Prevalence of Age-Related Macular Degeneration in Europe

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Abstract

Purpose

Age-related macular degeneration (AMD) is a frequent, complex disorder in elderly of European ancestry. Risk profiles and treatment options have changed considerably over the years, which may have affected disease prevalence and outcome. We determined the prevalence of early and late AMD in Europe from 1990 to 2013 using the European Eye Epidemiology (E3) consortium, and made projections for the future.

Design

Meta-analysis of prevalence data.

Participants

A total of 42 080 individuals 40 years of age and older participating in 14 population-based cohorts from 10 countries in Europe.

Methods

AMD was diagnosed based on fundus photographs using the Rotterdam Classification. Prevalence of early and late AMD was calculated using random-effects meta-analysis stratified for age, birth cohort, gender, geographic region, and time period of the study. Best-corrected visual acuity (BCVA) was compared between late AMD subtypes; geographic atrophy (GA) and choroidal neovascularization (CNV).

Main Outcome Measures

Prevalence of early and late AMD, BCVA, and number of AMD cases.

Results

Prevalence of early AMD increased from 3.5% (95% confidence interval [CI] 2.1%–5.0%) in those aged 55–59 years to 17.6% (95% CI 13.6%–21.5%) in those aged ≥85 years; for late AMD these figures were 0.1% (95% CI 0.04%–0.3%) and 9.8% (95% CI 6.3%–13.3%), respectively. We observed a decreasing prevalence of late AMD after 2006, which became most prominent after age 70. Prevalences were similar for gender across all age groups except for late AMD in the oldest age category, and a trend was found showing a higher prevalence of CNV in Northern Europe. After 2006, fewer eyes and fewer ≥80-year-old subjects with CNV were visually impaired ( P = 0.016). Projections of AMD showed an almost doubling of affected persons despite a decreasing prevalence. By 2040, the number of individuals in Europe with early AMD will range between 14.9 and 21.5 million, and for late AMD between 3.9 and 4.8 million.

Conclusion

We observed a decreasing prevalence of AMD and an improvement in visual acuity in CNV occuring over the past 2 decades in Europe. Healthier lifestyles and implementation of anti–vascular endothelial growth factor treatment are the most likely explanations. Nevertheless, the numbers of affected subjects will increase considerably in the next 2 decades. AMD continues to remain a significant public health problem among Europeans.

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Most cited references 44

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Ranibizumab and bevacizumab for neovascular age-related macular degeneration.

Daniel Martin, Maureen Maguire, Gui-shuang Ying … (2011)

Clinical trials have established the efficacy of ranibizumab for the treatment of neovascular age-related macular degeneration (AMD). In addition, bevacizumab is used off-label to treat AMD, despite the absence of similar supporting data. In a multicenter, single-blind, noninferiority trial, we randomly assigned 1208 patients with neovascular AMD to receive intravitreal injections of ranibizumab or bevacizumab on either a monthly schedule or as needed with monthly evaluation. The primary outcome was the mean change in visual acuity at 1 year, with a noninferiority limit of 5 letters on the eye chart. Bevacizumab administered monthly was equivalent to ranibizumab administered monthly, with 8.0 and 8.5 letters gained, respectively. Bevacizumab administered as needed was equivalent to ranibizumab as needed, with 5.9 and 6.8 letters gained, respectively. Ranibizumab as needed was equivalent to monthly ranibizumab, although the comparison between bevacizumab as needed and monthly bevacizumab was inconclusive. The mean decrease in central retinal thickness was greater in the ranibizumab-monthly group (196 μm) than in the other groups (152 to 168 μm, P=0.03 by analysis of variance). Rates of death, myocardial infarction, and stroke were similar for patients receiving either bevacizumab or ranibizumab (P>0.20). The proportion of patients with serious systemic adverse events (primarily hospitalizations) was higher with bevacizumab than with ranibizumab (24.1% vs. 19.0%; risk ratio, 1.29; 95% confidence interval, 1.01 to 1.66), with excess events broadly distributed in disease categories not identified in previous studies as areas of concern. At 1 year, bevacizumab and ranibizumab had equivalent effects on visual acuity when administered according to the same schedule. Ranibizumab given as needed with monthly evaluation had effects on vision that were equivalent to those of ranibizumab administered monthly. Differences in rates of serious adverse events require further study. (Funded by the National Eye Institute; ClinicalTrials.gov number, NCT00593450.).

