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Impact of incident age-related macular degeneration and associated vision loss on vision-related quality of life
  1. Ryan Eyn Kidd Man1,2,3,
  2. Alfred Tau Liang Gan1,
  3. Eva K Fenwick1,
  4. Kelvin Yi Chong Teo1,2,3,
  5. Anna C S Tan1,2,3,
  6. Gemmy Chui Ming Cheung1,2,3,
  7. Zhen Ling Teo1,3,
  8. Neelam Kumari1,4,
  9. Tien Yin Wong1,2,3,5,
  10. Ching-Yu Cheng1,2,5,
  11. Ecosse Luc Lamoureux1,2,5
  1. 1Singapore Eye Research Institute, Singapore
  2. 2Duke-NUS Medical School, Singapore
  3. 3Singapore National Eye Centre, Singapore
  4. 4Department of Ophthalmology and Visual Sciences, Khoo Teck Puat Hospital, Singapore
  5. 5National University of Singapore, Singapore
  1. Correspondence to Dr Ecosse Luc Lamoureux, HSSR, Duke-NUS Medical School, Singapore 169857, Singapore; ecosse{at}


Background We examined the associations between the 6-year incidence of age-related macular degeneration (AMD) and vision-related quality of life (VRQoL), and the contribution of presenting visual acuity (VA), in an Asian population.

Methods Fundus images from the Singapore Chinese Eye Study, a population-based cohort study (baseline: 2009–2011; follow-up: 2015–2017), were graded using a modified Wisconsin age-related maculopathy grading system. Incident AMD was defined as no baseline AMD in both eyes and early/late AMD in the worse eye at follow-up. Presenting VA was assessed using the logarithm of the minimum angle of resolution chart at 4 m under standard lighting conditions with habitual correction. Multiple linear regression models determined the associations between AMD incidence with changes in the Rasch-transformed scores of the Reading, Mobility and Emotional VRQoL domains of the 32-item Impact of Visual Impairment (IVI-32) questionnaire, adjusted for traditional confounders. The contribution of presenting VA to changes in VRQoL was also estimated.

Results Of the 2251 participants without AMD at baseline (mean age (SD): 57.7 (9) years, 51.4% women), 101 (4.5%) and 11 (0.5%) developed incident early and late AMD at follow-up, respectively. Incident late AMD was associated with significant 30.3%, 32.5% and 30.9% decrements in Reading, Mobility and Emotional IVI scores, respectively. The contribution of presenting VA ranged between 1.62% and 4.35% of the observed decrements. No significant associations were noted with incident early AMD.

Conclusion Incident late AMD had a substantial impact on all aspects of VRQoL, with presenting VA contributing only minimally to this longitudinal relationship.

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  • Contributors Study design: ELL, TYW and C-YC. Study conduct: REKM, NK and ZLT. Provided materials: TYW, ELL and C-YC. Data analysis/interpretation: REKM, ATLG, EKF and ELL. Manuscript drafting: REKM, ATLG and EKF. Manuscript proofing: KYCT, ACST, GCMC, ZLT, NK, TYW, C-YC and ELL.

  • Funding This research is supported by the Singapore Ministry of Health’s National Medical Research Council (STaR/0003/2008, NMRC/CIRG/1417/2015, NMRC/CIRG/1488/2018 and NMRC/OFLCG/004a/2018), the Singapore Bio Imaging Consortium (C-011/2006) and the Biomedical Research Council (08/1/35/19/550). ELL and C-YC are supported by the National Medical Research Council (NMRC) Senior-Clinician Scientist Awards (#NMRC/CSASI/0009/2016 for ELL; #NMRC/CSASI/0012/2017 for C-YC), and REKM is supported by the NMRC Transition Award (#MOH-TA19may-0002).

  • Disclaimer The funding bodies had no role in the design and conduct of this research.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The baseline study received approval from the Singapore Eye Research Institute (SERI) Institutional Review Board (R498/47/2006), while the follow-up study was approved by the SingHealth Institutional Review Board (#2015/2279).

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

  • Data availability statement Data are available upon reasonable request. Due to Singapore’s strict data sharing law, any data requests will be considered on a case-by-case basis.

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