Associations of cardiovascular disease and its risk factors with age-related macular degeneration: the POLA study

The POLA study (June 1995 through July 1997) is a population-based study on cataract and age-related macular degeneration (AMD) and their risk factors in 2584 residents of Séte (South of France), aged 60--95 years. Classification of AMD was performed on 50 degrees fundus photographs, according to an international classification. The presence of cardiovascular disease and its risk factors was determined by interviewer-based questionnaire, clinical examination (anthropometry, blood pressure) and fasting plasma measurements. Using a logistic model adjusted for age and gender, late AMD was not significantly associated with a history of cardiovascular disease, diabetes, use of hypocholesterolemic drugs, hypertension, blood pressure or plasma lipids. Obese subjects (body mass index greater than 30 kg/m( 2)) had a 2.29-fold (95% confidence interval (CI): 1.00--5.23) and 1.54-fold (CI: 1.05--2.26) increased risk of late AMD and pigmentary abnormalities in comparison with lean subjects. Finally, the risk of soft drusen was decreased in those subjects with a history of cardiovascular disease (odds-ratio (OR) = 0.72, CI: 0.54--0.97), and increased with increasing levels of HDL-cholesterol (OR = 1.52, CI: 1.14--2.02). None of these results were modified by further adjustments for smoking, educational level and plasma alpha-tocopherol. These results need to be confirmed by other studies, which ideally should be longitudinal and prospective.     

Associations of antioxidant enzymes with cataract and age-related macular degeneration: The POLA study

ObjectiveOxidative mechanisms may play an important role in the etiology of cataract and age-related macular degeneration (AMD). The authors present the level of two antioxidant enzymes in relation to cataract and AMD.DesignPopulation-based, cross-sectional study on cataract and AMD and their risk factors.ParticipantsThis study includes 2584 participants recruited among the residents of the town of Sète (in the south of France), who were 60 years of age or older.Intervention/methodsCataract was defined on the basis of slit-lamp examination, according to the Lens Opacities Classification System III, and AMD on the basis of fundus photographs according to an international classification. Biologic measurements were made centrally from blood samples for which the patient fasted.Main outcome measuresThe presence of early and late AMD and of subcapsular, cortical, nuclear, and mixed cataracts was assessed and related to the levels of plasma glutathione peroxidase and erythrocyte superoxide dismutase.ResultsAfter multivariate adjustment, higher levels of plasma glutathione peroxidase (plGPx) were significantly associated with a ninefold increase in late AMD prevalence, a sixfold increase in cortical cataract, and a twofold increase in nuclear and mixed cataracts. High levels of erythrocyte superoxide dismutase (SOD) activity were not associated with late AMD and early signs of AMD but were associated with a twofold increase in nuclear cataract.ConclusionThe authors show here, for the first time, a strong association of high levels of plGPx with age-related eye diseases. High levels of SOD also are associated with increased risk of nuclear cataract. More data are needed at the biochemical and epidemiologic levels for a better understanding of these findings.     

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。     

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。     

Twin study of age-related macular degeneration

PURPOSE To evaluate the genetic contribution in age-related macular degeneration (ARMD) by a disease-ascertained twin study. METHODS Concordance rates for ARMD in 25 twins were obtained by using four masked graders to confirm the diagnosis of ARMD and place subjects in one of three categories; concordant, intermediate, or discordant. Demographic features and known risk factors for ARMD were compared between monozygotic and dizygotic twin pairs. RESULTS Of the 25 twin pairs, 15 were monzygotic and 10 were dizygotic. All 15 monozygotic twins were concordant or intermediate for ARMD. Of the dizygotic twin pairs, only one was concordant and five were discordant. In the demographic and risk factor analysis no unusual contributing or confounding variables were detected. CONCLUSIONS The association between zygosity and concordance for ARMD suggests a major importance for genetics in the etiology of ARMD. Our data further support a multi-factorial, primarily polygenic etiology for the condition.     

Dietary and lifestyle risk factors associated with age-related macular degeneration: A hospital based study

Aim:

To establish the frequency, associations and risk factors for age-related macular degeneration (AMD) in hospital population of South India.

