Risk Factors for Progression of Early Age-Related Macular Degeneration in Koreans

Purpose: To identify risk factors for the progression of early age-related macular degeneration (AMD) in Koreans.

Methods: This study was conducted at a health-screening center and followed a prospective cohort study design. Of 10,890 participants older than 50 years, 318 (2.92%) presented with early AMD. Among these 318 participants, we re-examined 172 participants after a mean duration of 4.4 years. Progression was defined by the Age-Related Eye Disease Study (AREDS) simplified AMD severity scale. Multivariable logistic regression was used to examine associations between AMD progression and baseline physical, demographic, behavioral, and ocular characteristics.

Results: Of the 172 participants with early AMD who were re-examined, 34 (19.8%) had progression. Multivariable analyses revealed that current smoking (odds ratio, OR, 7.0, 95% confidence interval, CI, 1.4–34.4, adjusted for age, alcohol consumption, body mass index, BMI, blood pressure, BP, total cholesterol, and high density lipoprotein, HDL, cholesterol) and hypertension (OR 10.3, 95% CI 1.9–55.7, adjusted for age, smoking status, alcohol consumption, BMI, total cholesterol, and HDL cholesterol) were independently associated with progression of early AMD. Additionally, the presence of a central drusen lesion within one-third disc diameter of the macula (age-adjusted OR 4.8, 95% CI 1.3–17.6) and 20 or more drusen (age adjusted OR 7.8, 95% CI 2.5–24.0) were independently associated with progression of early AMD.

Conclusion: Current smoking, hypertension, central drusen location, and increasing number of drusen were associated with an increased risk of early AMD progression in Koreans.     

Prevalence of Age-Related Macular Degeneration in Thailand

Purpose: To determine the prevalence of age-related macular degeneration (AMD) in Thailand.

Methods: In this population-based study, data of participants in the Thailand National Survey of Visual Impairment in 2006–2007 were analyzed. Participants selected for this study were more than 50 years old, and were recruited from 42 districts of 21 provinces. They were interviewed, tested for visual acuity, examined for eye screening, and measured for intraocular pressure. They had digital fundus photographs taken using a nonmydriatic fundus camera through dilated pupils. The diagnosis of AMD, according to the standard international grading system, was made from the interpretation of the digital images by at least 2 retinal specialists. The observed data were used for predicting estimates of the prevalence of AMD in Thailand.

Results: Data from 10,788 participants were analyzed. There were 321/10,788 (3%, 95% CI: 2.7–3.3%) participants diagnosed as having AMD. The mean age was 62.1 (range 50–98, SD 8.8) years old. There were 294 (2.7%) and 27 (0.3%) participants with early AMD (38.4% male) and late AMD (74.1% male) respectively. Of the late AMD, 20 (74.1%) were wet AMD and 7 (25.9%) were geographic atrophy. Based on the population census of Thailand, this could be translated into 351,000 and 39,000 patients with early and late AMD respectively.

Conclusions: Based on these data, it is projected that Thailand will have a large number of late AMD sufferers. This makes it imperative to develop new strategies for the national public health system, aiming to incorporate already available late AMD treatment.     

Overview of Progress in the Epidemiology of Age-Related Macular Degeneration

Purpose: To provide an over-view of progress in the epidemiology of age-related macular degeneration. Methods: Review of epidemiological and clinical trial findings regarding AMD since initial National Eye Institute sponsored epidemiology meeting in 1982. Results: A growing number new epidemiological studies have provided data on the prevalence and long-term incidence of AMD. Despite a similar prevalence of early AMD in whites, blacks, and hispanics, whites have higher prevalence of late AMD. An age-period cohort effect has been shown in the Beaver Dam Eye Study suggesting that AMD incidence may be declining among younger birth cohorts. Genetic factors such as complement factor H have been shown to be strongly associated with AMD. Smoking is strongly related to risk of AMD. Randomized controlled clinical trials have shown the benefits of zinc-antioxidant supplementation in preventing visual loss in persons with signs of early AMD and anti-vascular endothelial growth factor agents in restoring vision in eyes with neovascular AMD. Conclusions: Despite remarkable progress in understanding AMD, many questions remain that can only be addressed by continuation of longitudinal population-based studies.     

