Incidence, progression and risk factors of age-related macular degeneration in 35–95-year-old individuals from three jointly designed German cohort studies

Abstract

ObjectiveTo estimate age-related macular degeneration (AMD) incidence/progression across a wide age range.Methods and analysisAMD at baseline and follow-up (colour fundus imaging, Three Continent AMD Consortium Severity Scale, 3CACSS, clinical classification, CC) was assessed for 1513 individuals aged 35–95 years at baseline from three jointly designed population-based cohorts in Germany: Kooperative Gesundheitsforschung in der Region Augsburg (KORA-Fit, KORA-FF4) and Altersbezogene Untersuchungen zur Gesundheit der Universität Regensburg (AugUR) with 18-year, 14-year or 3-year follow-up, respectively. Baseline assessment included lifestyle, metabolic and genetic markers. We derived cumulative estimates, rates and risk factor association for: (1) incident early AMD, (2) incident late AMD among no AMD at baseline (definition 1), (3) incident late AMD among no/early AMD at baseline (definition 2), (4) progression from early to late AMD.ResultsIncidence/progression increased by age, except progression in 70+-year old. We observed 35–55-year-old with 3CACSS-based early AMD who progressed to late AMD. Predominant risk factor for incident late AMD definition 2 was early AMD followed by genetics and smoking. When separating incident late AMD definition 1 from progression (instead of combined as incident late AMD definition 2), estimates help judge an individual’s risk based on age and (3CACSS) early AMD status: for example, for a 65-year old, 3-year late AMD risk with no or early AMD is 0.5% or 7%, 3-year early AMD risk is 3%; for an 85-year old, these numbers are 0.5%, 21%, 12%, respectively. For CC-based ‘early/intermediate’ AMD, incidence was higher, but progression was lower.ConclusionWe provide a practical guide for AMD risk for ophthalmology practice and healthcare management and document a late AMD risk for individuals aged <55 years.

Photostress Recovery Time as a Potential Predictive Biomarker for Age-Related Macular Degeneration

“…All color fundus images were manually graded for AMD according to the well-established 3CACSS 5 by one experienced ophthalmologist with double grading by an additional independent grader as published previously. 6 , 26 Some limitations need to be acknowledged. We have only one measurement of PRT per participant and time point.…”

“…Color fundus photography of the central retina and assessment of AMD features were conducted as described previously 6 , 25 , 26 ; they were the same for the baseline and follow-up assessments. For each eye, presence, size and area of drusen, pigment abnormalities (hyperpigmentation or depigmentation), GA, or NV was determined using gradable color fundus images.…”

“…AugUR study participants were genotyped and genetic information was imputed as described previously. 26 In brief, based on 50 of 52 variants reported for late AMD, 27 we computed a genetic risk score (GRS) by adding the dosages of AMD risk alleles, weighed by the respective variant's published effect size. 27 …”

“…The target population of 70+ years had been chosen to enable the observation of incident AMD within a relatively short follow-up. In AugUR, we previously estimated early and late AMD prevalence 6 as well as incidence 26 using color fundus imaging. In this present analysis of a total of approximately 1800 individuals aged 70 to 98 years, we (i) investigated the association of PRT with AMD status cross-sectionally in two independent surveys, thus enabling replication.…”

“…In this present analysis of a total of approximately 1800 individuals aged 70 to 98 years, we (i) investigated the association of PRT with AMD status cross-sectionally in two independent surveys, thus enabling replication. (ii) Given the strong genetic influence on AMD, 27 we evaluated association of the AMD genetic risk score (GRS) 26 with PRT to substantiate the PRT association with AMD – rather than with age. (iii) We investigated the potential of PRT to predict late as well as early AMD, by longitudinal analyses in an independent subset of AugUR participants with 3-year follow-up.…”