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Prevalence and risk factors for age-related macular degeneration in a population-based cohort study of older adults in Northern Ireland using multimodal imaging: NICOLA Study
  1. Ruth E Hogg1,
  2. David M Wright1,
  3. Nicola B Quinn1,
  4. Katherine Alyson Muldrew1,
  5. Barbra Hamill1,
  6. Laura Smyth1,
  7. Amy Jayne McKnight1,
  8. Jayne Woodside1,
  9. Mark A Tully2,
  10. Sharon Cruise1,
  11. Bernadette McGuinness3,
  12. Ian S Young4,
  13. Frank Kee1,
  14. Tunde Peto1,
  15. Usha Chakravarthy1
  1. 1Centre for Public Health, Queen's University Belfast Faculty of Medicine Health and Life Sciences, Belfast, UK
  2. 2Ulster University, Newtownabbey, UK
  3. 3Belfast Faculty of Engineering and Physical Sciences, Queen's University, Belfast, UK
  4. 4Centre for Public Health, Queen's University Belfast Faculty of Arts Humanities and Social Sciences, Belfast, UK
  1. Correspondence to Dr Ruth E Hogg, Centre for Public Health, Queen's University Belfast, Belfast BT7 1NN, UK; r.e.hogg{at}


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.

  • epidemiology
  • genetics
  • imaging
  • macula
  • retina

Data availability statement

Data are available on reasonable request. Details on data access policy available at

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Data availability statement

Data are available on reasonable request. Details on data access policy available at

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  • 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.

  • 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.