factors

Keywords: Age-related macular degeneration, ARMD, macular degeneration hypertension, risk factors, visual activity


How to cite this article:
Jaiswal S, Raut P, Kamble M, Gadegone A. Clinical study of age-related macular degeneration-incidence, visual acuity assessment, and risk factors. J Datta Meghe Inst Med Sci Univ 2021;16:42-6

How to cite this URL:
Jaiswal S, Raut P, Kamble M, Gadegone A. Clinical study of age-related macular degeneration-incidence, visual acuity assessment, and risk factors. J Datta Meghe Inst Med Sci Univ [serial online] 2021 [cited 2021 Sep 16];16:42-6. Available from: http://www.journaldmims.com/text.asp?2021/16/1/42/322608




  Introduction Top


Aging constitutes a decreasing ability to survive. No organ esacpes from this process of senescence including the eye. However though unavoidable, age-related conditions offer the opportunity for prevention, control, and treatment.

Senile macular degeneration nowadays known as “age-related macular degeneration” because of the pejorative connotation of the senile is also an age-related process, accounting for considerable visual loss in old age.

Though a primary age-related procedure several local and systemic risk factors have been incriminated. The study of these factors is necessary to help this aging population. The prevalence of age-related macular degeneration (AMD) has been variably reported from 8.8% to 29.3%.[1],[2],[3],[4],[5]

AMD is bilateral disease, the average age of onset of visual loss in the 1st eye being 65 years with a 12% incidence of involvement of the second eye per year. So that about 60% of patients are legally blind in both eyes by the time they reach their 70th birthday. It is rarity among colored races. AMD occurs in two forms first is dry or geographic macular degeneration characterized by drusens, changes in the retinal pigment epithelium, and various degrees of macular atrophy, second is wet or exudative type consisting of subretinal neovascularisation, hemorrhages, and scar formation.

Though exudative is rarer of two 80% visual loss is because of exudative type. Moreover in this era of LASER tools are at hand to reduce the rate of severe visual loss from the exudative type of AMD, when they are detected and treated early.

Thus there is a definite need for studies to provide more information regarding aetiopathogenesis and clinical features of AMD.

Aim

  • To study the incidence of AMD in relation to age and sex of patients
  • To evaluate the relationship between age-related macular degeneration and potential risk factors
  • To know the incidence of various forms of dry and wet AMD
  • To assess the visual impairment in patients with AMD.



  Materials and Methods Top


Study design

  • Randomized cross-sectional study
  • Total number of cases evaluated = 1230 cases
  • AMD = 97 cases
  • In all cases, the detailed history of ocular complaints was asked regarding, the onset of diminution of vision, duration and any sudden loss of vision, presence of micropsia, macropsia, metamorphopsia, and any scotoma in front of the eye. Relevant history regarding systemic problems was also noted
  • Blood pressure and blood sugar checkup were done in every patient. A detailed ocular examination was done. Visual acuity was taken in each patient and any visual improvement was noted with pinhole or glasses. Retinoscopy was done and the best-corrected distance and near visual acuity was recorded. The fundus examination was done in detail both with direct and indirect ophthalmoscopy. Fundus photography and fundus fluorescein angiography were done in few selected cases. The individual macular changes like pigmentation, drusens, neovascularisation, hemorrhages, and fibrous scarring were graded according to the severity. In assessing the risk factors, i.e., refractive status, lens changes, and associated fundus pathology were studied
  • Patients who improved with glasses were given the suitable correction both for distance and near. Patients who did not improve with glasses were explained about the visual prognosis.[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20]


Inclusion criteria

  1. Patients attending ophthalmology OPD at AVBRH
  2. Patients >50 years of age
  3. Patients having no previous history of any major ocular pathology


Exclusion criteria

  1. Patients with hazy media impairing visualization of the fundus, for example-corneal opacity, healed or active anterior uveitis, cataract, vitreous opacities, etc.
  2. Patients in whom dilatation of the pupil is contraindicated.


Ethical clearance

The Institutional Ethics Committee of DMIMSDU has approved the Research work proposed to be carried out at Jawaharlal Nehru Medical College, Sawangi(M), Wardha. Date: 11th Dec 2018 with Reference no DMIMS(DU)/IEC/2018-19/2231.


