Incidence Of Age-related Maculopathy Research Articles

Low Birth Weight Is Linked to Age-Related Macular Degeneration: Results From the Population-Based Gutenberg Health Study (GHS).

This study analyzed whether low birth weight is linked to prevalence and incidence of age-related maculopathy (AMD) in adulthood. The Gutenberg Health Study (GHS) is a population-based, observational cohort study in Germany. GHS participants at an age from 35 to 74 years were included. An ophthalmologic examination with fundus photography was carried out. Fundus photographs were graded according to the Rotterdam Grading Scheme for AMD at baseline and at the 5-year follow-up examination. Participants were divided into three different birth weight groups (low: <2500 g; normal: 2500-4000 g; and high: >4000 g). Poisson regression analysis with adjustment for several confounders was used to assess associations between birth weight and AMD prevalence (overall, early, late AMD) and 5-year cumulative incidence. Overall, 6492 participants were included (3538 female, aged 50.7 ± 10.4 years). Prevalence of total AMD was highest in the low birth weight group (11.2%; 40/358) compared to the normal birth weight group (6.5%; 346/5328) and the high birth weight group (8.4%; 68/806). Low birth weight was associated with overall AMD prevalence (prevalence ratio [PR] = 1.54, P = 0.006), and in particular with early AMD prevalence (PR = 1.52; P = 0.01). No association was observed between low birth weight and cumulative 5-year incidence of AMD. Our analyses indicate that low birth weight may lead to higher prevalence of retinal diseases in later life, as we observed for AMD. Our results are limited due to missing data and loss to follow-up, but may be a first hint that AMD has one of its origins in early life.

Sunlight-Related Factors and the 10-Year Incidence of Age-Related Maculopathy

Purpose: To examine the associations among iris, skin, or hair color, and skin sun sensitivity and the 10-year incidence of age-related maculopathy (ARM). Methods: The Blue Mountains Eye Study (BMES) recruited 3654 participants aged 49+ years at baseline (1992–1994, 82.4% participation rate). Re-examinations of 2335 participants (75.1% of survivors) were done after 5 years (1997–1999) and 1952 (76.5% of survivors) after 10 years (2002–2004). Retinal photographs were graded using the Wisconsin ARM Grading System and incident ARM confirmed using the side-by-side grading method. Iris, skin, and hair color, and sun-related skin damage were assessed and skin sun-sensitivity questions were asked at baseline. Ten-year ARM incidence was calculated using Kaplan Meier methods and discrete logistic models were used to assess associations after adjusting for age, sex, and smoking. Results: After adjustment, no significant associations were found between iris or hair color and either late- or early-incident ARM. Compared to persons with fair skin, those with very fair skin had an increased risk of developing geographic atrophy (multivariate adjusted risk ratio, RR = 7.6; 95% confidence interval, CI = 3.0–19.6). In contrast, compared to persons with average skin sun sensitivity, persons who reported that their skin would usually burn and tan with difficulty had a reduced risk of neovascular ARM (RR = 0.2, 95% CI = 0.0–0.7). Sun-related skin damage was not associated with late or early ARM. Conclusions: In this older cohort, we did not find a consistent pattern of association between sunlight-related factors and ARM incidence, except that persons with very fair skin might have an increased risk of geographic atrophy, consistent with our 5-year incidence data. The protective association between skin sensitivity to sun damage and neovascular ARM could have be the result of confounding by sun-avoidance behavior among persons sensitive to sunburn.

A preliminary model-based assessment of the cost-utility of a screening programme for early age-related macular degeneration

