Disparities in Age-Related Macular Degeneration (AMD)

Medically Reviewed by Whitney Seltman, OD on February 21, 2023
5 min read

Age-related macular degeneration (AMD) is a common reason people lose vision as they get older. It can make it hard to see things in detail. AMD can cause you to lose central vision over time. 

Your risk for AMD depends on many factors. Some of them you’ll have control over and others you won’t. Your access to care for AMD and resulting vision loss also can depend on many factors, including your race, education, health insurance, and support.

Risk factors for AMD include:

  • What you eat
  • Your weight
  • Whether you smoke
  • How old you are
  • Your blood pressure
  • If AMD runs in your family

Your risk for AMD also may depend on your race and other factors. Your race, income, and health insurance also may affect how and when you’ll find out you have AMD. 

These social factors, known as social determinants of health, can influence AMD treatment and your risk for vision loss in complicated ways. These social factors lead to disparities in many health conditions, including AMD. Health disparities are differences in health and certain health conditions between groups that could be prevented.

Almost 20 million Americans aged 40 and up have AMD. In about 1.5 million of them, AMD is a cause of vision loss. Your chances of getting AMD go up as you get older. About half of people aged 85 and up have AMD.

But AMD risk with age isn’t the same for everyone. For reasons that aren’t clear, non-Latino Black people get diagnosed with AMD less often than other groups. Non-Latino white people have AMD more often than other groups. 

Your AMD risk and risk of losing vision also depend on your sex. Men and women get AMD at similar rates, although it happens slightly more in women. But women more often have AMD that threatens vision. 

The risk of AMD also varies a lot depending on where you live. These differences between states and counties don’t go away when you consider race, age, or other factors. In the most recent U.S. data, AMD was lowest among people living in Washington, D.C., and highest in Florida. Rates of AMD also are high in the Midwest and New England.

Women and white people seem to get AMD more often than other groups. But health disparities also arise from differences in the way people are diagnosed and treated. One study looked at racial and ethnic differences in AMD and its treatment. They wanted to see if there were differences in groups that got treated with injected medicines that help to slow or stop the disease from getting worse and protect vision.

Because AMD happens with age, many people who have it are covered by Medicare health insurance. They looked at more than 28 million people 65 and up with Medicare to see who’d been diagnosed and treated for AMD. The study found that Black people got diagnosed with AMD less often than other groups. Latino and Asian people got diagnosed more than Black people but still less than white people.

But they also found differences based on race in how doctors treated people with AMD. White people more often got medicines that block certain proteins injected into their eyes than other groups. Black people were much less likely to have the same treatment than any other racial or ethnic group.

Treatment access including clinical trials also depends on where you live. One study found disparities in access to clinics running clinical trials for new AMD treatments based on where people live. 

Trials for new AMD treatments are harder to get to if you live in more rural places, the Midwest, or the South. White people and people with more resources will more often drive 60 or more miles to get to a clinical trial site compared to other groups, too. These factors lead to geographic access disparities that also are related in complicated ways to differences in race and income.

It’s hard to say why treatment differences in AMD happen. There can be lots of reasons. In general, people with lower incomes and fewer resources get treatment less often for AMD and other health conditions. 

Health and treatment disparities also can arise from cultural differences that influence how a person makes decisions about their medical treatment. Different groups may think about aging and related conditions including AMD differently. They may have had different access to health care over time. Medical mistrust, which is much higher in the Black community, also plays a role in disparities. 

One thing to keep in mind when thinking about health disparities and AMD is that there isn’t a lot known. Vision loss from various health conditions isn’t tracked in a systematic way. 

The data shows that AMD and related vision loss happens more in white people than other groups. But some related conditions that also lead to vision loss and blindness are more common in Black people than white people. An important one is called diabetic macular edema (DME), which happens from damage to the eyes from high blood sugar. 

To some degree, differences in AMD and AMD outcomes between racial groups also may be related to biology. One study showed that white people with AMD more often had features of worse or more advanced disease compared to Black people. Researchers suggested that Black people might have features that help to protect them from worsening AMD.

If you’re worried you may have AMD or may have more risk for AMD no matter your race or income, talk to your doctor and ask if you should see a specialist. If you are worried about cost, ask if there are resources to help or free screenings. 

If you have AMD, talk to your doctor about the treatment they recommend for you. It’s best to find out you have AMD and get any needed treatment early, before you lose vision. You also can take steps to lower your risk, including:

  • Not smoking
  • Exercising
  • Treating other health conditions, including blood pressure and cholesterol
  • Eating healthy