AGE RELATED MACULAR DEGENERATION (AMD) or (ARMD) Eye The Most Important square inch of the body

Age Related Macular Degeneration knowned as (AMD) or (AMRD) is the 2 nd largest threat to this important square inch of our body. AGE RELATED MACULAR DEGENERATION

The Risk An epidemic of “ageing” is impending in the Western world. According to the latest predictions released by the United Nations, the number of people aged over 60 will triple from 606 million worldwide in 2000 to nearly 2 billion by The increase in population aged over 80 is expected to be more than five fold, from 69 million in 2000 to 379 million by One major implication of this demographic change is the emergence of conditions that are directly related to ageing. Ref: BMJ 2003; 326: 485-8

AGE RELATED MACULAR DEGENERATION Age related macular degeneration (AMD) is the leading cause of severe visual loss in the western world in people over 50 years of age. Leading cause of IRREVERSIBLE visual loss in people over 60 years. Thirty percent of people over 75 years have some form of AMD Ref: Surveys of ophthalmology 32 (6) 1988:

AMD: TERMINOLOGY Degeneration is the change of a tissue to a less functionally active form. Referred as senile macular degeneration, a name given by Haab as early as 1885, Age Related macular degeneration has recently been named by Professor A C Bird and coworkers who performed the International ARM Epidemiological study group. The disorder is either referred to age related maculopathy (ARM) or age related macular degeneration (AMD)

The UN estimates the number of people with age related macular degeneration at million worldwide WHO’s estimate is 8 million people with severe visual impairment AMD was found to be second only to cataract as the cause of severe visual loss Ref: BMJ 2003; 326: AGE RELATED MACULAR DEGENERATION

TREATMENT No cure or treatment for this disease Only Prevention is Better Treatment If it can be identified earlier, it can be prevented to create permanent damage

NORMAL MACULA Eye Anatomy

Macula 90% of day light vision

AMD: SYMPTOMS VISUAL

AMD: SYMPTOMS Patient’s ability to perform normal daily tasks such as reading, sewing, telling the time, driving are greatly impaired. Normal Vision Early AMDLate AMD Damage Is Irreversible

AMD: EFFECT ON QUALITY OF LIFE General Consequences Reduced quality of life AMD is associated with higher risk of  Fall  Hip fracture  Reduced daily activity  Depression

AMD: ESTABLISHED AND POSSIBLE RISK FACTORS Established Risk FactorsPossible Risk Factors Older age (> 60 years)Female sex Family historyLight-colored iris Cigarette smokingCardiovascular disease Low dietary intake or plasma concentrations of anti-oxidant vitamins and zinc NEJM; Vol. 342 (7): 2000:

Progresses Unfortunately

AMD: PREVENTION Prevention is Better than Cure If It is identified before it creates permanent damages, we can have better control over it. Do Not Panic! Nature Protects We Have Macular Pigments

Macular Pigment Filters Blue Light 1 Macular Pigment 1. Snodderly et al; Invest Ophth Vis Sci Prevents Damage

People with AMD have 30% lower Macular Pigment Density 1 1. Landrum et al, Academy Press London, 1997

Damage Increases with Low Macular Pigment Density 1 Macular Pigment 1. Snodderly et al; Invest Ophth Vis Sci Prevents Damage Macular Degeneration

Measurement Of Macular Pigment Density Measurement Of Macular Pigment Density is NOW possible! Macular Pigment Density Meter

Regular check ups Screening and identifying HIGH RISK subjects Treatment for increasing macular pigments Reducing risk of development of macular degeneration THE BEST AND ONLY OPTION FOR AMD MANAGEMENT

Conclusion AMD is common but not inevitable Treatment options are limited Preventative treatment could be helpful to prevent serious complications

AMRD induced Blindness Prevention Program for INDIA

AIM TO ESTABLISH 100% CONTROL OVER AMD (ARMD) INDUCED BLINDNESS IN INDIA BY 2020

AMD: PREVALENCE IN INDIA Prevalence of AMD varies from 1.2% to 29.3% In South India, the prevalence is 1.1% whereas, another study from North India reports the prevalence rate to be 4.7% Different studies shows prevalence of AMD in India from 1.1% to 8.7% in the age group of So, average comes to almost 5% Invest Ophthalmol Vis Sci (abstract) 2000; 41; 5119 Ind. J Ophthalmol 1984; 32: 343-6

The economic burden of blindness in India The economic burden of blindness in India for the year 1997, based on the WHO studies : Individual: Rs. 159 billion (US$ 4.4 billion), Cumulative loss over lifetime of the blind is Rs. 2,787 billion (US$ 77.4 billion). Naturally, in 2010, it must’ve increased to more than 400% !

i.e. Rs. 477 billion per year (Rs. 16,296 per person) and Cumulative Loss comes to Rs. 8,361 billion (Rs. 2,85,651 per person!) Let’s 300% only The economic burden of blindness in India

Population in INDIA Figures showing Total Numbers of the People in INDIA and the Age Group of 50+ (The Figures are based on 2011 Census of India) We have taken that 50% of the total population are of this Age Group Country Population % of Total PersonsMalesFemales INDIA1,21,01,93,42262,37,24,24858,64,69,17460,50,96,711

A survey on ARMD shows that this disease is started showing from age of 45+ which was 60+ previously. People at High Risk of AMD in INDIA So, to prevent this disease, we must screen eyes of 45+ people. If we consider 50% population comes in this group, the figure comes to: 60,50,96,711 persons are at High Risk.

INDIA 60,50,96,711 people should be scanned for AMD to safeguard them from Blindness. (Age Group 45+ years)

Measuring Macular Pigment Density Total Persons to be Scanned in INDIA Persons Checked Per Machine Per Day Total Machine Days Required 60,50,96,711252,42,03,868

Required Nos of Machines Total Machine Days Required Working Days in a Year Minimum Nos. of Machines Required for Screening in One Year 2,42,03, ,092 Total No. of Machines required to set for total screening in One Year

Required Nos of Machines All the Machines, may not be utilized at its 100%, so we need to have at least 3 times more number of Machine Set up. Which Works out to 2,79,275 Machines…

LOGIC for Establishing ARMD Detection Network Look, the figures of Economic Burden of Blindness in India Rs. 477 billion each year. Amongst total blindness, more than 30% is caused of AMRD. 30% of Rs.477 billion is Rs billion

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