Factors beyond population ageing and common vascular comorbidities are likely contributing to the rising burden of neovascular age-related macular degeneration (nAMD), a new study suggests.
The large study found the prevalence and treatment burden of nAMD rose substantially in Japan between 2014 and 2019, with the steepest increases occurring among adults aged 75 years and older.
“Our findings extend prior reports of increasing nAMD prevalence in rapidly aging societies and underscores that this trend is apparent in both sexes and across all age groups, particularly among older individuals,” the researchers said.
“The results indicate that the overall upward trend in nAMD prevalence is not solely attributable to population aging. The lack of a positive correlation between the increase in the aging rate and the increase in nAMD prevalence further supports the notion that population aging was not the primary driver of the increase in nAMD prevalence in Japan from 2014 to 2019.“
They also explored whether common systemic conditions associated with ageing could explain the increase in nAMD prevalence.
Vascular comorbidites
They found diabetes, hypertension and dyslipidaemia were each independently associated with higher odds of nAMD, supporting the concept that nAMD was associated with cardiometabolic and cardiovascular diseases.
“These findings are consistent with earlier reports suggesting that systemic disorders such as dyslipidemia and diabetes may exacerbate the development or progression of nAMD,” they said.
However, adjusting for these comorbidities did not significantly alter the higher odds of nAMD observed in 2019 compared with 2014, suggesting that the secular rise in nAMD prevalence was unlikely to be explained by changes in comorbidity burden alone.
In the nationwide study, published in Investigative Ophthalmology & Visual Science April 2026 edition, researchers analysed data from Japan’s national claims database, which covers more than 95% of the population, to examine age-specific trends in nAMD prevalence and treatment use in what they described as a “super-aged society”.
They identified 76,125 cases of nAMD in 2014, rising to 125,190 cases in 2019. Age-standardised prevalence increased from 101.3 to 152.4 cases per 100,000 people over the five-year period.
Although prevalence peaked among people aged 80–84 years in both years studied, the most dramatic growth occurred in older age groups, with prevalence among people aged 75 years and older increasing by 62.9%.
Lead author Dr Masahiro Akada and colleagues said findings highlighted the growing impact of retinal disease in ageing populations worldwide.
More patients needing therapy
The researchers also examined treatment burden by analysing claims linked to anti-VEGF therapies. Total treatment claims increased markedly over the study period, driven primarily by aflibercept use. However, among patients already receiving treatment, the average number of injections per user rose only modestly.
“This suggests that the increase in treatment burden was mainly due to the growing number of patients requiring therapy, rather than substantial increases in treatment intensity per patient,” the authors said.
The researchers said wider optical coherence tomography adoption may have improved detection and earlier identification of treatment-requiring disease, and changes in referral patterns and treatment thresholds during the dissemination of OCT and anti-VEGF therapy may have increased treated case capture.
Improved survival related to declining cardiovascular mortality may have also expanded the pool of older adults at risk.
They said findings had important implications for healthcare planning in countries with rapidly ageing populations, particularly as demand for intravitreal injection services continued to grow. And understanding the drivers behind the increase in nAMD prevalence would be essential for future prevention strategies and resource allocation.
“With ongoing population ageing worldwide, these findings may foreshadow increasing clinical and economic burdens of nAMD in other countries,” they said.
