Four-Year Incidence and Progression of Age-Related Macular Degeneration: The Los Angeles Latino Eye Study

doi:10.1016/j.ajo.2010.01.009

American Journal of Ophthalmology

Volume 149, Issue 5, May 2010, Pages 741-751

https://doi.org/10.1016/j.ajo.2010.01.009 Get rights and content

Purpose

To estimate 4-year incidence and progression of early and advanced age-related macular degeneration (AMD).

Design

Population-based cohort study.

Methods

A comprehensive ophthalmologic examination including stereoscopic fundus photography was performed on adult Latinos at baseline and follow-up. Photographs were graded using a modified Wisconsin Age-Related Maculopathy Grading System. For estimations of incidence and progression of AMD, the Age Related Eye Disease Study Scale was used. Main outcome measures are incidence and progression of early AMD (drusen type, drusen size, and retinal pigmentary abnormalities) and advanced AMD (exudative AMD and geographic atrophy).

Results

A total of 4658 of 6100 subjects (76%) completed the follow-up examination. The 4-year incidence of early AMD was 7.5% (95% CI: 6.7, 8.4) and advanced AMD was 0.2% (95% CI: 0.1, 0.4). Progression of any AMD occurred in 9.2% (95% CI: 8.3, 10.1) of at-risk participants. Incidence and progression increased with age. Incidence of early AMD in the second eye (11.2%) was higher than incidence in the first eye (6.9%). Baseline presence of soft indistinct large drusen ≥250 μm in diameter was more likely to predict the 4-year incidence of pigmentary abnormalities, geographic atrophy, and exudative AMD than smaller or hard or soft distinct drusen.

Conclusions

Age-specific incidence and progression of AMD in Latinos are lower than in non-Hispanic whites. While incident early AMD is more often unilateral, the risk of its development in the second is higher than in the first eye. Older people and those with soft indistinct large drusen had a higher risk of developing advanced AMD compared to those who were younger and did not have soft indistinct large drusen.

Section snippets

Study Population

The Los Angeles Latino Eye Study is a population-based cohort study of eye disease in self-identified Latinos aged 40 years and older living in 6 census tracts in the city of La Puente, Los Angeles County, California. Latinos (Hispanics, Hispanic Americans, and Latino Americans) are individuals who are born into or have descended from a Spanish-speaking community, regardless of race. In the United States they are a heterogeneous group, with the majority of Mexican ancestry (66%). Baseline

Results

Of the 6100 living eligible participants identified, 4658 (76%) participated in the 4-year follow-up study. Mean follow-up period was 4.3 ± 0.03 years. Mean age of participants was 54.7 ± 10.5 years, 60% were female, and 76% were born outside of the United States. In this study, the country of origin was identified as Mexico in 64%, US in 24%, El Salvador in 5%, Guatemala in 2.5%, and Nicaragua 1%. Other countries were identified in 3.5% of participants. Living eligible participants who did not

Discussion

The Los Angeles Latino Eye Study (LALES) is the first longitudinal study to provide data on the incidence and progression of AMD and its associated lesions in a large, well-defined cohort of adult Latinos. The use of standardized protocols at both baseline and follow-up, particularly the identical grading procedure carried out by the same graders, ensured data compatibility between the 2 time points.

The LALES also used the AREDS classification scheme in describing AMD incidence and progression.

