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A team of U.S. researchers set out to compare AMD diagnostic rates between Asian American and White American Medicare recipients. Using data from the Vision and Eye Health Surveillance System from 2014-2018, the team discovered an accelerating prevalence of AMD among Asian Americans.¹ 

Investigators performed a population-based, retrospective, cohort study of Asian Americans and non-Hispanic White Americans who were over the age of 40 and receiving Medicare. For their analysis, the researchers calculated prevalence rate ratios (PRRs) for AMD, defined as the AMD prevalence rate among Asians divided by the AMD prevalence rate among non-Hispanic Whites. Their paper was published online ahead of print in Retina.¹

In an interview with 澳门老奇人论坛, lead author Zain S. Hussain discussed the study findings and the increasing AMD burden among the Asian American population. Mr. Hussain, from the Dean McGee Eye Institute, Oklahoma City, OK, is an M.D. Candidate at the University of Medicine and Health Sciences, Basseterre, Saint Kitts, and a pre-doctoral research fellow at the University of Oklahoma Health Sciences Center in Oklahoma City.

The interview was lightly edited.

Dr. Hussain: The observed increases in AMD prevalence rate within Asian populations could be attributed to a combination of genetic, environmental, and health-related factors. Genetic research has identified several genes in Asians living in Asia associated with an increased risk of AMD, which is thought to contribute to heightened risk for Asians Americans. The link between cardiovascular health and AMD is well-documented, suggesting that populations with higher rates of these comorbidities might also have higher rates of AMD. However, even after stratification for diabetes or hypertension, our study continues to note a higher prevalence of AMD in various Asian subpopulations. Limited access to healthcare, differences in dietary habits, lifestyle, and exposure to environmental factors could contribute to the disparity in AMD prevalence.

Additionally, the finding that Asian American males between 40 and 64 years have a higher prevalence of AMD compared to females in the same group suggests a need to explore gender-specific risk factors more deeply. As the population grows and ages, the number of individuals at risk for age-related diseases like AMD naturally increases. In summary, the increased prevalence of AMD in Asian populations is likely multifactorial, involving genetic, health-related, socioeconomic factors. Further research is needed to fully understand these disparities and to develop targeted prevention and treatment strategies.

What were some of the nuances associated with your findings? Were there any disparities observed by age, gender, or AMD subtype?

Our findings indicate a degree of variance in the prevalence of different types of AMD among Asian and non-Hispanic White populations, particularly among those aged 40-64 years. The increased prevalence of both all-inclusive and dry-form AMD in younger Asian adults compared to non-Hispanic Whites, and the significant differences in [choroidal neovascularization] CNV AMD prevalence in the same demographic, suggest ethnic and age-related disparities are at play. Furthermore, the data indicating that older Asians (ages 65-84 and 85+) have a lower static prevalence of both dry-form and CNV AMD compared to non-Hispanic Whites is also significant.

Also, while the female gender may serve as an AMD risk factor among White patients, our results suggest the opposite is true for the Asian Medicare population. Importantly, what ties our seemingly diverse outcomes altogether is a significant timewise increase in AMD prevalence among Asians across our 5-year study period. Future studies may further shed light on these findings.

You also state in your study that "Significant time-wise increases in PRR [prevalence rate ratios] were observed within several age groups, genders, and comorbidities"? Can you expound on this observation?

Despite the observed variations in the prevalence by age, gender, and clinically distinct subtypes of AMD, a consistent trend emerged in our study over the five years between 2014 and 2018: a significant timewise rise in AMD prevalence across almost all Asian subgroups by age, gender, and AMD subtypes. Prior US analyses highlight Asians as the second greatest demographic at risk for AMD, right behind Whites. However, our nationally representative analysis determined an accelerating diagnostic rate within the Asian Medicare beneficiary demographic relative to Whites. Ultimately, our predictive trend analytics demonstrate potential for Asian Americans to supersede non-Hispanic Whites in AMD prevalence within the near future.

These findings not only demonstrate the raw potential of big data to transform medicinal understanding but may also quite literally change the textbooks!

How should this AMD burden be addressed?

Minority groups have historically experienced lower healthcare utilization, often due to factors such as access barriers, language differences, and socioeconomic challenges. Notably, recent clinical trials leading to FDA approvals of ophthalmology drugs for AMD and diabetic retinopathy have shown an increased participation of the Asian demographic, unlike Latino and Black populations. This rise is partly credited to more extensive international collaboration, as seen in trials like the VIEW2 study.² Yet, the multifaceted nature of AMD in these populations, along with its significant impact on vision and overall health, calls for a comprehensive approach in prevention and management. This includes 1) proactive screening referrals by primary care providers for high-risk groups; 2) enhanced vigilance and management skills among specialized care providers; and 3) robust patient and healthcare provider education on accurate diagnosis and current treatment practices.

Diversity in ophthalmology clinical trials a current matter of high relevance. The push for equitable representation in phase 3 clinical trials is essential for validating AMD therapies, highlighting the need for more inclusive recruitment practices for minority populations. Additionally, the Asian American demographic's diverse nature suggests the value of incorporating detailed demographic data in large-scale databases for more nuanced subgroup analysis.

As the baby boomer generation ages, a projected increase in AMD cases is expected, although smoking rates and related health issues like lung cancer are declining. The National Latino and Asian American Study (NLAAS) shows that smoking prevalence in some Asian groups surpasses the general US population average; the study's exclusion of non-English speaking Asians possibly underestimates the actual smoking rates. Given smoking's modifiable nature, enhancing screening and cessation efforts could significantly benefit these at-risk groups.

Published: October 24, 2023