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Mortazavi A, Hashemi A, Jamali A, Hashemi H, Aghamirsalim M, Khabazkhoob M. Prevalence of retinal pathologies in people over 60 years: the Tehran Geriatrics Eye Study. Int J Ophthalmol 2024; 17:721-728. [PMID: 38638250 PMCID: PMC10988065 DOI: 10.18240/ijo.2024.04.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 11/20/2023] [Indexed: 04/20/2024] Open
Abstract
AIM To determine the prevalence of some retinal pathologies in people over 60y and their association with demographic and ocular factors. METHODS A cross-sectional study was conducted in Tehran using multistage cluster sampling. After selecting subjects aged 60 and over, optometric, and ophthalmic examinations were done. For retinal examination, a 90 D lens was used and indirect ophthalmoscopy was performed after instilling tropicamide drops. Biometry was done using the IOL Master for all participants. RESULTS Of 3791 people that were invited through cluster sampling, 3310 participated in the study (response rate=82%). The prevalence of retinal pigmented epithelium (RPE) change, drusen, geographic atrophy (GA), hypertensive retinopathy (HTR), nonproliferative diabetic retinopathy (NPDR), proliferative diabetic retinopathy (PDR), choroidal neovascularization (CNV), central retinal artery occlusion (CRAO), myopic retinopathy (MR), branch retinal vein occlusion (BRVO), and central retinal vein occlusion (CRVO) was 27.42%, 11.08%, 4.52%, 3.03%, 4.05%, 0.54%, 0.82%, 0.39%, 0.20%, 0.49%, and 0.19%, respectively. After removing the effect of age, the odds of NPDR were 1.68 times higher in women compared to men (P=0.014). After removing the effect of sex, the odds of drusen, RPE change, GA, CNV, BRVO, and CRVO increased with age. CONCLUSION There is a higher prevalence of RPE change, drusen, GA, CNV and a lower prevalence of MR and CRAO in the elderly population of Tehran aged over 60y compared to global average values. Considering the correlation of most of the diseases with age and their effects on vision, attention should be paid to these diseases and the related screening programs to prevent vision impairment.
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Affiliation(s)
- Abolghasem Mortazavi
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran 1416753955, Iran
| | - Alireza Hashemi
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran 1983963113, Iran
| | - Alirerza Jamali
- Rehabilitation Research Center, Department of Optometry, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran 1545913487, Iran
| | - Hassan Hashemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran 1983963113, Iran
| | - Mohammadreza Aghamirsalim
- Translational Ophthalmology Research Center, Tehran University of Medical Sciences, Tehran 1157715354, Iran
| | - Mehdi Khabazkhoob
- Department of Basic Sciences, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran 1968653111, Iran
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Association between Cataract Surgery and Age-Related Macular Degeneration: A Systematic Review and Meta-Analysis. J Ophthalmol 2022; 2022:6780901. [PMID: 35573811 PMCID: PMC9098349 DOI: 10.1155/2022/6780901] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 01/24/2022] [Accepted: 04/01/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose We performed a systematic review and meta-analysis to evaluate the association between cataract surgery and the development and progression of AMD. Methods This meta-analysis was registered at PROSPERO (CRD42017077962). We conducted a systematic literature search in August 2020 in Embase and PubMed and included cohort studies, case-control studies, or randomized controlled trials (RCTs) if they examined the association between cataract surgery and AMD. Odds ratio (OR) was used as a measure of the association with a random effect model. The analysis was further stratified by factors that could affect the outcomes. Results 15 studies were included in this study. In the overall analysis, cataract surgery was significantly associated with the incidence of late AMD (OR, 1.80; 95% CI, 1.26–2.56; P = 0.001), particularly geographic atrophy (OR, 3.20; 95% CI, 1.90–5.39; P ≤ 0.001). No significant associations were observed between cataract surgery and the incidence of early AMD. Subgroup analysis showed that the OR for incidence of early and late AMD was significantly higher for cataract surgery performed more than 5 years compared with less than 5 years. We also found an increased risk of progression of AMD after cataract surgery performed more than 5 years (OR, 1.97; 95% CI, 1.29–3.01; P = 0.002). Conclusions Our results suggest that cataract surgery may be associated with an increased risk of late AMD development and AMD progression. In addition, increasing the follow-up time since cataract surgery may further increase the risk for the development and progression of AMD. In the future, prospective multicenter studies with well-designed RCTs are required to confirm our findings.