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Prevalence of age-related macular degeneration in the United States.

David Friedman, Benita J O'Colmain, Beatriz Mateos Muñoz … (2004)

To estimate the prevalence and distribution of age-related macular degeneration (AMD) in the United States by age, race/ethnicity, and gender. Summary prevalence estimates of drusen 125 microm or larger, neovascular AMD, and geographic atrophy were prepared separately for black and white persons in 5-year age intervals starting at 40 years. The estimated rates were based on a meta-analysis of recent population-based studies in the United States, Australia, and Europe. These rates were applied to 2000 US Census data and to projected US population figures for 2020 to estimate the number of the US population with drusen and AMD. The overall prevalence of neovascular AMD and/or geographic atrophy in the US population 40 years and older is estimated to be 1.47% (95% confidence interval, 1.38%-1.55%), with 1.75 million citizens having AMD. The prevalence of AMD increased dramatically with age, with more than 15% of the white women older than 80 years having neovascular AMD and/or geographic atrophy. More than 7 million individuals had drusen measuring 125 microm or larger and were, therefore, at substantial risk of developing AMD. Owing to the rapidly aging population, the number of persons having AMD will increase by 50% to 2.95 million in 2020. Age-related macular degeneration was far more prevalent among white than among black persons. Age-related macular degeneration affects more than 1.75 million individuals in the United States. Owing to the rapid aging of the US population, this number will increase to almost 3 million by 2020.

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Pegaptanib for neovascular age-related macular degeneration.

Evangelos Gragoudas, Anthony P Adamis, Emmett Cunningham … (2004)

Pegaptanib, an anti-vascular endothelial growth factor therapy, was evaluated in the treatment of neovascular age-related macular degeneration. We conducted two concurrent, prospective, randomized, double-blind, multicenter, dose-ranging, controlled clinical trials using broad entry criteria. Intravitreous injection into one eye per patient of pegaptanib (at a dose of 0.3 mg, 1.0 mg, or 3.0 mg) or sham injections were administered every 6 weeks over a period of 48 weeks. The primary end point was the proportion of patients who had lost fewer than 15 letters of visual acuity at 54 weeks. In the combined analysis of the primary end point (for a total of 1186 patients), efficacy was demonstrated, without a dose-response relationship, for all three doses of pegaptanib (P<0.001 for the comparison of 0.3 mg with sham injection; P<0.001 for the comparison of 1.0 mg with sham injection; and P=0.03 for the comparison of 3.0 mg with sham injection). In the group given pegaptanib at 0.3 mg, 70 percent of patients lost fewer than 15 letters of visual acuity, as compared with 55 percent among the controls (P<0.001). The risk of severe loss of visual acuity (loss of 30 letters or more) was reduced from 22 percent in the sham-injection group to 10 percent in the group receiving 0.3 mg of pegaptanib (P<0.001). More patients receiving pegaptanib (0.3 mg), as compared with sham injection, maintained their visual acuity or gained acuity (33 percent vs. 23 percent; P=0.003). As early as six weeks after beginning therapy with the study drug, and at all subsequent points, the mean visual acuity among patients receiving 0.3 mg of pegaptanib was better than in those receiving sham injections (P<0.002). Among the adverse events that occurred, endophthalmitis (in 1.3 percent of patients), traumatic injury to the lens (in 0.7 percent), and retinal detachment (in 0.6 percent) were the most serious and required vigilance. These events were associated with a severe loss of visual acuity in 0.1 percent of patients. Pegaptanib appears to be an effective therapy for neovascular age-related macular degeneration. Its long-term safety is not known. Copyright 2004 Massachusetts Medical Society.

