Prevalence, Associations, and Visual Impact of Myopic Macular Degeneration in a Multi-ethnic Older Population in Singapore: The PIONEER Study.
11 affiliations
- 1Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Road Discovery Tower, Level 6 The Academia, Singapore, 169856, Singapore.
- 2Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
- 3Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- 4Ophthalmology and Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Singapore.
- 5Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Vagelos College of Physicians and Surgeons, New York City, NY, USA.
- 6Institute for Human Development and Potential, Agency for Science, Technology, and Research, Singapore, Singapore.
- 7Programme in Health Services Research and Population Health, Duke-NUS Medical School, Singapore, Singapore.
- 8Department of Ophthalmology and Visual Science, Institute of Science Tokyo, Tokyo, Japan.
- 9Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia.
- 10Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Road Discovery Tower, Level 6 The Academia, Singapore, 169856, Singapore. [email protected].
- 11Ophthalmology and Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Singapore. [email protected].
Abstract
Introduction
This study assessed the prevalence, associations, and dietary pattern of myopic macular degeneration (MMD), and its effect on vision among older adults in Singapore.Methods
Community-dwelling adults aged ≥ 60 years in the Population Health and Eye Disease Profile in Elderly Singaporeans (PIONEER) study underwent examinations, including spherical equivalent (SE), axial length (AL), best-corrected visual acuity (BCVA), contrast sensitivity (CS), and fundus photography. Dietary intake was assessed using a validated 110-item interviewer-administered food frequency questionnaire. Dietary patterns were generated by applying exploratory factor analysis. MMD was graded using the meta-analyses of pathologic myopia classification. Associations with MMD were evaluated using multivariable logistic regression, and the impact of MMD on visual outcomes using multivariable linear regression, with SE and AL modelled separately.Results
Among 1643 phakic participants (mean age 70.6 ± 7.6 years), the age-standardised MMD prevalence was 5.1% (95% confidence interval [CI] 4.0-6.2%), rising from 3.1% (60-65 years) across consecutive 5-year brackets (5.6%, 5.9%, 8.0%, 9.8%) to 13.1% (≥ 85 years). Among high myopes aged ≥ 75 years, MMD prevalence approached 80-100%. Multivariable analyses confirmed that more myopic SE, longer AL, and older age were associated with MMD (all p < 0.001). MMD was associated with worse BCVA and CS, with adjusted differences ranging from 0.05 to 0.10 logMAR and - 0.10 to - 0.15 logCS (all p < 0.05). Dietary patterns were not associated with MMD.Conclusion
MMD poses a substantial public health burden among older Singaporeans, presenting as a near-inevitable complication in older high myopes that drives significant visual impairment in distance acuity and contrast sensitivity. The strong structural and age associations, alongside the absence of a dietary association, highlight the need for primary prevention and structural monitoring in high-risk myopic populations.
Related
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BibTeX
@article{cheong2026prevalence,
title = {{Prevalence, Associations, and Visual Impact of Myopic Macular Degeneration in a Multi-ethnic Older Population in Singapore: The PIONEER Study.}},
author = {Kai-Xiong Cheong and Fan Wu and Quan V Hoang and Jun-Shi Lai and Yijia Zhang and Hla Myint Htoon and Kyoko Ohno-Matsui and Ecosse L Lamoureux and Seang-Mei Saw and Preeti Gupta},
journal = {Ophthalmology and therapy},
year = {2026},
month = oct,
doi = {10.1007/s40123-026-01514-x},
url = {https://europepmc.org/article/MED/42832167},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Prevalence, Associations, and Visual Impact of Myopic Macular Degeneration in a Multi-ethnic Older Population in Singapore: The PIONEER Study.
AU - Kai-Xiong Cheong
AU - Fan Wu
AU - Quan V Hoang
AU - Jun-Shi Lai
AU - Yijia Zhang
AU - Hla Myint Htoon
AU - Kyoko Ohno-Matsui
AU - Ecosse L Lamoureux
AU - Seang-Mei Saw
AU - Preeti Gupta
PY - 2026
DA - 2026/10/05
JO - Ophthalmology and therapy
DO - 10.1007/s40123-026-01514-x
UR - https://europepmc.org/article/MED/42832167
AB - Introduction This study assessed the prevalence, associations, and dietary pattern of myopic macular degeneration (MMD), and its effect on vision among older adults in Singapore.Methods Community-dwelling adults aged ≥ 60 years in the Population Health and Eye Disease Profile in Elderly Singaporeans (PIONEER) study underwent examinations, including spherical equivalent (SE), axial length (AL), best-corrected visual acuity (BCVA), contrast sensitivity (CS), and fundus photography. Dietary intake was assessed using a validated 110-item interviewer-administered food frequency questionnaire. Dietary patterns were generated by applying exploratory factor analysis. MMD was graded using the meta-analyses of pathologic myopia classification. Associations with MMD were evaluated using multivariable logistic regression, and the impact of MMD on visual outcomes using multivariable linear regression, with SE and AL modelled separately.Results Among 1643 phakic participants (mean age 70.6 ± 7.6 years), the age-standardised MMD prevalence was 5.1% (95% confidence interval [CI] 4.0-6.2%), rising from 3.1% (60-65 years) across consecutive 5-year brackets (5.6%, 5.9%, 8.0%, 9.8%) to 13.1% (≥ 85 years). Among high myopes aged ≥ 75 years, MMD prevalence approached 80-100%. Multivariable analyses confirmed that more myopic SE, longer AL, and older age were associated with MMD (all p < 0.001). MMD was associated with worse BCVA and CS, with adjusted differences ranging from 0.05 to 0.10 logMAR and - 0.10 to - 0.15 logCS (all p < 0.05). Dietary patterns were not associated with MMD.Conclusion MMD poses a substantial public health burden among older Singaporeans, presenting as a near-inevitable complication in older high myopes that drives significant visual impairment in distance acuity and contrast sensitivity. The strong structural and age associations, alongside the absence of a dietary association, highlight the need for primary prevention and structural monitoring in high-risk myopic populations.
SN - 2193-8245
SN - 2193-6528
ER -