Incidence and risk factors for neovascular age-related macular degeneration in the fellow eye

Graefe's Archive for Clinical and Experimental Ophthalmology - The epidemiology, risk factors, and the effect of anti-VEGF treatment on neovascular age-related macular degeneration (nAMD) have...     

Prevalence of age-related macular degeneration in Latinos: the Los Angeles Latino eye study

OBJECTIVE: To estimate the age- and gender-specific prevalence of early age-related macular degeneration (AMD; drusen and retinal pigmentary abnormalities) and advanced AMD (exudative AMD and geographic atrophy) in Latinos. DESIGN: Population-based, cross-sectional study. PARTICIPANTS: Six thousand three hundred fifty-seven Latinos 40 years and older from 6 census tracts in Los Angeles, California. METHODS: The study cohort consisted of self-identified Latinos 40 years and over. Participants underwent a complete ophthalmologic examination, including stereoscopic macular photographs. Photographs were graded using a modified Wisconsin Age-Related Maculopathy Grading System. MAIN OUTCOME MEASURES: Prevalence of early AMD, drusen, geographic atrophy, and exudative AMD. RESULTS: Of the 7789 eligible subjects, 6357 participants (82%) completed an interview and clinical examination, and 5875 (75%) had gradable photographs. Prevalence of advanced AMD increased from 0% in those 40-49 years of age to 8.5% in those 80 or older; that of early AMD from 6.2% to 29.7%, that of retinal pigment abnormalities from 4.1% to 19.3%, that of large drusen (> or =125 microm in diameter) from 8.5% to 45.3%, that of soft drusen from 15.4% to 58.1%, and that of soft indistinct drusen from 3.6% to 30.8%. The prevalence of early AMD and advanced AMD lesions increased with age (P<0.0001). Early AMD was significantly more common in males than in females. Of all participants with early or late AMD, only 57% reported ever visiting an eye care practitioner, and only 21% in the last year. CONCLUSION: Detailed population-based estimates of AMD in Latinos are provided. Despite relatively high rates of early AMD, corresponding rates of advanced AMD are not high. Data on progression of the high rates of early AMD in Latinos require further study.     

年龄相关性黄斑变性发病危险因素研究进展

年龄相关性黄斑变性（age-related macular degeneration,AMD）是一种主要的全球性致盲眼病之一。AMD是一种多因素的疾病,主要的危险因素包括年龄,吸烟,白内障手术史,环境因素,营养因素,遗传标志,包括基因调节补体,脂质,血管生成和细胞外基质的途径。除了治疗外,AMD的流行病学,危险因素和遗传学研究已有重大进展。本文将AMD发病的危险因素作简要综述。     

重视我国年龄相关性黄斑变性的特征研究

年龄相关性黄斑变性(AMD)是老年人群不可逆性视力丧失的主要原因,严重威胁患者的独立生活能力.由于人群的遗传背景、疾病易感性、生活环境和习惯等方面的不同,导致AMD的患病率、临床特征及对光动力疗法(PDT)的反应也各异,不同种族间亦存在差异.笔者就我国人群有关AMD的种族差异性进行分析,并与白色人群相比较,认为我国人群早期和晚期AMD的患病率相对较低,临床上息肉样脉络膜血管病变更为常见.在遗传易感基因研究方面,虽然补体因子CFH基因的Y402H变异型是西方白色人群AMD发病的重要危险因素,但Y402H与我国人群渗出性AMD的发病无相关性.此外,PDT治疗1年后,我国人群的视力预后好于西方白色人群.     

Genetic, behavioral, and sociodemographic risk factors for second eye progression in age-related macular degeneration

Purpose. This study was conducted to investigate the correlation of genetic, sociodemographic, and behavioral risk factors with second eye progression to end-stage AMD. Methods. One hundred and eight patients with end-stage AMD in one or both eyes were included in a retrospective time-to-event analysis of the onset of end-stage AMD in the second eye. Multivariate Cox regression survival analysis was performed for sex, age, smoking, body mass index (BMI), education, and 16 single nucleotide polymorphisms (SNPs) associated with AMD. Results. Except for education, all sociodemographic and behavioral risk factors analyzed were significantly associated with a more rapid progression toward second eye involvement. Hazard ratios (HRs) were 2.6 (95% confidence interval [CI], 1.4-5.0) for female sex; 5.0 (95% CI, 2.0-12.5) for age >80; 2.2 (95% CI, 1.1-4.1) for BMI >30; and 4.4 (95% CI, 1.4-14.3) for >40 pack years, compared with the referent groups. Carriers of the lipoprotein lipase (LPL; rs12678919) risk alleles were at risk for more rapid progression to end-stage AMD in the second eye compared with the referent wild-type genotype (HR 2.0; 95% CI, 1.0-3.6). For complement factor I (CFI; rs10033900), homozygous carriers of the risk allele progressed faster than wild-type individuals (HR 2.2; 95% CI, 1.1-4.3). Conclusions. Sociodemographic, behavioral, and genetic risk factors are associated with the rate of second eye progression toward end-stage AMD. The findings of this study underline the importance of lifestyle factors and the complement pathway in AMD progression and suggest a role of the high-density-lipoprotein metabolism in second eye progression.     

