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14 February 2012
The NHS may be significantly underestimating the number of people with sight loss caused by age-related macular degeneration, according to new research.
A study published in the British Journal of Ophthalmology suggests that as many as 40,000 people a year develop wet age-related macular degeneration (wet AMD), a condition which causes severe loss of central vision. The NHS and the National Institute for Health and Clinical Excellence (NICE) has previously used a much lower estimate of 26,000 new cases a year.
Wet AMD was largely untreatable until NICE approved a drug, Lucentis, in 2008. The drug is injected monthly into the eye to stop the formation of abnormal blood vessels which leak and scar the macula, (correct) the most sensitive part of the retina. The treatment appears to stop or slow the progress of the condition in most patients.
The cost of treating wet AMD already accounts for more than 1% of the entire NHS drugs budget and many hospitals are operating extra clinics to cope with demand.
The research also suggests that another 44,000 people a year are diagnosed with another, untreatable, form of AMD known as dry AMD. Most of these patients will also eventually lose their central vision and need rehabilitation and support services.
The study shows how the prevalence of AMD increases exponentially with age, roughly quadrupling every decade of life. Around one in two thousand people have AMD at 60 but by the age of 90 more than one in five will have it.
The study is the largest ever analysis of published data on AMD. It concludes that there are likely to be more than half a million people in the UK today living with late-stage AMD. Many will be so badly affected that they will qualify to be registered as sight impaired or severely sight impaired (formerly called “blind” or “partially sighted”).
As the population ages the numbers with AMD will rise. The researchers estimate that even as soon as 2020 as many as 650,000 people in the UK may have advanced AMD, 150,000 more than today. AMD affects more women than men.
Dr Christopher Owen, Senior Lecturer in Epidemiology, St George's, University of London and the lead investigator said:
"This work suggests that the number of people developing macular degeneration has been underestimated to date and that far more might benefit from treatment or are in need of advice about coping with the condition, especially in the elderly. With an ever ageing population there will be more and more people with the disease and these estimates can be used to plan current social and health care provision, both now and in the future. While treatments exist for some of those with wet AMD, treatments for the similar number with dry AMD need to be found."
Helen Jackman, CEO of the Macular Disease Society which funded the research said:
“This is a very important and welcome piece of research. It reveals the real impact of AMD and demonstrates the need for Government and the NHS to give this a higher priority. Macular degeneration is a devastating condition for many people and an urgent issue for society as a whole. It can lead to isolation, loss of independence and depression. We urge politicians and health and care planners to recognise the significance of this condition and ensure proper provision is made for people with AMD now and in future years.”
Winfried Amoaku, a senior ophthalmologist and chair of the Vision 2020 Macular Interest Group which commissioned the research said:
“The figures on incidence estimates for wet AMD confirm the view that the condition is more common that was previously thought. Different areas may see variations in the incidence or prevalence because of local differences in demography. With the ageing population, this is a call for us to make more provision for diseases in the elderly including wet AMD. At the same time we should brace ourselves for further explosion in numbers as potential treatments for dry AMD are developed. However, for those patients where treatments do not yet exist, we must double our efforts towards rehabilitation.”