“Screening for age-related macular degeneration: a feasible strategy for the Unified Health System?”
“Macular Degeneration; Wet Macular Degeneration; Geographic Atrophy; Mass Screening; Vision Screening; Effectiveness; Unified Health System ”
“Introduction: Age-related macular degeneration (AMD) is a chronic, progressive ophthalmological disease that generally affects patients over 50 years of age and causes damage to the central area of the retina, which can lead to reduced visual acuity or even to blindness. Clinically, the disease varies in early, intermediate and advanced stages, depending on the formation of drusen, pigmentary changes in the retina, presence of geographic atrophy or choroidal neovascularization. In high-income countries, the disease is one of the main causes of irreversible blindness in people over 50 years of age. Furthermore, the limitations imposed by AMD due to associated multimorbidity and reduced quality of life tend to increase the burden of the disease. The global prevalence of AMD is estimated to be 8.69% in individuals between 45 and 85 years of age. There is a prospect of an increase from 196 million to 288 million cases between 2020 and 2040, respectively. Early diagnosis allows for the administration of adequate treatment and a better prognosis of the disease, but it can be delayed for several reasons, such as the fact that the disease remains asymptomatic in the early stage, compensatory mechanisms in the brain that make it difficult for patients to perceive changes in vision at baseline, involvement of the non-dominant eye and lack of public awareness about the disease. Timely diagnosis allows patients to undergo drug treatment through intravitreal injection with antiangiogenic agents in order to stabilize disease progression or improve visual acuity. To this end, context-specific screening and public awareness of AMD can be early detection tools to reduce the clinical and social impact of the disease. Objective: To verify the evidence on the effectiveness of screening for agerelated macular degeneration and discuss the feasibility of possible screening strategies. Method: This research will consist of two methodological stages: (I) elaboration of a systematic review of clinical trials and observational studies, in order to evaluate the effectiveness of screening methods for early detection of AMD in adults aged 50 years and over, compared to the absence of screening or any other strategy in the primary care, outpatient or hospital setting; and (II) based on the findings of the systematic review, a qualitative study will be carried out to obtain consensus using the Delphi technique, together with a panel of ophthalmologists, on the feasibility of implementing a screening strategy for the disease, as well as its barriers and facilitators in the context of the Unified Health System. Therefore, this project aims to contribute to the discussion regarding the screening of agerelated macular degeneration, considering the need for new public health strategies to deal with healthy aging and reduction of inequities related to this process. ”