Keel Stuart, Xie Jing, Foreman Joshua, van Wijngaarden Peter, Taylor Hugh R, Dirani Mohamed
Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, Melbourne, Australia.
Department of Surgery, University of Melbourne, Melbourne, Australia.
JAMA Ophthalmol. 2017 Nov 1;135(11):1242-1249. doi: 10.1001/jamaophthalmol.2017.4182.
Age-related macular degeneration (AMD) is a leading cause of irreversible blindness among the elderly population globally. Currently, knowledge of the epidemiology of AMD in Australia remains scarce because of a paucity of recent population-based data.
To examine the prevalence of AMD in Australia.
DESIGN, SETTING, AND PARTICIPANTS: In this population-based, cross-sectional survey performed from March 11, 2015, to April 18, 2016, a sample of 3098 nonindigenous Australians 50 years and older and 1738 indigenous Australians 40 years and older from 30 geographic areas across Australia were examined.
Any AMD, early AMD, intermediate AMD, and late AMD graded according to the Beckman clinical classification system.
A total of 4836 individuals were examined, including 3098 nonindigenous Australian (64.1%; 58.9% female vs 41.1% male; age range, 40-92 years; mean [SD] age, 55.0 [10.0] years) and 1738 indigenous Australians (35.9%; 53.6% female vs 46.4% male; age range, 50-98 years; mean [SD] age, 66.6 [9.7] years). A total of 4589 (94.9%, 2946 nonindigenous and 1643 indigenous) participants had retinal photographs in at least 1 eye that were gradable for AMD. The weighted prevalence of early AMD was 14.8% (95% CI, 11.7%-18.6%) and of intermediate AMD was 10.5% (95% CI, 8.3%-13.1%) among nonindigenous Australians. In indigenous Australians, the weighted prevalence of early AMD was 13.8% (95% CI, 9.7%-19.3%) and of intermediate AMD was 5.7% (96% CI, 4.7%-7.0%). Late AMD was found in 0.96% (95% CI, 0.59%-1.55%) of nonindigenous participants (atrophic, 0.72%; neovascular, 0.24%). The prevalence of late AMD increased to 6.7% in participants 80 years or older and was higher in men (1.4% vs 0.61%, P = .02). Only 3 (0.17% [95% CI, 0.04%-0.63%]) indigenous participants had late (atrophic) AMD. Age-related macular degeneration was attributed as the main cause of vision loss (<6/12 in the better eye) in 23 of 208 nonindigenous Australians (11.1%) and 2 of 183 indigenous Australians (1.1%).
In line with data from other white populations, AMD is a prominent cause of vision loss in the nonindigenous Australian population. An increased provision of low vision rehabilitation services may be required to cope with the projected increase in AMD in Australia.
年龄相关性黄斑变性（AMD）是全球老年人群不可逆失明的主要原因。目前，由于缺乏近期基于人群的数据，澳大利亚AMD的流行病学知识仍然匮乏。
研究澳大利亚AMD的患病率。
设计、地点和参与者：在这项于2015年3月11日至2016年4月18日进行的基于人群的横断面调查中，对来自澳大利亚30个地理区域的3098名50岁及以上的非原住民澳大利亚人和1738名40岁及以上的原住民澳大利亚人进行了检查。
根据贝克曼临床分类系统对任何AMD、早期AMD、中期AMD和晚期AMD进行分级。
共检查了4836人，其中包括3098名非原住民澳大利亚人（64.1%；女性占58.9%，男性占41.1%；年龄范围40 - 92岁；平均[标准差]年龄55.0[10.0]岁）和1738名原住民澳大利亚人（35.9%；女性占53.6%，男性占46.4%；年龄范围50 - 98岁；平均[标准差]年龄66.6[9.7]岁）。共有4589名（94.9%，2946名非原住民和1643名原住民）参与者至少有一只眼睛的视网膜照片可用于AMD分级。非原住民澳大利亚人中早期AMD的加权患病率为14.8%（95%置信区间，11.7% - 18.6%），中期AMD为10.5%（95%置信区间，8.3% - 13.1%）。在原住民澳大利亚人中，早期AMD的加权患病率为13.8%（95%置信区间，9.7% - 19.3%），中期AMD为5.7%（96%置信区间，4.7% - 7.0%）。0.96%（95%置信区间，0.59% - 1.55%）的非原住民参与者患有晚期AMD（萎缩性，0.72%；新生血管性，0.24%）。80岁及以上参与者中晚期AMD的患病率增至6.7%，男性患病率更高（1.4%对0.61%，P = 0.02）。只有3名（0.17%[95%置信区间，0.04% - 0.63%]）原住民参与者患有晚期（萎缩性）AMD。在208名非原住民澳大利亚人中有23名（11.1%）、183名原住民澳大利亚人中有2名（1.1%）的年龄相关性黄斑变性被认为是视力丧失（较好眼视力<6/12）的主要原因。
与其他白种人群的数据一致，AMD是澳大利亚非原住民人群视力丧失的一个突出原因。可能需要增加低视力康复服务的提供，以应对澳大利亚预计增加的AMD病例。
