Apamd 2012 final 1


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Apamd 2012 final 1

  1. 1. Age Related Macular Degeneration (AMD)in the Asia Pacific Region:Where do we stand ?Rumita S. Kadarisman MD1, Gitalisa Adriono MD2,Mario Hutapea MD21R.S Mata AINI Prof DR Isak Salim, Jakarta, Indonesia2Dept of Ophthalmology, Dr Cipto Mangunkusumo Hospital,University of Indonesia, Jakarta,IndonesiaAsia Pacific AMD 1st Meeting , Singapore, 2012
  2. 2. AMD Many definitions in epidemiology studies making comparison difficult Classification and Grading, complicated by large variation in location,size,number and types of lesions
  3. 3. AMD Definition AMD is a degenerative retinal disease that can cause central vision loss and lead to legal blindness in Western and Asian countries AMD is the leading cause of permanent visual impairment among the elderly (severe vision loss in people >50 years of age) in the Western and Asian countriesFriedman et al, Vision Problems in the US: Prevalence of Adult Vision Impairment and Age-Related Eye Disease in America. 4th ed. Prevent Blindness America; 2002 Vingerling et al, Epidemiol Rev 1995; 17: 347 Ferris et al, Arch Ophthalmol 1984; 102: 1640 3
  4. 4. AMD classifications and grading The Wisconsin Age Related Maculopathy Grading with 5 gradings (grade 0-4). - Grade 0-3 Early AMD - Grade 4Late AMD The International Classification and Grading of Age Related Maculopathy The Age Related Eye Disease Study (AREDS) with 4 categories
  5. 5. Risk factors for AMD Age (Vingerling et al, 1995) Genetic factors  AMD is, at least in part, an inherited disease (AREDS, 2000)  certain phenotypes have heritability (Hammond et al, 2002)  the complement Factor H Gene (Klein, 2003) Smoking  cigarette smoking has been shown to increase the risk of AMD in a dose-dependent fashion (AREDS Study Research Group, 2000) Hypertension and cardiovascular disease (AREDS, 2000) Gender Race High cholesterol (Vingerling et al, 1995) Low intake of antioxidants / lutein (AREDS, 2001) 5
  6. 6. AMD diagnosis History (duration and characteristics, visual symptoms, metamorphopsia, scotoma) family history, risk factors VA (logMAR preferrable to Snellen) Stereoscopic biomicroscopic fundus examination (78D or similar lens) Fundus Photography Fundus Fluoresence Angiography (FFA) w/wo IndoCyanine Green Angiography (ICGA) Optical Coherence Tomography
  7. 7. Studies to investigate Prevalenceand risk factors of AMDIn Western population The Framingham Eye Study The Beaver Dam Eye Study The Blue Mountain Eye Study The Rotterdam Eye Study The EUREYE The Reykjavic Eye Study The Eye Disease Study
  8. 8. Prevalence of AMD Rotterdam Beaver Dam Eye Study Eye Study 1990–1993 1988–2005 (0.2%–11%) (3.1%–14.3%) Framingham Blue Mountains Eye Study Eye Study 1973–1975 1992–1993 (1.6%–28%) (2.8%–10.8%) 3-year incidence of AMD 9.4–11.4 per 1000 Klein et al, Ophthalmology 2007;114:253 Kahn et al, Am J Epidemiol 1977;106:17 Vingerling et al, Ophthalmology 1995; 102:205 Wang et al, Ophthalmology 2007;114:92 Javitt et al,8Ophthalmology 2003;110:1534
  9. 9. Studies to investigate Prevalenceand Risk factors of AMDMultiracial USA multiracial population study Arizona Hispanic people study The Los Angeles Latino eye studyMultiethnic The Singapore Multiethnic Asian studyEthnic The Hasayama study (Japan) The Singapore Malay Study The Central India eyes and medical study Risk Factors for AMD in eldery Cinese population of Shenyang in China
  10. 10. A S I A The largest continent with a population of almost half of the world population Almost 2.000.000 blind population Prevalence of bilateral blindness in developing countries 0.3-4.4% Mongoloid race, 4% of World population 400.000.000 are in South East Asia
  11. 11. AMD in Asia AMD is also a major cause of blindness in Asian countries, and the number is growing With more information on recent studies AMD has its own prespectives in terms of: epidemiology,genetics,phenotype presentation, clinical subtype and management Asia has mixed populations of different races and ethnics Different dietary intake, enviromental and maybe other factors might account for the disparity in prevalence among Asians
