Macular Degeneration: Muñoz B

Muñoz B, West SK. · Dana Center, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD 21287, USA. · Br J Ophthalmol. · Pubmed #11973241 links to  free full text

Abstract: AIM: To summarise available data on the prevalence and causes of visual impairment and blindness in the Americas and the Caribbean. METHODS: The published literature was searched in Medline and LILACS using the following key words: blindness, visual impairment, prevalence. Articles were reviewed, and the references of the articles were also searched for relevant articles, which were also reviewed. RESULTS: Using the mortality in children under the age of 5 as an indicator, the overall prevalence of childhood blindness (in the under age 15 group) for the region was estimated at 0.45/1000, with the majority (67%) living in countries with mortality of children under age 5 above 30/1000 live births. Corneal opacities were more common in countries where the under 5 year mortality are above 30/1000 live births and retinopathy of prematurity (ROP) was an important cause in countries with intermediate death rates. For adults, overall blindness rates were not estimated because of the social, economic, and ethnic diversity in the region. The primary causes of visual loss in adults in the Americas were age related eye diseases, notably cataract and glaucoma in the African-American and Hispanic populations, and age related macular degeneration in the white population. Uncorrected refractive error was a significant cause of decreased vision across ages, ethnic groups, and countries. CONCLUSION: More data are needed on the magnitude and causes of visual loss for the Caribbean and Latin American countries. Rates of blindness and visual loss from available data within these countries are widely disparate. Prevention and control of avoidable blindness needs to be an ongoing focus in this region.

Muñoz B, West SK, Rubin GS, Schein OD, Quigley HA, Bressler SB, Bandeen-Roche K. · Wilmer Eye Institute, The Johns Hopkins University, 600 N Wolfe St, Room 116, Baltimore, MD 21287, USA. · Arch Ophthalmol. · Pubmed #10865321 No free full text.

Abstract: OBJECTIVE: To determine the causes of blindness and visual impairment in a population-based sample of older Americans. METHODS: A random sample of 3821 residents of Salisbury, Md, between the ages of 65 and 84 years was identified from Medicare records. Sixty-six percent (2520 persons) agreed to undergo an eye examination; 26% of the participants were African American. The clinical examination included acuity testing with an Early Treatment Diabetic Retinopathy Study chart and standardized refraction testing for those with a visual acuity worse than 20/30, slitlamp and dilated retinal examination by an ophthalmologist, tonometry, lens and fundus photography, and a suprathreshold visual field test. Visual impairment was defined as a best-corrected acuity in the better-seeing eye worse than 20/40 and better than 20/200, while blindness was acuity in the better-seeing eye of 20/200 or worse. For those with a visual acuity worse than 20/40 in either eye, one or more causes were assigned by an ophthalmologist and a final cause for each eye was confirmed by a panel of 3 subspecialty ophthalmologists (O.D.S., H.A.Q., and S.B.B.) based on all available evidence. RESULTS: Bilateral presenting acuity worse than 20/40 increased from 4% in the 65- to 74-year age group to 16% in the 80- to 84-year age group. One third of those with presenting acuity worse than 20/40 improved to 20/40 or better with refraction. Overall, 4.5% had a best-corrected acuity worse than 20/40. African Americans were more likely to remain visually impaired than were whites despite refraction (odds ratio [95% confidence interval], 1.7 [1.1-2.6]). Whites were most often impaired or blind from age-related macular degeneration (1.2% vs 0.5%; P=.09). African Americans had higher rates of impairment and blindness from cataract or posterior capsular opacification (2.7% vs 1.1%; P=.006), glaucoma (0.9% vs 0.1%; P=.006), and diabetic retinopathy (1.2% vs 0.2%; P=. 004). CONCLUSIONS: More than half of those with visual impairment or blindness had conditions that were either surgically treatable or potentially preventable. African Americans had a disproportionate number of blinding diseases, particularly those amenable to eye care intervention. Targeted interventions for specific populations to increase appropriate eye care use would greatly improve vision and function in older Americans. Arch Ophthalmol. 2000;118:819-825

Bressler SB, Muñoz B, Solomon SD, West SK, Anonymous00118. · The Wilmer Eye Institute, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287-9228, USA. · Arch Ophthalmol. · Pubmed #18268216 links to  free full text

