Prevalence of Age-related Macular Degeneration in Elderly Caucasians: The Tromsø Eye Study

doi:10.1016/j.ophtha.2012.03.016

Ophthalmology

Volume 119, Issue 9, September 2012, Pages 1737-1743

Presented in part as poster presentations at: the Association for Research in Vision and Ophthalmology Annual Meeting, May 2-6, 2010, and May 1-5, 2011, Fort Lauderdale, Florida, and at the Nordic Ophthalmological Congress, August 4-7, 2010, Reykjavik, Iceland.

https://doi.org/10.1016/j.ophtha.2012.03.016 Get rights and content

Purpose

To describe the sex- and age-specific prevalence of drusen, geographic atrophy, and neovascular age-related macular degeneration (AMD).

Design

Population-based, cross-sectional study.

Participants

Caucasian adults aged 65 to 87 years from the 6th Tromsø Study, a population-based study conducted in 2007–2008 in the municipality of Tromsø, Norway.

Methods

Digital color fundus photographs were graded for predominant phenotype based on drusen size, geographic atrophy, and neovascular AMD.

Main Outcome Measures

Age-related macular degeneration.

Results

A total of 3025 subjects participated; 89% of those were invited to the eye examinations. Gradable photographs were available for 2631 persons (mean age 72.3 years). Drusen 63–125 μm as the predominant phenotype were found in 34.9% of participants (95% confidence interval [CI], 33.1–36.8), drusen >125 μm were found in 24.1% (95% CI, 22.5–25.8), geographic atrophy was found in 1.0% of participants (95% CI, 0.6–1.4), and neovascular AMD was found in 2.5% of participants (95% CI, 1.9–3.1). Bilateral involvement of late AMD was present in 1.1% of the sample. Eyes with late AMD had a significantly lower refractive error (spherical equivalent 0.078 vs. 0.99 diopters, P<0.0001), and 42.5% of eyes had Snellen visual acuity ≤0.32.

Conclusions

The prevalence of AMD among the elderly persons in this study was similar to rates in other Caucasian populations. Late AMD was present in 10.9% of subjects aged 80 years or more. No sex differences in prevalence rates of large drusen or late AMD were observed. Lower refractive error was observed in eyes with late AMD than in eyes without late AMD.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Study Population

The Tromsø Study is a longitudinal population-based survey initiated in 1974 and has been conducted periodically as cross-sectional surveys.¹⁷ Tromsø has a homogeneous, Caucasian population. Total birth cohorts and random samples from the municipality of Tromsø have been invited. The Tromsø Eye Study is a substudy of the 6th Tromsø Study conducted in 2007–2008, where eye health was included in a second visit. Materials and methods have been described.¹⁸ Participants from the second visit aged

Results

Of the 3025 participants, 2631 had retinal photographs gradable for AMD in at least 1 eye. Characteristics of the participants by sex are provided in Table 1. Female participants were more likely to have self-reported cataract and AMD.

Participants without photographs were older (73.8 vs. 72.3 years, P<0.0001), had lower visual acuity (Snellen ≤0.32, 6.4% vs. 2.2%, P<0.01), and had higher frequency of self-reported glaucoma (13.2% vs. 5.2%, P<0.001) and cataract (39.9% vs. 21.3%, P<0.001) than

Discussion

The present cross-sectional study described the prevalence rates of AMD among Caucasian elderly participants from the Tromsø Eye Study, a population-based study in Norway. The overall prevalence of late AMD was 3.5%, and neovascular disease outnumbered geographic atrophy. Symmetry between eyes was relatively low. Prevalence increased strongly with age. No significant sex differences in prevalence rates of AMD were observed. Refractive error was lower in eyes with late AMD than in eyes without