  Observation Top



  Discussion Top


1230 patients above the age of 50 years, attending eye OPD during the period from March 2019 to April 2020 were examined. Out of these patients, 97 cases having AMD were selected and were examined in detail with direct and indirect ophthalmoscopy. In selected cases, slit-lamp biomicroscopy and fundus photography were done. Fundus fluorescein angiography was also done in few cases.

Distortion or the absence of foveal reflex, presence of pigment epithelial changes, and drusens were taken as dry type of AMD. The presence of retinal pigment epithelial detachment, subretinal neovascularization, hemorrhages, exudates, and fibrovascular membrane formation were taken as the exudative type of macular degeneration.

Incidence of AMD in patients >50 years of age group attending eye OPD of AVBRH, Wardha was found to be 7.88% in our study. In the present study out of 97 cases, 91.76% of patients had dry type of AMD while only 8.24% of patients had exudative type of macular degeneration. Thus, the prevalence of exudative type is significantly lower than dry type. Various other authors have noticed similar results. In India, I. S. Jain and P. Prasad noticed that the incidence of dry type is 85% and that of exudative type is 15%. Similarly, in Western countries F. L. Ferris and S. L. Fine observed that the prevalence of exudative maculopathy is <10%.

The prevalence of AMD was found to increase significantly with increasing age. This is in collaboration with other studies. The incidence of disease was found to be 4.96% in 51–60 years of age group, 8.85% in 61–70 years, increasing to 13.37% in 71–80 tears age group, reaching as high as 14.54% in 81 years and above age group. The Health and Nutrition Survey (HANES) reported that the incidence of ARMD is strongly age related. In our study also the incidence of ARMD was higher above the age of 70 (13.95%).

In the present study, there was a slight preponderance of the disease in male patients. Out of 97 patients, 61 were male and 36 were females. The overall incidence in males above 50 years of age was 8.53% were as in females, it was 7.42%. The age-related eye disease study showed that more women than men had ARMD. In our study slight male preponderance was observed due to more awareness and outreach of males than females to the hospital facility.

In our study, only16% of patients with AMD were smokers while Strahman and Staurt got 75% history of smoking in their patients. This could be because of the lower prevalence of smokers in India than Western countries. In pooled data from Europe, America, Australia's history of smoking was present (25.6%) and it emerged as the most important preventable cause of ARMD.

The prevalence of hypertension in patients with AMD was found to be 19% in our study. The Beaver Dam Study showed Hypertension is associated with a higher risk of ARMD. In the present study, only one patient had background type of diabetic retinopathy though Rajwardhah Azad, etc. in their study observed that the prevalence of diabetes was higher in patients with AMD i.e. 21%–74% than in control.

In the present study, 87 patients presented with gradual progressive diminution of vision. 2 patients came with a history of metamorphopsia. 8 patients noticed black spot in front of the eye. Similarly, other authors also observed that gradual progressive diminution of vision is the most common presenting symptom in AMD.

The visual acuity both for distance and near was found to decrease with increasing severity of the disease. 2.06% of patients had visual acuity 6/6–6/9. 16.49% of patients had visual acuity of 6/12–6/18. 6/24–6/36 visual acuity was present in 20.71% of patients while 57.73% of patients had 6/60 or worse vision.

In the present study visual loss was found to be more in exudative type of AMD than dry type of AMD. In this study, 53.93% of patients with dry type of macular degeneration had visual acuity of 6/60 or worse while all the patients with the exudative type of AMD had visual acuity of 6/60 or worse. Similar results were obtained by other authors. Frederick and Staurt found that 13% of patients with dry type of degeneration had visual acuity of 6/60 or less while visual acuity of 6/60 or worse was present in 84% of patients with the exudative type of degeneration.

Thus, it is seen though the exudative type of AMD is less prevalent than dry type visual loss is more because of exudative type [Table 1],[Table 2],[Table 3],[Table 4],[Table 5],[Table 6],[Table 7],[Table 8],[Table 9],[Table 10],[Table 11].[21],[22],[23],[24],[25],[26],[27],[28],[29]
Table 1: Incidence of age-related macular degeneration in patients above 50 years

Click here to view
Table 2: Incidence of dry type and exudative type of agerelated macular degeneration

Click here to view
Table 3: Ophthalmoscopic picture in patients with dry age-related macular degeneration

Click here to view
Table 4: Ophthalmoscopic picture in patients with wet age-related macular degeneration

