1) The study examined the prevalence and risk factors of age-related macular degeneration (AMD) in patients seen at Drishti Eye Institute in Dehradun, India from 2010-2013. 2) Of the 14,698 patients seen, 221 (1.5%) had AMD, with 103 patients having the wet/exudative form. Older age, male sex, and history of hypertension, diabetes, and cataract surgery were significant risk factors for wet AMD. 3) Nearly a third (71 patients, 32.13%) of the 221 AMD patients had visual acuity of less than 3/60 in the better eye, meeting the criteria for blindness. While AMD

1. Prevalence and Determinants of
Age Related Macular Degeneration
in Dehradun, Uttarakhand
Megha Luthra*, Saurabh Luthra**, Shrutanjoy M. Das**, Gaurav
Luthra**, M.C. Luthra**, Ashwani Sharma*
* SGRRIM&HS, Dehradun
** Drishti Eye Institute, Dehradun

2. • Presented at Indian Public Health Association
conference held at SVMC,Tirupati in 2013

3. Abstract
• Background: Age-related macular degeneration (AMD) is the third leading cause of
blindness in India after cataract and diabetic retinopathy. We present the
magnitude and determinants of blinding AMD among patients presenting at Retina
Service of Drishti Eye Institute, Dehradun with this condition.
• Materials and Methods: This was a cohort of eye patients seen from July 2010 to
October 2013. After taking preliminary information, optometrist noted the best-
corrected vision. Ophthalmologists examined eyes using a slit-lamp bio-
microscope. AMD was confirmed by fluorescein angiography and optical
coherence tomography. The age, sex, history of smoking, sun exposure, family
history of AMD, diet, body mass index (BMI), history of hypertension,
hypercholesterolaemia and diabetes were noted.
• Result: Of the 14,698 patients seen, 221 had AMD (dry or wet) in at least one eye,
the overall proportion of AMD being 1.50%. Further analysis of 103 patients with
wet AMD revealed that old age (71-80 years), male sex and history of hypertension
, diabetes etc were significant risk factors of AMD. Of the 221 patients with AMD,
nearly a third, that is 71 patients (32.13%) had visual acuity of better eye < 3/60,
which was taken as criteria for blindness.
• Conclusion: AMD does not seem to be a problem of public health magnitude in
the study area. Age, being male, history of hypertension , diabetes etc were
significant risk factors for AMD.

4. Introduction
• Age Related Macular Degeneration (AMD) or Age Related
Maculopathy (ARM) is a degenerative disorder of the macula
characterised by clinical and histopathologic changes.
• It is the third leading cause of blindness in India after cataract
and diabetic retinopathy.
• It is of two types.
• Dry (Non exudative) AMD is slightly more common and its
rare advanced form is known as Geographic Atrophy. There is
asymmetric, gradual impairment of vision over months or
years, vision is better in bright light.
• Wet (Exudative) AMD is less common but has rapid
progression to loss of vision.

5. Methodolgy
• All 14,698 patients attending the Retina Service at Drishti Eye
Institute during the study period of July 2010 to October 2013
were included in the study.
• After taking preliminary information , the age, sex, history of
smoking, sun exposure, family history of AMD, diet, body
mass index (BMI), history of hypertension, dyslipidemia and
diabetes were noted.
• Optometrist noted the best-corrected vision.
• Ophthalmologists examined eyes using a slit-lamp bio-
microscope.
• Wet/Exudative AMD was confirmed by fluorescein
angiography and optical coherence tomography.
• Data was analysed with help of Epi Info version 6.0 (STATCALC)

6. Results
• Of the 14,698 patients attending the Retina Service at Drishti
Eye Institute during the study period, 221 persons had AMD
(dry or wet) in at least one eye
• The overall proportion of AMD was 1.50%
• 103( 46.61%)patients had wet/exudative AMD and were
more at risk of losing vision.
• 71 patients (32.13%) had visual acuity of better eye < 3/60,
which was taken as criteria for blindness.
• It was found that old age (71-80 years), male sex, history of
sun exposure, family history of AMD, vegetarian diet, history
of hypertension, cataract surgery and diabetes were
significant risk factors of AMD.