To estimate the cost-effectiveness of screening for age-related macular degeneration (AMD) by developing a decision analytic model that incorporated and assessed all of the National Screening Committee criteria. A further objective was to identify the major areas of uncertainty in the model, and so inform future research priorities in this disease area. Major databases were searched in March 2004 and updated in January 2005. Systematic literature reviews covered the epidemiology and natural history of AMD, the screening and treatment effectiveness and health-related quality of life relating to AMD. A hybrid cohort-individual sampling model was implemented to describe the range of pathways between the incidence of age-related maculopathy (ARM) and death via clinical presentation and treatment at different stages of the disease. As significant shortfalls in the data available from the literature were apparent, so a range of primary data sources were also used to populate the model. To obtain estimates for the value of parameters deemed to be within an expert's remit, data describing some parameters were elicited from relevant experts. The data identified informed probability distributions describing the uncertainty around the model parameters. To incorporate joint parameter uncertainty (i.e. correlations between parameters), the AMD natural history model was calibrated probabilistically. Randomly sampled sets of input parameters were assigned weights representing the accuracy of their predictions of a set of observed model outputs. The analysis of the AMD screening model estimated the costs, numbers of quality-adjusted life-years (QALYs) and cases of blindness in a general population sample of 50-year-olds over the remainder of their lifetime, for 16 alternative screening options (including no screening). The reference case analysis incorporated current treatment options of laser photocoagulation and photodynamic therapy. Sensitivity analyses describing six alternative sets of intervention strategies, based on horizon scanning of potential future treatments for AMD, were also undertaken. There remains significant uncertainty about whether any form of screening for AMD is cost-effective. However, annual screening from age 60 years seems to provide the highest mean net benefits, but this is based on a cost-effectiveness estimate that has very poor precision (high levels of uncertainty). The probabilistic sensitivity analysis shows that the 95% credible interval for annual screening from age 60 years ranges from this option dominating the previous option to an incremental cost per QALY of over 0.5 million pounds sterling. Plotting a cost-effectiveness acceptability frontier shows that although annual screening from age 60 years has the highest net benefits at a value of QALY of 30,000 pounds sterling, the associated probability of this option being the most cost-effective option is only around 20%. The sensitivity analyses around potential future treatment options indicate that screening may become more cost-effective with the new treatments. The conclusions focus on the interpretation of the results from the perspective of defining the major areas of uncertainty, which were defined as disease progression, rates of clinical presentation, screening test and optician effectiveness, treatment effectiveness, and costs of blindness. Future research may be best targeted at assessing how routine data may be used to describe clinical presentation rates of ARM. Other potential studies include a pilot study of the effectiveness of screening and opticians' referral patterns for AMD and a costing study of blindness as a continuum of association with deterioration in vision.

Dietary fatty acids and the 5-year incidence of age-related maculopathy

Dietary fatty acids and the 5-year incidence of age-related maculopathy

Dietary Fatty Acids and the 5-Year Incidence of Age-Related Maculopathy

To assess longitudinal associations between dietary fat and incident age-related maculopathy (ARM) in an older, population-based, historical cohort. A total of 3654 persons, 49 years or older, participated in the Blue Mountains Eye Study (1992-1994); 2335 (75.1% of survivors) were reexamined after 5 years (1997-1999). Dietary data were collected from 2895 people (79%) at baseline by means of a semiquantitative food frequency questionnaire to calculate dietary fat intakes. Presence of ARM was graded from retinal photographs (Wisconsin ARM Grading System). Logistic regression adjusted for age, sex, vitamin C intake, and smoking. Participants with the highest vs lowest quintiles of n-3 polyunsaturated fat intake had lower risk of incident early ARM (odds ratio [95% confidence interval], 0.41 [0.22-0.75). A 40% reduction of incident early ARM was associated with fish consumption at least once a week (odds ratio [95% confidence interval], 0.58 [0.37-0.90]), whereas fish consumption at least 3 times per week could reduce the incidence of late ARM (odds ratio [95% confidence interval], 0.25 [0.06-1.00]). We found no association between incident ARM and butter, margarine, or nut consumption. A regular diet high in n-3 polyunsaturated fat, especially from fish, suggests protection against early and late ARM in this older Australian cohort. Our study could not confirm deleterious effects of higher polyunsaturated fat intakes reported by other clinic-based studies.

Sunlight and the 10-Year Incidence of Age-Related Maculopathy: The Beaver Dam Eye Study—Correction

Sunlight and the 10-Year Incidence of Age-Related Maculopathy: The Beaver Dam Eye Study—Correction

Blood pressure, atherosclerosis, and the incidence of age-related maculopathy: the Rotterdam study

