Age-Related Macular Degeneration (AMD): Prevalence, Risk Factors, and Nutritional Support

Age-Related Macular Degeneration (AMD): A Growing Global Challenge and the Need for Proactive Measures

Age-Related Macular Degeneration (AMD) is a leading cause of vision loss in older adults worldwide, particularly in industrialized countries. AMD affects the macula, the central part of the retina responsible for sharp vision, and is categorized into two types: dry (atrophic) and wet (neovascular). As AMD prevalence continues to rise globally, proactive strategies are essential to mitigate its impact and improve patient outcomes, with the ultimate objective of enhancing the quality of life and well-being of patients and their caregivers.

Global Trends and the Need for Action

AMD prevalence trends are driven by aging populations, with limited access to costly anti-angiogenesis therapies in Asia, Africa, and Latin America compared to North America and Europe. By 2040, Asia is projected to have the highest number of cases, reaching 113 million, accounting for nearly one-third of global AMD cases. In Europe, AMD cases are expected to rise to 77 million by 2050, while other regions, including North America, will see an increase to 25 million cases by 2040. These data highlight the urgent need to prioritize eye health and integrate it into broader national and regional policies, particularly within the context of healthy and active aging.

Prevention, Awareness, and Healthcare System Strengthening

Efforts must focus on expanding prevention strategies, improving long-lasting treatments for neovascular AMD, and developing new therapies to prevent and slow geographic atrophy. Additionally, raising awareness about modifiable risk factors, such as smoking and the importance of nutrition, can help reduce AMD risk and improve eye health outcomes. However, awareness remains low in many countries, including Italy, where national efforts to inform and protect AMD patients have been relatively limited.

To curb this worsening trend, measures must be implemented promptly to ensure the autonomy and independence of the elderly. This includes:

• Early diagnosis of macular diseases to improve patient outcomes.
• Developing national, regional, and international efforts in vision loss prevention activities.
• Establishing national databases to make healthcare services more effective and efficient in prevention and care.
• Increasing awareness through public information campaigns to ensure that AMD and vision loss prevention become priorities in public health discussions.
• The development of a national plan to integrate AMD care into broader healthcare policies.

The Role of Technology in AMD Care

Technology will play a crucial role in addressing these challenges. Artificial intelligence (AI) is already being developed for AMD diagnosis, classification, and prognosis, acting as a decision-support tool for physicians. In the future, AI-assisted telemedicine could enable large-scale epidemiological studies, providing a consistent and uniform grading system for AMD classification.

To meet increasing demand and prevent the escalating burden of AMD on both patients and society, changes in healthcare infrastructure and care pathways will be necessary. Incorporating AI-based diagnostic tools and telemedicine into routine care will enhance efficiency and accessibility, ensuring timely diagnosis and management. Investing in technology-driven solutions, alongside preventive measures and workforce expansion, will be critical in mitigating the growing global burden of AMD.

By integrating eye health into national and regional policies and leveraging technological advancements, healthcare systems can improve the quality of life and well-being of patients and their caregivers while effectively addressing the increasing prevalence of AMD worldwide.

The Role of Lifestyle and Nutrition in AMD Prevention

Beyond medical advancements, promoting knowledge about modifiable risk factors is essential in AMD prevention. Public health efforts should emphasize the impact of smoking cessation, regular exercise, and maintaining a healthy weight in reducing AMD risk. Additionally, nutrition plays a crucial role in protecting eye health.

Diets rich in leafy greens like kale and spinach, as well as foods high in vitamins C and E, lutein, and zeaxanthin, have been shown to support macular health and slow AMD progression. Saffron, a powerful antioxidant, has also demonstrated protective effects on retinal cells and has been studied for its potential to improve visual function and slow AMD progression. Encouraging the consumption of eye-healthy foods and raising awareness of their benefits—including the role of saffron in supporting retinal health—can empower individuals to take proactive steps in preserving their vision and overall well-being.

Global and Regional Prevalence

Global Overview

AMD affects an estimated 196 million individuals globally as of 2020, with projections indicating a rise to 288 million by 2040 due to aging populations (1, 2). Early AMD accounts for the majority of cases, but late AMD causes most of the severe vision loss. The global prevalence of AMD is approximately 8.7%, with Europeans exhibiting higher rates compared to Asians and Africans. No significant gender differences in prevalence were noted. The prevalence of early and late disease increased with age in each of the ethnic groups and regions. Prevalence of late disease in populations with European ancestry increased most rapidly after age 75 years, with a similar trend seen in Europe and Oceania regions (1, 3).

