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Introduction

Age-related macular degeneration is a progressive degenerative disease of the retina in which the macula is most affected. It is the leading cause of irreversible blindness in elderly population after 5th decade. It is a degenerative disorder affecting macula, characterized by drusens and RPE changes, Choroidal neovascularization (CNV) and Pigment epithelial detachment (PED) [1]. Age-related macular degeneration (AMD) affects millions of people worldwide and is a leading cause of blindness globally. There are 2 main types of AMD, neovascular and nonneovascular AMD, which can be further classified based on specific features of the disease. Nonneovascular AMD (“dry” AMD) accounts for almost 80% to 85% of all cases and generally carries a more favorable visual prognosis. Neovascular AMD (“wet” AMD) affects the remaining 15% to 20% and accounts for approximately 80% of severe vision loss as a result of AMD [2].

The pathogenesis of AMD is complicated with multiple risk factors, including age, ocular dysfunctions, systemic diseases, diet, smoking, genetic, and environmental factors [15]. ARMD causes 54.4%, 4.4%, and 14.3% of legal blindness (acuity,20/200) and 22.9%, 3.2%, and 14.1% of low vision (acuity,6/12) Globally, it is estimated that 32.9 million people suffer from AMD-related visual impairments [14].

Age-related macular degeneration (ARMD) is one of the leading causes of visual impairment (VI) in elderly population. It is the disease of the central area in the ocular posterior segment, which leads to deterioration of central vision and thereby affecting the performance of daily living activities of aged people [3]. Although medical therapies for ARMD had been improving over past decade, Vision rehabilitation remains a mainstay of treatment for those with vision loss [4].

Specialized rehabilitation programs and external low-vision aids are available to support visual performance for those with advanced ARMD; it’s developing the quality of life tests including activities of daily life and objective assessments [5].

This study aim was to examine the clinical profile & refractive error & management included (optical & other low vision) on Age related macular degeneration among tertiary eye hospital.

Methodology

A hospital based prospective cross sectional study with ARMD, who were referred to Medical Retina and Low vision clinic at CITC encompassed in the study. The reason for referral was assessed from electronic medical records included FFA and OCT images by a Retina specialist. Patients with intellectual disability and any ocular pathology except ARMD also patients with aged below 50 years were excluded. Demographic information was collected by face to face interview from the patient and attendance. Patients personal history, family history, medical history, Smoking intake or not also collected. Systemic diseases like HTN, Cardiac, DM also noted.

Variable test included Color vision was assessed with Farnsworth D-15 test at a distance 50 cm, Contrast sensitivity done by 10% Bailey Lovie chart at a distance 6m in the well illuminated room condition. It is monocular procedure. Distance visual acuity was measured for each eye at distance 6meter was taken with the help of well illuminated Snellen’s Acuity chart in the well illuminated room condition. It was done with Snellen acuity chart from 6meter distance. It is monocular procedure and Near add was performed by N-Notation with patient’s refractive correction. Refractive assessment was performed with streak retinoscopy at the working distance at 50cm.According to response of patients to the corrective lenses was assessed.

Management protocol offered with Optical and Low vision management according to patient’s condition and need.

Data analysis was performed with Microsoft Excel version 2020 and SPSS (26.0 for Windows, SPSS Ine, Chicago, IL, USA). All data were entered into a Microsoft Excel database (Microsoft, version 2019) and converted to SPSS for analysis. According to the normality test, all parameters were parametric and frequency data were used to evaluate the demographic, ocular and management characteristics for the study population. The mean and standard deviation were used for the descriptive study. Cross-tabulation was done to segregate the data according to age and gender range. The significant level was determined as P-value <0.05. Graphical structures formed by Microsoft Excel to represent data.

Results

The average age of the patients was 62.21±7.38 years, with ages ranging from 50 to 80 years. Out of 41 patients, 51.20% were female. Among them, the majority (53.70%) were diagnosed with Dry Age-Related Macular Degeneration (ARMD). Table 1 provides the baseline demographic and clinical profiles of the ARMD patients. The prevalence of ARMD was higher among homemakers and urban populations.

Risk factors were associated found with ARMD in this study. Subjects were devided two aged group individually. Among the subjects, a subset analysis was performed to identify the risk factors of patients above 60 years. [Table 2]. In addition, individuals with gender, smoking intake and systemic diseases included DM, HTN had higher risk of having ARMD. Table -3 shows profile of ocular status of patients with Dry and Wet ARMD. Visual impairment mostly affected with Wet ARMD patients.

The data were also classified low vision according to subjects visual impairment. The most commonly prescribed near device was Hand - held magnifier (11.11%) and Base In prism (33.33%) also all patients prescribed with both distance and near reading spectacle According to their visual need which is shown in table 4. There was a statistically significant improvement (P =0.000 < 0.50) in near vision with the help of LVDs, which is shown in Table-5.

Discussion

Age-related macular degeneration (ARMD) is a leading cause of visual impairment (VI) among the elderly. This progressive disease affects the central area of the retina, leading to the deterioration of central vision. As a result, individuals with ARMD often struggle with daily living activities. Recognizing its impact, the World Health Organization (WHO) has included ARMD in its Vision 2020 program to address avoidable blindness.

