ImportanceThere is paucity of data on prevalence and disease asymmetry of age-related macular degeneration (AMD), particularly the earlier stages, in the UK population.Objective and PurposeTo determine the prevalence of age-related macular degeneration in an elderly Caucasian UK population.DesignCross-sectional population study, 2002-2006.ParticipantsResidents in the study area of Bridlington aged 65 years and older.MethodsFull-ophthalmic examination was undertaken in 3549 participants, of eligible 6319 Caucasian population (response rate of 56%). Non-stereoscopic Colour fundus photographs (30°) were graded masked using a modified Rotterdam Classification for 3475 (98%) participants with gradable images. Prevalence for different AMD grades were calculated. Demographic details were analysed then integrated with the AMD gradings for full analysis. Prevalence rates for the different AMD Grades were calculated, as well as the age-specific prevalences.ResultsAMD prevalence in the worst eye were 38.5% grade 0, 41.4% grade 1, 12.8% grade 2, 2.8% grade 3, and 4.6% grade 4. Geographic atrophy (grade 4a) occurred in 2.5%, and neovascular AMD (grade 4b) in 1.8%. Prevalence increased with age such that grade 4 (advanced) AMD was 2.2% in the 65-69 years group, 15.8% for the 85-90, and 21.2% for over 90 years. There was significant asymmetry between the two eyes of individuals with advanced AMD (P<0.001), such that vision loss was unilateral. Persons with more advanced AMD grades were more likely to be dissatisfied with their vision.ConclusionsAdvanced AMD occurs more commonly in the UK Caucasian population than previously reported. Significant asymmetry between the two eyes occurs in individuals with unilateral advanced AMD so that visual impairment statistics do not represent true prevalence of advanced AMD. Persons with more advanced AMD were more likely to be dissatisfied with their vision.

To the authors' knowledge, this is the first large study of optic nerve head parameters in the elderly normal population using the HRT II. This age range is particularly relevant to glaucoma detection and pertinent to discriminant analyses separating normal subjects from glaucoma in screening for the disease. Given the systematic differences between the parameters in men and women, reference ranges should be quoted by sex.

Purpose To determine population-based normative CCT data for elderly white subjects, with and without diabetes, and to explore the relationship between CCT and IOP and HRT2 measurements in such subjects with normal visual fields. Methods All eligible subjects were consecutive in a population screened for eye disease. CCT was measured by ultrasound pachymetry, and the optic disc was morphometrically defined using Heidelberg retinal tomography (HRT2). Inclusion criteria were: (1) normal visual field on suprathreshold testing and (2) corrected logMAR acuity of at least 0.3 in both eyes. Subjects with significant corneal pathology, previous corneal surgery, or known history of glaucoma or treatment for raised intraocular pressure were excluded. One eye was randomly selected from each subject for analysis. Results In all, 983 eyes of 983 subjects were included with 690 HRT images deemed acceptable for the analysis. The mean age (414 men and 569 women) was 73.3 years (minimum 65 years). Mean (SD) CCT was 544.1 (36.5) lm, with a normally distributed range of 429-633 lm. There was no significant difference in CCT between men and women (mean CCT 546.1 and 542.7 lm, respectively, P ¼ 0.15, Student's t-test), though CCT was correlated weakly and negatively with age (Pearson's r ¼ À0.063, P ¼ 0.047). Diabetic patients (n ¼ 103) had a greater mean CCT than non-diabetic patients (551.9 and 543.0 lm respectively, P ¼ 0.02). No significant correlation was found between any global optic disc parameter and CCT in the 690 eyes analysed. Conclusion Elderly white eyes with normal fields have CCTs that are normally distributed, with those from diabetic persons having greater CCTs. No clear evidence of a relationship between CCT and HRT2 optic disc parameters used in glaucoma diagnosis was found.

The normal range of parameter asymmetry in an age group relevant to glaucoma may be useful in the discrimination of normal from early glaucoma. Asymmetry analysis may improve discriminatory ability by reducing parameter variability based on disc size. The rim-to-disc area ratio asymmetry measure is likely to be the most useful parameter in describing normality with consistency.

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