A comparison of risk factors for age-related macular degeneration and polypoidal choroidal vasculopathy in Chinese patients
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Neovascular age-related macular degeneration (nAMD) and polypoidal choroidal vasculopathy (PCV) are important vision-threatening diseases worldwide. For effective treatment, the risk factors for the diseases merit investigation. This study aimed to compare the risk factors for nAMD vs. PCV in Chinese patients.
A total of 946 participants were recruited in this case-control study, including 281 patients with nAMD, 306 patients with PCV, and 359 controls. All participants underwent comprehensive ophthalmic examinations. Information on risk factors were collected by questionnaire. Multivariate logistic regression analyses were performed to investigate the difference in risk factors between nAMD and PCV. In a subgroup of subjects, serum lipid data were obtained and analyzed.
Risk factors for nAMD included older age (OR 1.03, P = 0.001), male gender (OR 1.55, P = 0.020), asthma (OR 2.50, P = 0.028), smoking (OR 1.92, P = 0.001), and family history (OR 6.82, P = 0.001), while smoking (OR 1.67, P = 0.013) was the only risk factor for PCV. Compared to patients with PCV, patients with nAMD were more likely to be older and suffer from hyperlipidemia, coronary artery disease, rheumatism, and tumor. Interestingly, higher levels of high-density lipoprotein were positively associated with PCV in the subgroup analysis (OR 7.74, P = 0.011). Besides, results were quite different between the combination of patients with nAMD and PCV and patients with nAMD or PCV alone.
The risk factors for nAMD and PCV is varying with the exception of smoking. Our findings suggest that different strategies might be applied in the clinical management and scientific research on nAMD and PCV.
KeywordsAge-related macular degeneration Polypoidal choroidal vasculopathy Risk factor Asthma Hyperlipidemia
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.
- 2.Koh AH, Chen LJ, Chen SJ, Chen Y, Giridhar A, Iida T, Kim H, Yuk Yau Lai T, Lee WK, Li X, Han Lim T, Ruamviboonsuk P, Sharma T, Tang S, Yuzawa M (2013) Polypoidal choroidal vasculopathy: evidence-based guidelines for clinical diagnosis and treatment. Retina (Philadelphia, Pa) 33(4):686–716. https://doi.org/10.1097/IAE.0b013e3182852446 CrossRefGoogle Scholar
- 3.Costa RA, Navajas EV, Farah ME, Calucci D, Cardillo JA, Scott IU (2005) Polypoidal choroidal vasculopathy: angiographic characterization of the network vascular elements and a new treatment paradigm. Prog Retin Eye Res 24(5):560–586. https://doi.org/10.1016/j.preteyeres.2005.01.001 CrossRefPubMedGoogle Scholar
- 4.Laude A, Cackett PD, Vithana EN, Yeo IY, Wong D, Koh AH, Wong TY, Aung T (2010) Polypoidal choroidal vasculopathy and neovascular age-related macular degeneration: same or different disease? Prog Retin Eye Res 29(1):19–29. https://doi.org/10.1016/j.preteyeres.2009.10.001 CrossRefPubMedGoogle Scholar
- 11.Chakravarthy U, Wong TY, Fletcher A, Piault E, Evans C, Zlateva G, Buggage R, Pleil A, Mitchell P (2010) Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis. BMC Ophthalmol 10:31. https://doi.org/10.1186/1471-2415-10-31 CrossRefPubMedPubMedCentralGoogle Scholar
- 15.Klein R, Klein BE, Franke T (1993) The relationship of cardiovascular disease and its risk factors to age-related maculopathy. Beaver Dam Eye Study Ophthalmol 100(3):406–414Google Scholar
- 16.Chen X, Rong SS, Xu Q, Tang FY, Liu Y, Gu H, Tam PO, Chen LJ, Brelen ME, Pang CP, Zhao C (2014) Diabetes mellitus and risk of age-related macular degeneration: a systematic review and meta-analysis. PLoS One 9(9):e108196. https://doi.org/10.1371/journal.pone.0108196 CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Ueta T, Obata R, Inoue Y, Iriyama A, Takahashi H, Yamaguchi T, Tamaki Y, Yanagi Y (2009) Background comparison of typical age-related macular degeneration and polypoidal choroidal vasculopathy in Japanese patients. Ophthalmology 116(12):2400–2406. https://doi.org/10.1016/j.ophtha.2009.06.013 CrossRefPubMedGoogle Scholar
- 20.Cackett P, Yeo I, Cheung CM, Vithana EN, Wong D, Tay WT, Tai ES, Aung T, Wong TY (2011) Relationship of smoking and cardiovascular risk factors with polypoidal choroidal vasculopathy and age-related macular degeneration in Chinese persons. Ophthalmology 118(5):846–852. https://doi.org/10.1016/j.ophtha.2010.09.026 CrossRefPubMedGoogle Scholar
- 21.Woo SJ, Ahn J, Morrison MA, Ahn SY, Lee J, Kim KW, DeAngelis MM, Park KH (2015) Analysis of genetic and environmental risk factors and their interactions in Korean patients with age-related macular degeneration. PLoS One 10(7):e0132771. https://doi.org/10.1371/journal.pone.0132771 CrossRefPubMedPubMedCentralGoogle Scholar
