Abstract
Purpose:
To investigate the impact of severity of age-related macular degeneration (AMD) in the fellow eye on incidence, progression and regression of AMD.
Methods:
Analyses included 4,379 persons aged 43 to 86 years at the time of initial examination. AMD status in each eye was graded on a five-step severity scale from retinal photographs taken at up to 5 study visits between 1988 and 2010. Multi-state models in continuous time were used to model the effects of age, sex, complement factor H (CFH) genotype, and AMD severity in the fellow eye on incidence, progression, and regression of AMD and mortality.
Results:
More severe AMD in the fellow eye was associated with increased incidence of AMD (hazard ratio 4.90, 95% confidence interval 4.26-5.63) and progression of AMD (Level 2 to 3: 2.09, 1.42-3.06; Level 3 to 4: 2.38, 1.74-3.25; Level 4 to Late AMD: 2.46, 1.65-3.66), but not with regression of AMD. Less severe AMD in the fellow eye was associated with decreased progression of AMD (Level 2 to 3: 0.42, 0.33-0.55; Level 3 to 4: 0.50, 0.34-0.83) and increased regression of AMD (Level 3 to 2: 2.00, 1.12-3.58; Level 4 to 3: 8.97, 1.01-80.1). Older age was associated with increased incidence of AMD (1.40 per 10 years, 1.35-1.45), progression of AMD (Level 2 to 3: 1.28, 1.20-1.38; Level 3 to 4: 1.11, 1.04-1.19; Level 4 to Late AMD: 1.22, 1.11-1.33), regression of AMD (Level 2 to 1: 1.12, 1.05-1.20; Level 3 to 2: 1.17, 1.03-1.33) and mortality (1.67, 1.63-1.71). Male sex was associated with mortality (1.55, 1.42-1.68), but not with incidence, progression, or regression of AMD. CFH genotype CC was associated with increased incidence of AMD (1.94, 1.62-2.33), progression of AMD (Level 2 to 3: 1.63, 1.18-2.25; Level 4 to Late AMD: 1.57, 1.01-2.46), but not with regression of AMD or mortality relative to the TT genotype. Late AMD in both eyes was associated with increased mortality (1.28, 1.03-1.58).
Conclusions:
Using multi-state models, we show that AMD severity in one eye tracks AMD severity in its fellow eye.
Keywords: 412 age-related macular degeneration •
461 clinical (human) or epidemiologic studies: natural history •
463 clinical (human) or epidemiologic studies: prevalence/incidence