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JAMA Ophthalmology Feb 2024Three leading disease causes of age-related visual loss are cataract, age-related macular degeneration (AMD), and glaucoma. Although all 3 eye diseases have been...
IMPORTANCE
Three leading disease causes of age-related visual loss are cataract, age-related macular degeneration (AMD), and glaucoma. Although all 3 eye diseases have been implicated with falls and fracture risk, evidence is mixed, with the contribution of different eye diseases being uncertain.
OBJECTIVE
To examine whether people with cataract, AMD, or glaucoma have higher risks of falls or fractures than those without.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study was a population-based study in England using routinely collected electronic health records from the Clinical Practice Research Datalink (CPRD) GOLD and Aurum primary care databases with linked hospitalization and mortality records from 2007 to 2020. Participants were people with cataract, AMD, or glaucoma matched to comparators (1:5) by age, sex, and general practice. Data were analyzed from May 2021 to June 2023.
EXPOSURES
For each eye disease, we estimated the risk of falls or fractures using separate multivariable Cox proportional hazards regression models.
MAIN OUTCOMES
Two primary outcomes were incident falls and incident fractures derived from general practice, hospital, and mortality records. Secondary outcomes were incident fractures of specific body sites.
RESULTS
A total of 410 476 people with cataract, 75 622 with AMD, and 90 177 with glaucoma were matched (1:5) to 2 034 194 (no cataract), 375 548 (no AMD), and 448 179 (no glaucoma) comparators. The mean (SD) age was 73.8 (11.0) years, 79.4 (9.4) years, and 69.8 (13.1) years for participants with cataract, AMD, or glaucoma, respectively. Compared with comparators, there was an increased risk of falls in those with cataract (adjusted hazard ratio [HR], 1.36; 95% CI, 1.35-1.38), AMD (HR, 1.25; 95% CI, 1.23-1.27), and glaucoma (HR, 1.38; 95% CI, 1.35-1.41). Likewise for fractures, there were increased risks in all eye diseases, with an HR of 1.28 (95% CI, 1.27-1.30) in the cataract cohort, an HR of 1.18 (95% CI, 1.15-1.21) for AMD, and an HR of 1.31 (95% CI, 1.27-1.35) for glaucoma. Site-specific fracture analyses revealed increases in almost all body sites (including hip, spine, forearm, skull or facial bones, pelvis, ribs or sternum, and lower leg fractures) compared with matched comparators.
CONCLUSIONS AND RELEVANCE
The results of this study support recognition that people with 1 or more of these eye diseases are at increased risk of both falls and fractures. They may benefit from improved advice, access, and referrals to falls prevention services.
Topics: Humans; Aged; Cohort Studies; Cataract; Glaucoma; Macular Degeneration
PubMed: 38153708
DOI: 10.1001/jamaophthalmol.2023.5858 -
Clinical & Experimental Optometry May 2020Age-related macular degeneration (AMD) is the leading cause of irreversible vision loss in people over the age of 50 years in Australia. Optometry Australia has... (Review)
Review
Age-related macular degeneration (AMD) is the leading cause of irreversible vision loss in people over the age of 50 years in Australia. Optometry Australia has developed this AMD chairside reference in consultation with a member-based working group comprised of experienced practitioners. It provides an evidence-based approach to current best practice in the diagnosis and management of AMD. Optometrists should be competent in assessing patients with or at risk of developing AMD, so that they are able to provide evidence-based management including appropriate communication, diagnosis and referral when indicated. This AMD chairside reference covers risk factors for the development of AMD or progression to late-stage AMD; the current clinical classification of AMD; common signs and symptoms; optometric assessment including ocular imaging and biomarkers; differential diagnoses; and management of early, intermediate and late AMD. Optometry Australia's chairside reference is intended as a general guide for optometrists, and is not a formal management protocol.