- 22.Cheung CM, Laude A, Yeo I, Tan SP, Fan Q, Mathur R, Lee SY, Chan CM, Tan G, Lim TH, Cheng CY, Wong TY (2017) Systemic, ocular and genetic risk factors for age-related macular degeneration and polypoidal choroidal vasculopathy in Singaporeans. Sci Rep 7:41386. https://doi.org/10.1038/srep41386 CrossRefPubMedPubMedCentralGoogle Scholar
- 23.Bird AC, Bressler NM, Bressler SB, Chisholm IH, Coscas G, Davis MD, de Jong PT, Klaver CC, Klein BE, Klein R et al (1995) An international classification and grading system for age-related maculopathy and age-related macular degeneration. The International ARM Epidemiological Study Group. Surv Ophthalmol 39(5):367–374CrossRefPubMedGoogle Scholar
- 24.Japanese Study Group of Polypoidal Choroidal Vasculopathy (2005) Criteria for diagnosis of polypoidal choroidal vasculopathy. Nippon Ganka Gakkai Zasshi 109(7):417–427Google Scholar
- 25.Chakravarthy U, Augood C, Bentham GC, de Jong PT, Rahu M, Seland J, Soubrane G, Tomazzoli L, Topouzis F, Vingerling JR, Vioque J, Young IS, Fletcher AE (2007) Cigarette smoking and age-related macular degeneration in the EUREYE Study. Ophthalmology 114(6):1157–1163. https://doi.org/10.1016/j.ophtha.2006.09.022 CrossRefPubMedGoogle Scholar
- 26.Shahid H, Khan JC, Cipriani V, Sepp T, Matharu BK, Bunce C, Harding SP, Clayton DG, Moore AT, Yates JR (2012) Age-related macular degeneration: the importance of family history as a risk factor. Br J Ophthalmol 96(3):427–431. https://doi.org/10.1136/bjophthalmol-2011-300193 CrossRefPubMedGoogle Scholar
- 29.Sho K, Takahashi K, Yamada H, Wada M, Nagai Y, Otsuji T, Nishikawa M, Mitsuma Y, Yamazaki Y, Matsumura M, Uyama M (2003) Polypoidal choroidal vasculopathy: incidence, demographic features, and clinical characteristics. Arch Ophthalmol 121(10):1392–1396. https://doi.org/10.1001/archopht.121.10.1392 CrossRefPubMedPubMedCentralGoogle Scholar
- 32.Nakata I, Yamashiro K, Kawaguchi T, Gotoh N, Nakanishi H, Akagi-Kurashige Y, Miyake M, Tsujikawa A, Oishi A, Saito M, Iida T, Yamada R, Matsuda F, Yoshimura N (2013) Association between the cholesteryl ester transfer protein gene and polypoidal choroidal vasculopathy. Invest Ophthalmol Vis Sci 54(9):6068–6073. https://doi.org/10.1167/iovs.13-11605 CrossRefPubMedGoogle Scholar
- 33.Kikuchi M, Nakamura M, Ishikawa K, Suzuki T, Nishihara H, Yamakoshi T, Nishio K, Taki K, Niwa T, Hamajima N, Terasaki H (2007) Elevated C-reactive protein levels in patients with polypoidal choroidal vasculopathy and patients with neovascular age-related macular degeneration. Ophthalmology 114(9):1722–1727. https://doi.org/10.1016/j.ophtha.2006.12.021 CrossRefPubMedGoogle Scholar
- 34.Huang EJ, Wu SH, Lai CH, Kuo CN, Wu PL, Chen CL, Chen CY, King YC, Wu PC (2014) Prevalence and risk factors for age-related macular degeneration in the elderly Chinese population in south-western Taiwan: the Puzih eye study. Eye (London, England) 28(6):705–714. https://doi.org/10.1038/eye.2014.55 CrossRefGoogle Scholar
- 36.Zhang X, Li M, Wen F, Zuo C, Chen H, Wu K, Zeng R (2013) Different impact of high-density lipoprotein-related genetic variants on polypoidal choroidal vasculopathy and neovascular age-related macular degeneration in a Chinese Han population. Exp Eye Res 108:16–22. https://doi.org/10.1016/j.exer.2012.12.005 CrossRefPubMedGoogle Scholar
- 37.Tan CS, Ngo WK, Lim LW, Tan NW, Lim TH (2016) EVEREST study report 3: diagnostic challenges of polypoidal choroidal vasculopathy. Lessons learnt from screening failures in the EVEREST study. Graefes Arch Clin Exp Ophthalmol 254(10):1923–1930. https://doi.org/10.1007/s00417-016-3333-y CrossRefPubMedPubMedCentralGoogle Scholar
- 38.Tan CS, Ngo WK, Chen JP, Tan NW, Lim TH (2015) EVEREST study report 2: imaging and grading protocol, and baseline characteristics of a randomised controlled trial of polypoidal choroidal vasculopathy. Br J Ophthalmol 99(5):624–628. https://doi.org/10.1136/bjophthalmol-2014-305674 CrossRefPubMedPubMedCentralGoogle Scholar
- 40.Huang L, Zhang H, Cheng CY, Wen F, Tam PO, Zhao P, Chen H, Li Z, Chen L, Tai Z, Yamashiro K, Deng S, Zhu X, Chen W, Cai L, Lu F, Li Y, Cheung CM, Shi Y, Miyake M, Lin Y, Gong B, Liu X, Sim KS, Yang J, Mori K, Zhang X, Cackett PD, Tsujikawa M, Nishida K, Hao F, Ma S, Lin H, Cheng J, Fei P, Lai TY, Tang S, Laude A, Inoue S, Yeo IY, Sakurada Y, Zhou Y, Iijima H, Honda S, Lei C, Zhang L, Zheng H, Jiang D, Zhu X, Wong TY, Khor CC, Pang CP, Yoshimura N, Yang Z (2016) A missense variant in FGD6 confers increased risk of polypoidal choroidal vasculopathy. Nat Genet 48(6):640–647. https://doi.org/10.1038/ng.3546 CrossRefPubMedGoogle Scholar