This article was originally published in a sponsored newsletter.

The breadth of AMD management among eye care providers typically begins with prescribing AREDS multivitamins but may culminate in lifelong intravitreal injections. While these medical interventions are crucial for preserving retinal structure, how do they impact visual function? We often focus on the retina, inadvertently overlooking how AMD detrimentally affects our patients' quality of life, from decreased independence and resulting support needs to financial and access burdens.

Numerous studies employing visual function questionnaires have consistently indicated diminished quality of life and increased anxiety among AMD patients.^1-3 Lower scores on these assessments correlate with poorer best corrected visual acuity and reduced contrast sensitivities.¹ Tasks such as driving, which is crucial for independent living, become increasingly challenging for AMD patients, leading many to reluctantly relinquish this privilege. A study by De Sousa Peixoto et al, demonstrated that individuals who stop driving due to AMD experience lower quality-of-life scores compared to those who stop driving for other reasons.³

The projected surge in AMD cases, estimated to affect 300 million individuals by 2040, highlights the urgent necessity for comprehensive low vision services.⁴ These services, facilitated by a multidisciplinary team consisting of low vision optometrists, occupational and physical therapists, orientation and mobility specialists, social workers, counselors and assistive technology specialists, aim to customize rehabilitation plans to maximize functional vision and enhance overall quality of life.

These rehabilitation plans often incorporate optical aids such as telescopes and handheld magnifiers to provide magnification for distance viewing and reading, respectively. Assistive technology, including text-to-speech software and smart devices, plays a pivotal role in modern low vision care. Additionally, rehabilitation strategies, such as teaching eccentric viewing and other compensatory skills, allow individuals with AMD to use their remaining vision most effectively.⁵

Psychosocial support is essential in addressing the emotional impact of an AMD diagnosis. Counseling and support groups provide a platform for patients and their families to share experiences and coping strategies.

Early intervention with low vision rehabilitation not only benefits individuals, but also mitigates the socioeconomic costs associated with AMD. A systematic review from Marques et al looked at the average treatment costs per patient among common visual impairments. They found that AMD had the highest costs, ranging from $2,209 to $7,524 per patient.⁶ These significant medical expenses are reflected in a recent report that shows that the loss of productivity (55%) is the biggest contributor to the socioeconomic burden of AMD in the United States.⁷

Despite the array of low vision services available, access challenges persist due to socioeconomic disparities, geographical barriers and lack of awareness.^8,9 Efforts to raise awareness about these life-changing services are imperative and ongoing.

As primary health care providers, we should offer comprehensive low vision services (or at least make referrals) as an integral component of AMD management plans to ensure that our patients get the support they need for optimal quality of life.

Key Clinical Takeaways

• AMD management should not be limited to medical treatments. Rather, it should take a holistic approach to managing how individuals function with their vision loss.
• A diagnosis of AMD can detrimentally affect one’s quality of life if they are not given the tools and skills to remain independent.
• There is a vast array of low vision services and resources for individuals with AMD, but patients and clinicians need to be aware of them for proper referrals to occur.

Reference(s):

1. Caballe-Fontanet D, Alvarez-Peregrina C, Busquet-Duran N, Pedemonte-Sarrias E, Andreu-Vázquez C, Sánchez-Tena MÁ. Quality of life and anxiety in age macular degeneration patients: a cross-sectional study. Int J Environ Res Public Health. 2022 Jan;19(2):820. doi:10.3390/ijerph19020820
2. Künzel SH, Möller PT, Lindner M, et al. Determinants of quality of life in geographic atrophy secondary to age-related macular degeneration. Invest Ophthalmol Vis Sci. 2020 May;61(5):63. doi:10.1167/iovs.61.5.63
3. De Sousa Peixoto R, Krstic L, Hill SCL, Foss AJE. Predicting quality of life in AMD patients-insights on the new NICE classification and on a bolt-on vision dimension for the EQ-5D. Eye (Lond). 2021 Dec;35(12):3333-3341. doi:10.1038/s41433-021-01414-3
4. Vyawahare H, Shinde P. Age-related macular degeneration: epidemiology, pathophysiology, diagnosis, and treatment. Cureus. 2022 Sep;14(9):e29583. doi:10.7759/cureus.29583
5. Hong SP, Park H, Kwon J-S, Yoo E. Effectiveness of eccentric viewing training for daily visual activities for individuals with age-related macular degeneration: a systematic review and meta-analysis. NeuroRehabilitation. 2014;34(3):587-595. doi:10.3233/NRE-141055
6. Marques AP, Ramke J, Cairns J, et al. The economics of vision impairment and its leading causes: a systematic review. EClinicalMedicine. 2022 Mar;46:101354. doi:10.1016/j.eclinm.2022.101354
7. Paudel N, Brady L, Stratieva P, Daly A. Socioeconomic burden of advanced age-related macular degeneration (AMD) in the United States of America (USA), Germany and Bulgaria. Invest Ophthalmol Vis Sci. 2023 Jun;64(8):1746.
8. Stolwijk ML, van Nispen RMA, van der Ham AJ, Veenman E, van Rens GHMB. Barriers and facilitators in the referral pathways to low vision services from the perspective of patients and professionals: a qualitative study. BMC Health Serv Res. 2023;23:64. doi:10.1186/s12913-022-09003-0
9. Takashi S, Kumiko I. Barriers to the utilization of low-vision rehabilitation services among over-50-year-old people in East and Southeast Asian regions: a scoping review. Int J Environ Res Public Health. 2023 Dec;20(23):7141. doi:10.3390/ijerph20237141

Joyce Zhang, OD, FAAO is a full-time optometrist at the Veterans Affairs Pacific Islands Health Care System Spark M. Matsunaga Medical Center in Honolulu, Hawaii. Dr. Zhang graduated from Herbert Wertheim School of Optometry and Vision Science at UC Berkeley and completed a residency in Low Vision Rehabilitation with an emphasis in Ocular Disease at the Rosenberg School of Optometry at the University of the Incarnate Word. She is a Fellow and member of the American Academy of Optometry, American Optometric Association (AOA), Hawaii Optometric Association (HOA), Association of Armed Forces and Federal Optometric Services (AFOS) and National Association of Veterans Affairs Optometrists (NAVAO). Financial Disclosures: none