Association of macular pigment optical density with risk factors for wet age-related macular degeneration in the Indian population

Purpose

To investigate macular pigment optical density (MPOD) in patients with and without wet age-related macular degeneration (AMD) and to elucidate the association between MPOD and the risk factors for AMD in an Indian population.

Methods

Thirty-three subjects with wet AMD and 29 controls above 50 years old underwent MPOD measurement with the ‘Macular Densitometer''. The subjects were also tested for their smoking history, lifetime ultraviolet (UV) exposure, dietary intake of carotenoids, and body mass index (BMI).

Results

Smokers had a higher risk for AMD than the non-smokers (P=0.032) and a lower MPOD level than non-smokers (mean (95% CI)) (0.16 (0.09–0.23) vs 0.28 (0.22–0.34), adjusted P=0.026). Subjects with lowest UV exposure had higher MPOD than those with the highest (0.46 (0.38–0.54) vs 0.17 (0.01–0.33), P=0.01). MPOD was significantly lower among those with the lowest quartile of dietary intake of carotenoids (0.14 (0.08–0.21) vs 0.25 (0.13–0.36), P=0.012). Smoking, obesity, and UV index showed an inverse association with the MPOD. Low MPOD, smoking, and UV exposure had 5.11 (1.73–15.08), 3.54 (1.08–11.57), and 5.24 (1.06–25.96) odds for AMD, respectively, whereas higher dietary intake of carotenoids showed a protective effect for AMD.

Conclusion

We found an inverse association between wet AMD and MPOD. Among the established risk factors of wet AMD, we found an inverse association of smoking, UV index, and obesity with MPOD, whereas a positive association was found between dietary intake of carotenoids and MPOD.     

中国人群年龄相关性黄斑变性危险因素的Meta分析

目的：系统评价中国人群年龄相关性黄斑变性(ARMD)的危险因素。

方法：计算机检索PubMed、EMbase、Web of Science、The Cochrane Library、CBM、CNKI、WanFang Data和VIP数据库,搜集有关中国人群ARMD危险因素的研究,检索时间均从建库至2019-12。由2位研究者独立筛选文献、提取资料、并按照纳入排除标准对文献进行质量评价,采用RevMan 5.3软件进行Meta分析。

结果：共纳入27个研究,共计204 767例研究对象,涉及10个危险因素。Meta分析结果显示：吸烟\〖OR=2.30,95%CI(1.95,2.71),P<0.0001\〗、高血压\〖OR=1.55,95%CI(1.23,1.95),P=0.0002\〗、HTRA1 rs11200638基因\〖OR=4.35,95%CI(2.35,7.48),P<0.0001\〗、CFH Y402H基因\〖OR=3.28,95%CI(2.51,4.28),P<0.00001\〗、LOC387715 rs10490924基因\〖OR=7.09,95%CI(3.48,14.44),P<0.00001\〗是中国人群ARMD的危险因素。描述性分析结果显示：糖尿病性视网膜病变(DR)、白内障手术、二氧化氮(NO₂)、一氧化碳(CO)、乙肝病毒感染(HBV)与中国人群ARMD有关。

结论：吸烟、高血压、HTRA1 rs11200638基因、CFH Y402H基因、LOC387715 rs10490924基因、DR、白内障手术、NO₂、CO、HBV感染是中国人群ARMD的危险因素。     

年龄相关性黄斑变性与生活方式危险因素的关系

目的:探讨年龄相关性黄斑变性(age-related macular degeneration,AMD)与饮食、生活方式中危险因素的关系。方法:年龄大于60岁眼病患者589例中筛选出48例AMD患者,从是否患高血压和糖尿病、是否患白内障和糖尿病视网膜病变、体重指数、是否吸烟和喝酒、饮食中是否摄入叶黄素/玉米黄素和β-胡萝卜素等方面进行问卷调查。结果:糖尿病、糖尿病视网膜病变、体重指数、吸烟、喝酒是AMD的危险因素,差别有统计学意义(P<0.05)。饮食中类胡萝卜素类的摄入能够减少AMD的发生,差别有统计学意义(P<0.05)。结论:停止吸烟和喝酒、增加类胡萝卜素的摄入能够减少AMD的发生。     

