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Impacts and Costs of AMD

Impact of AMD on The Ageing Population

In spite of advances in healthcare generally and even with the advent of new therapies, growth in the absolute number of people with AMD and particularly late AMD are expected to plateau and grow over the next number of decades. Advanced age is the most significant risk factor for AMD. This coupled with the anticipated changes in population demographics over the next few decades, means the number of people affected by AMD is expected to increase considerably over the next few decades.21 

A recent European study found that prevalence rates for AMD were 3.5% in people aged 55–59 years rising to 17.6% in those aged ≥85 years. In the same study prevalence rates for late-AMD were 0.1% and 9.8% respectively. Projections for AMD up to 2040 showed an almost doubling of affected persons despite a decreasing prevalence. By 2040, the number of individuals in Europe with early AMD is predicted to range between 14.9 and 21.5 million, and for late AMD between 3.9 and 4.8 million.

A recent global data analysis predicts that AMD will be the root cause of vision impairment in 8.8 million individuals with moderate or severe visual impairment and blindness in 2.0 million individuals globally by 2020.23 

Impact on Patients

The loss of visual function associated with AMD negatively impacts patients’ quality of life, and deprives them of their independence and social interaction.6 Visual impairment associated with AMD can prevent people from carrying out a number of everyday activities including:7 reading (e.g. books, newspapers, lists, medicine labels), recognising faces, driving, using public transport, general mobility, socialising, shopping and caring for themselves/dependants.The loss of ability to perform everyday tasks can lead to loss of independence, social isolation and absence from work. As visual impairment worsens, independence and overall quality of life decline. Even mild visual impairment can have a substantial impact on vision-related quality life.8

Vision loss that occurs with AMD also has a major impact on emotional well-being, and those affected often report feelings of frustration, annoyance and fear of coping with everyday life. Studies suggest that as many as 1 in 3 patients with AMD suffer from symptoms of depression.9, 10

People with AMD are also at a greater risk of falls and secondary injuries that may occur as a result of them, such as hip fractures.11, 12, 13 Some studies have found that the risk of falls increase as visual acuity worsens, which underlines the importance of visual rehabilitation for people affected by AMD.

The ERN-EYE created a video to explain how we can support, comfort and welcome patients in a hospital environment. This video clip describes how to interact and communicate with people living with visual impairments to relax them before their appointment. Helpful tips include assisting people to their appointment, adjusting lighting as necessary and avoid moving their belongings, so as not to confuse and upset them. The full video is available to watch here

 

Impact on Caregivers

Caring for somebody with loss of visual function due to AMD is associated with a substantial burden on the carer. In many cases, spouses and/or other family members are called upon to provide physical and emotional support.14, 15 Caregivers of people with late AMD are at high risk of emotional distress and often face significant disruption to their own lives.16

A study by Macular Disease Foundation Australia (MDFA) that surveyed 500 caregivers of people with neovascular AMD, revealed a high rate of psychological distress among carers, with over half reporting a negative state of mind. More than half also had to make changes to other areas of their lives (e.g. participation in social activities or retirement plans) as a consequence of caring for someone with neovascular AMD. In this study, the level of dependence and presence of comorbidity chronic illnesses in the care recipient were independent predictors of the caregiver experiencing psychological distress.

Cost of AMD

After Uncorrected Refractive Error (URE) and Cataract, AMD is the leading cause of global visual impairment (blindness + Moderate and Severe Visual Impairment) at 4.1% (10.37 million) of the visually impaired population. AMD causes 5.64% of global blindness (1.96 million people).17

AMD is associated with a significant economic burden to patient, caregiver and society. As the proportion of people affected by AMD is forecast to increase considerably over the next few decades due to population ageing 18 it is important to quantify the economic cost of AMD in order to inform future healthcare planning. The economic cost of AMD may be categorised into direct and indirect costs:19

 

 

Direct Costs

These include ophthalmological care, including physician visits and costs of therapies (e.g. vitamin supplements, intravitreal injections, imaging), etc., counselling, supportive equipment (low vision aids), transportation costs and resource utilisation associated with co-morbid conditions (e.g. depression, falls and other injuries).

 

Indirect Costs

These include loss of productivity and absence from work for both patients and their caregivers and general cost to society reflected by the negative impact on a country’s gross domestic product (GDP).20

 

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