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Education, socio-economic status and age-related macular degeneration in Asians: the Singapore Malay Eye Study
  1. P Cackett1,2,
  2. W T Tay1,
  3. T Aung1,2,3,
  4. J J Wang4,5,
  5. A Shankar6,
  6. S M Saw6,
  7. P Mitchell4,
  8. T Y Wong1,2,3,5
  1. 1
    Singapore Eye Research Institute, Singapore
  2. 2
    Singapore National Eye Centre, Singapore
  3. 3
    Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  4. 4
    Centre for Vision Research, University of Sydney, Australia
  5. 5
    Centre for Eye Research Australia, University of Melbourne, Australia
  6. 6
    Department of Community, Occupational and Family Medicine, Yong Loo Lin School of Medicine National University of Singapore, Singapore
  1. Professor T Y Wong, Centre for Eye Research Australia, The Royal Victorian Eye and Ear Hospital, University of Melbourne, 32 Gisborne Street, Melbourne 3002, Victoria, Australia; twong{at}


Background/aims: Low socio-economic status is increasingly being identified as a risk marker for chronic diseases, but few studies have investigated the link between socio-economic factors and age-related macular degeneration (AMD). The present study aimed to assess the association between socio-economic status and the prevalence of AMD.

Methods: A population-based cross-sectional study of 3280 (78.7% response rate) Malay adults aged 40–80 years residing in 15 south-western districts of Singapore. AMD was graded from retinal photographs at a central reading centre using the modified Wisconsin AMD scale. Early and late AMD signs were graded from retinal photographs following the Wisconsin grading system. Socio-economic status including education, housing type and income were determined from a detailed interview.

Results: Of the participants, 3265 had photographs of sufficient quality for grading of AMD. Early AMD was present in 168 (5.1%) and late AMD in 21 (0.6%). After adjusting for age, gender, smoking, hypertension, diabetes and body mass index, participants with lower educational levels were significantly more likely to have early AMD (multivariate OR 2.2, 95% CI 1.2 to 4.0). This association was stronger in persons who had never smoked (multivariate OR 3.6, 95% confidence CI 1.4 to 9.4). However, no association with housing type or income was seen.

Conclusions: Low educational level is associated with a higher prevalence of early AMD signs in our Asian population, independent of age, cardiovascular risk factors and cigarette smoking.

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  • Funding: This study was funded by Funded by the National Medical Research Council (NMRC), 0796/2003 & the Biomedical Research Council (BMRC), 501/1/25-5, with support from the Singapore Prospective Study Program and the Singapore Tissue Network, A*STAR.

  • Competing interests: None.

  • Ethics approval: The study was approved by the Singapore Eye Research Institute Ethics Committee.

  • Patient consent: Obtained.