March 2012
Volume 53, Issue 14
Free
ARVO Annual Meeting Abstract  |   March 2012
Risk Characteristics Associated with Development of Geographic Atrophy: The Blue Mountains Eye Study Cohort
Author Affiliations & Notes
  • Nichole D. Joachim
    Centre for Vision Research, Dept Ophthalmology, University of Sydney, Sydney, Australia
  • Paul Mitchell
    Centre for Vision Research, Dept Ophthalmology, University of Sydney, Sydney, Australia
  • Annette Kifley
    Centre for Vision Research, Dept Ophthalmology, University of Sydney, Sydney, Australia
  • Thomas H. Hong
    Centre for Vision Research, Dept Ophthalmology, University of Sydney, Sydney, Australia
  • Jie J. Wang
    Centre for Vision Research, Dept Ophthalmology, University of Sydney, Sydney, Australia
    Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia
  • Footnotes
    Commercial Relationships  Nichole D. Joachim, None; Paul Mitchell, None; Annette Kifley, None; Thomas H. Hong, None; Jie J. Wang, None
  • Footnotes
    Support  NHMRC (Australia), grants 974159, 211069, 457349
Investigative Ophthalmology & Visual Science March 2012, Vol.53, 1327. doi:https://doi.org/
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      Nichole D. Joachim, Paul Mitchell, Annette Kifley, Thomas H. Hong, Jie J. Wang; Risk Characteristics Associated with Development of Geographic Atrophy: The Blue Mountains Eye Study Cohort. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1327. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose:
 

To report factors and early age-related macular degeneration (AMD) lesion characteristics associated with the long-term development of geographic atrophy (GA) in an older Australian sample.

 
Methods:
 

Of 3654 Blue Mountains Eye Study participants at baseline, 75.8%, 76.7% and 56.1% of survivors were re-examined at the 5-, 10- and 15-year follow-ups, respectively. Retinal photographs and comprehensive questionnaires were taken at each visit and genotyping performed on DNA samples of 1854 participants. Incident GA was confirmed using a side-by-side grading method (Wisconsin AMD grading protocol). Development of GA was assessed based on the Age-Related Eye Disease Study (AREDS) severity scale and lesion type, location and area within the macula. Incident pure GA (excluding neovascular AMD cases) was estimated using Kaplan-Meier product-limit survival estimates. Generalized estimating equation models were used for analysis of eye-specific data. Odds ratios (ORs) are reported after adjusting for age, current smoking status, regular fish consumption and CFH and ARMS2 risk alleles.

 
Results:
 

Incident GA was confirmed in 61 participants with an overall 15-year incidence of 3.8%. Incidence rates (and 95% confidence intervals, CI) by steps 0, 1, 2, 3 and 4 of the AREDS scale were 1.3% (CI 0.8-2.3), 8.9% (CI 4.4-17.8), 38.8% (CI 25.2-56.7), 19.8% (CI 6.0-54.4) and 100.0%, respectively, over a 15-year period. Risk factors identified were baseline age (OR 1.2, CI 1.2-1.3 per year older), current smoking (OR 4.8, CI 2.0-11.6), the CFH (OR 1.6, CI 1.0-2.6 per risk allele) and ARMS2 genes (OR 2.6, CI 1.5-4.4 per risk allele). Baseline early AMD lesion characteristics that predicted higher GA risk included drusen type (soft indistinct: OR 46.0, CI 14.9-141.9; and reticular drusen: OR 13.3, CI 3.9-45.0); central drusen location within 500µm radius of the fovea (OR 9.8, CI 4.4-21.5); drusen area greater than 375µm in diameter (OR 8.0, CI 2.8-22.6), the presence of retinal pigment epithelial depigmentation (OR 6.9, CI 2.5-19.1) and hyperpigmentation (OR 11.9, CI 5.5-25.5), referenced to the group with none or hard drusen only.

 
Conclusions:
 

We confirm a substantial high risk of developing GA associated with early AMD lesion characteristics, independent of age, smoking and AMD genetic susceptibility from the two major AMD genes (CFH and ARMS2).

 
Keywords: age-related macular degeneration • clinical (human) or epidemiologic studies: prevalence/incidence • clinical (human) or epidemiologic studies: risk factor assessment 
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