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Bhandari S, Vitale S, Agrón E, Clemons TE, Chew EY. Cataract Surgery and the Risk of Developing Late Age-Related Macular Degeneration: The Age-Related Eye Disease Study 2 Report Number 27. Ophthalmology 2021; 129:414-420. [PMID: 34793832 DOI: 10.1016/j.ophtha.2021.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/06/2021] [Accepted: 11/09/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To evaluate the risk of developing late age-related macular degeneration (AMD) following incident cataract surgery. DESIGN A prospective cohort study within a randomized controlled clinical trial of oral supplementation for the treatment of AMD - the Age-Related Eye Disease Study 2 (AREDS2). PARTICIPANTS AREDS2 participants aged 50 to 85 years with either bilateral large drusen or unilateral late AMD. METHODS In eyes that were free of cataract surgery and late AMD at baseline, two groups were compared for incident late AMD: 1) eyes that received cataract surgery after the baseline visit and before any evidence of late AMD and 2) eyes that remained phakic until the study completion. Eyes that had at least 2 years of follow-up after cataract surgery were included in the analysis. We used Cox regression models, matched-pairs analysis, and logistic regression models that were adjusted for baseline age, sex, smoking, education, study treatment group, and AMD severity. MAIN OUTCOME MEASURES Late AMD was defined as the presence of geographic atrophy or neovascular AMD detected on annual stereoscopic fundus photographs or as documented by medical records, including intravitreous injections of anti-vascular endothelial growth factor medication. RESULTS A total of 1767 eligible eyes (1195 participants) received cataract surgery and 1981 eyes (1524 participants) developed late AMD during a mean (range) follow-up of 9 (1 - 12) years. The Cox regression model showed no increased risk of developing late AMD after cataract surgery: hazard ratios (Confidence Interval [CI]): 0.96 (0.8,1.13; p = 0.60) for the right eye and 1.05 (0.89,1.25; p = 0.56) for the left eye. Of the matched pairs, late AMD was identified in 412 eyes that received cataract surgery and in 433 phakic controls, resulting in an odds ratio (95% CI) of 0.92 (0.77,1.10; p = 0.34). The risk of late AMD after cataract surgery from the logistic regression model was not statistically significant (risk ratio [95%CI]: 0.92 [0.56,1.49], p = 0.73). CONCLUSIONS Cataract surgery did not increase the risk of developing late AMD among the AREDS2 participants with up to 10 years of follow-up. This study provides data for counselling AMD patients who might benefit from cataract surgery.
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Affiliation(s)
- Sanjeeb Bhandari
- Clinical Trials Branch, Division of Epidemiology and Clinical Applications, National Eye Institute/National Institutes of Health, Bethesda, Maryland
| | - Susan Vitale
- Clinical Trials Branch, Division of Epidemiology and Clinical Applications, National Eye Institute/National Institutes of Health, Bethesda, Maryland
| | - Elvira Agrón
- Clinical Trials Branch, Division of Epidemiology and Clinical Applications, National Eye Institute/National Institutes of Health, Bethesda, Maryland
| | | | - Emily Y Chew
- Clinical Trials Branch, Division of Epidemiology and Clinical Applications, National Eye Institute/National Institutes of Health, Bethesda, Maryland.
