Sir,

We commend the fresh perspectives offered by Cervantes-Castaneda et al1 on the possible lack of benefit of early awareness in age-related macular degeneration (AMD).

However, the basis of such a conclusion is questionable in view of several limitations and inadequacies of the study design. Fundamentally, the determination of early awareness of AMD may be biased as it was solely based on the patients’ recall of having been previously diagnosed of AMD, given oral supplementation or advised Amsler monitoring. More details could also be provided with regards to the source of such diagnosis and recommendations as clinical competencies and management of AMD may be variable across the spectrum of general practitioners, optometrists and ophthalmologists. Furthermore, we agree that even in patients who were aware of their condition, it is difficult to assess their compliance to treatment and self-examination regimens, which could then influence the rate of detection of neovascular AMD. Lastly, the single-centre design and the associated geographical bias, although minimised by the peculiar referral pattern in the study region, preclude the generalisation of findings to the population.

Contrary to what the authors had suggested, we believe that the benefits of early awareness of AMD are far reaching.2 Awareness of diseases promotes positive health-seeking behavioural changes in patients; patient education3 and a prior diagnosis of chronic eye diseases, such as AMD,4 are associated with increased utilisation of eye-care services. Coupled with effective counselling by clinicians, an early awareness of AMD allows the patient to take an active approach towards self-monitoring (with the Amsler chart remaining as a simple and inexpensive home-based test of choice despite its low sensitivity5) and regular eye follow-up. These may also facilitate the detection of other age-related eye diseases such as cataract and glaucoma as well.

As such, it may be premature to disprove the benefits of early awareness in the long-term management of AMD.