Purpose To report prevalence and risk factor associations for age-related macular degeneration (AMD) and AMD features from multimodal retinal grading in a multidisciplinary longitudinal population-based study of aging in Northern Ireland.
Study design Population-based longitudinal cohort study.
Methods Retinal imaging at the Norther Ireland Cohort for the Longitudinal Aging Study health assessment included stereo Colour Fundus Photography (CFP) (Canon CX-1, Tokyo, Japan) and Spectral-Domain Optical Coherence Tomography (SD-OCT) ((Heidelberg Retinal Angopgraph (HRA)+OCT; Heidelberg Engineering, Heidelberg, Germany). Medical history and demographic information was obtained during a home interview. Descriptive statistics were used to describe the prevalence of AMD and individual AMD features. Multiple imputation followed by multiple regression modelling was used to explore risk factor associations including relationships with AMD genetic risk score.
Results Retinal images from 3386 participants were available for analysis. Mean age of the sample was 63.4 (SD 9.01, range: 36–99). Population weighted prevalence of AMD using colour grading in those over 55 years was: no drusen: 6 0.4%; drusen <63 μm: 15.9%; drusen 63–125 µm: 13.7%; drusen >125 µm or pigmentary changes: 8.3%; late AMD: 1.6%. Prevalence of AMD features in those over 55 years was: OCT drusen 27.5%, complete outer retinal pigment epithelium and outer retinal atrophy (cRORA) on OCT was 4.3%, reticular drusen 3.2% and subretinal drusenoid deposits 25.7%. The genetic risk score was significantly associated with drusen and cRORA but less so for SDD alone and non-significant for hyperpigmentation or vitelliform lesions.
Conclusions Multimodal imaging-based classification has provided evidence of some divergence of genetic risk associations between classical drusen and SDD. Our findings support an urgent review of current AMD severity classification systems.
Data availability statement
Data are available on reasonable request. Details on data access policy available at https://www.qub.ac.uk/sites/NICOLA/InformationforResearchers/.
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Twitter @ruth_hogg, @MarkATully
Contributors Conceived and designed the study: REH, UC, TP, ISY and FK.Analysed the data: DMW, LS and AJM. Acquisition of data: BH, KAM, LS and TP. Administrative, technical or material support: AJM, LS, JW, MAT, SC, BM, ISY and FK. Wrote the paper: RH. Critically revised the manuscript: DMW, NBQ, KAM, BH, LS, AJM, JW, MAT, SC, BM, ISY, FK, TP and UC. RH and DMW had full access to all study data and takes responsibility for the integrity of the data and the accuracy of the data analysis. UC is guarantor. Statistical analyses were performed by DMW.
Funding Atlantic Philanthropies, Bayer, Belfast Association for the Blind, Centre for Aging Research and Development in Ireland, College of optometrists, Diabetes UK, Economic and Social Research Council, Macular Society, Medical Research Council, Novartis, Office of the First and Deputy First Minister, Optos Plc, Queen’s University Belfast Research and Development, Research and Development Division of the Public health Agency, Thomas Pocklington Trust and United Kingdom Clinical Research Collaboration. Grant numbers not available.
Disclaimer The sponsors and funding organisations had no role in the design or conduct of this research.
Competing interests Ruth Hogg: Optos PLC and Novartis; UC: Bayer. These all relate to non-restrictive grants awarded to QUB to support the retinal grading of this study.
Provenance and peer review Not commissioned; externally peer reviewed.
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