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Korb CA, Elbaz H, Schuster AK, Nickels S, Ponto KA, Schulz A, Wild PS, Münzel T, Beutel ME, Schmidtmann I, Lackner KJ, Peto T, Pfeiffer N. Five-year cumulative incidence and progression of age-related macular degeneration: results from the German population-based Gutenberg Health Study (GHS). Graefes Arch Clin Exp Ophthalmol 2021; 260:55-64. [PMID: 34424371 PMCID: PMC8763742 DOI: 10.1007/s00417-021-05312-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/23/2021] [Accepted: 07/01/2021] [Indexed: 11/05/2022] Open
Abstract
Purpose Age-related macular degeneration (AMD) is a major cause of visual impairment and blindness. This study evaluates the incidence and progression of AMD in a large German cohort. Methods The Gutenberg Health Study (GHS) is a population-based, prospective, observational cohort study in Germany that includes 15,010 participants between 35 and 74 years of age. The baseline examination, including fundus photography, was conducted between 2007 and 2012, and the 5-year follow-up examination was performed between 2012 and 2017. AMD grading of fundus photographs was performed according to the Rotterdam Eye Study classification. The 5-year cumulative incidence and progression of AMD were calculated. Poisson regression analysis was conducted to investigate factors associated with the cumulative incidence and progression of AMD. Results Six-thousand-eight-hundred-eighty-eight participants (49.8%, n = 3427 female) were included in the analysis. AMD prevalence was 8.5% [95% CI: 7.9–9.2%] at baseline and 10.3% [95% CI: 9.6–11.1%] at follow-up. The cumulative 5-year-incidence was 2.0% [1.7–2.4%]. AMD progression within 5 years was seen in 18.1% [95% CI: 15.1–21.5%] of the participants. AMD incidence and AMD progression were associated with higher age, for each 10-year increase in age, the risk of AMD doubles (RR = 2.30), and the risk of progression of the disease is increased by 1.6. while AMD incidence also with pseudophakic status. Conclusions In summary, this population-based sample provides substantial epidemiologic data from a large German cohort, including data on progression and cumulative incidence of macular degeneration in younger age groups. AMD progression over 5 years is common in the German population, 18.1% of subjects with AMD showed progression in at least one eye in this time frame and is associated with higher age. Nevertheless, although usually defined to occur over the age of 50, in this cohort AMD occurred in 0.5% and AMD progression occurred in 5.4% of those already affected in the youngest age group before 50 years of age.
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Affiliation(s)
- Christina A Korb
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
| | - Hisham Elbaz
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.,Department of Ophthalmology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Alexander K Schuster
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Stefan Nickels
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Katharina A Ponto
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.,Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Andreas Schulz
- Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Philipp S Wild
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.,Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Thomas Münzel
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany.,Center for Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Irene Schmidtmann
- Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Karl J Lackner
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany.,Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Tunde Peto
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.,Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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Madeira C, Godinho G, Vilares-Morgado R, Beato J, Pinheiro-Costa J, Carneiro Â, Falcão-Reis F, Falcão M. Long-term progression of geographic atrophy in age-related macular degeneration does the phakic status matter? Graefes Arch Clin Exp Ophthalmol 2021; 259:3711-3719. [PMID: 34169351 DOI: 10.1007/s00417-021-05255-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/25/2021] [Accepted: 05/26/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To assess the long-term risk of geographic atrophy (GA) progression after cataract surgery. METHODS Subjects with GA secondary to AMD followed for at least 1 year with fundus autofluorescence imaging and with at least two visits at our centre were included. Patients with wet AMD, disciform scar, past history of intravitreal injections or laser treatment, other maculopathies and with poor quality images were excluded. GA area at baseline and at follow-up visit was measured. Three study groups were defined according to their phakic status: (A) pseudophakia, (B) phakic and (C) phacoemulsification surgery performed during the study. Differences of GA area progression were compared between these study groups. In addition, comparison between GA progression rate in group (C) before and after the surgery was performed. The enlargement rate (ER) was calculated for lesion size after transforming the measurements to the square-root scale. RESULTS A total of 92 eyes of 92 patients were enrolled. Median follow-up time was 4 [1-10] years. Regarding the eye's phakic status, 29 (31.5%) were pseudophakic and 63 (68.5%) were phakic; of these, 22 underwent phacoemulsification during the study. Overall, the median baseline and follow-up area of GA were 1.42 [0.04-32.10] mm2 and 6.48 [0.25-47.40] mm2, respectively. The ER was similar between phakic and pseudophakic eyes (0.18 [0.01-1.03] vs 0.15 [0.01-0.65] mm/year, p = 0.62). In patients that underwent cataract surgery during the study, the GA ER remained stable (0.13 [0.01-0.92] vs 0.14 [0.01-0.63] mm/year, p = 0.43). CONCLUSION These results suggest that cataract surgery does not increase the risk of pre-existing GA progression. Therefore, cataract surgery seems safe and a potential therapeutic weapon to improve visual acuity and consequently quality of life in GA patients.
