Analysis of the burden of age-related macular degeneration

Age-related macular degeneration (AMD) is associated with aging and typified by a wide range of symptoms from vision impairment to blindness.¹ Once diagnosed, it has a profound effect on patients by increasing the risk of depression by 15%,^2,3 all-cause mortality⁴ decreased quality of life,^3,5 and by impacting national productivity.^4,6

The GBD 2021 Global AMD Collaborators sought to estimate the global, national, and region-specific prevalence and disability-adjusted life-years (DALYs) along with tobacco as a modifiable risk factor to aid public policy addressing AMD, they explained.

“… it is imperative to accurately estimate the extent of AMD's effect within societies undergoing population growth and aging worldwide,” the investigators commented. Their findings were published in The Lancet.⁵

AMD study methodology

The investigators used data on AMD obtained from the Global Burden of Disease, Injuries, and Risk Factor Study 2021 database in 204 countries and territories, 1990–2021.

They defined visual impairment as “moderate to severe vision loss (visual acuity [VA] from <6/18 to 3/60) and blindness (VA <3/60 or a visual field <10 degrees around central fixation)” and estimated the visual impairment resulting from AMD.

They then stratified the estimates by geographical region, age, year, sex, Healthcare Access and Quality (HAQ) Index, and Socio-Demographic Index (SDI) levels. They also investigated the effect of tobacco use on the burden of AMD, and the projections of the AMD burden were estimated out to 2050.

What did the AMD analyses find?

“Globally, the number of individuals with vision impairment due to AMD more than doubled, rising from 3.64 million (95% uncertainty interval [UI] 3·04–4·35) in 1990 to 8.06 million (6.71–9.82) in 2021. Similarly, the DALYs increased by 91% over the same period, from 0.30 million (95% UI 0.21–0.42) to 0.58 million (0.40–0.80),” the study reported.

The data also noted that in contrast, the age-standardized prevalence and DALY rates declined; the AMD prevalence rates decreased by 5.53% (99.50/100,000 of the population [95% UI 83.16–118.04] in 1990 to 94.00 [78.32–114.42] in 2021) and the DALY rates dropped by 19.09% (8.38 [5.70–11.53] to 6.78 [4.70–9.32]). From 1990 to 2021, these rates showed consistently decreased higher SDI quintiles, which reflected a negative correlation between the HAQ Index and the AMD burden; the largest age-standardized reduction was seen in the low-middle SDI quintile.

Regarding tobacco use, its global contribution to the age-standardized DALYs decreased by 20% from 12.45% (95% UI 7.73–17.37) in 1990 to 9.96% (6.12–14.06) in 2021.

“By 2050, the number of individuals affected by AMD is projected to increase from 3.40 million males (95% UI 2.81–4.17) in 2021 to 9.02 million (5.72–14.20) and from 4.66 million females (3.88–5.65) to 12.32 million (8.88–17.08). Eliminating tobacco use could reduce these numbers to 8.17 million males (5.59–11.92) and 11.15 million females (8.58–14.48) in 2050,” the investigators reported.

A valuable contribution of this study concerned the decreased use of tobacco.

“The findings suggest that tobacco regulation may have contributed to reducing the DALYs associated with AMD. Projections indicate that the number of affected individuals will rise to 21.34 million by 2050; however, eliminating tobacco use could reduce this burden by approximately 19.32 million, emphasizing the importance of targeted tobacco control measures,” they stated.

The investigators reemphasized that the visual impairment caused by AMD is a substantial global burden, and the number of individuals with the disease is estimated to increase from about 8 million in 2021 to 21.34 million by 2050.

“This study highlights the role of improved health-care access and reduced tobacco impact in lowering age-standardized DALY rates, particularly in lower SDI quintiles where resources are limited. Introducing cost-effective treatments and diagnostics, especially in LMICs, alongside tobacco regulation, could significantly reduce the global burden of AMD-related vision impairment,” they concluded.

References

1. Fleckenstein M, Schmitz-Valckenberg S, Chakravarthy U. Age-related macular degeneration: a review. JAMA. 2024;331:147-57.

2. Hwang S, Kang SW, Kim SJ, et al. Impact of age-related macular degeneration and related visual disability on the risk of depression: a nationwide cohort study. Ophthalmology. 2023;130:615-23.

3. Ehrlich JR, Ramke J, Macleod D, et al. Association between vision impairment and mortality: a systematic review and meta-analysis. Lancet Glob Health. 2021;9:e418-e430.

4. Assi L, Chamseddine F, Ibrahim P, et al. A global assessment of eye health and quality of life: a systematic review of systematic reviews. JAMA Ophthalmol. 2021; 139:526-41.

5. Marques AP, Ramke J, Cairns J, et al. Global economic productivity losses from vision impairment and blindness. EClinicalMedicine. 2021;35:100852.

6. GBD 2021 Global AMD Collaborators.Global burden of vision impairment due to age-related macular degeneration, 1990–2021, with forecasts to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2025;13:e1175-e1190.