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Meta-Analysis
. 2017 Dec;124(12):1753-1763.
doi: 10.1016/j.ophtha.2017.05.035. Epub 2017 Jul 14.

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

Johanna M Colijn  1 , Gabriëlle H S Buitendijk  1 , Elena Prokofyeva  2 , Dalila Alves  3 , Maria L Cachulo  4 , Anthony P Khawaja  5 , Audrey Cougnard-Gregoire  6 , Bénédicte M J Merle  6 , Christina Korb  7 , Maja G Erke  8 , Alain Bron  9 , Eleftherios Anastasopoulos  10 , Magda A Meester-Smoor  1 , Tatiana Segato  11 , Stefano Piermarocchi  11 , Paulus T V M de Jong  12 , Johannes R Vingerling  13 , Fotis Topouzis  10 , Catherine Creuzot-Garcher  9 , Geir Bertelsen  14 , Norbert Pfeiffer  7 , Astrid E Fletcher  15 , Paul J Foster  16 , Rufino Silva  4 , Jean-François Korobelnik  17 , Cécile Delcourt  6 , Caroline C W Klaver  18 ; EYE-RISK consortium; European Eye Epidemiology (E3) consortium
Collaborators, Affiliations
Meta-Analysis

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

Johanna M Colijn et al. Ophthalmology. 2017 Dec.

Abstract

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.

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Figures

Figure 3
Figure 3
Meta-analysis of (A) early and (B) late age-related macular degeneration (AMD) in Europe per age category for the participating studies. Meta-analysis of the prevalence of (C) early and (D) late AMD before and after 2006.
Figure 4
Figure 4
Meta-analysis of early (A) and late (B) age-related macular degeneration in Europe by 10-year birth cohorts.
Figure 7
Figure 7
A, Proportion of visually impaired eyes within each subgroup of late age-related macular degeneration (AMD). The proportion of visually impaired eyes remained the same for geographic atrophy (47.6%; P = 0.4), but dropped to 66.2% (P = 0.026) for choroidal neovascularization after 2006. B, Proportion of persons with late AMD with bilateral visual impairment before and after 2006 (P = 0.016). ∗P < 0.05.
Figure 8
Figure 8
Predicted number of persons with age-related macular degeneration (AMD) in years 2013–2040 as a function of 2 prevalence scenarios.
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