Although ARMD has traditionally been more prevalent in developed countries, its incidence is rising in developing nations like Bangladesh. This study aims to investigate the clinical profile, ocular status, and management protocols for ARMD in patients diagnosed at an outpatient department (OPD). A total of 41 patients clinically diagnosed with ARMD were included in the study.

Out of 41 patients, So more preponderance was seen in patients above 60 years and females are more affected than males. It was similar with Rohit Aphale study [1]. Out of 41 patients, so more preponderance was seen in patients above 60 years and females are more affected than males. It was similar with Rohit Aphale study [1]. Wherein few studies showed that according to demographic data people of urban area highly affected in this disease which would Very depending on the geographical area and food habits [6]. Which is also noticed in the current study.

With increasing age above 60 years risk factors Age, Gender,Family history and systemic disease like hypertension and Diabetes is one of the alarming risk factors associated with ARMD, associated with ARMD, mfound. Though our sample size is small, which reflects the same thoughts like other studies [7-9]?

Dry ARMD was seems more common than Wet ARMD in this study and visual disability was More in Wet ARMD than Dry ARMD. Jayashree MP et al. Stated that visual impairment more in Wet ARMD [11].

In case of refractive error, Simple hyperopia was found higher portion compared to other refractive error group, Tai ES and Kawasaki R also found the similar result [12,13].

The vision loss Associated with ARMD is associated with a substantial decrease in patient's quality of life and reading ability, Management protocol followed were spectacle to all the patients. The loss of contrast sensitivity was most pronounced in the lower spatial frequency range for the patients of Wet ARMD also Pronounced, Tritanopia is present due to colloid bodies present at foveal area. Whereas, a study done by Brinda Haren Shah et al found that Mild to Moderate Tritanopia occurs in Age Related Macular Degeneration [10].

This study also preponderance patient's in low vision with ARMD, among the subdivided group in study population, 2(4.90%) patients had low vision Dry ARMD and 7(17.10%) patients had low vision Wet ARMD. In total 9 low vision patients, all patients were prescribed spectacle to improve in distance visual acuity with optimum refractive correction according to their condition and need, no patients were trailed with distance device considering their age and needs. In case of near vision, the most commonly preferred near optical device were prism 3( 33.33%) and hand-held magnifier 1(11.11%).

The following formula was used to calculate the equivalent viewing power (EVP):

EVP = Presenting near visual acuity/target visual acuity × 100/working distance (cm) 3

On the basis of the EVP formula, the required magnification was calculated and appropriate magnifiers were given to the patients for trial and improved their near vision dramatically after device trail (P =0.000<0.50), which reflects same thoughts like other study [3].

In case of non-optical device, about 11.11% of patients advised to use Bright indirect illumination for near work, 1 patient advised to use torch light at night for outdoor work also sighted guide and bright indirect illumination for near work, 55.55% of patients advised for along with Bright indirect illumination + Torch light also Large print Holy Quran and 2 patients advised for along with Bright indirect illuminaton + Torch light additional Sighted guide for orientation mobility training for outdoor activities and also large print Holy Quran.

Age-related macular degeneration (ARMD) is one of the predominant causes of irreversible vision loss in older adults and remains incurable. Despite its prevalence and devastating impact, many patients are left to cope with their disability alone. This study highlights the importance of providing appropriate treatment to prevent severe eye complications and vision impairment. It also emphasizes the need to improve daily living performance, as ARMD can significantly affect a person's quality of life.

The study is aligned with global health initiatives, such as the World Health Organization’s Vision 2020 program, and connects local findings to broader international efforts to reduce avoidable blindness. This framework helps emphasize the importance of addressing vision loss on a global scale.

Moreover, the study paves the way for future research. It suggests areas that require further investigation to enhance the understanding and management of ARMD. However, a limitation of the study is that the field of vision was not assessed in all participants, which could affect the overall findings.

Conclusion

Age-related Macular Degeneration (ARMD) in elderly individuals highlights various aspects of different conditions. Females appear to be more affected than males, and timely management, including refractive error correction, has shown substantial improvement in visual acuity also underscores the prevalence of Dry ARMD over Wet ARMD and emphasizes the importance of identifying risk factors such as age, gender, family history, and systemic diseases. Additionally, observed color vision difficulties, contrast acuity variations further emphasize the diverse challenges faced by ARMD patients. The majority of patients benefit from optical management, particularly near optical and non-optical management.It is important to emphasizes the importance of early detection, timely management, and a comprehensive approach to address the multifaceted impact of ARMD on patients' lives.

Ethics Approval and Consent to Participate:

Chittagong Eye Infirmary & Training Complex (Pahartoli, Chittagong, Bangladesh) No-(880)1774-878991

Consent for Publication

Yes applicable, All the patients of Chittagong Eye Infirmary and Training Complex (CEITC) OPD, who were willingly participate and cooperative during this research work.

Availability Data and Material

The datasets used and/or analyzed in this study are not publicly available to ensure compliance with ethical standards and protect patient confidentiality. De-identified data may be made available upon reasonable request to the corresponding author, subject to approval by the ethics review board.

Competing Interest

Not applicable.

Funding

Not applicable.

Author Contributions

Ludmila Rudaba Mimfa (first author) she did all correction, data analysis, data collection and whole thesis. Additionally help Dr. Shams Mohammed Noman (second author) under his reference the thesis done.