Prevalence, Associations, and Visual Impact of Myopic Macular Degeneration in a Multi-ethnic Older Population in Singapore: The PIONEER Study

This study assessed the prevalence, associations, and dietary pattern of myopic macular degeneration (MMD), and its effect on vision among older adults in Singapore. 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. 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. 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.