Prevalence of age-related macular degeneration in a large European cohort: Results from the population-based Gutenberg Health Study
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The aim of this study was to describe the sex- and age-specific prevalence of age-related macular degeneration (AMD) and its correlation with urban or rural residence in a large and relatively young European cohort.
We evaluated fundus photographs from participants in the Gutenberg Health Study (GHS), a population-based, prospective, observational, single-centre study in the Rhineland-Palatine region in midwestern Germany. The participants were 35–74 years of age at enrolment. The fundus images were classified as described in the Rotterdam Study and were graded independently by two experienced ophthalmologists (CK and UBK) based on the presence of hard and soft drusen, retinal pigmentary abnormalities, and signs of atrophic or neovascular age-related macular generation (AMD).
Photographs from 4,340 participants were available for grading. Small, hard drusen (<63 μm, stages 0b and 0c) were present in 37.4 % of participants (95 % confidence interval [CI], stage 0b, 31.6 % [30.3–33.7]; stage 0c, 5.8 % [5.1–6.5]). Early AMD (soft drusen, pigmentary abnormalities, stages 1–3) was present in 3.8 % of individuals in the youngest age group (35–44 years) (95 % CI, stage 1a, 0.4 % [0.3–0.5 %]; stage 1b, 3.2 % [2.9–3.5 %]; stage 2a, 0.1 % [0.1–0.2 %]; stage 2b, 0 % [0–0.0 %]; stage 3, 0.1 % [0.1–0.2 %]), whereas late AMD (stages 4a and 4b) did not appear in the youngest age group. In all age groups, signs of early AMD were detected in 11.9 % of individuals (stage 1a, 2.1 % [1.7–2.6]; stage 1b, 8.0 % [7.2–8.8]; stage 2a, 1.0 % [0.7–1.3]; stage 2b, 0.5 % [0.3–0.7]; stage 3, 0.3 % [0.2–0.6]). Late AMD (geographic atrophy or neovascular AMD) was found in 0.2 % of individuals (stage 4a, 0.1 % [0.0–0.2]; stage 4b, 0.1 % [0.0–0.2]). AMD increased significantly with age (odds ratio [OR], 1.09; 95 % CI, 1.08–1.10). Sex, iris colour, and residence (rural vs. urban) were not associated with different rates of AMD.
In this study, the prevalence of AMD increased dramatically with age; however, although AMD is usually thought to occur after age 50, signs of early AMD were found in 3.8 % of individuals in the youngest age group (younger than 45 years). This population-based sample is the first to provide substantial epidemiologic data from a large German cohort, including data on macular degeneration in younger age groups and incidence data after recall.
KeywordsAge-related macular degeneration Age-related maculopathy Epidemiology Prevalence Population-based study
Philipp S. Wild is funded by the Federal Ministry of Education and Research (BMBF 01EO1003).
The Gutenberg Health Study is funded through the government of Rhineland-Palatine (“Stiftung Rheinland Pfalz für Innovation”, contract number AZ 961-386261/733); the research programs “Wissen schafft Zukunft” and “Schwerpunkt Vaskulaere Praevention” of the University Medical Center Mainz, Germany, and its contract with Boehringer Ingelheim, Germany; and PHILIPS Medical Systems, including an unrestricted grant for the Gutenberg Health Study. The Department of Ophthalmology received a grant from Novartis.
The sponsors and funding organisations did not play any role in the design or conduct of the presented study. All authors have full control of all primary data and they agree to allow Graefe’s Archive for Clinical and Experimental Ophthalmology to review their data if requested.
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