Is preventable sight loss truly preventable? An exploration of a public health indicator for sight loss due to age-related macular degeneration in England

Abstract

Background Age-related macular degeneration accounts for the majority of severe sight impairment and sight impairment registration and certifications in adults in the UK [1, 2]. Whilst these treatments are effective in arresting nAMD progression, there is currently no treatment for GA [1, 3, 4]. Methods This paper provides an update to the data collected by Bunce et al. [3] and details the number of people certified together with incidence rates for the various types of AMD by: sex, sight impairment status, and for all ages using the 2016/2017 and 2017/2018 CVI due to AMD data for England from the Moorfields Eye Hospital, supplemented with 2017–2018 PHOF indicator 4.12i/E12a data. The study population includes individuals of all ages in England who were newly certified with visual impairment due to AMD. Results Between 2016 and 2017, CVIs due to AMD totalled to 11,215; between 2017 and 2018, CVIs due to AMD totalled to 10,914. The PHOF indicator 4.12i/E12a assessed showed that overall rates of AMD certifications have steadily declined in England from 131.5 per 100,000 in 2010/2011 to 106.7 per 100,000 in 2017/2018. Conclusion As treatment is available for nAMD, a reduction in nAMD certifications could be expected; however, growth of the elderly population in England combined with there currently being no treatment available for GA means AMD certification rates should be increasing. Therefore, it is postulated that not all cases of AMD are being certified and registered with some likely going undiagnosed.

Age-Related Macular Degeneration: An Exponentially Emerging Imminent Threat of Visual Impairment and Irreversible Blindness

“…The other spectrum of AMD encompasses the neovascular form or exudative/wet type of AMD, where new blood vessels proliferate into the sub-RPE or subretinal spaces [ 50 ]. The development of CNV causes leakage of abnormal vessels resulting in hemorrhage and even serious complications such as RPE detachment, leading to rapid sight loss [ 55 ]. Although rare, serous pigment epithelial detachment (PED) can progress to life-threatening visual loss due to the accumulation of fluid in subretinal spaces causing tearing of RPE and secondary atrophy of the outer retina [ 56 ].…”

Optimizing Screening for Preventable Blindness With Head-Mounted Visual Assessment Technology

“…Progress in treating AMD as a disorder across its varied stages requires newer therapeutics along with a more detailed understanding of the genetic and cellular pathways of pathophysiology is needed to better counter this prevalent disorder of the eye. Brown et al (2022) recently showed that a significant portion of AMD cases is going unreported in England. This conclusion was based on the steady decrease in AMD certification rates in England from 131.5 per 100,000 in 2010-2011 to 106.7 per 100,000 in 2017-2018, whereas in a country with an aging population the rate should have increased significantly (Brown et al, 2022).…”

“…Brown et al (2022) recently showed that a significant portion of AMD cases is going unreported in England. This conclusion was based on the steady decrease in AMD certification rates in England from 131.5 per 100,000 in 2010-2011 to 106.7 per 100,000 in 2017-2018, whereas in a country with an aging population the rate should have increased significantly (Brown et al, 2022). This study demonstrates how current screening programs for AMD can still be further optimized as seen in countries such as England with significant investments in ophthalmic services.…”

“…Brown et al (2022) recently showed that a significant portion of AMD cases is going unreported in England. This conclusion was based on the steady decrease in AMD certification rates in England from 131.5 per 100,000 in 2010–2011 to 106.7 per 100,000 in 2017–2018, whereas in a country with an aging population the rate should have increased significantly (Brown et al, 2022).…”

“…This study demonstrates how current screening programs for AMD can still be further optimized as seen in countries such as England with significant investments in ophthalmic services. Early intervention can prevent sight loss due to neovascular AMD, with anti-VEGF injections allowing 90% of eyes to have a stabilized or improved visual acuity in over 1 year (Brown et al, 2022; Wecker et al, 2019).…”