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Chandana Papudesu, Traci E Clemons, Elvira Agron, Emily Chew; The Association of Mortality with Age-Related Macular Degeneration and Cataract Surgery in AREDS2.. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1338. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the association of mortality with ocular diseases (including cataract surgery and late age-related macular degeneration [AMD]) and visual acuity (VA).
Participants with at least intermediate AMD were enrolled in a randomized controlled clinical trial of lutein plus zeaxanthin and/or omega-3 fatty acids, the Age-Related Eye Disease Study 2 (AREDS2) for treatment of AMD and cataract. Comprehensive eye exams that included best-corrected visual acuity (BCVA) assessments, slit lamp examinations, and stereoscopic fundus photographs were conducted at baseline and annual study visits. A central reading center determined the development of late AMD (central geographic atrophy or neovascular AMD). Cause-specific mortality was determined based on ICD-9 or ICD-10 codes. Risk of all-cause and cause-specific mortality was assessed with Cox proportional hazards model adjusted for age, sex, AMD severity, VA, history of cataract surgery, and assigned AREDS treatment. Analyses included race, education, smoking status, diabetes, and cardiovascular disease as baseline covariates.
During follow-up (median of 5 years), 368 (9%) of the 4203 AREDS2 participants died. Participants with late AMD in 1 eye at baseline had a statistically significant increased risk for mortality compared to participants with few if any drusen (risk ratio [RR] 1.52, 95% confidence interval [CI], 1.06-2.02). Poorer survival was associated with bilateral cataract surgery compared to no surgery (RR, 1.61; 95% CI 1.27-2.04) and bilateral BCVA <20/40 compared to participants with bilateral BCVA ≥ 20/40 (RR, 1.47; 95% CI, 1.00-2.16) in analyses adjusted for age, gender and statistically significant covariates. The association between all-cause mortality and AREDS2 treatment whether assessing the main or individual treatment effect was not significantly different [omega-3 fatty acids main effect RR 1.19, 95% CI 0.97-1.46; lutein/zeaxanthin main effect RR 1.03, 95% CI 0.84-1.27].
In the AREDS2 population, the development of late AMD, bilateral cataract surgery and visual acuity <20/40 were associated with decreased survival. However, oral supplementation with omega-3, lutein/zeaxanthin, zinc, or beta-carotene had no statistically significant impact on mortality.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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