Association of treated neovascular AMD with disability and mood disorders: A longitudinal nationwide study

To describe the associations of treated neovascular AMD with the risk of disability, falls, fractures and mood disorders in a large sample representative of the French population.

Analyses were based on 77 582 individuals belonging to the 'Echantillon Généraliste des Bénéficiaires', a 1/97 random sample of the French population, aged 65 years or more on 1 April 2009 and followed until 31 December 2019. Treated neovascular AMD (nAMD) was identified through the reimbursement of anti-VEGF drugs, intravitreal injections and after exclusion of other pathologies requiring the use of intravitreal anti-VEGFs. Activities of daily living (ADL) disability was identified using a previously developed algorithm, while falls, fractures, head trauma and mood disorders were identified using relevant ICD codes and medications. Associations of nAMD with outcomes were assessed using Cox models with nAMD as a time-dependent variable and adjustment for confounders.

During the study period, 1662 cases of incident nAMD were identified. After adjustment for age, sex, Charlson comorbidity index and number of drugs, nAMD was significantly associated with the occurrence of ADL disability (Hazard ratio (HR): 1.19, 95% confidence interval (CI): 1.08-1.30; p = 0.0002) and of mood disorders (HR: 1.19, 95%CI: 1.07-1.32; p = 0.002). Associations with falls, fractures and head trauma were not statistically significant.

Treated neovascular AMD remains associated with a 19% increased risk of disability and mood disorders, while no association was detected with falls, fractures and head trauma. These results are consistent with a major improvement in functional outcomes, with respect to the pre-anti-VEGF era.