Elsevier

Ophthalmology

Volume 108, Issue 4, April 2001, Pages 697-704
Ophthalmology

Risk factors for age-related macular degeneration: Pooled findings from three continents

https://doi.org/10.1016/S0161-6420(00)00580-7Get rights and content

Abstract

Objective

To assess the prevalence and potential risk factors for late age-related macular degeneration (AMD) in three racially similar populations from North America, Europe, and Australia.

Design

Combined analysis of population-based eye disease prevalence data.

Participants

There were 14,752 participants with gradable photographs from the Beaver Dam Eye Study (n = 4756), Rotterdam Study (n = 6411), and Blue Mountains Eye Study (n = 3585).

Main outcome measures

AMD diagnosis was made from masked grading of stereo macular photographs. Final classification of AMD cases was agreed by consensus between study investigators.

Results

AMD prevalence was strongly age related. Overall, AMD was present in 0.2% of the combined population aged 55 to 64 years, rising to 13% of the population older than 85 years. Prevalence of neovascular AMD (NV) increased from 0.17% among subjects aged 55 to 64 years to 5.8% for those older than 85 years. Prevalence of pure geographic atrophy (GA) increased from 0.04% to 4.2% for these age groups. There were no significant gender differences in the prevalence of NV or GA. Subjects in the Rotterdam population had a significantly lower age-adjusted and smoking-adjusted risk of NV than subjects in the Beaver Dam and Blue Mountains populations. Apart from age, tobacco smoking was the only risk factor consistently associated with any form of AMD in all sites separately and in pooled analyses over the three sites.

Conclusions

These combined data from racially similar communities across three continents provide strong and consistent evidence that tobacco smoking is the principal known preventable exposure associated with any form of AMD.

Section snippets

Methods

The Beaver Dam Eye Study was conducted during the period 1988–1990 in Beaver Dam, Wisconsin, and examined 4926 of 5925 eligible residents aged 43 to 86 years (response, 83.1%) identified in a private census. The Rotterdam Study was conducted during the period 1990–1993 in Rotterdam, The Netherlands, and included 7983 of 10,275 eligible residents aged 55 to 106 years (response, 77.7%) identified from the municipal registers. From these 7983 participants, 6476 underwent a complete ophthalmologic

Characteristics of the combined population

The combined population with gradable photographs totalled 14,752 participants aged from 43 to 99 years (mean age, 66.0 years) and included 8464 women (57.4%) and 6288 men (42.6%) (Table 1). The female/male ratio averaged 1.35 for subjects with gradable photos and increased with age. Among the Beaver Dam, Rotterdam, and Blue Mountains studies, female/male ratios were 1.25, 1.45, and 1.30, respectively. These ratios reflect age differences between the three studies; in Beaver Dam, the mean age

Discussion

This report represents the first attempt to combine unit data from distinct population-based eye studies to investigate AMD and its two subtypes. Strengths of this pooled study include its large sample size and the relatively similar photographic documentation performed at each of the three sites. A further strength is the use of a similar grading protocol by graders who had all spent periods of training at the Fundus Photograph Reading Center in Wisconsin. Also, the inclusion of all cases

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