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Prevalence for different AMD grades were calculated. Demographic details were analysed then integrated with the AMD gradings for full analysis. Prevalence rates for the different AMD Grades were calculated, as well as the age-specific prevalences. AMD prevalence in the worst eye were Geographic atrophy grade 4a occurred in 2. Prevalence increased with age such that grade 4 advanced AMD was 2.

Persons with more advanced AMD grades were more likely to be dissatisfied with their vision. Significant asymmetry between the two eyes occurs in individuals with unilateral advanced AMD so that visual impairment statistics do not represent true prevalence of advanced AMD. Persons with more advanced AMD were more likely to be dissatisfied with their vision.

Age-related macular degeneration AMD is the leading cause of irreversible visual impairment in adult populations across developed countries, 1 and a leading cause of global blindness. AMD represents the advanced end of pathological changes within the ageing macula.

The earliest features referred to as age-related maculopathy ARM , consist of yellow sub-retinal pigment epithelial RPE deposits drusen , some types of which have long been an established risk factor for the development of AMD since first described by Gass. There are currently no proven treatments for dry AMD. Despite treatments with anti-vascular endothelial growth factor anti-VEGF therapies for nAMD, the number of individuals in the UK with sight loss secondary to AMD is expected to rise from in to by A recent meta-analysis of AMD prevalence across populations of European ancestry confirmed significant heterogeneity in prevalence rates between studies.

Some UK prevalence estimates were based on data from registration of visual impairment 22 with associated inherent shortcomings. Under-certification is reported; 23 while patients with bilateral visual impairment may be registered, persons with early ARM, asymptomatic, unilateral, or eccentric AMD, where bilateral visual acuity VA is not reduced go unrecorded. Furthermore, registration is dependent on patient consent.

Other estimates are based on pooled findings from studies undertaken in various white populations of shared European ancestry in the UK and elsewhere. A publication by Ngai et al 31 included only male subjects aged 65—83 years, as part of a longitudinal cohort, with potential selection bias from a healthy survivor effect. Other studies adopted non-standard grading definitions, making comparisons to other reports difficult. A recent systematic review, seeking to provide reliable estimates on AMD prevalence in populations of European ancestry 21 underpins the need for a more robust population based measure to provide information on asymptomatic and asymmetric disease along with information on ARM, allowing more adequate healthcare planning for the UK.

The primary ophthalmic diseases studied were AMD, cataract, and glaucoma. Bridlington, a coastal town in Yorkshire, UK, was chosen because it included a relatively stable predominantly Caucasian elderly population with little migration. A detailed description of the study design has been reported elsewhere. All participants were interviewed, in person, by a trained research nurse using structured questionnaire, and examined by one of four specially trained optometrists with structured proforma completed by the research staff.

Further details of Methodology are provided in Online Supplementary.

Drusen were categorised on the basis of their size, homogeneity, and outline. If doubt existed as to whether a lesion was AMD or other pathology such as diabetic retinopathy, pathological myopia, chorioretinitis, or laser burns, then it was not graded as AMD. All images graded as GA were specifically reviewed to ensure that none had a recorded history of diabetic retinopathy or previous macular laser. In addition, frequent sessions of simultaneous grading with a retinal specialist WMA were performed to maintain reproducibility.

Any differences in opinion were sent to CARF for grading. One in ten 1 in 10 randomly selected right eye images were sent to the CARF for secondary masked grading by certified graders. Statistical analysis was performed using Stata Continuous outcomes were compared between participants with gradable and non-gradable images. Where the assumptions of normality were violated for continuous variables non-parametric techniques were be applied.

Differences in proportions were assessed using Chi-squared tests. Binary outcome variables were analysed using logistic regression techniques.

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Basic demographic information was available for all subjects within the sampling frame. Gender balance was similar for both attenders and non-attenders. Inter-observer variability was assessed using Kappa. There was good agreement between graders across all AMD stages. Prevalence rates were very similar between right and left eyes, as illustrated in Table 2a and did not differ between the genders. Prevalence rates for the worse eye were: GA was 1. PPCNV 4c was infrequent, with prevalence of 0. The prevalence of the earlier stages of ARM decreased with age Table 3a.

In subjects aged 65—69 years, The prevalence of grade 4 AMD increased from 2. In this population, This symmetry was especially notable at the lower grades of AMD. However, at the higher AMD grades significant asymmetry was observed between the two eyes of participants. GA was unilateral in Similarly, bilateral nAMD was present in Bilateral advanced AMD 4a, 4b, or 4c occurred in 63 people 1. The proportion of the population with self-perceived dissatisfaction with vision is shown in Table 4a.

