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Ronald Gangnon, Kristine E Lee, Barbara E K Klein, Sudha K Iyengar, Theru A Sivakumaran, Ronald Klein; Impact of Fellow Eye on Incidence, Progression and Regression of Age-Related Macular Degeneration: Results from Multi-state Models Applied to the Beaver Dam Eye Study. Invest. Ophthalmol. Vis. Sci. 2014;55(13):6004.
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To investigate the impact of severity of age-related macular degeneration (AMD) in the fellow eye on incidence, progression and regression of AMD.
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.
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).
Using multi-state models, we show that AMD severity in one eye tracks AMD severity in its fellow eye.
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