Colijn Johanna M, Buitendijk Gabriëlle H S, Prokofyeva Elena, Alves Dalila, Cachulo Maria L, Khawaja Anthony P, Cougnard-Gregoire Audrey, Merle Bénédicte M J, Korb Christina, Erke Maja G, Bron Alain, Anastasopoulos Eleftherios, Meester-Smoor Magda A, Segato Tatiana, Piermarocchi Stefano, de Jong Paulus T V M, Vingerling Johannes R, Topouzis Fotis, Creuzot-Garcher Catherine, Bertelsen Geir, Pfeiffer Norbert, Fletcher Astrid E, Foster Paul J, Silva Rufino, Korobelnik Jean-François, Delcourt Cécile, Klaver Caroline C W
Department of Ophthalmology, Erasmus Medical Center, Rotterdam, Netherlands; Department of Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands.
Scientific Institute of Public Health (WIV-ISP), Brussels, Belgium; Federal Agency for Medicines and Health Products, Brussels, Belgium.
Ophthalmology. 2017 Dec;124(12):1753-1763. doi: 10.1016/j.ophtha.2017.05.035. Epub 2017 Jul 14.
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.
Meta-analysis of prevalence data.
A total of 42 080 individuals 40 years of age and older participating in 14 population-based cohorts from 10 countries in Europe.
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).
Prevalence of early and late AMD, BCVA, and number of AMD cases.
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.
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.
年龄相关性黄斑变性（AMD）是欧洲裔老年人中常见的复杂疾病。多年来，风险状况和治疗选择发生了很大变化，这可能影响了疾病的患病率和转归。我们利用欧洲眼流行病学（E3）联盟确定了1990年至2013年欧洲早期和晚期AMD的患病率，并对未来进行了预测。
患病率数据的荟萃分析。
来自欧洲10个国家的14个基于人群的队列研究中的42080名40岁及以上个体。
使用鹿特丹分类法根据眼底照片诊断AMD。采用随机效应荟萃分析计算早期和晚期AMD的患病率，并按年龄、出生队列、性别、地理区域和研究时间段进行分层。比较晚期AMD亚型（地理萎缩[GA]和脉络膜新生血管[CNV]）之间的最佳矫正视力（BCVA）。
早期和晚期AMD的患病率、BCVA及AMD病例数。
早期AMD的患病率从55 - 59岁人群中的3.5%（95%置信区间[CI]2.1% - 5.0%）增加到85岁及以上人群中的17.6%（95%CI 13.6% - 21.5%）；晚期AMD的患病率分别为0.1%（95%CI 0.04% - 0.3%）和9.8%（95%CI 6.3% - 13.3%）。我们观察到2006年后晚期AMD的患病率下降，在70岁以后最为明显。除最年长年龄组的晚期AMD外，各年龄组的性别患病率相似，且发现北欧CNV的患病率有升高趋势。2006年后，患有CNV的视力受损眼睛和≥80岁受试者数量减少（P = 0.016）。AMD的预测显示，尽管患病率下降，但受影响人数几乎翻倍。到2040年，欧洲早期AMD患者人数将在1490万至2150万之间，晚期AMD患者人数将在390万至480万之间。
我们观察到在过去20年中欧洲AMD患病率下降，CNV患者的视力有所改善。更健康的生活方式和抗血管内皮生长因子治疗的应用是最可能的原因。然而，在未来20年中受影响的人数将大幅增加。AMD在欧洲人中仍然是一个重大的公共卫生问题。
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