A Follow-Up Survey on the Knowledge of Age-Related Macular Degeneration and its Risk Factors among Singapore Residents after 5 Years of Nation-Wide Awareness Campaigns

Purpose: To re-evaluate the awareness of age-related macular degeneration (AMD) and knowledge of its risk factors among Singapore residents after 5 years of awareness campaigns.

Methods: Cross-sectional, questionnaire-based telephone survey (modified from the AMD Alliance International Global Report), conducted in Singapore in 2011. Participants were randomly selected using the Global Yellow Pages Singapore residential listings 2009/2010. Awareness of AMD and its risk factors was assessed among participants.

Results: Of 1773 Singapore residents contacted over the telephone, 559 participated (31.5% response rate). The mean age of participants was 43.1 years (range 21–85 years). A total of 157 participants (28.1%) were familiar with AMD. Among these, the number who correctly identified the risk factors were: smoking, n?=?132 (84.1%); ageing, n?=?123 (78.3%); lack of vitamins/nutrients, n?=?121 (77.1%); genetics, n?=?101 (64.3%); unprotected light exposure, n?=?100 (63.7%) and; sex, n?=?62 (39.5%). Participants aged >50 years (prevalence rate ratio, PRR 2.23, confidence interval, CI, 1.31–3.81) or who had undergone an eye test within the previous year (PRR 2.61, 95% CI 1.79–3.82) were more familiar with AMD, while females (PRR 0.68, 95% CI 0.47–0.98) were less familiar.

Conclusion: Self-reported awareness of AMD among Singapore residents increased four-fold from 7.3% in 2006 to 28.1% in 2011 following 5 years of awareness campaigns. Participants who were >50 years or had undergone an eye test within the previous year were more aware of AMD while female participants were less aware of AMD.     

The Prevalence of Age-Related Macular Degeneration in Italy (PAMDI) Study: Report 1

Purpose: The present study aimed to estimate prevalence and risk factors associated with age-related macular degeneration (ARMD) in an Italian population and to analyze differences between urban and rural communities.

Methods: We conducted a population-based cross-sectional study among elderly residents in Northeast Italy. Participants were divided into urban and rural groups based on whether they lived in the city of Padova or the villages of Teolo and Torreglia, respectively. Fundus photographs were graded according to the International Classification for Age-related Maculopathy.

Results: A total of 1162 randomly selected subjects aged 61 years or more were invited to participate in the study. We examined 885 subjects, and 845 were eligible for fundus photograph grading. ARMD was estimated to affect 62.7% of the whole population (drusen 63–124 μm?=?48.3%; drusen ≥125 μm?=?10.4%; advanced ARMD?=?4.1%). Age was confirmed as a risk factor for drusen ≥125 μm and advanced ARMD (Odds Ratio [OR]?=?1.47, 95% Confidence Interval [CI] 1.28–1.69 and OR?=?1.62, 95% CI 1.28–2.05, respectively, for a 5-year increase in age). The rural group appeared to be at a higher risk of developing large drusen compared to the urban sample (OR?=?1.61, 95% CI 1.01–2.63) when adjusting for age and gender.

Conclusions: The results confirmed that ARMD affects a high percentage of the elderly population in Italy. This study does not support the hypothesis that living in a rural environment or belonging to a population of the Mediterranean basin may be protective against the intermediate stages of the disease.     

The Effect of Genetic Variants Associated With Age-Related Macular Degeneration Varies With Age