Topics: Australia; Diagnostic Imaging; Disease Management; Humans; Macular Degeneration; Optometry; Referral and Consultation
PubMed: 31566818
DOI: 10.1111/cxo.12964 -
Molecular Aspects of Medicine Aug 2012Age-related macular degeneration (AMD) is a common condition among the elderly population that leads to the progressive central vision loss and serious compromise of... (Review)
Review
Age-related macular degeneration (AMD) is a common condition among the elderly population that leads to the progressive central vision loss and serious compromise of quality of life for its sufferers. It is also one of the few disorders for whom the investigation of its genetics has yielded rich insights into its diversity and causality and holds the promise of enabling clinicians to provide better risk assessments for individuals as well as to develop and selectively deploy new therapeutics to either prevent or slow the development of disease and lessen the threat of vision loss. The genetics of AMD began initially with the appreciation of familial aggregation and increase risk and expanded with the initial association of APOE variants with the disease. The first major breakthroughs came with family-based linkage studies of affected (and discordant) sibs, which identified a number of genetic loci and led to the targeted search of the 1q31 and 10q26 loci for associated variants. Three of the initial four reports for the CFH variant, Y402H, were based on regional candidate searches, as were the two initial reports of the ARMS2/HTRA1 locus variants. Case-control association studies initially also played a role in discovering the major genetic variants for AMD, and the success of those early studies have been used to fuel enthusiasm for the methodology for a number of diseases. Until 2010, all of the subsequent genetic variants associated with AMD came from candidate gene testing based on the complement factor pathway. In 2010, several large-scale genome-wide association studies (GWAS) identified genes that had not been previously identified. Much of this historical information is available in a number of recent reviews (Chen et al., 2010b; Deangelis et al., 2011; Fafowora and Gorin, 2012b; Francis and Klein, 2011; Kokotas et al., 2011). Large meta analysis of AMD GWAS has added new loci and variants to this collection (Chen et al., 2010a; Kopplin et al., 2010; Yu et al., 2011). This paper will focus on the ongoing controversies that are confronting AMD genetics at this time, rather than attempting to summarize this field, which has exploded in the past 5 years.
Topics: Disease Progression; Genetic Markers; Genetic Predisposition to Disease; Genetic Testing; Humans; Macular Degeneration; Phenotype; Risk Factors
PubMed: 22561651
DOI: 10.1016/j.mam.2012.04.004 -
Nature Communications Jul 2019Age-related macular degeneration (AMD) is the most common cause of blindness among the elderly in the developed world. While treatment is effective for the neovascular... (Review)
Review
Age-related macular degeneration (AMD) is the most common cause of blindness among the elderly in the developed world. While treatment is effective for the neovascular or "wet" form of AMD, no therapy is successful for the non-neovascular or "dry" form. Here we discuss the current knowledge on dry AMD pathobiology and propose future research directions that would expedite the development of new treatments. In our view, these should emphasize system biology approaches that integrate omic, pharmacological, and clinical data into mathematical models that can predict disease onset and progression, identify biomarkers, establish disease causing mechanisms, and monitor response to therapy.
Topics: Animals; Humans; Macular Degeneration; Oxidative Stress; Systems Biology
PubMed: 31350409
DOI: 10.1038/s41467-019-11262-1 -
Current Opinion in Pharmacology Apr 2022Age-related macular degeneration (AMD) is a progressive retinal disease that is a leading cause of visual impairment and severe vision loss. The number of people... (Review)
Review
Age-related macular degeneration (AMD) is a progressive retinal disease that is a leading cause of visual impairment and severe vision loss. The number of people affected by AMD is increasing and constitutes a huge worldwide health problem. The beneficial effects of fish consumption on AMD have been revealed over the past decades, and in this review, we summarizes the beneficial effects of fatty fish on AMD and its mechanism of action. Fatty fish affects the development of AMD by inhibiting neovascularization, interacting with retinal pigment epithelial (RPE) cells, displacing Omega-6, and inducing cellular responses. It is recommended that people at high risk or with moderate or more severe AMD should consider eating more fatty fish in addition to maintaining a healthy lifestyle of weight control and smoking cessation and the need to promote new models of personalized AMD prevention and treatment.
Topics: Animals; Humans; Macular Degeneration
PubMed: 35217394
DOI: 10.1016/j.coph.2022.102186 -
Ophthalmologica. Journal International... 2017The Age-Related Eye Disease Study (AREDS) and AREDS2 provided evidence for treating persons with age-related macular degeneration (AMD) with antioxidant vitamins and...
The Age-Related Eye Disease Study (AREDS) and AREDS2 provided evidence for treating persons with age-related macular degeneration (AMD) with antioxidant vitamins and minerals to reduce the risk of development of late AMD. The AREDS2 data suggest that the beta-carotene in the original AREDS supplements be replaced by lutein and zeaxanthin, providing a safer drug for those who are smokers or former smokers. Even though consuming fish reduced the risk of AMD in observational studies, the AREDS2 results showed that omega-3 long-chain polyunsaturated fatty acids (docosahexaenoic acid/eicosapentaenoic acid) had no beneficial effect on AMD. Despite the major progress in the discovery of gene variants associated with AMD, the use of genetic testing to predict disease has not been clinically useful. The use of genetic testing prior to AMD therapies such as administering AREDS supplements is not recommended by the American Academy of Ophthalmology and other organizations.