Abstract: OBJECTIVE: To determine differences in the prevalence of age-related macular degeneration (AMD) and its fundus manifestations in a population-based sample of older black and white Americans. DESIGN: Cross-sectional population-based study of 2520 participants of whom 1854 are white and 666 are black. Mean age was 73.5 years. Stereoscopic color fundus photographs were graded for presence, severity, and location of drusen, retinal pigment epithelium abnormalities, and choroidal neovascularization or disciform scarring. RESULTS: Drusen at least 64 microm in size were identified in 56% of black and white individuals within 3000 microm of the foveal center, but drusen larger than 125 microm were more common among white participants (16% white vs 11% black individuals). Drusen at least 250 microm in size, confluent drusen, or a larger area (> 10%) occupied by drusen were each more common among white participants. White individuals were 3 times more likely to have focal hyperpigmentation than black individuals. Racial differences were most pronounced for features within the central 1500-microm macular zone. Neovascular AMD was present in 1.7% of white participants and 1.1% of black participants (age-adjusted, P = .38), whereas geographic atrophy was more common in white than black individuals (1.8% vs 0.3%; age-adjusted, P = .02). CONCLUSIONS: White persons are generally more likely than black persons to have medium or large drusen, focal pigment abnormalities, and advanced AMD. Racial differences were prominent for nonneovascular AMD features only when present in the central zone. These data suggest that black individuals may have a mechanism for protection in the central zone against these critical fundus features, which themselves convey high risk of progression to advanced AMD.

Muñoz B, Klein R, Rodriguez J, Snyder R, West SK. · Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD 21287, USA. · Arch Ophthalmol. · Pubmed #16286621 No free full text.

Abstract: OBJECTIVE: To report the prevalence of age-related macular degeneration (AMD) in a population-based sample of Hispanic individuals aged 50 years and older. METHODS: Proyecto VER (Vision and Eye Research) is a population-based study of blindness and visual impairment of Hispanic people in Arizona. Participants underwent complete ophthalmic evaluation, including stereoscopic fundus photography of fields 1, 2, and 4. All photographs for participants aged 50 years and older were graded using the Wisconsin Age-Related Maculopathy Grading system. The following signs were graded: drusen size, drusen type, and the area covered by drusen; pigmentary abnormalities; geographic atrophy; and exudative AMD. RESULTS: Sixty-seven percent (3178) of the original 4774 participants were 50 years of age or older. Of those, 92% (2928) had fundus photographs in at least 1 eye, and 95% (2780) of the photographs were of sufficient quality to grade early and late AMD. OUTCOME MEASURES: The overall prevalence of late AMD was 0.5%. The prevalence increased from 0.1% in the 50- to 59-year age group to 4.3% in the group aged 80 years and older. Likewise, early AMD was strongly associated with age with a prevalence of 20% in the 50- to 59-year age group, increasing to 54% in the group aged 80 years and older. The prevalence of early AMD in Hispanic people was significantly higher than the reported prevalence in the white population. However, the prevalence of late AMD was lower than the estimates for the white population of the United States. CONCLUSIONS: Although early macular changes were very common among Hispanic people, the prevalence of late AMD was infrequent. Further work is necessary to understand the underlying reasons for the different patterns of presentation of early and late signs of AMD among racial/ethnic groups and to characterize early AMD based on predictive value for severe disease in different populations.

Freeman EE, Muñoz B, Bressler SB, West SK. · Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, MD 21287, USA. · Ophthalmic Epidemiol. · Pubmed #15848919 No free full text.

Abstract: PURPOSE: To evaluate a potential relationship between hormone replacement therapy (HRT), reproductive factors and age-related macular degeneration (AMD). METHODS: 1,458 female participants (age 65-84) from the Salisbury Eye Evaluation study were available for this cross-sectional analysis. AMD outcomes were identified by reading center assessment of fundus photographs. RESULTS: Women who currently used HRT had a lower adjusted odds of large drusen (> 125 microm) (OR = 0.5, 95% CI 0.2-1.0). Use of HRT was not statistically significantly associated with the prevalence of early AMD or advanced AMD, although the odds ratios were all much less than 1. Women who had had an increased number of births had a greater prevalence of large drusen (test of linear trend, p = 0.03). CONCLUSIONS: Current use of HRT was associated with a lower odds of large drusen, which may be predictive of advanced AMD. No statistically significant correlations were found between HRT or reproductive factors and early or advanced AMD.

