Risk factors for incident age-related macular degeneration: Pooled findings from 3 continents

doi:10.1016/j.ophtha.2003.11.010

Ophthalmology

Volume 111, Issue 7, July 2004, Pages 1280-1287

https://doi.org/10.1016/j.ophtha.2003.11.010 Get rights and content

Abstract

Objective

To examine risk factors for incident age-related macular degeneration (AMD) after combining data from 3 population-based cohort studies.

Design

Population-based cohort study.

Population

A population of 9523 adults (age range, 43–95 years at baseline) living in Australia, The Netherlands, and the United States who participated in a baseline examination and a follow-up examination on average 5 or 6 years later.

Methods

Similar procedures were used at all study sites. Examinations included a standardized questionnaire, pupillary dilation, and stereoscopic color fundus photography. Fundus photographs were graded for lesions associated with AMD using the Wisconsin and International Age-Related Maculopathy Grading Systems. Senior investigators from each site adjudicated all photos graded as late AMD.

Main outcomes measure

Incidence of late AMD.

Results

Among studies, distributions for most risk factors differed, and overall incidence rates were similar. In the Beaver Dam Eye Study, total serum cholesterol was inversely associated with incident neovascular AMD. In the Blue Mountains Eye Study, current smoking (defined as smoking at the time of the baseline examination) was associated with an increased risk of incident geographic atrophy and late AMD; increased total serum cholesterol, having diabetes, and older age at menopause were positively associated with incident geographic atrophy; and an increase in high-density lipoprotein serum cholesterol was inversely related to incident geographic atrophy. In the Rotterdam Study, current smoking was associated with an increased risk of incident geographic atrophy, neovascular AMD, and late AMD; past smoking was associated with an increased risk of incident neovascular AMD and late AMD; and an increased number of years between menarche and menopause was directly related to incident geographic atrophy. After pooling data, the only statistically significant relationships found were between smoking and total serum cholesterol and incident AMD. Current smoking was associated with an increased incidence of geographic atrophy and late AMD (odds ratios [ORs] relative to nonsmokers: 2.83 and 2.35, respectively; ORs relative to past smokers: 2.80 and 1.82, respectively), and total serum cholesterol was associated directly with incident geographic atrophy (OR: 1.08 per 10 mg/dl) and inversely with incident neovascular AMD (OR: 0.94 per 10 mg/dl).

Conclusions

Pooled data support a growing body of evidence indicating that smoking is related to an increased risk of incident AMD. Current smokers were at higher risk of incident AMD than both past smokers and those who never smoked. The relationships found in this study between total serum cholesterol and incident geographic atrophy and neovascular AMD are not readily explained.

Section snippets

Materials and methods

The BDES is a population-based survey of vision and common eye diseases and included persons 43 to 86 years old living in Beaver Dam, Wisconsin at the time of the baseline examination.18 Of those invited, 4926 (83.2%) provided informed consent and participated in the first examination conducted from 1988 to 1990. Of these, 3684 additionally participated in a 5-year follow-up examination completed in 1993 to 1995. Details of the examination and photographic procedures have appeared elsewhere and

Results

In the 3 studies, 38 (0.4%), 67 (0.7%), and 102 (1.1%) persons developed geographic atrophy, neovascular AMD, and late AMD, respectively. Three of the persons who developed neovascular AMD had geographic atrophy at baseline. The distributions of the risk factors for each study and pooled appear in Table 1. Except for gender and diabetes status, distributions significantly differed between studies for all risk factors.

Table 2presents crude incidence rates of geographic atrophy, neovascular AMD,

Discussion

We combined data from the BMES, BDES, and RS and examined relationships between a variety of risk factors and the incidence of late AMD and its associated lesions. Significant relationships were found between smoking and incident geographic atrophy and late AMD and serum total cholesterol level and incident geographic atrophy and neovascular AMD. Previously, we reported from the baseline phase of the same 3 studies that, apart from age, smoking was the only factor found to be associated with

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^☆

Manuscript no. 230391.

This research is supported by the National Institutes of Health, Bethesda, Maryland (grant no.: EY06594 [BDM]) (RK, BEKK); the Ophthalmic Research Institute of Australia, Surry Hills, Australia, and the National Health & Medical Research Council, Canberra, Australia (grant nos.: 975159, 211069); and, in part, by Research to Prevent Blindness, New York, New York (RK, Senior Scientific Investigator Award), the Optimix Foundation, Amsterdam, The Netherlands, and the OOG Foundation, The Hague, The Netherlands.

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Original articleRisk factors for incident age-related macular degeneration: Pooled findings from 3 continents☆

Abstract

Objective

Design

Population

Methods

Main outcomes measure

Results

Conclusions

Section snippets

Materials and methods

Results

Discussion

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Surv Ophthalmol

Ophthalmology

Vision Problems in the U.S.: Prevalence of Adult Vision Impairment and Age-Related Eye Disease in America

The Framingham Eye Study monographan ophthalmological and epidemiological study of cataract, glaucoma, diabetic retinopathy, macular degeneration, and visual acuity in a general population of 2631 adults, 1973-1975

Surv Ophthalmol

The relationship of age-related maculopathy, cataract, and glaucoma to visual acuity

Invest Ophthalmol Vis Sci

Natural course in fellow eyes of patients with unilateral age-related exudative maculopathy. A flourescein angiographic 4-year follow-up of 45 patients

Acta Ophthalmol (Copenh)

Second eye involvement in age-related macular degenerationa four-year prospective study

Eye

Original article
Risk factors for incident age-related macular degeneration: Pooled findings from 3 continents☆