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Six-year incidence of age-related macular degeneration and correlation to OCT-derived drusen volume measurements in a Chinese population
  1. Anna CS Tan1,2,3,
  2. Miao Li Chee3,
  3. Beau J Fenner1,2,3,
  4. Paul Mitchell4,
  5. Yih Chung Tham1,2,3,
  6. Tyler Rim1,2,3,
  7. Kelvin Teo1,2,3,5,
  8. Shaun S Sim1,2,3,
  9. Ching Yu Cheng1,2,3,
  10. Tien Yin Wong1,2,3,
  11. Usha Chakravarthy6,
  12. Chui Ming Gemmy Cheung1,2,3
  1. 1 Singapore National Eye Centre, Singapore
  2. 2 Duke-NUS, Singapore
  3. 3 Singapore Eye Research Institute, Singapore
  4. 4 Centre for Vision Research, The University of Sydney, Sydney, New South Wales, Australia
  5. 5 Save Sight Institute, Sydney, New South Wales, Australia
  6. 6 Queen's University Belfast, Belfast, Belfast, UK
  1. Correspondence to Dr Chui Ming Gemmy Cheung, Medical Retina Service, Singapore Eye Research Institute, Singapore 6576; gemmy.cheung.c.m{at}


Aims To report the 6-year incidence of optical coherence tomography (OCT)-derived age-related changes in drusen volume and related systemic and ocular associations.

Methods Chinese adults aged 40 years and older were assessed at baseline and 6 years with colour fundus photography (CFP) and spectral domain (SD) OCT. CFPs were graded for age-related macular degeneration (AMD) features and drusen volume was generated using commercially available automated software.

Results A total of 4172 eyes of 2580 participants (mean age 58.12±9.03 years; 51.12% women) had baseline and 6-year follow-up CFP for grading, of these, 2130 eyes of 1305 participants had gradable SD-OCT images, available for analysis. Based on CFP grading, 136 (3.39%) participants developed incident early AMD and 10 (0.25%) late AMD. Concurrently, retinal pigment epithelial-Bruch’s membrane (RPE-BrC) volumes decreased, remained stable and increased in 6.8%, 78.5% and 14.7%, respectively, over 6 years. In eyes where RPE-BrC volumes were >0 mm3 at baseline, this was associated with two-fold higher prevalence rate of any AMD at baseline (p<0.001). Multivariable analysis showed that when compared with eyes where RPE-BrC volume was unchanged, volume decrease was significantly associated with older age (OR=1.30; p<0.001), smoking (OR=2.21; p=0.001) and chronic kidney disease (OR=3.4, p=0.008), while increase was associated with older age (OR=1.36; p<0.001) and hypertension (OR=1.43; p=0.016).

Conclusion AMD incidence detected at 6 years on CFP and correlated OCT-derived drusen volume measurement change is low. Older age and some systemic risk factors are associated with drusen volume change, and our data provide new insights into relationship between systemic risk factors and outer retinal morphology in Asian eyes.

  • diagnostic tests/investigation
  • epidemiology
  • macula
  • retina

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. Data is de-identified participant data available from out database not reusable without permission.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. Data is de-identified participant data available from out database not reusable without permission.

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  • UC and CMGC contributed equally.

  • Contributors ACST, MLC, BJF, UC and CMGC made substantial contributions to the conception or design of the work; or the acquisition, analysis or interpretation of data for the work. ACST and MLC drafted the work and all authors revised it critically for important intellectual content.

  • Funding This study was funded by the National Medical Research Council of Singapore (NMRC/OFLCG/004a /2018; NMRC/CIRG/1488/2018). The funding sources had no role in the design or conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; or the decision to submit the manuscript for publication.

  • Competing interests ACST speaks and receives grant sponsorship for Zeis, Nidek, Bayer, Novartis receives sponsorship and travel grants from Allergan. CMGC speaks and receives sponsorship from Bayer, Novartis, Roche, Boehringer, Ingelheim, Topcon, Samsung. UC is DMC chairperson Photon and Pulsar sponsor Bayer, speaker fees Novartis, Consultant to Alimera, Apellis, Iveric, Roche.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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