Abstract
Purpose: :
To describe the 20-year cumulative incidence of macular holes and associated risk factors in a population-based study.
Methods: :
Of 4,926 persons, 43-86 years of age at the time of a baseline examination in 1988-1990, living in Beaver Dam, Wisconsin, 3,684, 2,764, 2,119, and 1,913 participated in 5, 10, 15, and 20-year follow-up examinations, respectively. The presence of macular holes was determined by grading of stereoscopic color film fundus photographs. A standardized protocol including height, weight, blood pressure (BP), intraocular pressure (IOP), blood studies and medical history was performed at each examination.
Results: :
Of the 4813 participants with gradable fundus photographs seen at baseline, 12 had a full thickness macular hole (FTH) all monocular; 4 had a partial thickness macular hole (PTH), 3 monocular, 1 binocular. There were 17 incident cases of FTH (20-year cumulative incidence 0.55%; 95% CI: 0.29% - 0.81%; 14 monocular, 3 binocular) and 29 incident cases of PTH (20-year CI 1.10%; 95% CI: 0.70% - 1.50%; 26 monocular, 3 binocular). No eyes with PTH went on to develop FTH. Incidence of a FTH was associated (presented as odds ratio, 95% CI) with older age (1.19 per 5 years; 1.08 - 1.31), and after controlling for age, with higher log C-reactive protein (CRP, 2.45 per log mg/L, 1.81 - 3.33). Incidence of a PTH was associated with older age (1.37 per 5 years, 1.22 - 1.54) and after controlling for age, with higher BMI (1.07 per kg/m2, 1.01 - 1.14), hypertension vs normotension (6.39, 1.92 - 20.94), more hyperopic refraction (1.18 per diopter 1.03 - 1.36), higher total/HDL cholesterol ratio (1.20 per order of magnitude difference, 1.10 - 1.32), and presence of an epiretinal membrane (13.31 present vs not present, 5.72 - 30.93), history of cataract surgery (3.31 present vs not present, 1.09 - 10.01), and higher white blood cell (WBC) count (1.28 per 1000/μL, 1.15 - 1.42) and log CRP (3.36 per log mg/L, 2.24 - 5.02). Both types of holes were associated with poor visual acuity. Eighty five percent of eyes with a FTH, and 30% of eyes with a PTH, had visual acuity worse than 20/40 compared to only 9.5% of eyes without a macular hole.
Conclusions: :
These data show a relation of age and CRP and WBC count, two markers of inflammation, to the incidence of macular holes.