7. Age
Table I
Age Group
No. of patients
with wet AMD
No. of patients
with problems
other than wet
AMD
41-50 6 2190
51-60 12 3180
61-70 19 3298
71-80 41 2833
81-90 21 2218
>=91 4 313
Total 103 14032
Chi Square=34.85
df=5
p<0.05
0
10
20
30
40
50
41-50 51-60 61-70 71-80 81-90 >=91
6
12
19
41
21
4
No. of patients with wet AMD
No. of patients with
wet AMD
0
500
1000
1500
2000
2500
3000
3500
41-50 51-60 61-70 71-80 81-90 >=91
2190
3180 3298
2833
2218
313
No. of patients with problems other
than wet AMD
No. of patients with
problems other than wet
AMD

8. Sex
Table II
Sex
No. of patients
with wet AMD
No. of patients
with problems
other than wet
AMD
Male 63 7294
Female 40 7301
Total 103 14595
Chi Square=5.12
df=1
P<0.05
63
40
No. of patients with wet AMD
Male
Female
7294
7301
No. of patients with problems other
than wet AMD
Male
Female

9. Diet
Table III
Diet
No. of patients
with wet AMD
No. of patients
with problems
other than wet
AMD
Veg 50 5692
Non veg 23 6189
Total 73 11881
Chi Square=12.32
df=1
p<0.05
50
23
No. of patients with wet AMD
Veg
Non veg
5692
6189
No. of patients with problems
other than wet AMD
Veg
Non veg

10. Sun Exposure
Table IV
Sun Exposure
No. of patients
with wet AMD
No. of patients
with problems
other than wet
AMD
Yes 14 1497
No 74 2845
Total 88 4342
Chi Square 13.23
df 1
p<0.05
1497
2845
No. of patients with problems
other than wet AMD
Yes
No
14
74
No. of patients with wet AMD
Yes
No

11. Hypertension
Table V
Hypertension
No. of patients
with wet AMD
No. of patients
with problems
other than wet
AMD
Yes 65 1256
No 38 3339
Total 103 4595
Chi Square 63.78
df 1
p<0.05
65
38
No. of patients with wet AMD
Yes
No
1256
3339
No. of patients with problems other
than wet AMD
Yes
No

12. Diabetes
Table VI
Diabetes
No. of patients
with wet AMD
No. of patients
with problems
other than wet
AMD
Yes 28 3162
No 75 1433
Total 103 4595
Chi Square 80.1
df 1
p<0.05
28
75
No. of patients with wet AMD
Yes
No
3162
1433
No. of patients with problems
other than wet AMD
Yes
No

13. Family History
Table VII
Family History
No. of patients
with wet AMD
No. of patients
with problems
other than wet
AMD
Yes 33 1478
No 36 2591
Total 69 4069
Chi Square 3.87
df 1
p<0.05
33
36
No. of patients with wet AMD
Yes
No
1478
2591
No. of patients with problems
other than wet AMD
Yes
No

14. Cataract Surgery
Table VIII
Cataract
Surgery
No. of patients
with wet AMD
No. of patients
with problems
other than wet
AMD
Yes 40 876
No 63 13719
Total 103 14595
Chi Square 188.67
df 1
p <0.05
40
63
No. of patients with wet AMD
Yes
No
876
13719
No. of patients with problems
other than wet AMD
Yes
No

15. Smoking
Table IX
Smoking
No. of patients
with wet AMD
No. of patients
with problems
other than wet
AMD
Yes 18 1638
No 46 6859
64 8497
Chi Square 3.19
df 1
p>0.05
18
46
No. of patients with wet AMD
Yes
No
1638
6859
No. of patients with problems
other than wet AMD
Yes
No

16. Body Mass Index
Table X
BMI
No. of patients
with wet AMD
No. of patients
with problems
other than wet
AMD
Underweight 4 258
Normal 43 5319
Ovrweight 24 4308
Obese 5 1019
76 10904
Chi Square 5.42
df 3
p>0.05
0
10
20
30
40
50
4
43
24
5
No. of patients with wet AMD
No. of patients with
wet AMD
258
5319
4308
1019
0
1000
2000
3000
4000
5000
6000
No. of patients with problems
other than wet AMD
No. of patients with
problems other than
wet AMD

17. Dyslipidemia
Table XI
Dyslipidemia
No. of patients
with wet AMD
No. of patients
with problems
other than wet
AMD
Yes 4 1253
No 99 3679
103 4932
Chi Square 24.95
df 1
p<0.05
4
99
No. of patients with wet AMD
Yes
No
1253
3679
No. of patients with problems
other than wet AMD
Yes
No

18. Conclusion
• AMD does not seem to be a problem of public
health magnitude in the study area.
• Old age (71-80 years), male sex, history of sun
exposure, family history of AMD, vegetarian diet,
history of hypertension, cataract surgery and
diabetes were significant risk factors of AMD.

19. References
1. Clinical Ophthalmology- A Systematic Approach (7th Edition)
by Jack K. Kanski and Brad Bowling
2. Prevalence and determinants of ARMD among the 50 year
old and older population: A hospital based study in
Maharashtra, India. Indian J Ophthalmol 2013 May;
61(5):196-201
3. Predictors of visual outcome in eyes with choroidal
neovascularisation secondary to AMD treated with IVB
monotherapy. Int J Ophthalmol 2012; 6(1):62-6
4. Ocular Perfusion pressure and choroidal thickness in eyes
with polypoidal choroidal vasculopathy, wet ARMD and
normals. Eye (London) 2013, Jun 14