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D.F. Martin, N.M. Bressler, S.B. Bressler, E.Y. Chew, T.E. Clemons, R. Klein, J.M. Seddon, AREDS Research Group; Risk Factors for the Incidence of Advanced Age-Related Macular Degeneration in the Age-Related Eye Disease Study (AREDS) . Invest. Ophthalmol. Vis. Sci. 2003;44(13):3077.
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Purpose: To describe the association of risk factors with the 6.3-year incidence of neovascular age-related macular degeneration (AMD) and geographic atrophy in AREDS. Methods: Incidence of neovascular AMD and of geographic atrophy was assessed in AREDS from stereoscopic color fundus photographs taken at baseline and at annual visits. Baseline risk factors were considered in 5 groups: demographic, medical history, use of medications and ocular (separating non-retinal from retinal). Staged model-building with repeated-measures logistic regression was used to identify and assess significant baseline risk factors separately for incident neovascular AMD and geographic atrophy, among 2,506 participants with 6.3 years average follow-up (maximum 8.1 years) at some risk of developing advanced AMD. Results: In multivariable models, while controlling for age and AREDS treatment group, the following variables were statistically significantly associated with the incidence of neovascular AMD: race (white vs black, OR 6.66, 95% CI: 1.23, 36.2), antacid use (OR 1.72, 95% CI: 1.00, 2.95), and amount smoked (>10 pack years vs #10 pack years, OR 1.48, 95% CI: 1.10, 1.98). Amount smoked (OR 1.93, 95% CI: 1.29, 2.88), greater body mass index (obese vs normal, OR 1.60, 95% CI: 1.02, 2.52), education (college grad. vs. high school grad. or less, OR 0.57, 95% CI: 0.34, 0.94), hormone replacement therapy use in women only (OR 0.52, 95% CI: 0.30, 0.90), and iris color (dark vs light, OR 0.37, 95% CI: 0.14, 0.99) were statistically significantly associated with the incidence of central geographic atrophy. When drusen area and pigmentary abnormalities were added to each model, few associations remained statistically significant. Increasing levels of drusen area were significantly associated with increasing risk of neovascular AMD (OR 1.3 to 7.2) and of central geographic atrophy (OR 3.7 to 14.0). Increasing levels of pigment abnormalities also showed increased risk of neovascular AMD (OR 2) and of central geographic atrophy (OR 3 to 21). Conclusions: These data identify several environmental and systemic exposures that are associated with the development of incident advanced AMD. Drusen area and pigment abnormalities are the most strongly associated risk factors.
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