Regional Insights

• Canada: AMD is the leading cause of vision loss in Canadians over the age of 55, impacting more than 2.5 million people nationwide (16). According to the Canadian Ophthalmological Society (COS), AMD is responsible for 90% of new cases of legal blindness in Canada (17).
• United Kingdom: Late AMD prevalence in individuals aged 50+ is approximately 2.4%, increasing to 4.8% in those aged 65 years or more, and further increasing to 12.2% in those aged 80+ (4).
• United States: In 2019, an estimated 18.34 million Americans aged 40+ had early-stage AMD, while 1.49 million had late-stage AMD. The prevalence rises significantly with age, affecting over 9% of individuals aged 80 and older (5, 1). AMD is estimated to account for 54.4% of visual impairment and 22.9% of blindness among Caucasians in the United States (1,15). 
• Europe: In Europe, 25.3% of adults aged 60+ have early/intermediate AMD, while 2.4% have late-stage AMD, affecting 67 million people—56.7 million with early/intermediate AMD and 10.2 million with late AMD. 
• France: In France AMD is the leading cause of visual impairment after the age of 50, affecting around 8% of the population; it affects 1% of people aged 50–55, around 10% of people aged 65–75 and 25–30% of people over 75 (14).
• Spain: Approximately 800,000 people over 65 suffer from AMD. Spain is amongst the worst affected countries in Western Europe in terms of visual loss prevalence (14). 
• Italy: Approximately 170,000 patients suffer from dry AMD.
• Germany: In Germany, recent studies estimate that approximately 7 million individuals are currently living with AMD, with about 400,000–450,000 affected by geographic atrophy (GA) (13). Age- and sex-adjusted projections for 2021 estimated 644,153 diagnosed non-exudative and 367,086 diagnosed exudative AMD patients in Germany. Projections indicate that the number of individuals with AMD in Germany will continue to rise due to demographic changes, underscoring the need for enhanced public health strategies and resource allocation to manage this growing burden (14).

Global Projections:

• By 2040, the global number of cases of any AMD is expected to rise to 288 million, reflecting a substantial increase in the global burden of AMD.

 Regional Projections:

• Asia: Asia will have the largest number of cases, increasing to 113 million by 2040. This will be a third of the cases globally. By 2040, Asia is projected to have more than half of the world’s late AMD cases.
• Europe: Europe will be second, with projected cases rising to 69 million by 2040. Each year, 400,000 new late AMD cases are diagnosed, with projections indicating 77 million individuals will have AMD by 2050, including 65 million with early/intermediate AMD and 11.7 million with late AMD. Annual late AMD incidence is expected to rise to 700,000 new cases by 2050, driven solely by aging populations (3, 4,11,12).
  The projected 77 million AMD cases in the EU by 2050 will have a significant public health impact. 
• Africa: Cases in Africa are expected to reach 39 million by 2040.
• Latin America and the Caribbean: This region will also see 39 million cases by 2040.
• North America: Projected cases will increase to 25 million by 2040.
• Oceania: Oceania will have the smallest number of cases, reaching 2 million by 2040(1).

Key Risk Factors

Non-Modifiable Risks

1. Age: AMD risk increases significantly after the age of 50, with exponential growth beyond 70 (6, 3).
2. Genetics: Variations in genes such as CFH, ARMS2, and HTRA1 strongly correlate with AMD susceptibility (6).
3. Ethnicity: Europeans have higher prevalence rates, particularly for geographic atrophy, while Asians and Africans exhibit lower rates (1, 3).

Modifiable Risks

1. Smoking: Smokers have up to a four-fold increased risk of developing AMD, and even former smokers remain at elevated risk (1, 3).
2. Cardiovascular Health: Hypertension and high cholesterol levels contribute to AMD progression (6, 7).
3. Obesity and Lifestyle: Higher Body Mass Index (BMI) and irregular exercise are thought to increase inflammatory and oxidant products, influencing AMD progression (4).

Nutritional Support in AMD

Several clinical studies, including AREDS1, AREDS2, and others, highlight the importance of specific nutrients in managing AMD progression (6, 7). Key findings include:

1. Antioxidants: Vitamins C and E protect against oxidative stress, a key driver of AMD (6, 7).
2. Carotenoids: Lutein and zeaxanthin are concentrated in the macula, where they help filter harmful blue light and combat oxidative damage (6, 7).
3. Saffron: Clinical studies have demonstrated that saffron, a spice rich in the carotenoids crocin and crocetin, provides neuroprotective and anti-inflammatory benefits for early AMD. Short-term supplementation of saffron (20 mg/day) significantly improves retinal sensitivity and visual acuity. Falsini et al. (2010) found that saffron supplementation enhances retinal flicker sensitivity and macular function over three months, while Piccardi et al. (2012) reported sustained benefits over 14 months of supplementation (8, 9).
4. Omega-3 Fatty Acids: Found in fish, omega-3s reduce inflammation and are associated with a lower risk of advanced AMD (1, 3).

These nutrients, often combined in supplements, are recommended for individuals with intermediate AMD to reduce the risk of progression to advanced stages (6, 7).

