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Nichole Joachim, Paul Mitchell, Gerald Liew, George Burlutsky, Harshil Dharamdasani, Bamini Gopinath; Smoking and the Clinical Features of Neovascular Age Related Macular Degeneration in a Clinic-Based Cohort. Invest. Ophthalmol. Vis. Sci. 2018;59(9):6012. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
There is limited knowledge of how smoking affects clinical features of neovascular age-related macular degeneration (nAMD). We aimed to assess the association of current smoking with (1) the age of onset of nAMD and (2) the presence of fluid and central macular thickness (CMT) in nAMD patients.
Cross-sectional analysis of a clinic-based cohort of 511 patients with nAMD, recruited from an eye clinic in Sydney Australia during 2012-2015. Clinical diagnosis of nAMD was confirmed by an ophthalmologist from retinal fundus photographs, fluoroscein angiography and optical coherence tomography (OCT) images. Smoking was determined from self-reported history as never smoked, past smoker (with both combined as non-smokers) and current smoker. Age of onset was defined as when the patient first experienced visual complaints of nAMD in either eye or date of first anti-vascular endothelial growth factor injection. Presence of intraretinal and subretinal fluid (IRF and SRF), pigment epithelial detachment (PED) and CMT were recorded from OCT images. Multivariable models adjusting for age, sex, ethnicity, body mass index, hypertension, presence of diabetes, self-rated health and alcohol consumption were constructed and means, odds ratios (ORs) and 95% confidence intervals (CIs) are presented.
In current smokers, nAMD onset occurred at an earlier age (<75 years), with the highest proportion of current smokers developing nAMD between 65 to 74 years (46.7% current smokers versus 22.2% non-smokers, p<0.0001). The age of nAMD onset among currently smoking men and women was similar (p=0.7). After multivariable adjustment, the mean age of nAMD onset was 71.1 years in current smokers versus 76.2 years in non-smokers (p=0.002). The presence of IRF (OR 1.7, 95% CI 0.7-4.4), SRF (OR 1.0, 95% CI 0.4-2.7) and PED (OR 2.1, 95% CI 0.8-5.2) was not significantly different in smokers compared to non-smokers. Adjusted mean CMT was significantly larger in smokers compared to non-smokers (289.2µm versus 242.0µm, respectively, p=0.03).
Onset of nAMD occurred approximately 5 years earlier in smokers compared to non-smokers. Smoking was also associated with increased retinal thickness. As this correlates with worse visual outcomes, it provides further evidence for promoting the cessation of smoking in patients being treated for nAMD.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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