Prevalence, Risk Factors, and Impact of Myopic Macular Degeneration on Visual Impairment and Functioning Among Adults in Singapore

• Published in: Investigative ophthalmology & visual science Vol. 59; no. 11; pp. 4603 - 4613
• Main Authors: Wong, Yee-Ling, Sabanayagam, Charumathi, Ding, Yang, Wong, Chee-Wai, Yeo, Anna Chwee-Hong, Cheung, Yin-Bun, Cheung, Gemmy, Chia, Audrey, Ohno-Matsui, Kyoko, Wong, Tien-Yin, Wang, Jie Jin, Cheng, Ching-Yu, Hoang, Quan V, Lamoureux, Ecosse, Saw, Seang-Mei
• Format: Journal Article
• Language: English
• Published: United States 14-09-2018
• ISSN: 1552-5783; 1552-5783
• DOI: 10.1167/iovs.18-24032

To determine the prevalence, risk factors, and impact of myopic macular degeneration (MMD) on visual impairment and functioning among adults in Singapore.
A comprehensive eye examination, including subjective refraction, axial length, and visual acuity (VA) measurements, was performed in adults aged ≥40 years in the Singapore Epidemiology of Eye Diseases (SEED) study. From fundus photographs, MMD was graded using the International META-PM classification. Vision-specific functioning (VSF) was assessed with a validated visual-functioning questionnaire (VF-11) using Rasch analysis.
A total of 8716 phakic subjects were included in this analysis. The mean age (± SD) was 57.2 ± 9.5 years (33.5% Malays, 33.2% Indians, and 33.3% Chinese). The prevalence of myopia (spherical equivalent [SE] ≤ -0.5 diopters [D]) and high myopia (SE ≤ -5.0 D) was 35.7% and 6.0%, respectively. The age-standardized prevalence of MMD was 3.8% (95% confidence interval [CI], 3.4-4.3%). The prevalence of MMD was 7.7% among low to moderate myopes, and 28.7% among high myopes. The prevalence of MMD increased nonlinearly with SE and age. MMD was associated with older age, more myopic SE, and lower education. Subjects with Meta-PM categories 3 or 4 in the better-seeing eye had worse best-corrected VA (β, 0.19; 95%CI, 0.16-0.23) and poorer VSF (β, -9.7; 95%CI, -17.6 to -1.8) than those without MMD after multivariate adjustments.
Approximately 1 in 26 phakic adults in Singapore has MMD. Older age and myopic SE are major risk factors of MMD. Severe MMD has a substantial impact on visual impairment and functioning.