The remarkable progress of recent years in treatment options for age-related macular degeneration has deservedly dominated the headlines that reach consumers regarding advances in vision care. PDT, Macugen and Lucentis have all had their moment and raised hope for further progress.
As is the media's wont in so many areas, the health-care media favor the big story, the life-saving breakthrough, the sight-restoring advance.
What's being lost in this breakthrough focus is the less splashy message of AREDS which, believe it or not, was reported nearly six years ago. Prevention, apparently, closes out of town.
Two years after the initial AREDS report, further work by the same group estimated that nearly 300,000 cases of advanced AMD could be prevented in the
Last month, another group reported results of their computer simulation of the economic benefits and cost effectiveness of implementing the AREDS recommendations.1 Part of the group's work compared vitamin supplementation in AMD to other more widely known and routinely implemented health-care interventions.
In patients diagnosed with early or intermediate AMD, at an 85-percent compliance rate with vitamin therapy, such intervention would warrant as high a priority as breast cancer screening for women over 50. Even if compliance with vitamin therapy were as low as 30 percent, vitamin therapy in AMD patients would be as desirable as folic acid to prevent birth defects and screening and behavioral intervention in obese patients. And at either compliance level, vitamin therapy has a more favorable cost effectiveness than screenings for depression, hearing, cholesterol risk, osteoporosis or diabetes.
Six years isn't really all that long in terms of public education about a health issue. But, as Senior Editor Chris Kent shows in his excellent review of this issue (p. 31), it's plenty long enough for confusion, misinformation and other obstacles to develop that may be preventing untold numbers of AMD patients from benefiting from a relatively simple intervention. And educating anyone in this society about prevention versus cure is an uphill battle. The evidence is mounting, however, that it's one we'd better start thinking more seriously about.
1. Ophhalmology 2007;114:1319