  12. 12. AMD in Asian populations Genetics of AMD in Asian populations are different compared to Western population The Y402H is present in 34.9% of Caucasian population but low in Chinese and Japanese population The CFH polymorphism Tyr402His is strongly linked to AMD in Indian population
  13. 13. Prevalence and Risk factors of AMD in Asian populationsStudy Early AMD (%) Late AMD (%)The Hisayama Study (Japan) 12.7 0.9The Beijing Eye Study (China) 1.4 0.2The Shihpai Eye Study (Taiwan) 9.2 1.9The Singapore Malay Study (Singapore) 4.9 0.7Andra Pradesh Eye Study (India) 1.9Jakarta Urban Eye Health Study (FKUI) 4.2 0.1Indonesia
  14. 14. Prevalence and Risk factors of AMD in Asian populationsStudy Early AMD Late AMD (%) (%)Handan Eye Study (China) 3.0 0.1Funagata (Japan) 3.5 0.5PakistanBangladesh 2.1-8.7NepalIndian subcontinent 1.8-4.7INDEYE feasibility Study 1.4Yogjakarta (Indonesia) 1.11Korea 3.08Thailand 7.4
  15. 15. AMD studies in Asia
  16. 16. AMD in Asian populationsDiagnosisFundus Fluorescein Angiography Exudative AMD: - Classic - OccultRecently clinical subtypes of AMD are foundIndocyanine Green Angiography Polypoidal Choroidal Vasculopathy (PCV) Retinal Angiomatosis Proliferation (RAP)
  17. 17. AMD in Asian populationsTreatmentPreferred treatment for Excudative AMD and subtypes of AMD: Ranibizumab Bevacizumab Combined with other Treatment modalities Depending on: Accessibility in the medical system Affordability Physician preference
  18. 18. Indonesia An Archipelago of 17.000 islands Population 237.424.363 ( census 2010 ) 248.216.193 ( 2012 ) Age structure 0-14 years 27.3% 15-64years 66.5% 65 years and over 6.1% Life expectancy male 69.07 years female 74.29 years Ophthalmologists 1.179 ( 2011) Population growth 254 milion by 2020 288 milion by 2050
  19. 19. AMD/AMD Studies in Indonesia Prevalence of AMD in Yogjakarta Province (2005) Jakarta Urban Eye Health Study (2008) Prevalence of AMD in Dept of Ophthalmology Cipto Mangunkusumo Hospital,Jakarta(2012)
  20. 20. Indonesian National Guidelinefor the management of AMD (2012)  Definition  Classification  Risk factors  Clinical findings  Diagnosis  Treatment
  21. 21. Perception of AMD The negative effect of AMD on quality-of-life can be underestimated by1  non-ophthalmic physicians  by the public  even by ophthalmologists who treat patients with AMD The assessment of quality-of-life may be an important factor in patients’ perception of overall outcome of any therapy2 1Brown et al, Can J Ophthalmol 2005; 40(3): 277 2Mitchell and Bradley, Health Qual life Outcomes 2006; 4: 97 21
  22. 22. AMD impacts the patient(physical burden) More likely to have difficulty with daily activities such as meal preparation, handling money, and using the telephone Increased risk of recurrent falls Experience more depression and emotional distress than those without AMD Potentially as debilitating as other chronic disabling diseases, such as arthritis, chronic obstructive pulmonary disease, and AIDS Health-related quality-of-life questionnaires may detect problem areas in functionWilliams et al, Arch Ophthalmol 1998; 116: 514Ivers et al, J Am Geriatr Soc 1998; 46: 58Brody et al, Ophthalmology 2001; 108: 1893 22
  23. 23. Conclusions The magnitude and awareness of AMD is growing. some studies in Asia shows the prevalence of AMD in Asian studies compared to European studies is quite similar,but Risk Factors vary, some conflicting Accurate diagnosis of AMD subtypes are important for appropiate management
  24. 24. Conclusions PCV constitues a high precentage of patients with Excudative AMD in Asian Population Life expectancy is increasing . Besides the physical burden, cost of the longlife treatment will be a social and financial burden which increasing awareness towards AMD should be a prority
  25. 25. Thank you