Topics: Antioxidants; Clinical Trials as Topic; Eye Proteins; Genetic Testing; Humans; Macular Degeneration; Nutrition Assessment; Vitamins
PubMed: 28478452
DOI: 10.1159/000473865 -
The New England Journal of Medicine Oct 2006
Review
Topics: Aging; Antioxidants; Bruch Membrane; Disease Progression; Humans; Macular Degeneration; Pigment Epithelium of Eye; Retina; Retinal Drusen; Smoking
PubMed: 17021323
DOI: 10.1056/NEJMra062326 -
Retina (Philadelphia, Pa.) Dec 2016There is a lack of agreement regarding the types of lesions and clinical conditions that should be included in the term "geographic atrophy." Varied and conflicting... (Review)
Review
PURPOSE
There is a lack of agreement regarding the types of lesions and clinical conditions that should be included in the term "geographic atrophy." Varied and conflicting views prevail throughout the literature and are currently used by retinal experts and other health care professionals.
METHODS
We reviewed the nominal definition of the term "geographic atrophy" and conducted a search of the ophthalmologic literature focusing on preceding terminologies and the first citations of the term "geographic atrophy" secondary to age-related macular degeneration.
RESULTS
According to the nominal definition, the term "geography" stands for a detailed description of the surface features of a specific region, indicating its relative position. However, it does not necessarily imply that the borders of the region must be sharply demarcated or related to any anatomical structures. The term "geographical areas of atrophy" was initially cited in the 1960s in the ophthalmologic literature in the context of uveitic eye disease and shortly thereafter also for the description of variants of "senile macular degeneration." However, no direct explanation could be found in the literature as to why the terms "geographical" and "geographic" were chosen. Presumably the terms were used as the atrophic regions resembled the map of a continent or well-defined country borders on thematic geographical maps. With the evolution of the terminology, the commonly used adjunct "of the retinal pigment epithelium" was frequently omitted and solely the term "geographic atrophy" prevailed for the nonexudative late-stage of age-related macular degeneration itself. Along with the quantification of atrophic areas, based on different imaging modalities and the use of both manual and semiautomated approaches, various and inconsistent definitions for the minimal lesion diameter or size of atrophic lesions have also emerged.
CONCLUSION
Reconsideration of the application of the term "geographic atrophy" in the context of age-related macular degeneration seems to be prudent given ongoing advances in multimodal retinal imaging technology with identification of various phenotypic characteristics, and the observation of atrophy development in eyes under antiangiogenic therapy.
Topics: Geographic Atrophy; Macular Degeneration; Semantics; Terminology as Topic
PubMed: 27552292
DOI: 10.1097/IAE.0000000000001258 -
The Journal of the American Board of... 2002The neovascular form of age-related macular degeneration (AMD) can rapidly lead to severe loss of central vision and adversely affect the patient's quality of life.... (Review)
Review
BACKGROUND
The neovascular form of age-related macular degeneration (AMD) can rapidly lead to severe loss of central vision and adversely affect the patient's quality of life. During the 1990s the only proven treatment for neovascular AMD was laser photocoagulation. Only a minority of patients are eligible to receive this treatment, however, and the treatment itself can cause acute retinal damage with immediate vision loss. Verteporfin therapy is a new treatment option involving photodynamic therapy that was recently shown to be relatively safe and effective in reducing the risk of vision loss in selected cases.
METHODS
Recent literature was reviewed on management of choroidal neovascularization caused by AMD that proved beneficial in large-scale randomized clinical trials. These studies were selected through a MEDLINE search of files from 1982 to the present using the keywords "randomized clinical trials," "choroidal neovascularization," and "age-related macular degeneration," as well as through personal knowledge of recently completed trials.
RESULTS AND CONCLUSIONS
Primary care physicians can effect good treatment outcomes by detecting early signs of AMD and educating patients about the necessity of prompt referral to an ophthalmologist. Immediate referral is increasingly important because, compared with laser photocoagulation, current photodynamic therapy with verteporfin is applicable to more patients. Greater patient awareness of neovascular AMD and the importance of self-testing of vision can also be communicated to patients in primary care.
Topics: Aged; Female; Humans; Laser Therapy; Macular Degeneration; Male; Middle Aged; Patient Education as Topic; Photosensitizing Agents; Porphyrins; Primary Health Care; Referral and Consultation; Retinal Neovascularization; Risk Factors; Verteporfin
PubMed: 12002198
DOI: No ID Found -
The Ulster Medical Journal Sep 2005