Incidence Of Geographic Atrophy Research Articles

The association of cardiovascular disease with the long-term incidence of age-related maculopathy: The Beaver Dam eye study

Purpose To examine the association between cardiovascular disease and its risk factors and the 10-year incidence of age-related maculopathy. Design Population-based cohort study. Participants Persons 43 to 86 years of age at baseline examination from 1988 to 1990, living in Beaver Dam, Wisconsin, of whom 3684 persons participated in a 5-year follow-up examination and 2764 participated in a 10-year follow-up examination. Methods Standardized protocols for physical examination, blood collection, administration of a questionnaire, and stereoscopic color fundus photography to determine age-related maculopathy. The Kaplan–Meier (product–limit) survival approach and discrete linear logistic regression were used in the data analysis. Main outcome measures Incidence and progression of age-related maculopathy. Results When age, gender, and history of heavy drinking, smoking, and vitamin use were controlled for, higher systolic blood pressure at baseline was associated with the 10-year incidence of retinal pigment epithelial depigmentation (risk ratio [RR] per 10 mmHg systolic blood pressure, 1.10; 95% confidence interval [CI], 1.01–1.18; P = 0.02) and exudative macular degeneration (RR, 1.22; 95% CI, 1.06–1.41; P = 0.006). Higher pulse pressure at baseline was associated with the incidence of retinal pigment epithelial depigmentation (RR per 10 mmHg, 1.17; 95% CI, 1.07–1.28; P < 0.001), increased retinal pigment (RR, 1.10; 95% CI, 1.01–1.19; P = 0.03), exudative macular degeneration (RR, 1.34; 95% CI, 1.14–1.60; P < 0.001), and progression of age-related maculopathy (RR, 1.08; 95% CI, 1.01–1.17; P = 0.03). Higher serum high-density lipoprotein cholesterol at baseline was associated with pure geographic atrophy (RR per 10 mg/dl high-density lipoprotein cholesterol, 1.29; 95% CI, 1.05–1.58; P = 0.01). Physical activity at baseline was associated with the incidence of geographic atrophy (RR in those who worked up a sweat 5 times a week compared with those who did not, 0.12; 95% CI, 0.02–0.91; P = 0.04) exudative macular degeneration (RR, 0.27; 95% CI, 0.08−0.87; P = 0.05), and progression of age-related maculopathy (RR, 0.69; 95% CI, 0.47–1.00; P = 0.05). Neither a history of stroke nor heart attack was associated with the incidence or progression of age-related maculopathy. Conclusions These findings indicate relationships between higher pulse pressure (a presumed indicator of age-related elastin and collagen changes in Bruch’s membrane) and systolic blood pressure with an increased 10-year incidence of some lesions defining early age-related maculopathy and exudative macular degeneration.

Smoking and the 5-year incidence of age-related maculopathy: the Blue Mountains Eye Study.

To assess the relationship between baseline smoking and the 5-year incidence of late and early age-related maculopathy (ARM) in an older population cohort. The Blue Mountains Eye Study examined 3654 participants aged 49 years or older during 1992 to 1994 and then 2335 survivors (75.1%) after 5 years. Retinal photographs were graded using the Wisconsin Age-Related Maculopathy Grading System. Those with any ARM lesions at either examination were regraded in detail using a side-by-side method similar to that developed for the Beaver Dam Eye Study. We also used similar definitions for incident ARM lesions. Smoking status was recorded at interview. Age-standardized incidence rates for any late ARM lesions were 3.1%, 1.2%, and 1.4%, respectively, among baseline current, past, or never smokers. Corresponding age-standardized incidence rates for early ARM were 10.6%, 8.2%, and 9.3%, respectively. The mean age for cases with incident late ARM was 67 years for baseline current smokers, 73 years for past smokers, and 77 years for those who had never smoked (P =.02). After adjusting for age, current smokers, compared with never smokers, had an increased risk of incident geographic atrophy (age-adjusted relative risk [RR], 3.6; 95% confidence interval [CI], 1.1-11.3) and any late ARM lesions (RR, 2.5; 95% CI, 1.0-6.2). Current smokers had an increased risk of incident retinal pigmentary abnormalities (RR, 1.7; 95% CI, 1.1-2.7), with the risk higher in men (RR, 2.8; 95% CI, 1.4-5.6). Five-year incidence of early ARM, late ARM, and ARM lesions. In this cohort, persons who were current smokers had an increased risk of 5-year incident late ARM lesions and retinal pigmentary abnormalities. Current smokers developed late ARM at a significantly earlier age than never or past smokers.