Friedman DS, O'Colmain BJ, Muñoz B, Tomany SC, McCarty C, de Jong PT, Nemesure B, Mitchell P, Kempen J, Anonymous00108. · Wilmer Eye Institute, Wilmer 120, 600 N. Wolfe Street, Baltimore, MD 21287, USA. · Arch Ophthalmol. · Pubmed #15078675 No free full text.

Abstract: OBJECTIVE: To estimate the prevalence and distribution of age-related macular degeneration (AMD) in the United States by age, race/ethnicity, and gender. METHODS: Summary prevalence estimates of drusen 125 microm or larger, neovascular AMD, and geographic atrophy were prepared separately for black and white persons in 5-year age intervals starting at 40 years. The estimated rates were based on a meta-analysis of recent population-based studies in the United States, Australia, and Europe. These rates were applied to 2000 US Census data and to projected US population figures for 2020 to estimate the number of the US population with drusen and AMD. RESULTS: The overall prevalence of neovascular AMD and/or geographic atrophy in the US population 40 years and older is estimated to be 1.47% (95% confidence interval, 1.38%-1.55%), with 1.75 million citizens having AMD. The prevalence of AMD increased dramatically with age, with more than 15% of the white women older than 80 years having neovascular AMD and/or geographic atrophy. More than 7 million individuals had drusen measuring 125 microm or larger and were, therefore, at substantial risk of developing AMD. Owing to the rapidly aging population, the number of persons having AMD will increase by 50% to 2.95 million in 2020. Age-related macular degeneration was far more prevalent among white than among black persons. CONCLUSION: Age-related macular degeneration affects more than 1.75 million individuals in the United States. Owing to the rapid aging of the US population, this number will increase to almost 3 million by 2020.

Congdon N, O'Colmain B, Klaver CC, Klein R, Muñoz B, Friedman DS, Kempen J, Taylor HR, Mitchell P, Anonymous00102. · Wilmer Eye Institute, Wilmer 120, 600 N. Wolfe Street, Baltimore, MD 21287, USA. · Arch Ophthalmol. · Pubmed #15078664 No free full text.

Abstract: OBJECTIVES: To estimate the cause-specific prevalence and distribution of blindness and low vision in the United States by age, race/ethnicity, and gender, and to estimate the change in these prevalence figures over the next 20 years. METHODS: Summary prevalence estimates of blindness (both according to the US definition of < or =6/60 [< or =20/200] best-corrected visual acuity in the better-seeing eye and the World Health Organization standard of < 6/120 [< 20/400]) and low vision (< 6/12 [< 20/40] best-corrected vision in the better-seeing eye) were prepared separately for black, Hispanic, and white persons in 5-year age intervals starting at 40 years. The estimated prevalences were based on recent population-based studies in the United States, Australia, and Europe. These estimates were applied to 2000 US Census data, and to projected US population figures for 2020, to estimate the number of Americans with visual impairment. Cause-specific prevalences of blindness and low vision were also estimated for the different racial/ethnic groups. RESULTS: Based on demographics from the 2000 US Census, an estimated 937 000 (0.78%) Americans older than 40 years were blind (US definition). An additional 2.4 million Americans (1.98%) had low vision. The leading cause of blindness among white persons was age-related macular degeneration (54.4% of the cases), while among black persons, cataract and glaucoma accounted for more than 60% of blindness. Cataract was the leading cause of low vision, responsible for approximately 50% of bilateral vision worse than 6/12 (20/40) among white, black, and Hispanic persons. The number of blind persons in the US is projected to increase by 70% to 1.6 million by 2020, with a similar rise projected for low vision. CONCLUSIONS: Blindness or low vision affects approximately 1 in 28 Americans older than 40 years. The specific causes of visual impairment, and especially blindness, vary greatly by race/ethnicity. The prevalence of visual disabilities will increase markedly during the next 20 years, owing largely to the aging of the US population.