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How does macular degeneration affect real-world visual ability and quality of life?1

Devinder Chauhan

24/08/2017

This recently published systematic review has confirmed the devastating impact of age-related macular degeneration (AMD) on quality of life (QoL) and visual ability. The highly prevalent condition, classified as a ‘priority eye disease’ by the World Health Organization, negatively affects a number of activities of daily living (ADLs) and the emotional impact can be severe.

AMD

AMD is the leading cause of vision loss in Australians aged 60 years and older. The macula, a small area in the retina at the back of the eye, is responsible for central vision and may start to deteriorate as a person ages. AMD is the most common type of macular problem, with two distinct stages:

  1. Early stage

    • Also called age-related maculopathy (ARM)
    • Characterised by the formation of yellow/white deposits (drusen) under the retina
  2. Advanced stage

    • Dry/atrophic AMD
    • The most common type of AMD
    • The macular tissue thins (atrophies) and eventually stops functioning properly
    • Vision loss is insidious and gradual
    • Wet/exudative/neovascular AMD
    • Around 10% of people with AMD have the wet form
    • Abnormal blood vessels grow, and can leak, beneath the retina
    • Vision loss is sudden and generally more noticeable than with dry AMD.

Symptoms of AMD include blurred vision and loss or distortion of central vision. Peripheral vision remains unaffected. An Amsler Grid can help to detect AMD, but an ophthalmologist must confirm the diagnosis. Intravitreal injections can shrink the abnormal blood vessels in wet AMD to help prevent further vision loss for many patients – indeed, vision may improve for some people. No treatment is currently available for dry AMD, although vitamin therapy may lower the risk of progression to a more advanced stage in some cases.

Visual function and QoL

People who do not have AMD (e.g. family members, carers and even some healthcare providers) often underestimate the effect of this condition, particularly on visual function and QoL. While there have been various studies to date assessing this impact, they do not include real-world performance-based measures, and the most recent large-scale systematic review is now over a decade old. This is the first systematic review to include patient-reported and performance-based outcome measures of QoL and visual function in patients with AMD. The authors identified 5284 studies through a literature search, of which 123 were eligible for inclusion.

Previous studies have already established the detrimental impact that AMD has on reading ability. Making note of the variability between individual studies in this review, the authors confirm that other ADLs are also negatively affected and include:

Ability to provide adequate self-care may also be compromised. Unsurprisingly, psychological wellbeing can be affected by the presence of a visual impairment, and people with AMD may be at higher risk of psychological harm compared to those with other causes of vision loss. Having AMD has been associated with a higher rate of depression, with symptom severity linked to the degree of the visual impairment. Interestingly, available evidence does not suggest a relationship between AMD and anxiety. The authors note that the impact of AMD can vary over the time course of the disease, perhaps due to adaptation by the affected person.

Conclusion

A more comprehensive understanding of the potential impact that AMD can have on a person’s life is critical for the successful management of a disease that currently has no cure. Clinical management should embrace a more holistic approach in the real world – in other words, successful management is not just defined by visual clarity but also by appropriate access to social, emotional and physical support.

Click here to see a list of Vision Eye Institute ophthalmologists who specialise in retinal conditions (including macular degeneration).

Reference
  1. Taylor DJ et al. How does age-related macular degeneration affect real-world visual ability and quality of life? A systematic review. BMJ Open 2016;6:e011504

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