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F. Choudhury, R. Klein, S. P. Azen, R. Varma, Los Angeles Latino Eye Study Group; Risk Factors Associated With Four-Year Incidence of Early Age Related Macular Degeneration: The Los Angeles Latino Eye Study (LALES). Invest. Ophthalmol. Vis. Sci. 2010;51(13):4538.
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To assess the impact of baseline socio-demographic, behavioral and clinical factors on the 4 year cumulative incidence of early age-related macular degeneration (AMD) in adult Latinos
The LALES is population-based longitudinal study of Latinos aged 40 years and older. Participants underwent standardized comprehensive ophthalmological examinations at baseline and at four years of follow-up. Early AMD was diagnosed from stereoscopic fundus photography using the Age-Related Eye Disease Study (AREDS) grading system. Early AMD was defined as any soft indistinct drusen or any drusen with pigmentary changes. Univariate and multivariate stepwise logistic regression were used to examine the association of incident early AMD and incident soft indistinct drusen and various baseline factors including age, gender, country of birth, acculturation, working status, years of education, marital status, income, insurance coverage; history of high blood pressure, history of heart attack, history of stroke, diabetes, pulse pressure, smoking and alcohol intake. Odds ratios (OR) for each of the significant variables were calculated.
Out of the 4568 people 4029 (88%) participant with gradable fundus photo at baseline and follow-up were included in this analysis. The 4-year incidence of early AMD and soft indistinct drusen was 6.9% and 2.2%. Multivariate analyses revealed that older age [OR=1.4 per decade of age] and retirement [OR=1.9] were independent risk indicators for early AMD. Native American ancestry was inversely associated with early AMD [OR= 0.2]. Independent risk factors for soft indistinct drusen included age [OR=1.7 per decade of age], male gender [OR=1.8] and higher pulse pressure [OR=2.7 for >=40 compared to <40(mmHg)].
While many risk factors are associated with early AMD and soft indistinct drusen, only elevated pulse pressure is a modifiable risk factor. Interventions aimed at reducing pulse pressure should be explored for the reduction in incidence of soft indistinct drusen as these drusen are most likely to progress to late vision threatening AMD.
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