PurposeThe prevalence of age-related macular degeneration (AMD) increases dramatically with age. This large collaborative study investigates the effects of 51 late-AMD–associated genetic variants in different ages, focusing on individuals above the age of 90 years.MethodsThe study included 27,996 individuals of the International AMD Genomics Consortium; 14,539 showed late AMD (51.9%) and 13,457 were controls (48.1%). Four age groups were compiled: 60 to 69 years, n = 6514, AMD = 2210 (33.9%); 70 to 79 years, n = 12228, AMD = 6217 (51.7%); 80 to 89 years, n = 8285, AMD = 5326 (64.3%); and ≥90 years, n = 969, AMD = 686 (70.8%). The effect sizes of 51 AMD-associated genetic variants were calculated for all age groups and were compared among the age groups.ResultsSix variants were associated with late AMD in individuals ≥ 90 years of age (P ≤ 0.0006). For rs10922109 and rs570618 (both in CFH), the minor allele (MA) was protective, and minor allele frequency (MAF) increased with age in cases and controls. For rs116503776 in C2/CFB/SKIV2L, the MA was protective, and MAF increased in cases. For rs3750846 in ARMS2/HTRA1, the MA increased risk, and MAF was lower in cases with increasing age. For rs6565597 in NPLOC4/TSPAN10, the MA increased risk. For rs5754227 in SYN3/TIMP3, the MA was protective, and there was no consistent variation in MAF with age. Variants in CFH and ARMS2 showed lower effect sizes at greater age. Interaction analysis showed strong age-related effects for rs570618 (P = 2.24 × 10^–7) and rs3750846 (P = 0.001). Total genetic risk was lower in individuals ≥ 90 years old (area under the curve [AUC], 0.795) than in those 70 to 79 years old (AUC, 0.831; P = 0.03)ConclusionsEffect sizes and MAF of genetic risk factors for late AMD differed among the age groups. These results could guide future work on AMD risk assessment in older individuals.     

Depressive Symptoms and Age-Related Macular Degeneration in Older People: The Cardiovascular Health Study

Purpose: To examine the association between age-related macular degeneration (AMD) and depressive symptoms. Methods: Population-based, cross-sectional study. A total of 2,194 persons aged 69–97 years were included in the current analyses. During the 1997–1998 examination, retinal photography from one randomly selected eye was graded for presence of early and late AMD using a modified Wisconsin AMD by Grading System. Depressive symptoms were assessed via a modified version of the Centers for Epidemiologic Studies Depression (CES-D) scale annually from 1989 through 1997–1998. Depressive symptoms were defined as a CES-D score of > 9 (top quartile of CES-D score) at the 1997–1998 examination. Results: There were 338 (15.6%) individuals with early AMD and 29 (1.3%) with late AMD. Among them, 368 (16.8%) persons had depressive symptoms at the 1997–1998 examination. Depressive symptoms were not associated with early AMD (multivariable adjusted odds ratio [OR]: 0.97; 95% confidence intervals [CI]: 0.69–1.36) or late AMD (OR: 1.15; 95% CI: 0.38–3.46). Including persons using anti-depressive medications did not alter these associations (OR: 0.98; 95% CI: 0.74–1.32 for early AMD and OR: 0.97; 95% CI: 0.35–2.67 for late AMD). There was no association in multinomial logistic regression models of increasing quartiles of the CES-D scores with early or late AMD status. Conclusions: Our study did not find an association between early AMD and depressive symptoms in older people.     

Risk Factors for Poor Quality of Life among Patients with Age-Related Macular Degeneration

Purpose: The purpose of this study was to evaluate the quality of life in patients with age-related macular degeneration (AMD) and compare it with that of healthy controls. Additionally, our study aims to investigate the possible risk factors for poor quality of life in AMD patients. Methods: Participants in the study were 114 patients with AMD, 63 male and 51 female, mean-aged 76.5 ± 6.1 years. Demographic data, lifestyle factors, and medical history were recorded. All patients underwent a routine examination for AMD, including best-corrected visual acuity measurement, dilated fundoscopy and optical coherence tomography, and completed three questionnaires assessing quality of life (SF-36, EQ-5D, NEI VFQ-25). In addition, 100 controls, adjusted for gender and age, were included in the study. Risk factors for quality of life in AMD patients were investigated. Univariate analysis was performed using SPSS 22.0. Results: Patients with AMD scored lower in vision- and health-related quality-of-life questionnaires compared to controls. Risk factors associated with quality of life in patients with AMD were found to be the female gender, alcohol consumption, the presence of hypertension, diabetes mellitus, cardiovascular diseases, myosceletal problems, migraine, anxiety/depression, subretinal or intraretinal fluid, pigment epithelium detachment, previous treatment for AMD, visual acuity, the stage of the disease, and the integrity of the ellipsoid zone. Conclusion: Patients with AMD presented lower quality of life in comparison with controls. Potential risk factors should be taken into account and clinicians should thus focus on the most vulnerable subgroups.     

CETP Gene may be Associated with Advanced Age-Related Macular Degeneration in the Chinese Population

Objectives: This study aims to investigate whether variations in LIPC, CETP, ABCA1 and LPL, which are involved in high-density lipoprotein (HDL) metabolism, are associated with advanced age-related macular degeneration (AMD) in the Chinese population.

