The Evolving Burden of Age-Related Macular Degeneration in China (1990-2023): Insights from an Aging Society and the Anti-VEGF Era.

BACKGROUND: Age-related macular degeneration (AMD) is a leading cause of vision loss in the elderly. China bears the world's largest AMD burden. This study analyzes the evolving AMD burden in China (1990-2023) and the impact of anti-VEGF therapy. METHODS: We analyzed data from the Global Burden of Disease (GBD) 2023 study using joinpoint regression, decomposition analysis, and Bayesian modeling. A supplementary meta-analysis of single-arm studies was conducted to assess anti-VEGF efficacy in Chinese patients. RESULTS: From 1990 to 2023, China's age-standardized prevalence rate (ASPR) and disability-adjusted life year rate (ASDR) for AMD decreased by -0.67% and -1.48% annually, respectively. In 2023, China accounted for 35.82% of global cases and 30.25% of global DALYs. A supplementary meta-analysis of 13 single-arm observational studies showed a pooled efficacy rate of 74% for anti-VEGF drugs in China, albeit with substantial heterogeneity (I2 = 93.07%), warranting cautious interpretation. The accelerated decline in ASDR after 2011 coincided temporally with the clinical introduction and subsequent insurance coverage of anti-VEGF therapy. Projections indicate a continued decline in burden through 2038. CONCLUSION: Despite a declining age-standardized burden, China's absolute AMD burden remains substantial due to rapid population aging and other challenges. The temporal association between anti-VEGF therapy availability and the accelerated burden decline suggests a potential contribution of this treatment, though causality cannot be directly inferred from this ecological analysis. The observed trends likely reflect multiple factors, including improved healthcare access, early diagnosis, socioeconomic development, and anti-VEGF therapy. Comprehensive strategies focusing on prevention and equitable healthcare access are needed.