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Jie Jin Wang, Nichole Diane Lucy Joachim, Christine Younan, George Burlutsky, Ching-Yu Cheng, Gemmy Chui Ming Cheung, Yingfeng Zheng, Mireille Moffitt, Tien Y Wong, Paul Mitchell; Ethnic Variation in the Distribution and Pattern of Early Age-related Macular Degeneration Lesions in Whites and Asians. Invest. Ophthalmol. Vis. Sci. 2014;55(13):6003.
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© ARVO (1962-2015); The Authors (2016-present)
To compare pattern, distribution and characteristics of early age-related macular degeneration (AMD) lesions between white and Asian populations.
Population-based, cross-sectional studies of the Blue Mountains Eye Study (BMES; whites, n=3508) and the Singapore Epidemiology of Eye Disease Study (SEED, Malay, n=3280, Indian, n=3400 and Chinese, n=3353) were included. Retinal photographs were taken at examination and comprehensive questionnaires were administered. AMD lesions were assessed from retinal images, following the Wisconsin AMD grading protocol. The prevalence of AMD lesions, frequency of bilateral involvement, and early AMD lesion characteristics were compared between the BMES and the SEED after age standardization. The associations between ethnicity and early AMD lesion types were analyzed using logistic regression models adjusting for age, sex and smoking (current or past).
Participants with early AMD were older and more likely to be women in the Australian compared to the Asian population. After age-standardization to the BMES population, the prevalence of distinct soft drusen was significantly higher in Asians compared to Australians (23.9%, 95% confidence interval (CI) 22.9-25.0 versus 6.2%, 95% CI 5.3-7.0), with an adjusted odds ratio (OR) 5.4 (95% CI 4.6-6.5). In contrast, the prevalence of indistinct soft or reticular drusen was lower in Asians compared to Australians (6.5%, 95% CI 5.9-7.1 versus 8.3%, 95% CI 7.4-9.3), though the adjusted OR 0.9 (95% CI 0.7-1.1) was not significant. Soft drusen of any type were frequently present at the inner macula (within a zone ≥500µm to <1500µm radius from the foveal centre) among Asians, while among Australians soft drusen were more frequently present at the central macula (<500µm radius) and more likely to involve a larger area than Asians. A smaller area of hyperpigmentation and location further from the fovea was more frequent in Asians compared to Australians.
A milder spectrum of early AMD lesions and lesion characteristics (predominantly distinct soft drusen and non-central location) was demonstrated in Asians compared to white Australians of similar age. These observations may reflect ethnic differences in risk factors and pathogenic pathways in AMD.
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