Design and Methods: A total of 119 Chinese patients with advanced AMD and 99 control individuals were recruited. Genomic DNA was extracted from peripheral blood leukocytes. Genotypes of seven single nucleotide polymorphisms (SNPs) including rs1061170 and rs1410996 in CFH, rs10490924 in HTRA1, rs10468017 in LIPC, rs3764261 in CETP, rs1883025 in ABCA1 and rs12678919 near LPL were determined by polymerase chain reaction (PCR) followed by allele-specific restriction enzyme digestion or SNaPshot. Unconditional logistic regression analyses were performed to generate a risk predictive model.

Results: We observed the frequency of allele A of rs3764261 in CETP to be significantly lower in advanced AMD after Bonferroni correction (15.5% in patients with AMD and 20.7% in controls; OR?=?0.49, 95% CI: 0.29–0.85; p?=?0.011). Furthermore, we found that it was also associated with reduced risk of both unilateral AMD (OR?=?0.52, 95% CI: 0.28–0.98; p?=?0.043) and bilateral AMD (OR?=?0.45, 95% CI: 0.22–0.91; p?=?0.026). Rs10468017 in LIPC, rs12678919 near LPL and rs1883025 in ABCA1 were not found to be associated with advanced AMD (all p?>?0.05).

Conclusion: Our data suggested that the allele A in rs3764261 in CETP gene may be associated with a decreased risk of advanced AMD in Chinese population.     

Fundus Autofluorescence Imaging in Age-Related Macular Degeneration

Abstract

Fundus autofluorescence (FAF) is a noninvasive imaging technology that provides information on the distribution of lipofuscin within the retinal pigment epithelial cells. Progressive accumulation of lipofuscin within retinal pigment epithelial cells is involved in the pathogenesis of age-related macular degeneration (AMD). Fundus autofluorescence imaging using a confocal scanning laser ophthalmoscope is a useful technique to identify high-risk characteristics in patients with nonexudative AMD. It gives also some valuable knowledge and clues in differantial diagnosis of exudative age-related macular degeneration. This review comprises an introduction to fundus autofluorescence, a review of FAF imaging in AMD, and the recent classification of geographic atrophy (GA) and early AMD phenotypes by the Fundus Autofluorescence in Age-related Macular Degeneration Study. The association of phenotype and atrophy progression and choroidal neovascularization development are also summarized.     

The Role of Matrix Metalloproteinases Polymorphisms in Age-Related Macular Degeneration

Background: Matrix metalloproteinases (MMP) are responsible for the degradation of extracellular matrix components and play an important role in the physiological and pathological remodeling of tissues.

Purpose: To assess the impact of MMP-2 Rs2285053 (C?–>?T), MMP-3 Rs3025039 (5A?–>?6A), and MMP-9 Rs3918242 (C?–>?T) single nucleotide polymorphism on the development of early age-related macular degeneration (AMD).

Methods: The study group comprised 148 patients with AMD, and the control group enrolled 526 randomly selected persons. The genotyping of MMP-3 Rs3025039, MMP-2 Rs2285053, and MMP-9 Rs3918242 was performed by using the real-time PCR method.

Results: The frequency of the MMP-2 (?735) C/T and MMP-3 (?1171) 5A/6A genotypes did not differ significantly between the patients with AMD and the control group, while the MMP-9 (?1562) C/C genotype was more frequently detected in patients with AMD than the control group (73.7% vs. 64.6%, p?=?0.048). Logistic regression analysis showed that the MMP-9 (?1562) C/C genotype increased the likelihood of developing early AMD (OR?=?1.51, 95% CI: 1.01–2.21; p?=?0.046). After the subdivision into the groups by age, a significant difference only in the frequency of the MMP-9 (?1562) C/C genotype was found comparing the AMD patients and the control group younger than 65 years (79.7% vs. 66.4%, p?=?0.039).

Conclusions: Only MMP-9 Rs3918242 (C?–>?T) single nucleotide polymorphism was found to play a significant role in the development of AMD, and the effect was more pronounced at the age of less than 65 years.     

