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ORIGINAL ARTICLE
Year : 1984  |  Volume : 32  |  Issue : 5  |  Page : 343-346

Senile macular degeneration in Northern India


Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Correspondence Address:
I S Jain
Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


PMID: 6545319

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How to cite this article:
Jain I S, Prasad P, Gupta A, Ram J, Dhir S P. Senile macular degeneration in Northern India. Indian J Ophthalmol 1984;32:343-6

How to cite this URL:
Jain I S, Prasad P, Gupta A, Ram J, Dhir S P. Senile macular degeneration in Northern India. Indian J Ophthalmol [serial online] 1984 [cited 2021 Aug 1];32:343-6. Available from: https://www.ijo.in/text.asp?1984/32/5/343/27507



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Senile macular degeneration (SMD) is an age related process accounting for consider­able visual loss in older people. Prevalence of SMD has been variably reported as 8.8% and 29.3%.[1],[2] However, it has been considered a rarity amongst the coloured races.[3] Although primarily degenerative in nature, systemic and local risk factors have been incriminated.[4],[5],[6] Both these facts prompted us to undertake a study of SMD in the North Indian Population.


  Materials and methods Top


Patients over the age of 50 years were screened for macular changes, covering the period between July, 1981 to Feb. 1983. A com­plete R medical history of ocular and systemic problems was noted. The best corrected dis­tance and near visual acuity was recorded. Biomicroscopic examination was performed in each case after adequate pupillary dilata­tion to assess lens changes. The macula was examined in detail with direct ophthalmos­copy. Macular changes were graded accord­ing to the criteria used in Framingham eye study.' Fluorescein angiography was carried out in few selected cases. The individual macular changes viz pigment and drusens were graded according to the severity and scored accordingly [Table - 1]. From- these, macular degeneration as a whole was graded as pigment change score plus drusen score [Table - 2]. All disciform degenerations were grouped in the severe form of SMD [Table - 2]. In assessing the risk factors two variables were studied i.e., refractive errors and senile len­ticular changes. Eighty five age related con­trols were also studied. Emmeteropia was defined as between -0.5 Dsp and +0.5 Dsph. in phakics and between +9.50 Dsph to + 10.00 Dsph in aphakes. Senile cataracts were classified as axial and peripheral. Axial cataract included those opacities within 2mm of central axis and peripheral those with opacities beyond 2 mm zone.


  Observations Top


We detected 100 cases of SMD from a total of 2122 patients who were screened during the period of study. The prevalence rate of SMD was 4.7%. Of these, 85 were of dry and 15 dis­ciforrn in nature. Thus disciform degenera­tion accounted for 15% of all SMD and was seen in 0.7% of the population. SMD was bilateral in 67 patients and unilateral in 33. Distance vision was found to decrease com­mensurately with increasing severity of SMD (P<0.01) [Table - 3]. Similarly near vision was proportionately affected by the disease pro­cess [Table - 4]. Age related increase in severity was noted [Table - 5]. SMD was seen to pro­gress with the progress in cataract [Table - 6]. Hypermeteropia was seen in 70% of cases of SMD as compared to 40% in controls [Table - 7] which was found statistically significant (P<0.05). The degree of hypermeteropia was found to be less significantly associated with degree of SMD [Table - 8]. The association of peripheral cataract with SMD and axial cataract with controls was highly significant (P<0.01) [Table - 9].


  Discussion Top


In our study, the prevalence rate of SMD was found to be 4.7%. In a study of black African population, prevalence rate of SMD was found to be 17.4%.[7] These two studies show that SMD in coloured races is not as rare as reported by Schatz.[3] Disciform macular degeneration (DMD) accounted for higher percentage of SMD (15%) in our study as opposed to both the caucasion and the black African groups[7]. The reason for this apparent susceptibility of the North India population to SMD remains to be solved.

Although distance and near vision dec­reased with increasing severity of disease, 61 eyes (36.5%) had a visual acuity of 6/9 orbetter. This feature has not been highlighted in other series since SMD was diagnosed by them only if vision was less than 6/9. This disparity bet­ween ophthalmoscopic grading and visual loss shows that clinical picture is not reliable indicator of amount of visual loss due to SMD. An increase in severity of SMD with age and progressive lens changes supports the observations that it is an age related process.

Risk Factors

The Framingham eye study[2] identified systemic blood pressure, height, vital capacity, left ventricular hypertrophy and interim his­tory of lung infection as risk factor in SMD . A case controlled study 6 revealed that SMD had an age related increase and related to hyper­tension. It was also stated that hypermetropia may predispose to SMD and myopia may have a protective influence.[6] A similar study estimated the relative odds of having hyper­meteropia among the SMD group versus the control as 2.4%.[4]

The present study supports the obser­vations of the above two series in that hyper­metropia was seen in almost twice as many cases as controls.

For the first time, the type of cataract has been shown to have an effect on SMD. Peripheral cataracts are more often associated with SMD and probably predis­pose to the development of disease. Central cataract on the other hand may have protec­tive influence by cutting of solar rays from reaching the macula in aged susceptible eyes. Studies have[8],[9] demonstrated histopathologi­cal changes in the chorio-capillaries of aging eye i.e. thickening of intercapillary septa, narrowing of the lumen and acellularity of the capillaries. These changes, disturb the heat dissipating mechanism of the choroidal blood flow and render the retina more suscep­tible to light induced heat damage.[10]


  Summary Top


Senile macular degeneration (SMD) is an age related process supposedly rare in the colored races. All patients over the age of 50 years were studied clinically for macular degeneration. Of these, 100 cases were detec­ted over a period of 2 years, (Prevalence 4.7%). Disciform degeneration accounted for a high proportion of cases (15%). SMD was found to affect significantly both distance and near vision. Hypermetropia was seen more often in these cases (70%) as opposed to controls (40%). SMD occurred more frequently in associa­tion with peripheral cataracts whereas central cataracts appeared to protect the macula from degeneration.

 
  References Top

1.
Kahn H.A, Leibowitz H.M., Ganley J.P., Kini M.S., Colton T., Nickerson RS., Dawber T.R., 1977. Amer. J. Epidemiol 106:17  Back to cited text no. 1
    
2.
Kahn, H.A, Leibowitz H.M., GanleyJ.P., KiniM.S., Colton T., 1977. Amer. J. Epidemiol., 106: 33  Back to cited text no. 2
    
3.
Schatz H., 1975. Int. Ophthalmol. Clin., 15: 169  Back to cited text no. 3
    
4.
Delaney W.V., Oates RP., 1982. Ann. Ophthalmol., 14:31  Back to cited text no. 4
    
5.
Kornzweig AL., Feldstein M., Schneider J., 1957. Amer. J. Ophthalmol., 44: 29  Back to cited text no. 5
    
6.
Malzman B.A, Mulvithill M.B., Greenbaum A, 1979. Ann. Ophthalmol., 11: 1197  Back to cited text no. 6
    
7.
Gregorz, Joffel., 1978. Brit. J. Ophthalmol., 62: 547   Back to cited text no. 7
    
8.
Kornzweig A, 1977. Ann. Ophthalmol.,   Back to cited text no. 8
    
9.
9: 753 9. Sark S.H., 1976. Brit. J. Ophthalmol., 60: 324  Back to cited text no. 9
    
10.
Parver L.M., Auver C., Capenter D.O.,1980. Amer. J. OphthalmoL, 89: 641  Back to cited text no. 10
    



 
 
    Tables

  [Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5], [Table - 6], [Table - 7], [Table - 8], [Table - 9]


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