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Affiliation(s)
- Carolina Madeira
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal.
| | - Gonçalo Godinho
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Rodrigo Vilares-Morgado
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - João Beato
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| | - João Pinheiro-Costa
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Ângela Carneiro
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Manuel Falcão
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
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Westborg I, Albrecht S, Granstam E, Karlsson N, Kugelberg M, Lundström M, Montan P, Behndig A. Treatment of age-related macular degeneration after cataract surgery: a study from the Swedish National Cataract and Macula Registers. Acta Ophthalmol 2021; 99:e124-e129. [PMID: 32573070 DOI: 10.1111/aos.14519] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 05/26/2020] [Indexed: 01/25/2023]
Abstract
PURPOSE To characterize pre- and perioperative factors associated with treatment for wet age-related macular degeneration (wet AMD) after cataract surgery. METHODS This register-based cohort study with data from the Swedish National Cataract Register (NCR) and the Swedish Macula Register (SMR) from 2010 to 2017 compared eyes with and without preoperative AMD that had undergone cataract surgery and was subsequently treated for wet AMD to eyes not treated within the study period. All first-eye surgeries registered in the NCR from 2010 to 2017 and matching eyes found in the SMR that had undergone treatment for wet AMD ≥ 1 year after the cataract procedure were included. Data for cataract surgery date, age and gender, use of a blue-blocking IOL, preoperative visual acuity, ocular comorbidities, posterior capsule rupture and date of AMD treatment initiation were extracted. RESULTS The only independent factor associated with postoperative treatment of wet AMD in both groups was female gender (67.3% vs. 58.8%, p < 0.001 and 66.4% vs. 60.6%, p = 0.001, respectively). Older age was an independent factor in eyes without preoperative AMD (78.4 ± 6.5 vs. 73.4 ± 9.6 years, p < 0.001). A blue-blocking IOL appeared to decrease the likelihood of subsequent wet AMD treatment slightly but not statistically significant in eyes with preoperative AMD (52.7% vs. 56.8%, p = 0.110). CONCLUSIONS Some factors (female gender, high age) are associated with undergoing subsequent treatment for wet AMD to a higher extent. If the use of a blue-blocking IOL offers any protection from undergoing AMD treatment after cataract surgery, such an effect must be very small.
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Affiliation(s)
- Inger Westborg
- Department of Clinical Sciences/Ophthalmology Umeå University Hospital Umeå Sweden
| | | | | | | | | | - Mats Lundström
- Department of Clinical Sciences Ophthalmology Faculty of Medicine Lund University Lund Sweden
| | - Per Montan
- St. Erik Eye HospitalKarolinska Institutet Stockholm Sweden
| | - Anders Behndig
- Department of Clinical Sciences/Ophthalmology Umeå University Hospital Umeå Sweden
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Zhu Z, Wang W, Liao H, Keel S, Zhang J, He M. Cross-sectional study of the association between cataract surgery and age-related macular degeneration in the era of phacoemulsification in the national health and nutrition examination survey 2005-2008. BMJ Open 2020; 10:e032745. [PMID: 32895258 PMCID: PMC7477991 DOI: 10.1136/bmjopen-2019-032745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To determine the association between cataract surgery and age-related macular degeneration (AMD) in a representative US sample. DESIGN Population-based, cross-sectional study. SETTING The US National Health and Nutrition Examination Survey 2005-2008. PARTICIPANTS A total of 5401 participants aged ≥40 years had information in cataract surgery status and gradable retinal photographs for right eyes. METHODS Cataract surgery status was obtained from questionnaire. Non-mydriatic fundus photographs were collected and AMD status was assessed. The associations between AMD and cataract surgery were evaluated in right eyes using logistic regression models. RESULTS Of 338 right eyes with any AMD, 107 right eyes (28.9%) had cataract surgery. After adjusting for multiple variables, there were significant associations between cataract surgery and any AMD (OR 1.36; 95% CI 1.03 to 1.81) or late AMD (OR 2.48; 95% CI 1.01 to 6.09). No significant association was found between cataract surgery and early AMD after adjusting for multiple covariates (OR 1.20; 95% CI 0.91 to 1.59). CONCLUSION Our results suggest that cataract surgery is associated with the presence of AMD, particularly for late AMD. Longitudinal studies investigating the risk and progression of AMD after cataract surgery are needed in the era of phacoemulsification.
