Refractive status and the 5-year incidence of age-related maculopathy: the Blue Mountains Eye Study

This study aimed to assess the longitudinal association between refraction and 5-year incident age-related maculopathy (ARM) in the Blue Mountains Eye Study population. The dataset included 3654 participants aged 49+ (82.4% of eligible) examined at baseline (1992-1994), and 2335 (75.1% of survivors) examined after 5 years. Retinal photograph grading followed the International ARM Classification. Incident ARM was assessed using a side-by-side comparison. Refraction was performed using autorefraction with subjective refinement. Spherical equivalent was calculated from spherical plus half the cylindrical power. After adjusting for age, sex and smoking, no association was found between baseline spherical equivalent and 5-year incident late or early ARM. Hyperopic right eyes had slightly higher incident rates for late (0.8%) and early (6.3%) ARM, compared with myopic (0.4% and 4.1%, respectively) or emmetropic (0.5% and 5.0%, respectively) right eyes. After multivariable adjustment, this study found no significant association between hyperopia and the 5-year incidence of late or early ARM. Left eyes or the combined data from both eyes had similar findings.     

The relation of coffee and caffeine to the 5-year incidence of early age-related maculopathy: the Beaver Dam Eye Study

PURPOSE: To examine the relationship between coffee and caffeine consumption and the 5-year incidence of early age-related maculopathy and its component lesions, soft indistinct drusen or pigmentary abnormalities. DESIGN: A prospective cohort study conducted from 1988 to 1995 with an average follow-up of 4.8 years. METHODS: Data from baseline and 5-year follow-up examinations were analyzed for Beaver Dam Eye Study participants (n = 3435). The Wisconsin Age-Related Maculopathy Grading System was used to assess the presence and severity of early age-related maculopathy. RESULTS: Men were more likely to be coffee and caffeine drinkers than were women. For both men and women, coffee and caffeine intake decreased with age. Coffee and caffeine consumption were not associated with the 5-year incidence of early age-related maculopathy, soft indistinct drusen, or pigmentary abnormalities. CONCLUSION: Neither a history of coffee nor caffeine consumption is associated with incident early age-related maculopathy.     

Five-year incidence of age-related maculopathy lesions: the Blue Mountains Eye Study

PURPOSE: To describe the 5-year incidence and progression of early and late age-related maculopathy (ARM) lesions. DESIGN: Population-based cohort study. PARTICIPANTS: Three thousand six hundred fifty-four noninstitutionalized residents, aged 49 years or older, living in the Blue Mountains area west of Sydney, Australia, participated in the study during 1992 to 1994. The cohort was reexamined after 5 years (1997-1999). Excluding 543 participants who died since the baseline, 2335 (75%) survivors attended 5-year follow-up examinations. METHODS: Retinal photographs from both examinations were graded using the Wisconsin ARM Grading System. Photographs of participants with any ARM lesions at either examination were regraded in detail using a modification of the side-by-side method developed for the Beaver Dam Eye Study. MAIN OUTCOME MEASURES: Incidence and progression of ARM lesions were defined in a similar manner to that used in the Beaver Dam Eye Study. RESULTS: Incidence rates for all ARM lesions increased significantly with age. For late ARM lesions (geographic atrophy and neovascular ARM), the overall 5-year incidence was 1.1%. The combined late ARM incidence was 0.0%, 0.6%, 2.4%, and 5.4% for participants aged 60 years and younger, 60 to 69 years, 70 to 79 years, and 80 years and older at baseline, respectively. After excluding participants with either early or late ARM in either eye at baseline, the overall 5-year incidence of early ARM was 8.7%, including 3.2%, 7.4%, 18.3%, and 14.8% for the corresponding age groups. The incidence of neovascular ARM in women was double that for men (P = 0.1). CONCLUSIONS: This study has documented the incidence of ARM lesions in an older Australian population. The slightly higher incidence of hyperpigmentation found in our population compared with the Beaver Dam Eye Study may be due to sample variability, or this could reflect real differences between the two populations. Our lower incidence of soft drusen could have resulted from our non-inclusion of intermediate soft drusen in the soft distinct and indistinct drusen categories.     

Refractive errors and 10-year incidence of age-related maculopathy

PURPOSE: To describe the relationship of refractive errors to the 10-year incidence of age-related maculopathy (ARM) in a defined white population. METHODS: Persons aged 43 to 86 years of age in Beaver Dam, Wisconsin, were invited for a baseline examination from 1988 through 1990, and follow-up examinations 5 and 10 years later (n = 3684). Refraction was measured at baseline, with myopia defined as a spherical equivalent of -1.00 D or less, emmetropia as -0.75 to +0.75 D and hyperopia as +1.00 D or more. At each examination, signs of ARM were ascertained from grading stereoscopic color fundus photographs based on a standard protocol. The association between baseline refractive status and the 10-year incidence and progression of ARM was analyzed. RESULTS: The 10-year cumulative incidence for early ARM was 7.1%, 7.7%, and 11.7%, in eyes with myopia, emmetropia, and hyperopia, respectively. The corresponding 10-year cumulative incidence for late ARM was 0.3%, 0.8%, and 2.2%. When age was controlled for, there was no association between myopia and incident early (relative risk [RR] 1.0, 95% confidence interval [CI], 0.7-1.3) and late (RR 0.5, 95% CI, 0.2-1.5) ARM. Similarly, after controlling for age, hyperopia was not associated with incident early (RR 0.9, 95% CI, 0.7-1.1) or late (RR 1.2, 95% CI, 0.6-2.3) ARM. CONCLUSIONS: These prospective population-based data provide no evidence of an association between refractive errors and risk of ARM.     

