Elsevier

Ophthalmology

Volume 111, Issue 3, March 2004, Pages 513-517
Ophthalmology

Original article
Age-related macular degeneration causing visual impairment in people 75 years or older in Britain: An add-on study to the Medical Research Council Trial of Assessment and Management of Older People in the Community

https://doi.org/10.1016/j.ophtha.2003.07.012Get rights and content

Abstract

Purpose

Age-related macular degeneration (AMD) is the most commonly occurring cause of visual loss in people registered as blind or partially sighted. There are no nationally representative data on the prevalence of AMD in the British population. We aimed to estimate the prevalence of AMD causing visual impairment in people 75 years or older in Britain.

Design

Population-based cross-sectional study.

Participants

Thirteen thousand nine hundred people 75 years or older in 49 practices taking part in the Medical Research Council Trial of the Assessment and Management of Older People in the Community.

Methods

Trial nurses tested visual acuity in everyone 75 years or older in participating practices. We collected data on the cause of visual loss for everyone who was visually impaired. We obtained these data from review of the general practice medical notes and by sending a questionnaire to the hospital ophthalmologist. Visual impairment was defined as a binocular acuity of less than 6/18.

Main outcome measure

Prevalence of AMD causing visual impairment.

Results

There were 976 visually impaired people for whom a cause of visual loss was established. Of these, 516 (53%) had AMD as a cause of visual loss. We estimate that 3.7% (95% confidence interval, 3.2%–4.2%) of the population 75 years or older and 14.4% (11.6%–17.2%) of the population 90 years or older are visually impaired due to AMD. There are an estimated 192 000 people 75 years or older visually impaired due to AMD in the United Kingdom (95% confidence interval, 144 000–239 000).

Conclusion

Our results, from the largest and most representative study of the causes of vision loss in older people in the British population, confirm the substantial burden of AMD in people 75 years and older. As the population ages, this problem will get worse. The needs of this group for vision aids and other support in the community should be addressed; research on the causes of AMD and possible preventive measures should be given priority.

Section snippets

Materials and methods

The MRC Trial of the Assessment and Management of Older People in the Community is a large-cluster randomized trial taking place in 106 general practices from the MRC General Practice Research Framework.8 The practices in the study were selected to be representative of the mortality (standardized mortality ratio) and Jarman scores of general practices in Britain (England, Wales, and Scotland). All patients 75 years or older on the general practitioner list were invited to participate in the

Results

Response rates for visual acuity testing have been published elsewhere.6 Briefly, there were 21 241 eligible people in 53 general practices. Of these, 15 126 (71%) had a detailed health assessment. People taking part in the study had ages (median age, 80.3 years [interquartile range, 77.2–84.2]) similar to those not taking part (median age, 81.0 [interquartile range, 77.7–85.2]).

Details of the causes of visual impairment study have been published previously.7 In brief, practices taking part in

Discussion

We estimate that 3.7% (95% CI, 3.2%–4.2%) of the population 75 years or older has AMD causing visual impairment. The prevalence increases rapidly with increasing age—14.4% (11.6%–17.2%) of the population 90 years or older are visually impaired due to AMD. Applying the age-specific prevalence rates to the United Kingdom population gives an estimated 192 000 people 75 years or older visually impaired due to AMD in the United Kingdom (95% CIs, 144 000–239 000).

The MRC Trial of the Assessment and

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Manuscript no. 230157.

The Medical Research Council Trial of the Assessment and Management of Older People in the Community was funded by the United Kingdom Medical Research Council, the Department of Health, and the Scottish Office. Collection of data on causes of visual impairment was funded by the Gift of Thomas Pocklington.

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