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Zhe Liu, Amitha Domalpally, Barbara Blodi, Steven Bailey, Karen M. Gehrs, Ron Gangnon, Kim Wood, Tom Lawler, Yao Liu, Robert B Wallace, Cynthia Hurtenbach, Lesley Tinker, Courtney Blomme, Jennifer Maykoski, Julie A Mares; Ascertainment of Age-related Macular Degeneration (AMD) Status in the Second Carotenoids in Age-Related Eye Disease Study (CAREDS2), an Ancillary Study of the Women’s Health Initiative (WHI). Invest. Ophthalmol. Vis. Sci. 2021;62(8):178.
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We report a multi-pronged strategy for ascertaining AMD status in the CAREDS cohort and the prevalence of AMD in CAREDS2 (2016-2019).
AMD was assessed in CAREDS1 (2001-2004), primarily, from stereoscopic fundus photographs, among 2,005 women aged 53 to 86 years, who attended three study centers in the U.S. (Iowa, Oregon, and Wisconsin). Fifteen years later, in CAREDS2 639 women had died, and surviving women resided in 21 states, requiring updated protocols to assess AMD presence and severity. In CAREDS2 we ascertained AMD in 697 women who either participated in person (487), or by mail (198), or whose AMD status could be additionally assessed from Medicare billing records accessed via the WHI Virtual Data Enclave (12). A multipronged approach was used to reconcile AMD status for each woman, integrating AMD features from: 1) graded stereoscopic fundus photos taken in study visits, or by providers according to study specification, 2) spectral domain-optical coherence tomography (SD-OCT), 3) AMD features abstracted from medical records or questionnaires completed by providers, and from 4) International Classification of Diagnoses-10 codes for AMD in Medicare billing records.
In CAREDS2, participants aged 69 to 101 years, intermediate AMD (n=135) or late AMD (n=38) were identified from fundus photographs. SD-OCT captured an additional 55 women with intermediate AMD (large or reticular pseudodrusen or nascent geographic atrophy). Further capture of AMD outcomes from participants’ eyecare providers, either directly or via ICD-10 AMD diagnoses, increased the prevalence of documented clinically significant AMD by an additional 27 cases, for a total of 255 cases. Overall, 37% of women had either intermediate (n=202) or late AMD (n=53). The prevalence of clinically significant AMD (intermediate or late), by age tertile, was 30%, 44%, and 61%, in women <78, 73-83, and >83 years old, respectively.
The multi-pronged approach to ascertaining AMD prevalence, maximizes capture of clinically significant AMD outcomes, which steeply increased in prevalence with age in older women.
This is a 2021 ARVO Annual Meeting abstract.
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