Survival Bias When Assessing Risk Factors for Age-Related Macular Degeneration: A Tutorial with Application to the Exposure of Smoking

Purpose: We illustrate the effect of survival bias when investigating risk factors for eye disease in elderly populations for whom death is a competing risk. Our investigation focuses on the relationship between smoking and late age-related macular degeneration (AMD) in an observational study impacted by censoring due to death.

Methods: Statistical methodology to calculate the survivor average causal effect (SACE) as a sensitivity analysis is described, including example statistical computing code for Stata and R. To demonstrate this method, we examine the causal effect of smoking history at baseline (1990–1994) on the presence of late AMD at the third study wave (2003–2007) using data from the Melbourne Collaborative Cohort Study.

Results: Of the 40,506 participants eligible for inclusion, 38,092 (94%) survived until the start of the third study wave, 20,752 (51%) were graded for AMD (60% female, aged 47–85 years, mean 65 ± 8.7 years). Late AMD was detected in 122 participants. Logistic regression showed strong evidence of an increased risk of late AMD for current smokers compared to non-smokers (adjusted naïve odds ratio 2.99, 95% confidence interval, CI, 1.74–5.13). Among participants expected to be alive at the start of follow-up regardless of their smoking status, the estimated SACE odds ratio comparing current smokers to non-smokers was at least 3.42 (95% CI 1.57–5.15).

Conclusions: Survival bias can attenuate associations between harmful exposures and diseases of aging. Estimation of the SACE using a sensitivity analysis approach should be considered when conducting epidemiological research within elderly populations.     

Age-Related Macular Degeneration and Mortality: A Systematic Review and Meta-Analysis

Purpose: Age-related macular degeneration (AMD) is the leading cause of severe, irreversible vision loss in older adults. Evidence for an association between AMD and mortality remains inconclusive despite evidence for an association with cardiovascular and inflammatory diseases. We aim to compare all-cause, cardiovascular and cancer mortality between those with early or late AMD and control study participants.

Methods: A protocol was registered at PROSPERO (CRD42015020622). A systematic search of Medline (Ovid), PubMed, and Embase (Ovid) was conducted on 6 June 2015. Reference lists from identified studies and four clinical trial registries were searched for additional studies. Participants were required to be over the age of 40 years, and AMD status must have been objectively assessed. The Risk Of Bias In Non-Randomized Studies – of Interventions (ROBINS-I) tool was used to assess the risk of bias. Random-effects meta-analyses were performed.

Results: A total of 12 reports from 10 studies were included in the meta-analysis. Late AMD was associated with elevated rates of all-cause (nine studies, hazard ratio (HR) 1.20, 95% confidence interval, CI, 1.02–1.41) and cardiovascular mortality (six studies, HR 1.46, 95% CI 1.13–1.98), but early AMD was not (all-cause mortality, 10 studies, HR 1.06, 95% CI 0.98–1.14; cardiovascular mortality, five studies, HR 1.12, 95% CI 0.96–1.31). There was no evidence of an association between early or late AMD and cancer mortality (early AMD, three studies, HR 1.17, 95% CI 0.78–1.75; late AMD, three studies, HR 1.01, 95% CI 0.77–1.33).

Conclusion: Late AMD is associated with increased rates of all-cause and cardiovascular mortality, suggesting shared pathways between late AMD and systemic disease.     

Association between Previous Cataract Surgery and Age-Related Macular Degeneration

Purpose: To assess the association between age-related macular degeneration (AMD) and previous cataract surgery. Methods: We studied 17,987 randomly selected participants from the Korea National Health and Nutrition Examination Survey who were aged ≥40 years and underwent additional ophthalmologic examinations in 2008?12. The associations between previous cataract surgery and early/late AMD were identified using multivariate logistic regression analysis of data from right or left eyes. Clustered multivariate logistic regression analysis was performed using both eyes to assess inter-eye correlation in same subject. Previous cataract surgery and cataract subtypes were based on slit-lamp examination without pupil dilation. Early and late AMD diagnoses were based on non-mydriatic digital retinal image. Results: By univariate logistic regression, both early and late AMD prevalence were higher in subjects with pseudophakia/aphakia compared to subjects with cataract as a reference group, or subjects with phakic eye (including clear lens) as a reference group. In univariate logistic regression, both early and late AMD prevalence were higher in eyes with cataract or pseudo/aphakia compared to eyes with clear lens. However, after adjusting for age with multivariate logistic regression, all statistically significant differences in AMD prevalence among subgroups disappeared. Conclusions: We found no association between the previous cataract surgery and increased early/late AMD risk in our representative, large, national patient database. This suggests that increasing age, and not cataract surgery history, is predictive of AMD risk. These findings are limited by cross-sectional study and need to be replicated by other longitudinal observational studies.     