In order to determine whether blood pressure and subclinical atherosclerosis are associated with age-related maculopathy (ARM), a study was performed within the Rotterdam Study, a population-based prospective cohort study in Rotterdam, The Netherlands. A total of 4,822 patients who at baseline were 55 years of age or older and who had no evidence of ARM participated in at least one of two follow-up examinations after means of 2 and 6.5 years. Baseline blood pressure, presence/absence of atherosclerosis, and ARM assessed according to the International Classification and Grading System were determined. After a mean follow-up of 5.2 years, incident ARM was diagnosed in 417 subjects. Increased systolic blood pressure or pulse pressure was associated with a higher risk of ARM. Adjusted for age, gender, smoking, total and high-density lipoprotein cholesterol, body mass index, and diabetes mellitus, odds ratios per 10-mm Hg increase were 1.08 (95% Confidence Interval (CI), 1.03–1.14) and 1.11 (95% CI, 1.04–1.18), respectively. Different measures of atherosclerosis were associated with the risk of ARM. An increase in carotid wall thickness (odds ratio per 1 standard deviation, 1.15;95% CI, 1.03– 1.28) increased the risk of ARM. A weak association was found between aortic calcifications and the risk of ARM. Elevated systolic blood or pulse pressure or the presence of atherosclerosis may associated with an increased risk of development of ARM.—Hans E. Grossniklaus

Relationship between refraction and prevalent as well as incident age-related maculopathy: the Rotterdam Study.

To study the relationship between baseline spherical equivalents (SphE) of refraction and prevalent as well as incident age-related maculopathy (pARM and iARM, respectively). The study was performed as part of the Rotterdam Study, a population-based, prospective cohort study. The SphE (in diopters), measured with autorefraction and subjective optimization, was recorded in 6209 subjects aged 55 years or more. Aphakic or pseudophakic eyes at baseline were excluded. Stereoscopic transparencies of the macular region were graded according to the International Classification and Grading System. ARM was defined as large soft drusen with pigmentary changes, or indistinct drusen, or atrophic or neovascular age-related macular degeneration (AMD). For the prevalence analyses, ARM was classified into no, p(early)ARM, or pAMD, and in each subject the eye with the most advanced ARM and the corresponding refraction was selected. After a mean 5.2 years of follow-up, 4935 subjects had complete data for these incidence analyses. In each subject, the eye with iARM was selected. The age- and gender-adjusted odds ratio (OR) of pARM (n = 536) for every diopter of progress toward hyperopia was 1.09 (95% confidence interval [CI]1.04-1.13). For p(early)ARM (n = 440) the OR was 1.09 (1.04-1.14) and for pAMD (n = 96) the OR was 1.09 (1.00-1.19). Baseline refraction was significantly associated with increased risk of iARM (n = 497). For each diopter of progress toward hyperopia the OR was 1.05 (95% CI 1.01-1.10). Additional adjustments for smoking, atherosclerosis, and blood pressure did not alter the relationship. These population-based incidence data confirm results from prevalence and case-control studies that there is an association between hyperopia and ARM.

Blood pressure, atherosclerosis, and the incidence of age-related maculopathy: the Rotterdam Study.

To determine whether blood pressure and subclinical atherosclerosis are associated with incident age-related maculopathy (ARM). The study was performed within the Rotterdam Study, a population-based, prospective cohort study in Rotterdam, The Netherlands. A total of 4822 subjects who at baseline were aged 55 years more, were free of ARM, and participated in at least one of two follow-up examinations after a mean of 2 and 6.5 years, were included in the study. At baseline, blood pressure and the presence of atherosclerosis were determined. ARM was assessed according to the International Classification and Grading System and defined as large, soft drusen with pigmentary changes; indistinct drusen; or atrophic or neovascular age-related macular degeneration. After a mean follow-up of 5.2 years, incident ARM was diagnosed in 417 subjects. Increased systolic blood pressure or pulse pressure was associated with a higher risk of ARM. Adjusted for age, gender, smoking, total and high-density lipoprotein cholesterol, body mass index, and diabetes mellitus, odds ratios (OR) per 10-mm Hg increase were 1.08 (95% confidence interval [CI]: 1.03-1.14) and 1.11 (95% CI: 1.04-1.18), respectively. Moreover, different measures of atherosclerosis were associated with the risk of ARM. An increase in carotid wall thickness (OR per 1 SD, 1.15; 95% CI: 1.03-1.28) increased the risk of ARM. The lowest compared with the highest tertile of ankle-arm index had an OR of 1.32 (95% CI: 1.00-1.75). A weak association was found between aortic calcifications and the risk of ARM. Elevated systolic blood or pulse pressure or the presence of atherosclerosis may increase the risk of development of ARM.