Dietary antioxidant intake and incidence of early age-related maculopathy: the Blue Mountains Eye Study

OBJECTIVE: To investigate associations between dietary intake, including modest supplement intake, of antioxidant vitamins and zinc at baseline and the 5-year incidence of early age-related maculopathy (ARM). DESIGN: Population-based cohort study. PARTICIPANTS: From 1992 through 1994, 3654 persons aged 49 years or more (82% of those eligible) living in two postcode areas west of Sydney, Australia, were examined for the Blue Mountains Eye Study baseline. Five years later, 2335 persons (75% of known survivors) were reexamined. METHODS: A 145-item Food Frequency Questionnaire (FFQ) was used to assess nutrient intakes. Of the 2335 people who attended a follow-up visit, 1989 (85%) had completed a FFQ at baseline. The nutrients examined in this study included: alpha-carotene, beta-carotene, beta-cryptoxanthin, lutein and zeaxanthin, lycopene, retinol, vitamin A, vitamin C, and zinc. MAIN OUTCOME MEASURES: Early ARM was assessed by masked grading of stereo retinal photographs. Definitions for incidence closely followed those used in the Beaver Dam Eye Study. RESULTS: Early ARM developed in 192 persons (8.7% 5-year incidence) who did not have either late or early ARM at baseline. Of these, 159 persons completed the FFQ at baseline. After adjusting for age, gender, family history of ARM, and smoking status at baseline, no associations, or any trends suggesting possible association, were found between baseline intake of the nutrients examined, apart from vitamin C, and the 5-year incidence of early ARM. Compared with the lowest quintile, increasing baseline intakes of vitamin C, from diet and supplements, was associated with an increased risk of incident early ARM (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.0-3.0; and OR, 2.3; 95% CI, 1.3-4.0 for the fourth and fifth quintiles, respectively). CONCLUSIONS: Our cohort study of an older population could not find evidence of protection associated with usual dietary antioxidant or zinc intakes (including use of supplements) on the 5-year incidence of early ARM.     

Risk factors for age-related maculopathy in a 14-year follow-up study: the Copenhagen City Eye Study

PURPOSE: To examine the association between potential risk factors and the 14-year incidence of age-related maculopathy (ARM). DESIGN: Population-based cohort study. PARTICIPANTS: At baseline, 946 volunteers participated in the study during 1986--88. These subjects were between 60 and 80 years of age and lived in the ?sterbro district of Copenhagen. Excluding participants who had died since baseline, 359 subjects (97.3% of survivors) were re-examined 14 years later, during 2000--2002. A total of 31.8% (301/946) of the original material was included in the risk factor analyses. METHODS: Participants underwent an ophthalmological examination at Rigshospitalet, the National University Hospital of Copenhagen. Similar standardized protocols for physical examination were used at the baseline and follow-up examinations. Age-related maculopathy lesions were determined by the same grader grading colour fundus photographs from both examinations using a modification of the Wisconsin Age-related Maculopathy Grading System protocol. RESULTS: Of the 359 participants, 94 had incident early ARM and 52 had incident late ARM at follow-up in either eye. In logistic regression, the risk factors for early ARM or worse were as follows: cataract (odds ratio [OR] 2.8, 95% confidence interval [CI] 1.2-6.2); family history of ARM (OR 4.5, 95% CI 1.3--15.5), and alcohol consumption >250 g/week (OR 4.6, 95% CI 1.1-19.2). High levels of apolipoprotein B (>100 mg/l) decreased the risk of development of early ARM or worse (OR 0.4, 95% CI 0.2-0.8), while high levels of apolipoprotein A1 (>or= 150 mg/l) increased the risk of late ARM (OR 2.5, 95% CI 1.2-5.3). Advanced age at baseline was also associated with the incidence of late ARM (OR 2.0, 95% CI 1.4-2.9). CONCLUSIONS: These findings indicate a direct correlation between age, cataract, family history, alcohol consumption, the apolipoproteins A1 and B and the 14-year incidence of ARM.     