Materials and Methods:

In this cross-sectional hospital based study, 3549 subjects (2090 men and 1459 women) above 45 years of age were screened randomly for AMD. Participants underwent ocular evaluation and were interviewed for lifestyle variables and dietary intake of carotenoids by structured food frequency questionnaire. AMD was defined according to the international classifications and grading system.

Results:

Either form of AMD was detected in 77 (2.2%) participants. Of which, early and late AMD was present in 63 (1.8%) and 14 (0.4%) subjects, respectively. Binary logistic analysis showed that the incidence of AMD was significantly higher with increasing age (Odds ratio [OR] 1.17; 95% CI 1.13-1.22) and diabetes (OR 3.97; 95% CI 2.11-7.46). However, AMD was significant among heavy cigarette smokers (OR 5.58; 95% CI 0.88-7.51) and alcoholics (OR 4.85; 95% CI 2.45-12.22). Dietary lutein/zeaxanthin (L/Z) and β-carotene intake were associated (P < 0.001) with the reduction in risk for AMD, with an OR of 0.38 and 0.65, respectively.

Conclusions:

Higher dietary intake of carotenoids, especially L/Z, was associated with lower risk for AMD. Risk of AMD is higher with increasing age and was prevalent among subjects with diabetes. Cessation of smoking and alcohol may reduce the risk of AMD in this population.     

年龄相关性黄斑变性危险因素的研究进展

年龄相关性黄斑变性(age-related macular degeneration,ARMD)是一种严重损害视力及视功能的进行性眼底疾病,是老年人口失明的重要原因之一。随着人口老龄化的进展,ARMD现已成为一个严重的公共卫生问题。随着国内外学者的不断研究,发现ARMD常在多种危险因素共同作用下发病,如年龄、遗传、环境、饮食等因素。深入认识ARMD的危险因素,从而采取有效的预防措施,对于降低ARMD的发生和延缓疾病进展具有重要意义。本文就ARMD的相关危险因素做一简单的综述。     

Cardiovascular disease, its risk factors and treatment, and age-related macular degeneration: Women's Health Initiative Sight Exam ancillary study

PURPOSE: To examine the association of cardiovascular disease (CVD), CVD risk factors, and CVD treatment with age-related macular degeneration (AMD). DESIGN: Observational analysis of a randomized clinical trial. METHODS: SETTINGS: The Women's Health Initiative Sight Examination (WHISE), an ancillary study to the Women's Health Initiative's clinical trial of hormone replacement therapy. STUDY POPULATION: A total of 4,288 women age 63 years and older. OBSERVATION PROCEDURES: Information on CVD and its risk factors were obtained from a standardized questionnaire and examination. MAIN OUTCOME MEASURE: AMD as determined by standardized grading of fundus photographs. RESULTS: Prevalence of any AMD was 21.4% (n = 919). Of those with AMD, 5.8% (n = 53) had signs of exudative AMD (n = 39) or pure geographic atrophy (n = 14), limiting the power to examine associations. Significant associations between late AMD and CVD risk factors were (odds ratio [OR], 95% confidence interval [CI]) older age (1.19, 1.13 to 1.27, P < .0001), more pack years smoked (1.02 per pack-year smoked, 1.003 to 1.03, P = .01), systolic blood pressure (0.84 per 10 mm Hg, 0.71 to 0.995, P = .04), report of taking calcium channel blockers (2.49, 1.21 to 5.12, P = .04), self-reported history of diabetes (2.00, 1.01 to 3.96, P = .05), and greater body mass index (1.05 per 1 kg/m, 1.001 to 1.10, P = .05). History of myocardial infarction, stroke, use of statins, or white blood cell count was not associated with AMD. CONCLUSIONS: Results suggest that smoking, use of calcium channel blockers, diabetes, and obesity are risk factors for late AMD in women. However, the association of late AMD with systolic blood pressure and the effects of other CVD risk factors on early AMD need to be further explored.     