As the grade of AMD increased the self-perceived dissatisfaction with vision worsened. A significant number of participants with the more advanced grades of AMD In the early stages of ARM, the majority of subjects were happy with their vision, as shown in Table 4a. As the worse eye AMD grade increased, the percentage of subjects happy with their vision decreased from With the better eye, there was significant increase in subject dissatisfaction with vision, particularly for individuals with bilateral nAMD. Table 4b demonstrates that individuals with grade 4a or 4b AMD in their better eye were over four times more likely to report dissatisfaction with their vision when compared to individuals with no AMD.

There was widespread variation in vision, ranging from excellent LogMAR 0. Eyes with nAMD were most likely to suffer significant visual impairment, with Data are numbers row percentage. The relationship between AMD and cataract was explored with linear and logistic regression models using the grade of nuclear cataract and the presence of significant cataract as the respective dependent variables. Supplementary Results are provided in Online Supplementary. The study utilised digital fundus photography and grading methods that are well-recognised and used in previous population based studies.

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As such, a significant number of persons with bilateral advanced AMD may have been excluded. This implies that our reported prevalence of advanced AMD grade 4 , despite being higher than previously reported, may actually be an underestimation. Nevertheless, the prevalence rates of AMD in this BEAP study are generally higher than previously reported in similar age subgroupings in other studies, 7 , 9 , 10 , 11 , 12 , 13 , 14 , 16 and may be related to the larger participation of the older population than in previous studies, or higher detection rates.

To the best of our knowledge, this study provides for the first time, the population prevalence for grade 4c AMD in the UK, and data on the prevalence of early stages of AMD and persons with asymmetric AMD. There is a significant proportion of the population who have advanced AMD in one eye, while the other eye functions normally. Such persons are not captured by current methods of visual impairment data collection in the UK. Similarly, persons with the earlier and intermediate stages of AMD are asymptomatic, and can only be detected by regular checks.

Such information is necessary for health care planning.

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A common finding among previous prevalence studies in populations of, or derived from European ancestry was that nAMD was more common than GA. This difference remained for the worse eye, with GA being 1. The nature and significance of these differences is uncertain but could reflect genetic factors which have been reported to play a role in the prevalence of AMD.

It shows that a large proportion of individuals with GA in their worse eye remained satisfied with their vision. With regards to the worse eye, nAMD is the only stage at which the majority of participants are dissatisfied, while with the better eye, subject dissatisfaction with vision increased, particularly for individuals with bilateral nAMD. Our results are highly likely representative of the Caucasian population studied.

Associated Data

Attendance rates are lower than in some studies, 7 , 9 , 11 , 13 probably reflecting the older age of inclusion in our study, but largely comparable to those in others, 8 , 10 , 12 , 16 , 43 considering that many of these latter studies used lower minimum age inclusions. Allowing home examination may have increased our response rate but would have reduced the degree of standardisation of procedures and grading, through exclusion of photography. A limitation of the current study is that the use of non-stereoscopic photographs could have resulted in an underestimation of the prevalence of nAMD by missing subtle PEDs.

However, chronic PEDs with significant activity from a CNV would likely be associated with other signs including retinal haemorrhages or gliosis, which would have allowed their identification. Furthermore, as this study excluded persons registered as visually impaired, a significant number of patients with bilateral advanced AMD may have been excluded resulting in an underestimation of true prevalence. Another limitation is that the population was purely Caucasian, and does not provide any information on racial differences in AMD in the UK. However, this is also strength, as a similar sized study of a mixed population would have wider confidence limits for each finding in each racial group.

The limitation of utilising colour photographs as the only imaging modality in this study is obvious, as the early stages of AMD may be overlooked, where optical coherence tomography and autofluorescence images are not available.

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Similarly reticular pseudodrusen may be difficult to detect without multimodal imaging. Despite such potential under-estimation, the technology and grading system used is similar to that in previous AMD population studies, and should therefore yield comparable reliability. In conclusion, this study provides contemporary prevalence rates of different stages of AMD in a UK population, and indicates that the prevalence of advanced AMD is more common than previously thought. It has also, for the first time, provided data on the occurrence of AMD asymmetry in the population.

Further studies are required in other UK communities to determine differences in prevalence amongst the different ethnicities, as well as determine incidence rates. The remaining authors declare no conflict of interest. Read article at publisher's site DOI : Int Ophthalmol , 40 6 , 04 Mar Eye Lond , 33 3 , 12 Oct Cited by: 0 articles PMID: Eye Lond , 33 4 , 01 Nov PLoS One , 13 11 :e, 08 Nov This data has been text mined from the article, or deposited into data resources.

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