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'My sister phoned me at the weekend. She said she has been told she has macular degeneration in one eye and that I should get my eyes checked, as she thinks it may run in families.'
'I took my father to the eye clinic again last week, and the specialist said there was nothing more he could do, apart from putting him on the blind register. What do you think my risk is?'
When did you last hear a similar story? Probably several times in the last week alone. Then at lunch time you open the latest Optician journal. 'A recent survey suggests eating oily fish may reduce the risk of AMD.'
'People with outdoor lifestyles are X-times more likely to develop AMD.'
How is the busy optometrist able to make sense of all this, and advise patients accordingly?
The cumulative risk factor index for visually consequential AMD has been developed following a detailed review of the scientific literature (over 300 published scientific papers). The software was created by specialists across a number of relevant disciplines, including ophthalmology, science, optometry, mathematics, physics and statistics.
The patient's risk profile, from the age of 55 to 100 years, is generated using a mathematical model, which computes a composite percentage risk based on entries made on the online calculator (www.sightrisk.com). Each risk factor is weighted according to the literature. The web-based design is quick and simple to use, but at the same time delivers a strong message to the patient. This message is that the possibility of developing AMD in later life can be reduced by making informed decisions about an individual's personal risk factors and lifestyle.
To create the patient's risk profile, all the currently identified risk factors are processed by the calculator, weighted according to the scientific literature. In addition, the software is able to incorporate clinical information, where available, for example, the presence of drusen (a clinical feature of early-stage disease) or the patient's macular pigment level (antioxidants in the central retina believed to protect against macular disease).
Why is the calculator such a powerful tool in the fight against AMD? In an ideal world, all possible scenarios with respect to the risk of developing AMD would be researched, (eg smokers, overweight smokers, individuals with hypertension, good and bad diets, and all possible combinations of these). Obviously, many studies have been conducted, and research in this area is ongoing. However, due to the large number of established and putative risk factors, it would be impossible to research all possible combinations. Using the AMD risk calculator, in less than three minutes, all the patient's risks can be inputted to the calculator and their risk profile generated.
The results are displayed in graphical form: percentage risk to age. Two risk curves are generated the first curve defines the computed result after inputting all available information. The patient's risk is shown for any given age from 55 to 100. The second curve demonstrates the possible reduced risk when all possible modifiable risks are optimised. Modifiable risks include, among others, smoking and diet. In this way, patients at risk are easily identified, and most importantly, can be offered advice to improve their lifestyle in order to significantly reduce the risk of suffering from AMD in later years. The calculator will recognise risk factors which can be favourably modified, for the first time enabling the eye care professional to give meaningful and scientifically supported advice to patients. ?
? Further information on the calculator is available at www.sightrisk.com.
? Dr John Nolan is lead researcher at the Waterford Macular Pigment Research Group where Stephen Beatty works as a consultant ophthalmologist. Graham O'Regan is an optometrist based in Wales
Sightrisk Case study
A 48-year-old patient has had regular eye examinations for a number of years at his routine visit in March, he mentioned that his mother had recently developed AMD, and was concerned that he might also be at risk. Learning that he was, he made an appointment to have a Sightrisk AMD risk assessment.
His results (below) clearly demonstrated his risk of developing AMD with increasing age, reaching the upper calculated limit of 95 per cent in his 90s. His age 70 reference point risk was 46.32 per cent (compared to around 11 per cent across the population as a whole). However, the patient's potential areas for improvement were also clearly demonstrated, and each of these was fully discussed in turn. He is typical of patients who are becoming increasingly health-conscious and welcome informed advice from professionals.
At his six-month follow up (right), his risk at the age of 70 had fallen from 46.32 per cent to 26.75 per cent. This has been achieved by a significant reduction in smoking (he has yet to give up entirely), improvements to diet and nutrition, and active protection from light exposure.
Measurements of his macular pigment level were taken at his initial visit, and again at his six-month follow-up. Six months could be considered too short an interval to expect any improvement in this area however his readings were marginally higher at the second visit. Measurements will be repeated at his next visit, and results reported in Optician.
The patient's current cumulative risk is still some way above his fully optimised risk, but he is now fully aware of how to reduce his risk further, and the improvement to date has been visibly demonstrated by the calculator. Most importantly, he has been offered advice, encouragement and of course incentive to significantly reduce his risk of suffering from the devastating effects of AMD in later years.