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To evaluate the association between age-related macular degeneration (AMD) and periodontal disease, two frequent conditions in the elderly, with some risk factors in common.
Single center, pilot, case-control study performed in a center specialized in the diagnosis and management of AMD. Periodontal status was evaluated in 43 AMD patients and 19 controls. Fundus examination and a complete periodontal examination were performed in all subjects.
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Incidence of Age-Related Macular Degeneration in a Multi-Ethnic United States Population the Multi-Ethnic Study of Atherosclerosis
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Citation Excerpt :
In MESA, while adjusting for other factors, the odds of developing early AMD were not significantly different between whites and Hispanics. In the population-based Los Angeles Latino Eye Study,11 the 4-year incidence of early AMD was 7.5% and late AMD was 0.2%, lower than that found in non-Hispanic whites in the Beaver Dam Eye Study or the Blue Mountains Eye Study.44,45 In the Los Angeles Latino Eye Study, the lower prevalence and incidence of late AMD were attributed to a lower frequency of persons homozygous for the CFH Tyr402His polymorphism variant, which was present in only 3% of the Mexican-American population compared with 9% to 21% of whites in the Beaver Dam Eye Study.
To describe the incidence of age-related macular degeneration (AMD) and associated risk factors in 4 racial/ethnic groups (white, black, Hispanic, and Chinese) residing in the United States.
Prospective cohort study.
A total of 3811 participants, aged 46 to 86 years, from the Multi-Ethnic Study of Atherosclerosis (MESA) cohort, with retinal data collected twice, on average, 8 years apart.
Fundus images, taken using a digital camera through dark-adapted pupils using a standard protocol and the same equipment at both study visits, were graded centrally for early and late AMD on the basis of drusen size, type and area, increased retinal pigment, retinal pigment epithelial depigmentation, neovascular lesions, and geographic atrophy using the modified Wisconsin Age-Related Maculopathy Grading System. Demographic, clinical, and laboratory measures were included in multivariable regression models to determine their impact on the variation in AMD incidence among racial/ethnic groups.
Incident early and late AMD.
The overall 8-year age- and sex-standardized incidence of early and late AMD were 4.1% and 2.3%, respectively, with incidence of early and late AMD highest in whites (5.3% and 4.1%, respectively), intermediate in Chinese (4.5% and 2.2%, respectively) and Hispanics (3.3% and 0.8%, respectively), and lowest in blacks (1.6% and 0.4%, respectively). By adjusting for age and sex, blacks had a 70% lower risk of developing early AMD than whites, and this decreased only slightly to a 67% lower risk after multivariable adjustment. By adjusting for age, sex, and race/ethnicity, hyperopia was associated with early AMD (odds ratio [OR], 1.51; 95% confidence interval [CI], 1.04–2.20), as was astigmatism (OR, 1.47; 95% CI, 1.00–2.16), but not myopia (P = 0.29). Age, race/ethnicity, current smoking, hyperopia, and AMD-susceptibility genotypes Complement Factor H (CFH) RS1061170 and Age Related Maculopathy Susceptibility 2 (ARMS2) RS3793917 were independently associated with incident early AMD in multivariable models for the combined sample. However, the only statistically significant factor consistently associated with incident early AMD across the 4 racial/ethnic groups was increasing age. Risk factors for late AMD were not assessed because of its low incidence, particularly across racial/ethnic groups.
Variation in the incidence of early AMD exists among racial/ethnic groups in the United States and is not explained by the clinical, genetic, and environmental factors included in this study.
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La rétine est le tissu neurosensoriel de l’œil qui assure la transduction visuelle, c’est-à-dire le codage de l’information lumineuse en influx nerveux. Le terme « rétine » regroupe l’association de la rétine neurale et de l’épithélium pigmentaire rétinien qui repose sur la membrane de Bruch. L’association physique de ces deux partenaires et leurs interactions métaboliques sont des éléments indispensables au bon fonctionnement de la rétine, à la fois en termes d’apport en nutriments et de maintien de l’homéostasie. Des dérèglements de ces équilibres sont associés au vieillissement et à des pathologies comme la dégénérescence maculaire liée à l’âge, première cause de malvoyance après 50 ans dans les populations occidentales. La rétine neurale est composée de plusieurs types cellulaires, incluant la glie dont le rôle est crucial pour la biosynthèse du cholestérol dans la rétine. Le cholestérol est le principal stérol de la rétine. Il y est présent au niveau cellulaire essentiellement en tant que cholestérol libre, et d’esters de cholestérol au niveau extracellulaire dans la membrane de Bruch. L’accumulation d’esters de cholestérol à ce niveau est un marqueur du vieillissement de la rétine et de la diminution de sa fonction. Soumis à l’influence alimentaire et synthétisé localement, le cholestérol est également régulé via ses interactions avec les différentes populations cellulaires de la rétine, et en particulier celles qui font intervenir les communications neurones/glie via la cholestérol 24S-hydroxylase (CYP46A1). Des liens physiopathologiques entre le métabolisme du cholestérol et les glaucomes ou la dégénérescence maculaire liée à l’âge (DMLA) sont avancés.
The retina is the neurosensory tissue at the posterior pole of the eye that encodes the visual transduction pathway, i.e. codes light into a nervous signal. The retina is the association of the neural retina and the retinal pigment epithelium that lays on Bruch's membrane. The physical association between these two partners and their metabolic interactions are required for the functioning of the retina, including the intake of nutrients in the retina and the maintenance of its homeostasis. Dysregulations of these equilibriums are involved in the aging processes and related diseases such as age-related macular degeneration, the leading cause of visual loss after the age of 50 years in Western populations. The retina is composed of various cell types, including glia which role is crucial for cholesterol biosynthesis in the retina. Cholesterol is the main sterol in the retina. It is mainly present as free form and as cholesteryl esters in Bruch's membrane. The extracellular accumulation of cholesteryl esters thereof is a hallmark of aging of the retina and associated to the loss of its function. Being of dietary origin and synthesized in situ, cholesterol is regulated via the interactions between retinal cells, including communications between neurons and glia and cholesterol 24S-hydroxylase (CYP46A1). Pathophysiological associations can be suggested between cholesterol homeostasis and glaucoma or age-related macular degeneration.
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To investigate the incidence and progression of age-related macular degeneration (AMD) and associated risk factors.
Population-based, prospective, cohort study.
We included 2868 participants from the Age Gene/Environment Susceptibility-Reykjavik Study with retinal data at baseline and 5-year follow-up.
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.
We assessed AMD, defined as early or late.
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/m²; 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).
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Original articleFour-Year Incidence and Progression of Age-Related Macular Degeneration: The Los Angeles Latino Eye Study

Purpose

Design

Methods

Results

Conclusions

Section snippets

Study Population

Results

Discussion

Am J Ophthalmol

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Am J Ophthalmol

Ophthalmology

Ophthalmology

Ophthalmology

Original article
Four-Year Incidence and Progression of Age-Related Macular Degeneration: The Los Angeles Latino Eye Study