Five-year incidence, progression, and risk factors for age-related macular degeneration: the age, gene/environment susceptibility study.
OBJECTIVE
To investigate the incidence and progression of age-related macular degeneration (AMD) and associated risk factors.


METHODS
Population-based, prospective, cohort study.


METHODS
We included 2868 participants from the Age Gene/Environment Susceptibility-Reykjavik Study with retinal data at baseline and 5-year follow-up.


METHODS
Digital macular photographs were graded for presence of AMD. Participants completed a questionnaire and extensive clinical battery. Biomarkers were assessed. Risk factors for AMD were analyzed using multivariate regression analysis with odds ratios (ORs) and 95% CIs.


METHODS
We assessed AMD, defined as early or late.


RESULTS
Among 2196 participants free of AMD at baseline, 14.9% developed incident AMD. In multivariate models, incident AMD was significantly associated with age (OR per year, 1.14; 95% CI, 1.11-1.17), current smoking (OR, 2.07; 95% CI, 1.38-3.11), former smoking (OR, 1.36; 95% CI, 1.04-1.79), plasma high-density lipoprotein (HDL) cholesterol level (OR, 1.62 per mmol/L; 95% CI, 1.19-2.22), and body mass index (BMI; OR, 1.04 per kg/m(2); 95% CI, 1.01-1.07). Among 563 participants with early AMD at baseline, 22.7% progressed to late AMD (11.0% pure geographic atrophy [GA] and 11.7% exudative AMD). On multivariate analyses, age was significantly associated with progression to GA (OR 1.14; 95% CI, 1.07-1.21) and exudative AMD (OR, 1.08; 95% CI, 1.01-1.14). Adjusting for age, female sex was associated with exudative AMD (OR, 2.10; 95% CI, 1.10-3.98) and plasma HDL cholesterol with GA (OR, 2.03 per mmol/L; 95% CI, 1.02-4.05).


CONCLUSIONS
By age 85, 57.4% of participants had signs of AMD. Age, smoking, plasma HDL cholesterol, BMI, and female sex are associated with AMD. Elevated HDL cholesterol is associated with GA development.
Department of Ophthalmology, Landspitali University Hospital, Reykjavik, Iceland; Faculty of Medicine, University of Iceland, Reykjavik, Iceland. Electronic address: fridbert@landspitali.is.
Fridbert
F
Jonasson
Division of Epidemiology and Clinical Applications, National Eye Institute, Bethesda, Maryland.
Diana E
DE
Fisher
Icelandic Heart Association, Kopavogur, Iceland.
Gudny
G
Eiriksdottir
Icelandic Heart Association, Kopavogur, Iceland.
Sigurdur
S
Sigurdsson
Ophthalmology and Visual Sciences, University of Wisconsin Madison, Madison, Wisconsin.
Ronald
R
Klein
Laboratory of Epidemiology, Demography and Biometry, Intramural Research Program, National Institute of Aging, Bethesda, Maryland.
Lenore J
LJ
Launer
Laboratory of Epidemiology, Demography and Biometry, Intramural Research Program, National Institute of Aging, Bethesda, Maryland.
Tamara
T
Harris
Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Icelandic Heart Association, Kopavogur, Iceland.
Vilmundur
V
Gudnason
Division of Epidemiology and Clinical Applications, National Eye Institute, Bethesda, Maryland.
Mary Frances
MF
Cotch
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D015992:Body Mass Index; D008076:Cholesterol, HDL / Q000097:blood; D018450:Disease Progression; D005260:Female; D059647:Gene-Environment Interaction; D006801:Humans; D007055:Iceland / Q000453:epidemiology; D015994:Incidence; D008268:Macular Degeneration / Q000453:epidemiology / Q000209:etiology; D008297:Male; D015999:Multivariate Analysis; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects
D015415:Biomarkers; D008076:Cholesterol, HDL