Click here to view
Table 5: Age wise distribution of patients with age-related macular degeneration

Click here to view
Table 6: Sex wise distribution of patients with age-related macular degeneration

Click here to view
Table 7: Associated fundus pathology in patients with age-related macular degeneration

Click here to view
Table 8: Symptoms of patients with age-related macular degeneration

Click here to view
Table 9: Distant visual acuity in patients with age-related macular degeneration

Click here to view
Table 10: Severity of visual loss due to dry and exudative type of age-related macular degeneration

Click here to view
Table 11: Correlation of risk factors with age-related macular degeneration

Click here to view



  Conclusion Top


  1. The incidence of AMD in the present study is 7.88%
  2. AMD is a rarity among colored races
  3. AMD is exclusively related with age, its prevalence increases with an increase in age
  4. There is slight male preponderance of the disease
  5. There is a definite relation between AMD and hypertension, hypertension being more prevalent in patients with AMD
  6. There is no significant relation between diabetes mellitus and AMD
  7. AMD is essentially bilateral disease
  8. Visual loss in patients with AMD increases with the severity of the disease
  9. Visual loss is more in the exudative type of AMD than dry type.


Regular follow-up of patients with bilateral macular drusens and proper advise to them is important to prevent blindness from AMD.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Peeters A, Magliano DJ, Stevens J, Duncan BD, Klein R, Wong TY, et al. Age-related macular degeneration. Arch Ophthalmol 2008;126:1554-60.  Back to cited text no. 1
    
2.
Klein R, Klein BE, Tomany SC, Meuer SM, Huang GH. Ten-year incidence and progression of age-related maculopathy: The Beaver Dam eye study. Ophthalmology 2002;109:1767-79.  Back to cited text no. 2
    
3.
Mitchell P. Five year incidence of age related maculopathy lesions: The blue mountains eye study. Ophthalmology 2002;109:1092-7.  Back to cited text no. 3
    
4.
Klein R, Klein BE, Marino EK, Kuller LH, Furberg C, Burke GL, et al. Early age-related maculopathy in the cardiovascular health study. Ophthalmology 2003;110:25-33.  Back to cited text no. 4
    
5.
Vingerling JR. The prevalence of Age related maculopathy in the Rotterdam study. Ophthalmology 1995;102:205-10.  Back to cited text no. 5
    
6.
Holz FG. Bilateral macular drusens in age related macular degeneration. Prognosis and risk factors. Ophthalmol 1994;101:1522-2825.  Back to cited text no. 6
    
7.
Smith W. Smoking and age related maculopathy. The blue mountains eye study. Arch Ophthalmol 1996;114:1518-23.  Back to cited text no. 7
    
8.
The eye disease case control study group Risk factors for neovascular age related macular degeneration. Arch Ophthalmol 1992;110:1701-8.  Back to cited text no. 8
    
9.
Ambati J, Ambati BK, Yoo SH, Ianchulev S, Adamis AP. Age-related macular degeneration: Etiology, pathogenesis, and therapeutic strategies. Surv Ophthalmol 2003;48:257-93.  Back to cited text no. 9
    
10.
Fine SL. Age related macular degeneration. N Engl J Med 2000;342:483-92.  Back to cited text no. 10
    
11.
Brown MM, Brown GC, Stein JD, Roth Z, Campanella J, Beauchamp GR. Age related macular degeration: Economic burden and value based medicine analysis. Can J Ohthalmol 2005;40:277-87.  Back to cited text no. 11
    
12.
Anderson DH. A role for local inflammation in the formation of drusen in the aging eye. Am J Ophthalmol 2002;134:411-31.  Back to cited text no. 12
    
13.
Klaver CC, Wolfs RC, Assink JJ, van Duijn CM, Hofman A, de Jong PT. Genetic risk of age-related maculopathy. Population-based familial aggregation study. Arch Ophthalmol 1998;116:1646-51.  Back to cited text no. 13
    
14.
Schachat AP. Features of age related macular degeneration in a black population. The barbadous eye study group. Arch Ophthalmol 1995;113:728-35.  Back to cited text no. 14
    
15.
Schaumberg DA. Body mass index and the incidence of visually significant age related maculopathy in men. Arch Ophthalmol 2001;119:11259-65.  Back to cited text no. 15
    