HTRA1 variant increases risk to neovascular age-related macular degeneration in Chinese population

Age-related macular degeneration (AMD) is a leading cause of irreversible visual impairment in the world. Advanced AMD can be divided into wet AMD (choroidal neovascularization) and dry AMD (geographic atrophy, GA). Drusen is characterized by deposits in the macula without visual loss and is an early AMD sign in the Caucasian population. rs11200638 in the promoter of HTRA1 has recently been shown to increases the risk for wet AMD in both Caucasian and Hong Kong Chinese populations. In order to replicate these results in a different cohort, we genotyped rs11200638 for 164 Chinese patients (90 wet AMD and 74 drusen) and 106 normal controls in a Han Mainland Chinese cohort. The genotypes were compared using chi square analysis for an additive allelic model. rs11200638 was significantly associated with wet AMD (p=5.00x10(-12)). Unlike in the Caucasian population, the risk allele of rs11200638 was not associated with drusen in our Chinese population. These findings confirm the association of HTRA1 with wet AMD.     

年龄相关性黄斑变性致病危险因素

随着人口日趋老龄化,年龄相关性黄斑变性（AMD）已经成为老年人重要的致盲性眼病之一,其流行病学研究资料显示,AMD存在大量危险因素,主要包括：社会人口学因素、个人行为和生活方式、全身疾病和药物、遗传学因素以及眼部情况。本文综述近年来与AMD发病有关的危险因素,以期为今后AMD的病因学研究和临床防治提供线索和依据。     

Risk factors for age-related macular degeneration

There is an increasing body of evidence as to the risk factors for age-related macular degeneration. Age and genetic make-up are the most important risk factors identified to date. Over the next decade, the different genes that are involved in the development of age-related macular degeneration will be identified. There is reasonably consistent evidence that smoking cigarettes results in increased risk of the disease. The question as to whether antioxidant vitamin and mineral supplementation prevents or delays the development of the disease will be resolved as the results of large ongoing trials become available in the next few years. Currently, there is conflicting evidence as to their benefits and some indication as to possible harm. Other risk factors such as alcohol consumption, oestrogen replacement and lifetime light exposure require further study. The study of the epidemiology of age-related macular degeneration would be facilitated by a greater standardization of methods. Studies with large numbers of late stage disease are needed in order to provide the power to investigate moderate risks. This may either be achieved by adding on macular degeneration studies to large cohort studies already in place, or by pooling data from smaller studies.     

Risk factors for age-related macular degeneration: findings from the Andhra Pradesh eye disease study in South India

PURPOSE: To assess prevalence, potential risk factors, and population attributable risk percentage (PAR%) for age-related macular degeneration (AMD) in the Indian state of Andhra Pradesh. METHODS: A population-based study, using a stratified, random, cluster, systematic sampling strategy, was conducted in the state of Andhra Pradesh in India from 1996 to 2000. Participants from 94 clusters in one urban and three rural areas representative of the population of Andhra Pradesh underwent a detailed interview and a detailed dilated ocular evaluation by trained professionals. In this report, the authors present the prevalence estimates of AMD and examine the association of AMD with potential risk factors in persons aged 40 to 102 years (n = 3723). AMD was defined according to the international classification and grading system. Standard bivariate and multivariate analyses were performed to identify the potential risk factors for AMD. PAR% was calculated by Levin's formula. RESULTS: AMD was present in 71 subjects--an age-gender-area-adjusted prevalence of 1.82% (95% confidence interval [CI], 1.39%-2.25%). Risk factors that were significant in bivariate analyses were considered for multivariate logistic regression analysis. Multivariate analysis showed that the adjusted prevalence of AMD was significantly higher in those 60 years of age or older (odds ratio [OR], 3.55; 95% CI, 1.61-7.82) and history of prior cigar smoking (OR, 3.29; 95%CI, 1.42-7.57). Presence of cortical cataract and prior cataract surgery were significantly associated with increased prevalence of AMD (adjusted OR, 2.87; 95% CI, 1.57-5.26 and 3.79; 95% CI, 2.1-6.78), respectively. The prevalence of AMD was significantly lower in light alcohol drinkers (adjusted OR, 0.38; 95% CI, 0.19-0.76) compared with nondrinkers. The PAR% for hypertension and heavy cigar smoking was 10% and 14%, respectively, in this population. CONCLUSIONS: The prevalence of AMD in this south Indian population is similar to those reported in other developed countries. Abstinence from smoking may reduce the risk of AMD in this population.