Relative Telomere Length Is Associated With Age-Related Macular Degeneration in Women

PurposeRelative telomere length (RTL) is a biomarker for physiological aging. Premature shortening of telomeres is associated with oxidative stress, which is one possible pathway that might contribute to age-related macular degeneration (AMD). We therefore aimed to investigate the association between RTL and AMD in a well-characterized group of elderly individuals.MethodsWe measured RTL in participants of the AugUR study using a multiplex quantitative PCR-based assay determining the ratio between the telomere product and a single-copy gene product (T/S ratio). AMD was assessed by manual grading of color fundus images using the Three Continent AMD Consortium Severity Scale.ResultsAmong the 2262 individuals 70 to 95 years old (627 with AMD and 1635 without AMD), RTL was significantly shorter in individuals with AMD compared to AMD-free participants. In age- and sex-adjusted logistic regression analyses, we observed an 8% higher odds for AMD per 0.1 unit shorter RTL (odds ratio [OR] = 1.08; 95% confidence interval [CI], 1.02–1.14; P = 0.005). The estimates remained stable when adjusted for smoking, high-density lipoprotein cholesterol, cardiovascular disease, diabetes, and hypertension. Interestingly, this association was only present in women (OR = 1.14; 95% CI, 1.06–1.23; P < 0.001), but not in men (OR = 1.01; 95% CI, 0.93–1.10; P = 0.76). A significant sex-by-RTL interaction on AMD was detected (P = 0.043).ConclusionsOur results show an association of RTL with AMD that was restricted to women. This is in line with altered reactive oxygen species levels and higher telomerase activity in women and provides an indication for a sex-differential pathway for oxidative stress and AMD.     

Risk factors for Age-related Macular Degeneration in a Greek population: The Thessaloniki Eye Study

Purpose: To assess the association of potential risk factors with early and late age-related macular degeneration (AMD) in the Thessaloniki Eye Study (TES) population

Design: Population-based, cross-sectional study of subjects over age of 60 living in Thessaloniki, Greece

Methods: Subjects without any AMD features and subjects with early and late AMD (neovascular AMD or geographic atrophy) were identified in the TES cohort using standardized procedures and masked grading of stereo color fundus photos. Demographic, lifestyle, systemic and other ophthalmic covariates were also collected during a detailed examination process. Their association with AMD was investigated using univariate and multivariate adjusted logistic regression models.

Results: Among the 2108 participants with gradable photos, the grading process identified 1204 subjects with no AMD, 848 subjects with early AMD, and 56 subjects with late AMD (24 with geographic atrophy and 32 with neovascular AMD). In multivariate analysis, compared to no AMD, late AMD was positively associated with older age (OR:1.16; 95%CI:1.10–1.22 per year of age), current smoking (smoking vs. never smoking, OR:2.34; 95%CI:1.12–4.90), prior cataract surgery (cataract surgery vs. no cataract surgery OR:2.06; 95%CI:0.96–4.40), marital status (divorced/separated vs. married, OR:3.10; 95%CI:1.08–8.93) and with 60% lower odds when sleeping in the afternoon (yes vs. no, OR:0.40; 95%CI:0.22–0.72). Early AMD was positively associated with older age (OR: 1.03; 95%CI:1.01–1.05 per year of age) and negatively with higher pulse pressure (OR:0.99; 95%CI:0.98–0.99 per mmHg).

Conclusions: In TES, apart for well-known risk factors for AMD like age, smoking, and cataract surgery, two novel behavioral risk factors for prevalent late AMD were suggested. Sleeping in the afternoon was associated with 60% decreased odds for late AMD and 67% decreased odds for neovascular AMD. Being divorced/separated compared to married was associated with 3-fold higher odds for late AMD. Large longitudinal population-based studies will be necessary to further establish the potential late AMD risk effects of these two novel factors, to demonstrate potential implications of underlying pathogenetic mechanisms, and to explore preventive measures and therapeutic targets.     

