J Korean Ophthalmol Soc.  2018 May;59(5):444-450. 10.3341/jkos.2018.59.5.444.

Characteristics of Patients Older than 90 Years Diagnosed with Neovascular Age-related Macular Degeneration

• Lee YG
• Han SY
• Han JW
• Kim JW
• Kim CG
• Lee DW
• Kim JH

• KMID: 2411452
• DOI: http://doi.org/10.3341/jkos.2018.59.5.444

Abstract

PURPOSE
To evaluate the characteristics of patients aged ≥ 90 years who were diagnosed with neovascular age-related macular degeneration (AMD).
METHODS
A retrospective review of medical records was performed for 44 patients aged ≥ 90 years diagnosed with neovascular AMD. History of cerebrovascular or cardiovascular disorder and visual acuity at diagnosis were assessed. Fellow eye visual acuity data were also collected. When the fellow eye visual acuity was worse than 0.5, the primary reason for the visual deterioration was identified.
RESULTS
The mean patient age was 91.5 ± 1.5 years (range: 90-95 years). Ten (22.7%) patients had histories of cerebrovascular or cardiovascular disorders. The mean logarithm of the minimal angle of resolution (logMAR) of visual acuity was 1.11 ± 0.51 and the visual acuity was worse than 0.1 in 20 eyes (45.5%). The fellow eye visual acuity was worse than 0.5 in 26 eyes (59.1%). The primary reason was neovascular or atrophic AMD in 23 eyes (88.5%).
CONCLUSIONS
The incidence of cerebrovascular or cardiovascular disorders was relatively high in patients aged ≥ 90 years. Patients also had poor visual acuity at diagnosis and a high incidence of fellow eye visual deterioration. These systemic conditions should be considered when treating these patients. Additionally, a regular ophthalmic examination is recommended for the early detection of these disorders.

Keyword

Age-related macular degeneration; Characteristics; Choroidal neovascularization; Old

MeSH Terms

Choroidal Neovascularization
Diagnosis
Humans
Incidence
Macular Degeneration*
Medical Records
Retrospective Studies
Visual Acuity

Figure

• 

  Figure 1 Representative cases of neovascular age-related macular degeneration (AMD) in patients aged 90 years or older. (A–C) Typical neovascular AMD in a 91-year-old patient. (D–F) Retinal angiomatous proliferation in a 95-year-old patient (an arrow in panel E indicates retinal angiomatous proliferation lesion). (A, D) Fundus photography. (B, E) Iindocyanine-green angiography. (C, F) Optical coherence tomography.

Reference

1. Buch H, Vinding T, La Cour M, et al. Prevalence and causes of visual impairment and blindness among 9980 Scandinavian adults: the Copenhagen City Eye Study. Ophthalmology. 2004; 111:53–61.

2. Congdon N, O'Colmain B, Klaver CC, et al. Causes and prevalence of visual impairment among adults in the United States. Arch Ophthalmol. 2004; 122:477–485.

3. Park SJ, Kwon KE, Choi NK, et al. Prevalence and incidence of exudative age-related macular degeneration in South Korea: a nationwide population-based study. Ophthalmology. 2015; 122:2063–2070.

4. Subhi Y, Sørensen TL. Neovascular age-related macular degeneration in the very old (≥90 years): epidemiology, adherence to treatment, and comparison of efficacy. J Ophthalmol. 2017; 2017:7194927.

5. Rosen E, Rubowitz A, Assia EI. Visual outcome following cataract extraction in patients aged 90 years and older. Eye (Lond). 2009; 23:1120–1124.

6. Ji MJ, Kim MS, Lee SJ, Han SB. Evaluation of visual outcome after cataract surgery in patients aged 85 years or older. J Korean Ophthalmol Soc. 2016; 57:214–220.

7. Muto T, Ide T, Chikuda M, Machida S. Vitrectomy in patients over 90 years of age. Clin Ophthalmol. 2016; 10:239–242.

8. Hong T, Mitchell P, Burlutsky G, et al. Visual impairment and the incidence of falls and fractures among older people: longitudinal findings from the Blue Mountains Eye Study. Invest Ophthalmol Vis Sci. 2014; 55:7589–7593.

9. Shin J, Choi Y, Lee SG, et al. Relationship between socioeconomic status and mortality after femur fracture in a Korean population aged 65 years and older: Nationwide retrospective cohort study. Medicine (Baltimore). 2016; 95:e5311.

10. Koh GC, Tai BC, Ang LW, et al. All-cause and cause-specific mortality after hip fracture among Chinese women and men: the Singapore Chinese Health Study. Osteoporos Int. 2013; 24:1981–1989.

11. Jang HJ, Song SJ, Bae JH. Long-term effect of intravitreal ranibizumab injection on choroidal neovascularization in age-related macular degeneration. J Korean Ophthalmol Soc. 2013; 54:1359–1364.

12. Oh SB, Cho WB, Moon JW, Kim HC. Effects and prognostic factors of intravitreal bevacizumab injection on choroidal neovascularization from age-related macular degeneration. J Korean Ophthalmol Soc. 2009; 50:202–210.

13. Kim JH, Chang YS, Kim JW, Kim CG. Characteristics of submacular hemorrhages in age-related macular degeneration. Optom Vis Sci. 2017; 94:556–563.

14. Regillo CD, Busbee BG, Ho AC, et al. Baseline predictors of 12-month treatment response to ranibizumab in patients with wet age-related macular degeneration. Am J Ophthalmol. 2015; 160:e2.

15. Avery RL, Fekrat S, Hawkins BS, Bressler NM. Natural history of subfoveal subretinal hemorrhage in age-related macular degeneration. Retina. 1996; 16:183–189.

16. Elshout M, van der, de Jong-Hesse Y, et al. Distinguishing between better and worse visual acuity by studying the correlation with quality of life in neovascular age-related macular degeneration. Ophthalmology. 2016; 123:2408–2412.

17. Klein BE. Is the risk of incidence or progression of age-related macular degeneration increased after cataract surgery? Arch Ophthalmol. 2009; 127:1528–1529.

18. Weinberg DV, Shapiro H, Ehrlich JS. Ranibizumab treatment outcomes in phakic versus pseudophakic eyes: an individual patient data analysis of 2 phase 3 trials. Ophthalmology. 2013; 120:1278–1282.