The Prevalence of Age-Related Macular Degeneration in Asians A Systematic Review and Meta-Analysis Ryo Kawasaki, MD, PhD, 1,2 Miho Yasuda, MD, PhD, 3 Su Jeong Song, MD, PhD, 4 Shih-Jen Chen, MD, 5 Jost B. Jonas, MD, 6 Jie Jin Wang, MMed, PhD, 1,7 Paul Mitchell, MD, PhD, 7 Tien Y. Wong, MD, PhD 1,8 Objective: To determine the prevalence of age-related macular degeneration (AMD) in Asian populations and to compare this with prevalence in white populations. Design: A clear understanding of AMD prevalence in Asians is essential to meet future demands for eye health care. Methods: We searched published literature reporting AMD prevalence in Asian populations. We limited studies examined to those using standardized grading systems (either the Wisconsin Age-Related Maculopathy Grading System or the international classification proposed by the International ARM Epidemiological Study Group). We used metaanalytical methods to calculate age-specific pooled prevalence of AMD using inverse- variance weighting in a random effect model. We also calculated pooled estimates of age-standardized preva- lence. A metaregression model was used to examine gender differences and differences between Asian and white populations. Results: We identified 9 studies reporting AMD prevalence from 4 Asian populations. Pooled prevalence estimates of early and late AMD in Asian populations aged 40 to 79 years were 6.8% (95% confidence interval [CI], 4.6%– 8.9%) and 0.56% (95% CI, 0.30%– 0.81%), respectively; corresponding prevalence estimates in white populations were 8.8% (95% CI, 3.8%–13.8%) and 0.59% (95% CI, 0.35%– 0.84%), respectively. Reliable prevalence estimates of AMD in Asian persons aged 80 years were not available owing to small subject numbers in this age category. Conclusions: Among persons aged 40 to 79 years, the age-specific prevalence of late AMD in Asians was comparable with that reported from white populations, but early AMD signs were less common among Asians. Further studies in Asian populations are warranted to investigate whether certain specific AMD phenotypes or subtypes, such as polypoidal choroidal vasculopathy, are more common. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references. Ophthalmology 2010;117:921–927 © 2010 by the American Academy of Ophthalmology. Age-related macular degeneration (AMD) has been recog- nized as one of the leading causes of vision loss in elderly people in Western populations. 1 It has been also suggested that racial/ethnic differences in prevalence of AMD exist, but to date, racial/ethnic differences have only been docu- mented between black and white populations. 2–5 Asia is expected to see a substantial increase in the number of older persons in the next few decades, 6 and it has been estimated that 25% of Asians will be aged 60 years by 2050. A clear knowledge of the epidemiology of AMD in Asia is therefore essential to meet future demands for eye health care and social support for persons with AMD, as well as to prioritize expensive new treatments (e.g., use of anti–vascular endothelial growth factor agents). A traditional view has been that AMD is less frequent in Asians than in whites, 7 based on earlier observations from hospital-based samples of Asian countries. In Japan, for example, the estimated prevalence of AMD, accord- ing to a report of a multicenter, hospital-based study, was only 0.035% in persons aged 50 years in 1993. 8 How- ever, estimates from hospital-based study samples do not provide the best information on the prevalence or impact of AMD in the general community. The lack of reliable, population-based data from Asian prevents meaningful interracial/ethnic comparisons between Asian and white populations. 9 In the last 10 years, however, an increasing number of studies have reported the epidemiology of AMD in Asian populations. 10 –17 Most important, these recent studies have adopted standardized methods to clas- sify AMD lesions. It is also suggested that frequency of subtypes of late AMD might be different between Asians and whites. For example, it is now recognized that polypoidal choroidal vasculopathy (PCV) lesions are frequently observed in Asian patients with exudative AMD. 18,19 Polypoidal cho- roidal vasculopathy has been shown to have similarities and differences compared with typical neovascular AMD in genetic predisposition, 20 –23 clinical 18,19,24 and pathologic 25 characteristics, and response to photodynamic therapy 26 –28 or anti–vascular endothelial growth factor agents; 29 whether 921 © 2010 by the American Academy of Ophthalmology ISSN 0161-6420/10/$–see front matter Published by Elsevier Inc. doi:10.1016/j.ophtha.2009.10.007