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Affiliation(s)
- Zhuoting Zhu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Huan Liao
- Neural Regeneration Group, Institute of Reconstructive Neurobiology, University of Bonn, Bonn, Germany
| | - Stuart Keel
- Centre for Eye Research, Melbourne University, East Melbourne, Victoria, Australia
| | - Jian Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Mingguang He
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Centre for Eye Research, Melbourne University, East Melbourne, Victoria, Australia
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Wood A, Guggenheim JA. Refractive Error Has Minimal Influence on the Risk of Age-Related Macular Degeneration: A Mendelian Randomization Study. Am J Ophthalmol 2019; 206:87-93. [PMID: 30905725 DOI: 10.1016/j.ajo.2019.03.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 03/11/2019] [Accepted: 03/11/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To test the hypothesis that refractive errors such as myopia and hyperopia cause an increased risk of age-related macular degeneration (AMD) and to quantify the degree of risk. DESIGN Two-sample Mendelian randomization analysis of data from a genome-wide association study. PARTICIPANTS As instrumental variables for refractive error, 126 genome-wide significant genetic variants identified by the Consortium for Refractive Error and Myopia and 23andMe Inc. were chosen. The association with refractive error for the 126 variants was obtained from a published study for a sample of 95,505 European ancestry participants from UK Biobank. Association with AMD for the 126 genetic variants was determined from a genome-wide association study (GWAS) published by the International Age-related Macular Degeneration Genomics consortium of 33,526 (16,144 cases and 17,832 controls) European ancestry participants. METHODS Two-sample Mendelian randomization (MR) analysis was used to assess the causal role of refractive error on AMD risk, using the 126 genetic variants associated with refractive error as instrumental variables, under the assumption that the relationship between refractive error and AMD risk is linear. MAIN OUTCOME MEASUREMENT the risk AMD was caused by a 1-diopter (D) change in refractive error. RESULTS MR analysis suggested that refractive error had very limited influence on the risk of AMD. Specifically, 1 D more hyperopic refractive error was associated with an odds ratio (OR) of 1.080 (95% confidence interval [CI], 1.021-1.142; P = 0.007) increased risk of AMD. MR-Egger, MR pleiotropy residual sum and outlier, weighted median, and Phenoscanner-based sensitivity analyses detected minimal evidence to suggest that this result was biased by horizontal pleiotropy. CONCLUSIONS Under the assumption of a linear relationship between refractive error and the risk of AMD, myopia and hyperopia only minimally influence the causal risk for AMD. Thus, inconsistently reported strong associations between refractive error and AMD are likely to be the result of noncausal factors such as stochastic variation, confounding, or selection bias.
