Prevalence, incidence and risk factors of visual disability in patients with exudative age-related macular degeneration: a nationwide population-based study in Korea

Background Age-related macular degeneration (AMD) is a leading cause of irreversible visual loss in the elderly. Although anti-vascular endothelial growth factor (VEGF) therapy has improved the visual prognosis of exudative AMD, a considerable proportion of patients still develop severe vision loss. However, real-world data on the prevalence, incidence and risk factors for visual disability among patients with exudative AMD remain limited. This study investigates the prevalence, incidence and risk factors for visual disability among patients with exudative AMD. Methods This nationwide, population-based retrospective cohort study used Korean National Health Insurance Service data from 2009 to 2023. Patients with newly diagnosed exudative AMD were identified, with a two-year washout period (2009–2010). Prevalence, incidence, hazard ratio (HR) for visual disability were analyzed. Results A total of 147,406 patients with exudative AMD were included. The prevalence of visual disability in 2023 was 4.82% and the overall incidence rate was 12.18 per 1,000 person-years. At 8 years, the cumulative incidence probability of monocular visual disability was 4.8% (95% CI, 4.6–5.1), and that of binocular visual disability was 4.4% (95% CI, 4.1–4.7). The mean duration from exudative AMD diagnosis to visual disability was 3.3 ± 2.6 years. The risk of visual disability increased with older age group (HR, 1.38; 95% CI, 1.35–1.42) and lower income level (HR, 1.06; 95% CI, 1.05–1.08). Female sex (HR, 1.41; 95% CI, 1.35–1.47), diabetic retinopathy (HR, 1.16; 95% CI, 1.08–1.25), glaucoma (HR, 1.10; 95% CI, 1.05–1.15), and severe intraocular hemorrhage requiring vitrectomy (HR, 3.14; 95% CI, 2.63–3.75) were also significant risk factors. A decreasing trend in visual disability incidence was observed among patients who were more recently diagnosed with exudative AMD (−0.25% point per year; p < 0.001). Conclusion The burden of AMD-related visual disability remains significant, highlighting the need for strategies to improve treatment adherence and ensure equitable access to vision-preserving care. The decreasing trend of visual disability in recent years suggests the practical benefit of improved access to anti-VEGF treatment through lower drug costs and expanded insurance coverage.