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Prevalence and Pattern of Geographic Atrophy in Asia: The Asian Eye Epidemiology Consortium
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Although there have been many population-based studies of age-related macular degeneration (AMD), only limited information is available in Asia on the epidemiology of geographic atrophy (GA). We aimed to determine the prevalence and patterns of GA through an analysis of multiple studies conducted within the Asian Eye Epidemiology Consortium (AEEC).
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The mean age was 60.8 ± 10.0 years, and 42 673 (43.9%) were male. Overall, a total of 223 individuals (0.2%) had GA. The pooled overall prevalence of GA was 1.57 per 1000 persons (95% confidence interval [CI], 1.04–2.10), which was 3 times less than that of neovascular AMD of 5.20 per 1000 persons (95% CI, 3.97–6.43). Compared with those aged 50 to 59 years, the prevalence of GA increased from 0.34 per 1000 persons (95% CI, 0.07–0.62) to 2.90 per 1000 persons (95% CI, 1.55–4.25) in those aged ≥70 years. The GA prevalence per 1000 persons was similar between urban (2.22; 95% CI, 1.22–3.23) and rural residents (1.33; 95% CI, 0.70–1.96). Geographic atrophy was more prevalent in South Asia (based on studies from India and Nepal, 3.82 per 1000 persons; 95% CI, 1.72–5.93) compared with East Asia (based on studies from China, Korea, Hong Kong, Taiwan, and Japan, and the Singapore Chinese Eye Study, 0.76 per 1000 persons; 95% CI, 0.31–1.22, P = 0.005).
Geographic atrophy is uncommon in Asian populations compared with those of European ancestry. Even within Asia, geographic differences in GA prevalence were seen. The findings of this meta-analysis suggest that better dissection of risk factors in the Asian population for GA may provide insights into the biological pathways that drive these late-stage manifestations, thus suggesting better targets for prevention.
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In total, 152 patients with clinical AMD and 150 healthy controls (without AMD in either macula) were studied. Subjects were ≥50 years of age. Exclusion criteria were diabetic retinopathy, previous retinal surgery, high myopia, or dense cataract, as well as any retinal inflammatory, degenerative, or occlusive disease.
For both groups of patients, color fundus images were captured with the Optos P200 MA camera (Optos, Dunfermline, Scotland). Image analysis software was used to characterize each image. Angiography was performed on the AMD group only. Morphological and angiographic peripheral retinal changes were studied per the frequency of their occurrence, the affected peripheral retina (clock hours), and the localization of peripheral changes with regard to the eye equator. Statistical significance was defined at a level of P < 0.05.
Peripheral changes in both groups according to their type and frequency (percentage of eyes with detected retinal changes), the number of clock hours of affected peripheral retina, and their localization with regard to the equator of the eye.
Drusen, reticular pigmentary changes, and paving stone degeneration occurred more frequently in the AMD group than in controls (P < 0.001, P < 0.001, and P < 0.001 respectively), whereas white without pressure occurred more frequently in the control group (P = 0.027). In both groups, peripheral retinal changes were observed peripheral to the equator in more than 40% of analyzed eyes. In control Croatian subjects, peripheral drusen were seen in 38% of subjects compared with 68% of AMD subjects.
Drusen, reticular pigmentary change , and paving stone degeneration occur significantly more frequently in subjects with AMD compared with controls. White without pressure degeneration was present in a high percentage of control subjects.
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This trend was the result of a higher prevalence of CNV in the north. Our findings are in concordance with the results previously published by the Tromsø Eye Study40 but are in contrast with other studies performed in the north of Europe finding a higher prevalence of GA (EUREYE, Reykjavik Eye Study, and Oslo Macular Study).41–43 Considering the larger sample size and high response rate of the Tromsø Eye Study compared with the other studies, these findings might be more legitimate.
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: Manuscript no. 2011-1489.

: Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

: Supported by Grant SFP897-09 from The Northern Norway Regional Health Authority. The funding organization had no role in the design or conduct of this research.

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Original articlePrevalence of Age-related Macular Degeneration in Elderly Caucasians: The Tromsø Eye Study

Purpose

Design

Participants

Methods

Main Outcome Measures

Results

Conclusions

Financial Disclosure(s)

Section snippets

Study Population

Results

Discussion

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Surv Ophthalmol

Ophthalmology

Ophthalmology

Ophthalmology

Br J Ophthalmol

Global data on visual impairment in the year 2002

Bull World Health Organ

The natural history and prognosis of neovascular age-related macular degeneration: a systematic review of the literature and meta-analysis

Ophthalmology

Ranibizumab for neovascular age-related macular degeneration

N Engl J Med

Quality of life in age-related macular degeneration: a review of the literature

Health Qual Life Outcomes [serial online]

Prevalence and causes of visual impairment and blindness in Icelanders aged 50 years and older: the Reykjavik Eye Study

Acta Ophthalmol

Original article
Prevalence of Age-related Macular Degeneration in Elderly Caucasians: The Tromsø Eye Study