Srinivasan S, Swaminathan G, Kulothungan V, Raman R, Sharma T
Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India.
Eye (Lond). 2017 Jun;31(6):846-855. doi: 10.1038/eye.2017.72. Epub 2017 May 26.
PurposeTo characterize the type, and the causes of visual impairment (VI) in various stages of early and late age-related macular degeneration (AMD) and the factors associated with visual impairment in subjects with AMDMethods6617 subjects ≥60 years were enumerated; 5495 (83.04%) participated in eye examination. Of which, 4791 subjects had gradable fundus images. AMD was graded per International ARM Epidemiological Study Group. Subjects underwent detailed ophthalmic exam. VI was defined per the WHO classification. Mild VI was defined as VA less than 6/12 to 6/18, moderate VI-VA less than 6/18 but up to 6/60, severe VI-VA less than 6/60 but up to 3/60 and legal blindness-VA worse than 3/60. Factors associated with VI in AMD was analyzed with univariate and logistic regression analysis.ResultsNine hundred and eighty-eight subjects were identified as having AMD (893 with early AMD and 95 with late AMD); 85% of the subjects (95% CI: 82.7-87.1) had no VI, 13.1% had mild VI (95% CI: 11.1-15.3), 0.8% had severe VI (95% CI: 0.4-1.6), 1.1% had legal blindness (95% CI: 0.6-1.9). Prevalence of any VI was 13.7% in early AMD and 27.4% in late AMD, P=0.0004; age group 65-70 years (OR=1.89, 95% CI: 1.16-3.08, P=0.011), and those ≥75 years (OR=3.67, 95% CI: 1.95-6.91, P=0.0001) had greater odds of VI compared with age group 60-64 years. Male gender was a protective factor for VI (OR=0.57, CI: 0.36-0.90, P=0.016). Cataract (31.8%) and refractive error (28.4%) accounted for a majority of the VI.ConclusionsCataract and refractive error account for a significant proportion of VI in the south Indian population with AMD. Early AMD is the third leading cause of VI. Greater age and female gender are associated with VI in subjects with AMD.
目的
描述早、晚期年龄相关性黄斑变性（AMD）各阶段视力损害（VI）的类型、原因以及AMD患者中与视力损害相关的因素
方法
对6617名年龄≥60岁的受试者进行统计；5495名（83.04%）参加了眼部检查。其中，4791名受试者有可分级的眼底图像。根据国际年龄相关性黄斑变性流行病学研究组的标准对AMD进行分级。受试者接受了详细的眼科检查。视力损害根据世界卫生组织的分类进行定义。轻度视力损害定义为视力低于6/12至6/18，中度视力损害为视力低于6/18但高于6/60，重度视力损害为视力低于6/60但高于3/60，法定盲为视力差于3/60。采用单因素和逻辑回归分析来分析AMD患者中与视力损害相关的因素。
结果
988名受试者被确定患有AMD（893例早期AMD和95例晚期AMD）；85%的受试者（95%可信区间：82.7 - 87.1）没有视力损害，13.1%有轻度视力损害（95%可信区间：11.1 - 15.3），0.8%有重度视力损害（95%可信区间：0.4 - 1.6），1.1%有法定盲（95%可信区间：0.6 - 1.9）。早期AMD中任何视力损害的患病率为13.7%，晚期AMD中为27.4%，P = 0.0004；65 - 70岁年龄组（比值比 = 1.89，95%可信区间：1.16 - 3.08，P = 0.011）以及75岁及以上年龄组（比值比 = 3.67，95%可信区间：1.95 - 6.91，P = 0.0001）与60 - 64岁年龄组相比，视力损害的几率更高。男性是视力损害的保护因素（比值比 = 0.57，可信区间：0.36 - 0.90，P = 0.016）。白内障（31.8%）和屈光不正（28.4%）占视力损害的大部分。
结论
在印度南部患有AMD的人群中，白内障和屈光不正占视力损害的很大比例。早期AMD是视力损害的第三大主要原因。年龄较大和女性与AMD患者的视力损害相关。