Conclusion:
Take Charge of Your Vision Health Today

AMD is on the rise, but vision loss doesn’t have to be inevitable. The key to protecting eyesight lies in early action, awareness, and the right choices—from better nutrition to cutting-edge technology. Whether it’s integrating AI in diagnostics, training more ophthalmologists, or simply eating more leafy greens, every step matters.

Saffron, a powerful natural antioxidant, has been shown to support retinal health and improve visual function, offering a promising addition to AMD prevention and management. Incorporating saffron alongside other eye-healthy nutrients can further help maintain macular health and slow disease progression.

Your vision is your independence. By prioritizing prevention, early diagnosis, and lifestyle changes, we can empower millions to see a brighter future. The solution is clear—start now.

Table 1: Global and Regional AMD Prevalence: Current Statistics and Future Projections

References

1. Wong WL, et al. (2014). Global Prevalence of AMD and Projections for 2040. Lancet Glob Health. http://dx.doi.org/10.1016/S2214-109X(13)70145-1
2. Vujosevic S, et al. (2023). Epidemiology of Geographic Atrophy and Intermediate AMD. Acta Ophthalmologica. 2023;101:839–856.  DOI: 10.1111/aos.15767.
3. Rein DB, et al. (2022). Prevalence of Age-Related Macular Degeneration in the US in 2019. JAMA Ophthalmol. 2022 Nov 3;140(12):1202–1208. doi:10.1001/jamaophthalmol.2022.4401
4. Owen CG, et al. (2012). UK AMD Prevalence Estimates. Br J Ophthalmol 2012;96:752e756. doi:10.1136/bjophthalmol-2011-301109.
5. Apte RS. (2021). Age-Related Macular Degeneration. N Engl J Med 2021;385:539-47. DOI: 10.1056/NEJMcp2102061
6. Klein R, et al. (2012). The Age-Related Eye Disease Study 2 (AREDS2). Archives of Ophthalmology. DOI: 10.1016/j.ophtha.2012.05.027
7. Flaxman SR, et al. (2020). Causes of Visual Impairment Worldwide in 2020. Lancet. https://doi.org/10.1016/S2214-109X(20)30489-7.
8. Falsini B, et al. (2010). Influence of Saffron Supplementation on Retinal Flicker Sensitivity in Early AMD. IOVS. DOI: 10.1167/iovs.09-4995.
9. Piccardi M, et al. (2012). A Longitudinal Follow-Up Study of Saffron Supplementation in Early AMD. Evidence-Based Complementary and Alternative Medicine. DOI: 10.1155/2012/429124.
10. Thomas C, et al. (2021) Age-Related Macular Degeneration.  Med Clin N Am 105 (2021) 473–491.  https://doi.org/10.1016/j.mcna.2021.01.003.
11. Keenan & Chew (2020). Study the past if you would define the future. Br J Ophthalmol. 2020 April ; 104(4): 449–450. doi:10.1136/bjophthalmol-2020-315890.
12. Li et al (2020). Prevalence and incidence of age-related macular degeneration in Europe. Br J Ophthalmol. 2020 Aug;104(8):1077-1084.  doi: 10.1136/bjophthalmol-2019-314422. Epub 2019 Nov 11.
13. Schuster et al (2024).  Epidemiology of Diagnosed Age-related Macular Degeneration in Germany. Ophthalmol Ther 13:13:1025–1039.  https://doi.org/10.1007/s40123-024-00901-6.
14. Querques et al. (2024). Expert Consensus on Geographic Atrophy in the EU: A Call for Urgent Policy Action. Ophthalmol. Ther. 2024 Feb 22;13(4):867–881. doi: 10.1007/s40123-024-00899-x.
    
15.  Eye Diseases  Prevalence Research Group. (2004). Causes and Prevalence of Visual Impairment Among Adults in the United States
    Archives of Ophthalmology, Vol. 122, April 2004.
16. Fighting Blindness Canada. https://www.fightingblindness.ca/eyehealth/eye-diseases/age-related-macular-degeneration/.
17. Canadian Ophthalmological Society (COS). https://www.cos-sco.ca/ophthalmology-innovations-paving-the-way-for-diagnosis-treatment-of-age-related-macular-degeneration-amd/. 

 

Global AMD prevalence statistics 2020-2040  
AMD projections for Asia and Europe  
How does saffron help with macular degeneration  
AI in AMD diagnosis and telemedicine  
AMD risk factors smoking and genetics  
Best diet to prevent age-related macular degeneration  
AMD prevalence differences Europeans vs Asians  
Latest treatments for geographic atrophy GA  
AMD cases in Germany and France statistics  
AREDS supplements for slowing AMD progression  
Why is AMD increasing globally  
AMD public health policies and prevention strategies  
AMD vision loss statistics in Canada and the US  
How to reduce AMD risk with lifestyle changes  
Role of omega-3 fatty acids in AMD management