Prevalence and prospective risk factors for age‐related macular degeneration: The Bristol Speedwell cohort, UK

Abstract

Abstract Purpose Age‐related macular degeneration (AMD) is a progressive eye disease, with a pre‐clinical stage of age‐related maculopathy (ARM), and is the leading cause of blindness in the Western world. This study aimed to determine the population prevalence in a representative group of men (65‐83 years) and identify prospective risk factors for ARM/AMD. Methods 2348 men (45‐63 years from Speedwell, Bristol) were enlisted into a cohort study in 1979. At phase V (mean of 17.9 years follow‐up) they had retinal photographs taken which were assessed using the Wisconsin Age‐related Maculopathy Grading System. Results Data were obtained on 934 men from a potentially eligible sample of 1394 (67%). Early ARM was found in 9.2% of all men and late ARM in 0.5%; the rates increased with age. Baseline risk factors collected in 1979 that were associated with increased risk of AMD (ARM stage 2‐4) seen in 1997 were: diastolic blood pressure, C‐reactive protein, and increased consumption of lard, oils and fats whilst triglycerides were associated with a reduced risk. In multivariable analyses, elevated mean arterial pressure (OR per z‐score 1.37, 95% CI 1.04, 1.79) and fat consumption were significant predictors of increased risk, whilst triglycerides had reduced risk (OR 0.68, 95% CI 0.47, 0.99). Conclusion Whilst the prevalence of AMD was only 0.5%, almost 10% of elderly men in this UK sample were at high risk of developing AMD over the next 5 years. Our observation that elevated triglycerides is associated with reduced risk, if replicated, may provide insights into pathophysiological pathways. Early detection and possible risk factor modification should be explored to prevent ARM progression and blindness.