Age-Related macular degeneration

This paper was epublished ahead of print and was highlighted as a must read in Canadian medical news. Age-related macular degeneration (AMD) is a complex, multifactorial disease affecting approximately 13% of Canadians. AMD may lead to the progressive loss of central vision and ultimately the complete loss of vision. Early AMD has a significant effect on a person’s quality of life, including the potential loss of independence. Correct identification of AMD in primary eye care (optometrists and ophthalmologists) is critical so that the disease can be treated in its earliest phases and vision loss potentially avoided.


  • Cross-sectional study
  • 644 adults (1288 eyes) 60 years and older with normal macular health per medical record (recent eye examination by a primary eye care ophthalmologist or optometrist) enrolled in the Alabama Study on Early Age-Related Macular Degeneration (ALSTAR) from May 1, 2009 to December 31, 2011
  • Presence of AMD was defined by the Clinical AMD Staging system based on colour fundus photography
  • This study was unable to discern the reasons underlying AMD underdiagnoses in primary eye care
  • It is more difficult to visualize the retina on routine eye examinations in older adults
  • First report to address the extent of under diagnosed AMD by primary eye care physicians in the USA
  • First study to show that the presence of cataracts does not contribute to non-diagnosis
  • 25% of eyes that were diagnosed as normal during routine eye examination had signs of AMD when examined using fundus photography
  • 30% of missed AMD eyes would have been treatable with nutritional supplements (lutein and zeaxanthin) had it been diagnosed
  • There was no difference in the prevalence of undiagnosed AMD between ophthalmologists and optometrists

Neely, D.C. et al (2017) Prevalence of undiagnosed age-related macular degeneration in primary eye care. JAMA Ophthalmology (epub): doi: 10.1001/jamaophthalmol.2017.0830. Hot Topic Small Talk – Volume 2, Number 5