Age-related macular degeneration (AMD) will increase prevalence as the world’s population ages, and falls are a public health issue and a burden on the healthcare system (approximately 28-35% of people 65 and older fall annually, with 37.3 million falls requiring medical attention per year). To understand the wet and dry AMD treatments’ impact on patient falls and mobility, a systematic review was completed.
This review unveiled 10 publications with heterogeneous study designs, methods and findings. Two authors screened, extracted data and assessed bias using RoB-2 and ROBINS-I. A third author served as a tie breaker.
This database search resulted in 3,525 studies, with an additional 112 identified through bibliography review. 10 out of the 11 outcomes had a moderate to serious risk of bias.
Despite the potential positive impact of AMD treatments on patient falls and mobility, quality data on this relationship is lacking, which concerns the authors of this study.
“The majority of evidence presented in these papers is weak with a concerning risk of bias, making it impossible to remark on the relationship of AMD treatments on participants’ mobility,” the authors concluded in their study. “This knowledge-gap is a red flag, considering that there will be an inevitable increase in AMD and falls in the world’s aging population. If AMD treatments are shown to minimize fall risk by improving visual function or for a different reason that could be explored, there will be broad benefits in adhering to AMD treatment recommendations, including improved quality of life, morbidity and perhaps mortality.”
The authors noted that the first step in learning how AMD treatments impact falls and its burden on the healthcare system is to standardize measurement tools used in research to assess mobility and patient falls.
“Instead of listing falls and mobility as an unelicited, patient-reported adverse event, we believe that this outcome should be intentionally assessed,” they explain. “If feasible, we suggest requesting that patients complete a prospective “falls” calendar with monthly clinician check-ins, which is the current gold standard of falls reporting. Eventually, this mode of falls assessment could be translated clinically into regularly asking patients over 65 years old if they fell during the past year or interval between ophthalmology appointments, as suggested by the American Geriatrics Society and British Geriatrics Society Clinical Practice Guidelines. Using this method will more effectively utilize each healthcare contact to tackle this pervasive public health issue.”
Garrigan H, Hamati J, Lalakia P, et al. Does age-related macular degeneration (AMD) treatment influence patient falls and mobility? A systemic review. Ophthalmic Epidemiology. Epub ahead of print.