16.
Sarks JP, Sarks SH, Killingsworth MC. Evolution of geographic atrophy of the retinal pigment epithelium. Eye (Lond) 1988;2 ( Pt 5):552-77.  Back to cited text no. 16
    
17.
Sunnes JS. Geographic atrophy. In: Berger JW, Fine SL, Maguire MG, editors. Age Related Macular Degeneration. St. Luis: Mosby; 1999. p. 155-72.  Back to cited text no. 17
    
18.
Schumacher S, Schlötzer-Schrehardt U, Martus P, Lang W, Naumann GO. Pseudoexfoliation syndrome and aneurysms of the abdominal aorta. Lancet 2001;357:359-60.  Back to cited text no. 18
    
19.
Larsen WJ. Churchill Livingstone. 6th ed. PhiladelphiaPA: WB Saunders Co; 1998. p. 229-72.  Back to cited text no. 19
    
20.
Shaban RI, Asfour WM. Ocular pseudoexfoliation associated with hearing loss. Saudi Med J 2004; 25:1254-7.  Back to cited text no. 20
    
21.
Cahill M, Early A, Stack S, Blayney AW, Eustace P. Pseudoexfoliation and sensorineural hearing loss. Eye (Lond) 2002;16:261-6.  Back to cited text no. 21
    
22.
Turacli ME, Ozdemir FA, Tekeli O, Gökcan K, Gerçeker M, Dürük K. Sensorineural hearing loss in pseudoexfoliation. Can J Ophthalmol 2007;42:56-9.  Back to cited text no. 22
    
23.
Walavalkar R, Lohiya S, Waigi R. To Evaluate Macular Changes after Uncomplicated Phacoemulsification by Optical Coherence Tomography. Int J Pharm Res 2019;11:1834-9. Available from: https://doi.org/10.31838/ijpr/2019.11.02.207. [Last accessed on 2020 May 18].  Back to cited text no. 23
    
24.
Mehta K, Sune P, Belsare A. Study of Correlates of Age-Related Macular Degeneration in Patients Attending Tertiary Hospital. Int J Pharm Res 2019;11:1825-8. Available from: https://doi.org/10.31838/ijpr/2019.11.02.205. [Last accessed on 2020 May 18].  Back to cited text no. 24
    
25.
Bajpayee N, Tidake PK, Palsodkar PM. Comparative Study of Visual Acuity and Astigmatism Determination between Small Incision Cataract Surgery and Phacoemulsification by Corneal Topography. Int J Cur Res Rev 2020;12:65-8. Available from: https://doi.org/10.31782/IJCRR.2020.SP82. . [Last accessed on 2020 May 18].  Back to cited text no. 25
    
26.
Bele A, Tidake P, Patil PS. A Comparative Study of Visual Acuity and Surgically Induced Astigmatism after Phacoemulsification by Temporal Clear Corneal and Superior Clear Corneal Incision. Int J Pharm Res 2019;11:2006-12. Available from: https://doi.org/10.31838/ijpr/2019.11.04.501. [Last accessed on 2020 May 18].  Back to cited text no. 26
    
27.
Gu A, Daigavane S, Palsodkar PM. Effect of Heparinised Irrigating Solution during Cataract Surgery on Postoperative Inflammation. Int J Pharm Res 2019;11:1800-3. Available from: https://doi.org/10.31838/ijpr/2019.11.02.200. [Last accessed on 2020 May 18].  Back to cited text no. 27
    
28.
Muley S, Saoji C, Daigavane S, Patil R, Ghogare AS. Anxiety in Cataract Patients, Benefits of Counseling on Patient Anxiety in Routine Cataract Surgery. Int J Res Pharm Sci 2020;11:2620-5. Available from: https://doi.org/10.26452/ijrps.v11i2.2272. [Last accessed on 2020 May 18].  Back to cited text no. 28
    
29.
Nimbulkar G, Wagh V, Gaidhane A, Chhabra KG, Deolia S, Ingole A. A Study to Determine the Role of Different Types of Intraocular Lenses in the Management of Traumatic Cataract in a Tertiary Healthcare Centre. Eur J Mol Clin Med 2020;7:2035-9.  Back to cited text no. 29
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10], [Table 11]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Materials and Me...
Observation
Discussion
Conclusion
References
Article Tables

 Article Access Statistics
    Viewed208    
    Printed24    
    Emailed0    
    PDF Downloaded18    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]