Abstract
Purpose :
The pathogenesis of age-related macular degeneration (AMD) involves aberrant complement activation and is a leading cause of vision loss worldwide. Complement aberrations are also implicated in the development of many autoimmune diseases, but the relationship between AMD and these conditions remains undescribed. This study assesses the association between AMD and several complement-mediated autoimmune diseases.
Methods :
This study used de-identified data from the national TriNetX database (2006-2023), using ICD10 codes to select for autoimmune diseases associated with complement aberration. A control cohort was generated by identifying patients with a diagnosis of cataract, but no history of AMD, ensuring that the control patients had an exam by an ophthalmologist. Propensity score matching was used to match the cohorts on age, sex, race, and ethnicity. Odds ratios and 95% confidence intervals (CI) were generated for each autoimmune disease and compared between AMD and control patients. Additional analyses were conducted by AMD stage, dichotomized to early/intermediate AMD and advanced AMD (geographic atrophy and neovascular AMD).
Results :
After propensity-score matching, the AMD cohort (n = 140,207) had a mean age of 76 (SD=11.4) and was 60% female and the control cohort (n = 140,207) also had a mean age of 76 (SD=11.4) and was 60% female. AMD was associated with systemic lupus erythematosus (OR 1.24, 95% CI 1.12 - 1.38, p < 0.001), Crohn’s disease (OR 1.35, 95% CI 1.22 – 1.50, p < 0.001), ulcerative colitis (OR 1.19, 95% CI 1.10 – 1.29, p < 0.001), rheumatoid arthritis (OR 1.15, 95% CI 1.10 – 1.20, p < 0.001), and psoriasis (OR 1.12, 95% CI 1.09 – 1.27, p < 0.001). Associations were also seen with several types of vasculitis including antineutrophilic cytoplasmic antibody vasculitis (OR 1.30, 95% CI 1.03 – 1.64, p = 0.03), giant cell arteritis (1.14, 95% CI 1.03 – 1.27, p = 0.009), and unclassified necrotizing vasculitis (OR 1.12, 95% CI 1.02 – 1.22, p = 0.01). Early/intermediate AMD showed the same associations as the overall AMD cohort. Advanced AMD showed a positive association with Crohn’s disease (OR 1.40, p<0.001), but an inverse relationship with Sjogren’s syndrome (OR 0.78, p<0.001).
Conclusions :
AMD is associated with common systemic autoimmune diseases. Since these diseases tend to co-occur, these patients may benefit from closer screening and monitoring.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.