Pharmacogenetic Aspect of Intravitreal Ranibizumab Treatment in Neovascular Age-Related Macular Degeneration: A Five-Year Follow-Up

Purpose: This study aims to evaluate the role of complement factor H (CFH) in response to intravitreal ranibizumab (IVR) treatment, which is administered to patients with neovascular age-related macular degeneration (nAMD).

Methods: In this retrospective study, 90 nAMD patients’ 90 eyes were evaluated. IVR was injected once a month for three consecutive months, and then, patients were followed up for five years by using pro re nata method.

Results: Average visual acuity (BCVA) values in TT group for the third, fourth and fifth years were found to be significantly higher than those in TC and CC groups, while average BCVA values in TC group were significantly higher than those in CC group (all p = .000 < .0167).

Conclusion: Patients with CFH TT genotype responded significantly better to treatment after third year, while patients with CC genotype had a poorer response to IVR.     

Metabolomics in Age-Related Macular Degeneration: A Systematic Review

PurposeAge-related macular degeneration (AMD) is one of the leading causes of blindness among the elderly, and the exact pathogenesis of the AMD remains unclear. The purpose of this review is to summarize potential metabolic biomarkers and pathways of AMD that might facilitate risk predictions and clinical diagnoses of AMD.MethodsWe obtained relevant publications of metabolomics studies of human beings by systematically searching the MEDLINE (PubMed) database before June 2020. Studies were included if they performed mass spectrometry–based or nuclear magnetic resonance–based metabolomics approach for humans. In addition, AMD was assessed from fundus photographs based on standardized protocols. The metabolic pathway analysis was performed using MetaboAnalyst 3.0.ResultsThirteen studies were included in this review. Repeatedly identified metabolites including phenylalanine, adenosine, hypoxanthine, tyrosine, creatine, citrate, carnitine, proline, and maltose have the possibility of being biomarkers of AMD. Validation of the biomarker panels was observed in one study. Dysregulation of metabolic pathways involves lipid metabolism, carbohydrate metabolism, nucleotide metabolism, amino acid metabolism, and translation, which might play important roles in the development and progression of AMD.ConclusionsThis review summarizes the potential metabolic biomarkers and pathways related to AMD, providing opportunities for the construction of diagnostic or predictive models for AMD and the discovery of new therapeutic targets.     

Self-Reported Sleep Duration in Patients with Neovascular Age-Related Macular Degeneration

Purpose: To examine the relationship between self-reported sleep duration and neovascular age-related macular degeneration (nAMD).

Methods: This case-control study comprised 165 subjects (57 patients with nAMD and 108 controls). Controls were matched to cases by age and sex. Participants completed a questionnaire that included questions about sleep duration and quality. Four categories of sleep duration were established; <6 hours, 6–7 hours, 7–8 hours and >8 hours. Association of sleep duration and nAMD was assessed by logistic regression analysis. Multiple logistic regression models were performed to control for possible confounders.

Results: We found a significant association between short sleep duration and nAMD (for <6 hours, odds ratio, OR, 3.29, 95% confidence interval, CI, 1.32–8.27; for 6–7 hours, OR 2.25, 95% CI 0.80–6.32; and for >8 hours, OR 1.39, 95% CI 0.53–3.73) compared with the reference category of 7–8 hours. This association remained significant after adjustment for confounders (<6 hours, OR 3.09, 95% CI 1.20–7.97). In addition, a borderline significant association was observed between self-reported very bad sleep quality and nAMD (OR 2.84, 95% CI 1.02–7.88). The highest rate of sleep medication use was found in the nAMD group (p < 0.001).

Conclusion: Our findings provide evidence to support an association between short sleep duration and nAMD. Considering strategies to improve sleep in these patients may prevent the negative effects of sleep deficiency.     

早期老年性黄斑变性的暗视ERG检测

用暗视视网膜电图（ERG）检测了眼底有drusen的早期老年性黄斑变性（AMD）患者42例（56眼）和正常对照组50例（50眼）。结果与正常对照组相比，发现早期AMD有a波峰时和幅值异常。红光ERG的a波谷数减少（P＜0．005），而兰光ERG改变不显著（P＞0．05）。同时还发现，红光ERG的改变与视力、病变部位、类型有关．提示：暗视ERG可作为AMD早期的检测手段之一。