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Impact of early and late age-related macular degeneration on vision-specific functioning
  1. Ecosse L Lamoureux1,2,
  2. Paul Mitchell3,
  3. Gwyn Rees1,
  4. Gemmy Cheung2,
  5. Ian Yeo2,
  6. Shu Yen Lee2,
  7. Erica Liu2,
  8. Tien Y Wong1,2,4
  1. 1Centre for Eye Research Australia, the Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia
  2. 2Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
  3. 3Centre for Vision Research (Westmead Millennium Institute), University of Sydney, Sydney, Australia
  4. 4Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  1. Correspondence to Professor Ecosse Lamoureux, University of Melbourne, 32 Gisborne Street, East Melbourne, Victoria 3002, Australia; ecosse{at}


Aim To assess the impact of early and late age-related macular degeneration (AMD) on vision-specific functioning in Singapore Malays.

Methods AMD was assessed from fundus photographs. The following endpoints were considered for (a) AMD: no AMD, early AMD, and late AMD; (b) drusen: absence and presence; and (c) retinal pigment epithelium (RPE) abnormality: absence and presence. Vision functioning was assessed using the modified VF-11 scale validated using the Rasch analysis. The overall functioning score was used as the main outcome measure.

Results Retinal photographs and vision functioning data were available only for 3252 participants. After age standardisation, the prevalence of early AMD was 3.5% and late AMD 0.34%. In multivariate models, after adjusting for age, gender, education, level of income, smoking status, ocular condition and hypertension, only late AMD was independently associated with poorer vision functioning when compared with no AMD or early AMD (β (β regression coefficient)=−6.4 (CI −11.7 to −2.1; p=0.01)). Early AMD or its principal components, drusen or RPE abnormality, were not independently associated with vision functioning (p>0.05). In adjusted multinomial logistic regression models, people with late AMD were twice as likely (OR=2.23; 95% CI 1.16 to 7.11) to have low overall functioning than those without AMD.

Conclusions Late AMD has a significant impact on visual functioning, but early AMD, drusen and RPE changes have no impact. These data highlight the importance of preventive public health strategies targeting patients with early AMD signs in order to prevent progression to late AMD when visual function is compromised.

  • Age-related macular degeneration
  • vision-specific functioning
  • drusen and RPE
  • macula
  • degeneration

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  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by the Singapore Eye Research Institute Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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