First Author: F.Jonasson ICELAND
Co Author(s): D. Fisher G. Eiriksdottir R. Klein T. Harris V. Gudnason M.F. Cotch 0 0 0 0 0 0 0 0 0
Back to previous
To investigate the incidence and progression of age related macular degeneration (AMD) and the impact of AMD on mortality in a population-based cohort of older persons participating the Age, Gene/Environment Susceptibility-Reykjavik Study.
The Icelandic Heart Association Research Center, using a standardized protocol, including digital fundus photographs taken through pharmocologically dilated pupils using a Canon CR6 nonmydriatic camera. Images were assessed at the University of Wisconsin Ocular Epidemiology Reading Center using a modified Wisconsin AMD grading scheme
There were 4910 persons ages 66 years and older (mean age 76 years) with retinal images available from the baseline study visit which collected data between 2002 and 2006. A follow-up examination was held, on average, 5 years later. Retinal data at both baseline and 5-year follow up was available for 2868 study participants. AMD was defined by lesion and classified as either early or late. The eye with the more severe lesion was used in this analysis. Mortality was assessed by cross- referencing participant information with the complete adjudicated death registry maintained by Statistics Iceland.
Among the 2196 participants free of AMD at baseline 328 persons (14.9%) developed incident AMD within 5 years including 16 persons with late AMD. The five year incidence of early and late AMD combined increased from 6.9% among those with baseline age under 70 years to 31.3% among those whose baseline age was 80 years and older. Among 563 persons with early AMD at baseline,128 (22.7%) developed late AMD five years later, increasing from 12.8% among those <70 years old to 31.9% among those ≥80 years at baseline. Risk factors associated with incident AMD from multivariate analysis included advancing age, being female, cigarette smoking, higher body mass index, and elevated HDL cholesterol. Among individuals whose AMD progressed, 62 had pure geographic atropy and 66 had exudative AMD. By 2013, 1742 (35.5%) of participants had died, approximately one-third of whom had signs of AMD at baseline. After multivariate adjustment of risk factors including comorbid conditions, AMD (either early or late) was not associated with mortality for those under age 82 years whereas among persons ages 83 years and older, signs of late AMD were associated with increased risk of mortality (OR=1.8, 95% confidence interval 1.2-2.6).
Signs of AMD are more common than not among people by the age of 80 years. Persons with signs of early AMD, regardless of their age, are not at increased risk of mortality; however, octogenerians with signs of late AMD may be at increased risk of mortality, particularly men. Cigarette smoking increases the risk of developing AMD. The health benefits of smoking cessation, even among elderly persons, are worth communicating to reduce the risk of many diseases and conditions, including AMD.