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Author and article information

Contributors

Caroline C.W. Klaver

Journal

Journal ID (nlm-ta): Ophthalmology

Journal ID (iso-abbrev): Ophthalmology

Title: Ophthalmology

Publisher: Elsevier

ISSN (Print): 0161-6420

ISSN (Electronic): 1549-4713

Publication date PMC-release: 1 December 2017

Publication date (Print): December 2017

Volume: 124

Issue: 12

Pages: 1753-1763

Affiliations

[1 ]Department of Ophthalmology, Erasmus Medical Center, Rotterdam, Netherlands

[2 ]Department of Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands

[3 ]Scientific Institute of Public Health (WIV-ISP), Brussels, Belgium

[4 ]Federal Agency for Medicines and Health Products, Brussels, Belgium

[5 ]Faculty of Medicine, University of Coimbra (FMUC), Coimbra, Portugal

[6 ]Department of Ophthalmology, Coimbra Hospital and University Center (CHUC), Coimbra, Portugal

[7 ]Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal

[8 ]Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom

[9 ]NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom

[10 ]University Bordeaux, Inserm, Bordeaux Population Health Research Center, Team LEHA, Bordeaux, France

[11 ]Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany

[12 ]UiT The Arctic University of Norway/University Hospital of North Norway, Tromsø, Norway

[13 ]Department of Ophthalmology, Oslo University Hospital, Oslo, Norway

[14 ]Department of Ophthalmology, University Hospital, Eye and Nutrition Research Group, Dijon, France

[15 ]Department of Ophthalmology, Aristotle University of Thessaloniki AHEPA Hospital, Thessaloniki, Greece

[16 ]Integrative Epidemiology, UCL Institute of Ophthalmology, London, United Kingdom

[17 ]CHU de Bordeaux, Service d'Ophtalmologie, Bordeaux, France

[18 ]Department of Ophthalmology, University of Padova, Padova, Italy

[19 ]Netherlands Institute of Neurosciences (NIN), Institute of the Royal Netherlands Academy of Arts and Sciences (KNAW), Department of Ophthalmology, AMC, Amsterdam and LUMC, Leiden, Netherlands

[20 ]Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom

[21 ]Department of Ophthalmology, Radboud University Medical Center, Nijmegen, Netherlands

Author notes

[∗ ]Correspondence: Caroline C.W. Klaver, MD, PhD, Department of Ophthalmology, Erasmus Medical Centre, P.O. Box 2040, NL-3000 CA Rotterdam, the Netherlands.Department of OphthalmologyErasmus Medical CentreP.O. Box 2040NL-3000 CA Rotterdamthe Netherlands c.c.w.klaver@ 123456erasmusmc.nl

[∗]

Drs Colijn and Buitendijk contributed equally to this manuscript.

[‡,§]

See list in Appendix.

Article

Publisher ID: S0161-6420(16)32475-7

DOI: 10.1016/j.ophtha.2017.05.035

PMC ID: 5755466

PubMed ID: 28712657

SO-VID: 78870655-96e7-47d3-aa69-132427dd4020

License:

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

History

Date received : 2 January 2017

Date revision received : 2 May 2017

Date accepted : 26 May 2017

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Prevalence of Age-Related Macular Degeneration in Europe : The Past and the Future

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Abstract

Purpose

Design

Participants

Methods

Main Outcome Measures

Results

Conclusion

Related collections

Karger: Ophthalmology

Most cited references 44

Ranibizumab and bevacizumab for neovascular age-related macular degeneration.

Prevalence of age-related macular degeneration in the United States.

Pegaptanib for neovascular age-related macular degeneration.

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Contributors

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Comments

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Cited by 160

Most referenced authors 912