老年性黄斑变性危险因素研究进展

年龄相关性黄斑变性( ARMD)是随着年龄增长出现的一种退行性疾病。在西方国家是50岁以上人群不可逆失明的最常见原因,在我国其患病率也在逐年增加。但是,到目前为止仍未明确其发病机制,也无有效治疗措施。本文就近年来国内外学者对其相关危险因素研究进展做一综述,旨在进一步了解ARMD从而预防或减缓其发病,避免失明。     

Characteristics of progression of early age-related macular degeneration: the cardiovascular health and age-related maculopathy study

AIMS: To determine the risk of age-related macular degeneration (AMD) progression posed by the presence of each early AMD characteristic. METHODS: A prospective cohort study of 254 participants aged 50 years and older, all with early AMD features at their baseline visit followed for an average of 7 years. Stereoscopic colour fundus photographs were graded for early AMD features using the International Classification System. AMD status was stratified into six exclusive levels along a continuum of disease severity according to drusen type, pigmentary abnormalities, or late AMD. Progression was assessed according to three definitions: a change between or within a severity level, or by side by side grading. RESULTS: The progression rate of early AMD ranged between 3.4 and 4.67% per annum depending upon the definition used. In total, 15 (6%) cases progressed from early AMD to the late complication of AMD. After controlling for age and smoking, cases with soft indistinct drusen at baseline were at a greater risk of progressing from early to late AMD than were cases without this characteristic (OR=3.72, 95%CI 1.20-11.54; P=0.02). CONCLUSION: Our proposed definitions of AMD progression give rates that are consistent with current knowledge of progression and its determinants. Each early AMD characteristic conveys its own risk of progression to an eye, with soft indistinct drusen carrying the greater risk. An international consensus on what defines AMD progression would greatly help the research community when trying to assess the importance of new risk factors and the effectiveness of novel interventions.     

Survey on the knowledge of age-related macular degeneration and its risk factors among Singapore residents

Purpose:  To assess the awareness of age-related macular degeneration (AMD) and its risk factors among Singapore residents.
Methods:  A cross-sectional questionnaire-based telephone survey was conducted to ascertain the awareness of AMD with regards to knowledge of the disease entity and possible risk factors among Singapore residents. A Singapore residential telephone directory was used to identify potential households by choosing the first and last entries on randomly selected pages. Respondents included individuals from households with landline telephone connection who were willing to participate in the study after a brief introduction about the study. Verbal consent was sought before proceeding with the interview. Interpreters were used for respondents whose ability to converse in English was limited. Prior to commencement of the study, the protocol was reviewed and approved by Ethics committee of the Domain Specific Review Board.
Results:  The interviewers contacted 796 subjects from different households, of which 520 participated (response rate, 65.3%). The age of the respondents ranged from 18 to 85 (median 41) years. Only 38 (7.3%) of them were aware of AMD, the majority of whom had completed secondary or higher education. Two hundred (38.5%) and 191 (36.7%) of the respondents considered age and smoking, respectively, to be risk factors for AMD.
Conclusions:  The awareness of AMD among Singapore residents is low. AMD awareness needs to be improved by educational programmes designed for this specific purpose.     

提高对年龄相关性黄斑变性危险因素的认识

年龄相关性黄斑变性(AMD)是老年人的致盲性眼病,严重影响其独立生活能力.流行病学研究资料显示,AMD存在各种危险因素,除了年龄、遗传、种族等不可改变的因素之外,还包括生活方式、眼部情况、全身疾病等可改变因素.然而,公众对AMD危险因素的了解,甚至广大眼科医师对AMD危险因素的重视程度也不尽如人意.对AMD的危险因素进行了复习,以期提高对AMD致病危险因素的认识,扩展AMD的研究思路及指导临床工作.     

湿性年龄相关性黄斑变性危险因素的研究进展

年龄相关性黄斑变性(age-related macular degeneration,ARMD)是全球主要的老年性致盲眼病之一,其中湿性年龄相关性黄斑变性(wet age-related macular degeneration,wARMD)造成视功能损害较严重。在我国,由于人口趋于老龄化,与年龄相关的退行性疾病构成严重的医疗负担。随着国内外学者对wARMD危险因素的深入研究,wARMD的防控已成为重要研究课题。因此,通过对wARMD危险因素的研究,从而采取有效的预防措施,有望降低wARMD的发病率和延缓疾病发展。本文就wARMD相关危险因素的研究进展进行综述。     

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。