Prevalence of Age-Related Macular Degeneration in Europe: The Past and the Future

doi:10.1016/j.ophtha.2017.05.035

Ophthalmology

Volume 124, Issue 12, December 2017, Pages 1753-1763

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https://doi.org/10.1016/j.ophtha.2017.05.035 Get rights and content

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Purpose

Age-related macular degeneration (AMD) is a frequent, complex disorder in elderly of European ancestry. Risk profiles and treatment options have changed considerably over the years, which may have affected disease prevalence and outcome. We determined the prevalence of early and late AMD in Europe from 1990 to 2013 using the European Eye Epidemiology (E3) consortium, and made projections for the future.

Design

Meta-analysis of prevalence data.

Participants

A total of 42 080 individuals 40 years of age and older participating in 14 population-based cohorts from 10 countries in Europe.

Methods

AMD was diagnosed based on fundus photographs using the Rotterdam Classification. Prevalence of early and late AMD was calculated using random-effects meta-analysis stratified for age, birth cohort, gender, geographic region, and time period of the study. Best-corrected visual acuity (BCVA) was compared between late AMD subtypes; geographic atrophy (GA) and choroidal neovascularization (CNV).

Main Outcome Measures

Prevalence of early and late AMD, BCVA, and number of AMD cases.

Results

Prevalence of early AMD increased from 3.5% (95% confidence interval [CI] 2.1%–5.0%) in those aged 55–59 years to 17.6% (95% CI 13.6%–21.5%) in those aged ≥85 years; for late AMD these figures were 0.1% (95% CI 0.04%–0.3%) and 9.8% (95% CI 6.3%–13.3%), respectively. We observed a decreasing prevalence of late AMD after 2006, which became most prominent after age 70. Prevalences were similar for gender across all age groups except for late AMD in the oldest age category, and a trend was found showing a higher prevalence of CNV in Northern Europe. After 2006, fewer eyes and fewer ≥80-year-old subjects with CNV were visually impaired (P = 0.016). Projections of AMD showed an almost doubling of affected persons despite a decreasing prevalence. By 2040, the number of individuals in Europe with early AMD will range between 14.9 and 21.5 million, and for late AMD between 3.9 and 4.8 million.

Conclusion

We observed a decreasing prevalence of AMD and an improvement in visual acuity in CNV occuring over the past 2 decades in Europe. Healthier lifestyles and implementation of anti–vascular endothelial growth factor treatment are the most likely explanations. Nevertheless, the numbers of affected subjects will increase considerably in the next 2 decades. AMD continues to remain a significant public health problem among Europeans.

Abbreviations and Acronyms

AMD

age-related macular degeneration

confidence interval

CNV

choroidal neovascularization

European Eye Epidemiology (consortium)

EPIC

European Prospective Investigation into Cancer and Nutrition

EUREYE

European Eye Study

geographic atrophy

Rotterdam Study

United Kingdom

VEGF

vascular endothelial growth factor

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: Supplemental material available at www.aaojournal.org.

: Financial Disclosure(s): C.D.: Consultant – Allergan, Bausch & Lomb, Laboratoires, Théa, Novartis, and Roche.

: R.S.: Consultant – Alimera, Allergan, Alcon, Bayer, Novartis, and Théa.

: The Rotterdam Study is funded by Erasmus Medical Center and Erasmus University, Rotterdam, Netherlands Organization for the Health Research and Development (ZonMw), the Research Institute for Diseases in the Elderly (RIDE), the Ministry of Education, Culture and Science, the Ministry for Health, Welfare and Sports, the European Commission (DG XII), and the Municipality of Rotterdam. The authors are grateful to the study participants, the staff from the Rotterdam Study, and the participating general practitioners and pharmacists.

: The Gutenberg Health Study (GHS) is funded through the government of Rhineland-Palatinate (“Stiftung Rheinland-Pfalz für Innovation,” contract AZ 961-386261/733), the research programs “Wissen schafft Zukunft” and “Center for Translational Vascular Biology (CTVB)” of the Johannes Gutenberg-University of Mainz, and its contract with Boehringer Ingelheim and PHILIPS Medical Systems, including an unrestricted grant for the GHS. The authors thank all study participants for their willingness to provide data for this research project and we are indebted to all coworkers for their enthusiastic commitment.

: H2020-RIA, EYE-RISK, grant number: 634479. Uitzicht grant number: 2015-36, Oogfonds, MaculaFonds, LSBS, Novartis Fonds. The sponsors and funding organization had no role in the design or conduct of this research.

: Author Contributions:

: Conception and design: Khawaja, Korb, Erke, Piermarocchi, Creuzot-Garcher, Pfeiffer, Delcourt, Klaver

: Analysis and interpretation: Colijn, Buitendijk, Prokofyeva, Alves, Cachulo, Khawaja, Cougnard-Gregoire, Merle, Korb, Erke, Bron, Anastasopoulos, Segato, Piermarocchi, Vingerling, Topouzis, Creuzot-Garcher, Pfeiffer, Silva, Korobelnik, Delcourt, Klaver

: Data collection: Colijn, Buitendijk, Cachulo, Khawaja, Korb, Erke, Bron, Anastasopoulos, Meester-Smoor, Segato, Piermarocchi, de Jong, Vingerling, Topouzis, Creuzot-Garcher, Bertelsen, Fletcher, Foster, Silva, Delcourt, Klaver

: Obtained funding: Not applicable

: Overall responsibility: Colijn, Buitendijk, Prokofyeva, Khawaja, Cougnard-Gregoire, Merle, Korb, Erke, Anastasopoulos, Topouzis, Bertelsen, Pfeiffer, Fletcher, Foster, Silva, Korobelnik, Delcourt, Klaver

^∗: Drs Colijn and Buitendijk contributed equally to this manuscript.

^‡,§: See list in Appendix.

© 2017 by the American Academy of OphthalmologyThis is an open access article under the CC BY-NC-ND license ?(<inter-ref xlink: href=http://creativecommons.org/licenses/by-nc-nd/4.0/>http://?creativecommons.org/licenses/by-nc-nd/4.0/</inter-ref>).