Some epidemiology

  • see

  • 100,000 blind people in the UK,

  • 64,000 blind from ARMD

  • There are about 26,000 new cases of wet AMD in the UK each year and the condition affects more women than men. The condition usually affects people who are over 50 years old and the risk increases significantly with age. The most commonly cited risk factor for AMD is cigarette smoking; the risk of developing AMD is 3.6 times greater for current and former smokers than for people who have never smoked. (NICE)

  • 770,000 have early ARMD

  • 84:16 female:male ratio

  • Major impact:

    • falls...x8 risk of fractured hip, x4 risk of needing home care

    • each line of vision represents about 20% 'quality of life'

    • person's own self-esteem is reduced

  • risks of soft drusen progressing

  • more about drusen and progression Wang et al

  • Participants with light iris colour had twofold the risk of AMD progression of those with dark or intermediate iris colours

  • lipofuscin (in drusen etc) originates from vitamin A

  • there is at lease a 10x difference between countries...eg Japan and China have very low rates.

  • 33% of people >75y develop armd   also

  • Early treatment is more effective (here)..this suggests screening would be helpful. I recommend all high risk patients with soft drusen, especially smokers, to see their optometrist every 6 months for an assessment...waiting for symptoms is probably too late (limited evidence for this at present)

  • Genes controlling breakdown of other chemicals (including pollutants) may also contribute to ARMD, see

  • at presentation of exudative ARMD: 24% were wholly/predominately classic, 38% minimally classic, 38% occult no classic. Only the 24% were suitable for PDT. (Poster, RCO, 2005)

  • autofluoresence findings are related to macular function. I expect this will become a useful examination procedure, but you need a scanning laser ophthalmoscope see

  • there are skin autofluoresence changes Mulder 2010

  • 28,000 Cases of ARMD causing visual loss in people aged 75 years and above in the United Kingdom may be attributable to smoking.see

  • We know urban pollution increases the risk of heart disease so that it equals the risk of smoking 20 cigarettes a day, here. This it is likely that urban pollution will also cause many cases of ARMD. Definitive evidence is awaited. For cities the size of Birmingham and London similar numbers of patients affected by smoking will be affected by pollution. (nearly 500 and 5500 cases respectively.)

  • Occult ARMD is merely an earlier stage of CNV, see

  • ARMD is much less common in Japan and China, and much more common in countries such as Greenland.

  • one if the biggest problems is the inability to find patients with early CNV.

  • results are better without risk factors

  • peripapillary CNV are related to armd: the associations of  peri-papillary CNV are

      52(45.2%), age-related maculopathy (ARM);
      45 (39.1%), idiopathic;
      5 (4.3%), multifocal choroiditis;
      3 (2.6%), angioid streaks;
      2 (1.7%), histoplasmosis;
      2 (1.7%), choroidal osteoma;
      1 (0.9%), optic disc drusen;
      1 (0.9%), congenital disc anomaly
      (3 [2.6%]) peripapillary pseudopodal pigment epithelial a
      (1 [0.9%]) choroidal atrophy
      Second-eye involvement was observed in 19.8% of patients over a median follow-up of 2 years

  • CNV are associated with staphylomas

  • CNV are related to many inflamatory conditions, including sarcoid See CNV due to sarcoid membrane    other healthy eye

  • Drusen can be graded.

  • US epidemiology (Archives 2011)

stage description
0a nil
0b small hard drusen <63µ
1a soft distinct drusen > 63µ
1b pigmentary abnormalities only
2a soft indistinct drusen >125 µ or reticular drusne only
2b soft indistinct drusen >63 <125µ with pigmentary abnormalities
3 soft indistinct drusen/reticular >125µ with pigmentary abnormalities
4 atrophic/neovascular ARMD