Impact of Early and Late Age-Related Macular Degeneration on Quality of Life

Abstract

The impact of early and late age-related macular degeneration (AMD) on quality of life (QoL) has been comprehensively assessed to date (Lamoureux et al. 2011; Wong et al. 2004; Espallargues et al. 2005; Finger et al. 2011a; Mangione et al. 1999). Early stages of the disease are associated with little functional loss (i.e. normal visual acuity) and few symptoms. However, the prognosis is poor for most patients affected by either atrophic or neovascular late-stage AMD. In the late-stage condition, central vision can be severely impaired, leading to a central scotoma. The implications of this level of visual impairment on daily functioning activities include inability to read, watch TV, recognise faces or do manual work requiring near central vision (Birk et al. 2004). Vision impairment associated with AMD also impacts on falls, mobility and emotional well-being (Parrish et al. 1997; Mackenzie et al. 2002). However, to understand the impact of AMD on QoL, it is important to consider vision loss not in isolation, but in the context of a patient’s ability to adapt and cope (Slakter and Stur 2005). For example, functional difficulties can be partly alleviated by using magnifying glasses, screen-projection devices such as CCTVs and other low-vision aids and devices. Despite this, patients with late-stage AMD remain severely limited in undertaking many everyday activities. As highlighted in previous chapters (e.g. Chap. 3), the incidence of AMD is projected to increase due to current demographic trends, but less cases may progress to the more severe late stages due to treatment and other unknown factors in high-income countries. Thus, a large proportion of the elderly population is likely to experience serious QoL detriments associated with AMD.