Cataract and age-related maculopathy: the Blue Mountains Eye Study

PURPOSE. To assess the relationship between different types of cataract or past cataract surgery and late or early age-related maculopathy (ARM) in an older population. METHODS. A population-based survey examined 3,654 people aged =49 years, 82% of permanent residents of an area near Sydney, Australia. Participants had a detailed eye examination, including standardised dilated lens and stereo macular photographs. Presence of cataract and ARM was diagnosed from masked photographic grading using the Wisconsin Cataract and Age-related Maculopathy Grading Systems. Generalized Estimating Equation (GEE) and logistic regression models were used in the statistical analysis. RESULTS. Higher prevalence was found for both late and early ARM in eyes with cataract or a past history of cataract surgery. However, after adjusting for age, sex and other ARM risk factors, no consistent association was found between presence of cortical, nuclear or posterior subcapsular (PSC) cataract or past history of cataract surgery and either late or early ARM. In the GEE model, the only statistically significant association found was between PSC and late ARM. Non-significant increased odds were found for late ARM in eyes with cortical cataract. However, detailed analyses of cortical cataract location failed to show a relationship. CONCLUSIONS. The co-existence of cataract and ARM was almost entirely explained by the age-related increase in prevalence of both conditions. We found no evidence of a consistent relationship between cortical, nuclear or PSC cataract or history of past cataract surgery and either late or early ARM, after adjusting for age and other potential ARM risk factors. The possibility of a relationship between PSC and late ARM or between cortical cataract and any ARM was not excluded. Long-term follow up data from this population will be useful.     

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.     

Dietary antioxidants and age-related maculopathy: the Blue Mountains Eye Study

OBJECTIVE: To assess associations between the stages of age-related maculopathy (ARM) and dietary intake of carotene, vitamin C, retinol, and zinc. DESIGN: Cross-sectional, population-based study. PARTICIPANTS: A total of 3654 subjects 49 years of age and older from a defined area, west of Sydney, Australia, participated. A total of 2900 participants (79.4%) completed accurate food records. INTERVENTION: Masked grading of stereoscopic macular photographs, detailed interviewer-administered questionnaire, and 145-item self-administered food frequency questionnaire. MAIN OUTCOME MEASURES: Late ARM and early ARM were diagnosed from photographic grading. RESULTS: The authors found no statistically significant associations between ARM and dietary intake of either carotene, zinc, or vitamins A or C, either from diet or supplements or from the combined intake from diet and supplements. Multivariate-adjusted odds ratios (95% confidence interval) were calculated comparing highest to lowest dietary intake quintiles. For late ARM, the odds ratios were carotene, 0.7 (range, 0.3-2.0); vitamin A, 1.2 (range, 0.5-3.3); vitamin C, 1.3 (range, 0.5-3.4); and zinc, 1.0 (range, 0.4-2.8). For early ARM, the odds ratios were carotene, 0.7 (range, 0.4-1.1); vitamin A, 1.2 (range, 0.7-2.0); vitamin C, 0.9 (range, 0.5-1.4); and zinc, 0.8 (range, 0.5-1.3). No significant trends were apparent. Adjustment for energy intake also showed no associations between these antioxidants and ARM. Further, no associations were found between increasing intake of foods high in antioxidant vitamins and decreasing prevalence of either late or early ARM. CONCLUSIONS: The authors found no associations between ARM and dietary antioxidants, either from diet alone or including supplements, or from selected foods, in the Blue Mountains Eye Study population.     

Location of lesions associated with age-related maculopathy over a 10-year period: the Beaver Dam Eye Study

PURPOSE: To describe cumulative incidence and changes in retinal lesions associated with age-related maculopathy (ARM) by location over a 10-year period and to examine the relation of location of those lesions to progression of ARM. METHODS: Persons ranging in age from 43 to 84 years and living in Beaver Dam, Wisconsin, at the time of a census (1987-1988) were examined two to three times over a 10-year period (n = 3684). Drusen area, size, and type; retinal pigment epithelium depigmentation; increased pigment; geographic atrophy; and neovascular macular degeneration were determined in each of nine macular subfields: central, inner and outer superior, inner and outer nasal, inner and outer inferior, and inner and outer temporal by grading of stereoscopic color fundus photographs. Late ARM was defined as presence of either geographic atrophy or neovascular ARM. RESULTS: Lesions were more likely to change or develop in specific locations. Drusen area increased most in the central circle. Compared with other quadrants, drusen greater than 125 micro m in diameter and soft indistinct or reticular drusen were most likely to develop in the superior or temporal quadrants, whereas pigmentary abnormalities were most likely to occur in the nasal or superior quadrants. In general, large drusen, soft indistinct drusen, and pigmentary abnormalities were more likely to develop in the inner circle versus the central and outer circles. The quadrant location of early ARM lesions in 72 persons in whom late ARM developed was generally similar to that in persons who did not have late ARM. However, persons who had geographic atrophy were more likely to have large drusen in the inner circle than in the outer circle, while those who did not have late ARM were more likely to have large drusen in the outer circle. CONCLUSIONS: Lesions associated with early ARM were more likely to develop in specific locations in the macular area, and persons with lesions closer to the fovea may be related to a higher risk of development of late ARM. The quadrant location of early ARM lesions does not appear to add additional information to the risk of development of late ARM.