title: The Incidence and Progression of Age-Related Macular Degeneration over 15 Years: The Blue Mountains Eye Study.
abstract: OBJECTIVE
  To assess the 15-year incidence and progression of age-related macular degeneration (AMD) in an older Australian population.
  
  
  METHODS
  Population-based cohort study.
  
  
  METHODS
  Blue Mountains Eye Study (BMES) participants (n = 3654) aged 49+ years were examined during 1992-1994. Of these, 2334 (75.8% of survivors) were reexamined after 5 years (1997-1999), 1952 (76.7% of survivors) after 10 years (2002-2004), and 1149 (56.1% of survivors) after 15 years (2007-2010).
  
  
  METHODS
  Color retinal photographs were taken, and comprehensive questionnaires were administered at each visit and DNA was genotyped. Retinal photographic grading was performed by the same graders following the Wisconsin AMD grading protocol. Side-by-side comparisons were used to confirm newly developed AMD lesions. Incidence was estimated using Kaplan-Meier estimates. Associations of AMD incidence with age, sex, smoking status, presence of the complement factor H (CFH)-rs1061170 and age-related maculopathy susceptibility 2 (ARMS2)-rs10490924 polymorphisms, and fish consumption were analyzed using discrete logistic regression models. Generalized estimation equation models were used to assess the risk of incident late AMD associated with baseline AMD lesion characteristics.
  
  
  METHODS
  The 15-year incidence and progression of AMD, and associated factors.
  
  
  RESULTS
  The 15-year incidence was 22.7% for early AMD and 6.8% for late AMD. After adjusting for competing risks, early and late AMD incidence were 15.1% and 4.1%, respectively. Age was strongly associated with early and late AMD incidence (both P < 0.0001). After age standardization to the Beaver Dam Eye Study (BDES) population, early and late AMD incidence in the BMES were 13.1% and 3.3%, respectively. Female sex and the presence of both risk alleles of CFH-rs1061170 or ARMS2-rs10490924 were independently associated with early AMD incidence, whereas current smoking and presence of ≥1 risk allele of CFH-rs1061170 or ARMS2-rs10490924 were associated with late AMD incidence. Fish consumption was inversely associated with late but not early AMD incidence. Severity of early AMD lesion characteristics was a strong predictor of progression to late AMD.
  
  
  CONCLUSIONS
  We documented the 15-year incidence of early and late AMD in an older Australian population that were comparable to BDES observations. Risk of progression to late AMD was strongly associated with severity of early AMD lesions.
authors.affiliation: Centre for Vision Research, Department of Ophthalmology, and The Westmead Millennium Institute for Medical Research, The University of Sydney, Sydney, Australia.
authors.forename: Nichole
authors.initials: N
authors.lastname: Joachim
authors.affiliation: Centre for Vision Research, Department of Ophthalmology, and The Westmead Millennium Institute for Medical Research, The University of Sydney, Sydney, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Mitchell
authors.affiliation: Centre for Vision Research, Department of Ophthalmology, and The Westmead Millennium Institute for Medical Research, The University of Sydney, Sydney, Australia.
authors.forename: George
authors.initials: G
authors.lastname: Burlutsky
authors.affiliation: Centre for Vision Research, Department of Ophthalmology, and The Westmead Millennium Institute for Medical Research, The University of Sydney, Sydney, Australia.
authors.forename: Annette
authors.initials: A
authors.lastname: Kifley
authors.affiliation: Centre for Vision Research, Department of Ophthalmology, and The Westmead Millennium Institute for Medical Research, The University of Sydney, Sydney, Australia. Electronic address: jiejin.wang@sydney.edu.au.
authors.forename: Jie Jin
authors.initials: JJ
authors.lastname: Wang
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D017242:Complement Factor H / Q000235:genetics; D004032:Diet; D018450:Disease Progression; D005260:Female; D005396:Fish Products; D005500:Follow-Up Studies; D060005:Genotyping Techniques; D006801:Humans; D015994:Incidence; D008268:Macular Degeneration / Q000175:diagnosis* / Q000453:epidemiology* / Q000235:genetics; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D010781:Photography; D016133:Polymerase Chain Reaction; D020641:Polymorphism, Single Nucleotide; D011506:Proteins / Q000235:genetics; D012307:Risk Factors; D017678:Sex Distribution; D011795:Surveys and Questionnaires
chemical_list: C514392:ARMS2 protein, human; C493495:CFH protein, human; D011506:Proteins; D017242:Complement Factor H