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Affiliation(s)
- Ashley Wood
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, Wales, United Kingdom.
| | - Jeremy A Guggenheim
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, Wales, United Kingdom
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Pan CW, Zhang O, Hu DN, Wu RK, Li J, Zhong H, Hu M. Iris Color and Lens Thickness in Chinese Teenagers. Transl Vis Sci Technol 2018; 7:25. [PMID: 30323998 PMCID: PMC6181192 DOI: 10.1167/tvst.7.5.25] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 08/17/2018] [Indexed: 11/24/2022] Open
Abstract
Purpose We aimed to determine the association of iris color with lens thickness (LT) in a school-based sample of Chinese teenagers. Methods In total, 2346 grade 7 students, from 10 middle schools, aged 13 to 14 years in Mojiang located in Southwestern China were included in the analysis. A grading system was developed to assess iris color based on standardized slit-lamp photographs. LT was measured by the LenStar LS900. Refractive error was measured after cycloplegia using an autorefractor and ocular biometric parameters, including axial length (AL), were measured using an IOL Master. Results There was a significant trend of decreasing LTs with darker iris color. On average, eyes with “grade 1” (the lightest) iris color, when compared with those with “grade 5” (the darkest), had greater LTs (mean difference, 0.1 mm). After adjusting for other potential confounders including sex, height, and ALs in generalized estimating equation models, the trend was similar and did not change significantly. Compared with individuals with iris color of grade 1, those with grade 5 had a thinner lens of 0.1 mm (95% confidence interval [CI]: 0.01, 0.19) in sex-adjusted model and a 0.09 mm (95% CI: 0, 0.18) in multivariate-adjusted model. Conclusions Lighter iris color might be associated with greater LTs in Chinese teenagers. The biological mechanisms underlying the association warrant further clarification. Translational Relevance As LT is an important refractive component, knowledge on the effect of iris color on LTs may assist in the design of novel technologies, which could control refractive development.
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Affiliation(s)
- Chen-Wei Pan
- School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Ou Zhang
- Department of General Medicine, Kunming Children's Hospital, Kunming, China
| | - Dan-Ning Hu
- New York Eye and Ear Infirmary at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rong-Kun Wu
- School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Jun Li
- Department of Ophthalmology, the Second People's Hospital of Yunnan Province, Kunming, China
| | - Hua Zhong
- Department of Ophthalmology, the First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Min Hu
- Department of Ophthalmology, the Second People's Hospital of Yunnan Province, Kunming, China
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Anastasopoulos E, Haidich AB, Coleman AL, Wilson MR, Harris A, Yu F, Koskosas A, Pappas T, Keskini C, Kalouda P, Karkamanis G, Topouzis F. Risk factors for Age-related Macular Degeneration in a Greek population: The Thessaloniki Eye Study. Ophthalmic Epidemiol 2018; 25:457-469. [PMID: 30265203 DOI: 10.1080/09286586.2018.1512634] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE To assess the association of potential risk factors with early and late age-related macular degeneration (AMD) in the Thessaloniki Eye Study (TES) population Design: Population-based, cross-sectional study of subjects over age of 60 living in Thessaloniki, Greece Methods: Subjects without any AMD features and subjects with early and late AMD (neovascular AMD or geographic atrophy) were identified in the TES cohort using standardized procedures and masked grading of stereo color fundus photos. Demographic, lifestyle, systemic and other ophthalmic covariates were also collected during a detailed examination process. Their association with AMD was investigated using univariate and multivariate adjusted logistic regression models. RESULTS Among the 2108 participants with gradable photos, the grading process identified 1204 subjects with no AMD, 848 subjects with early AMD, and 56 subjects with late AMD (24 with geographic atrophy and 32 with neovascular AMD). In multivariate analysis, compared to no AMD, late AMD was positively associated with older age (OR:1.16; 95%CI:1.10-1.22 per year of age), current smoking (smoking vs. never smoking, OR:2.34; 95%CI:1.12-4.90), prior cataract surgery (cataract surgery vs. no cataract surgery OR:2.06; 95%CI:0.96-4.40), marital status (divorced/separated vs. married, OR:3.10; 95%CI:1.08-8.93) and with 60% lower odds when sleeping in the afternoon (yes vs. no, OR:0.40; 95%CI:0.22-0.72). Early AMD was positively associated with older age (OR: 1.03; 95%CI:1.01-1.05 per year of age) and negatively with higher pulse pressure (OR:0.99; 95%CI:0.98-0.99 per mmHg). CONCLUSIONS In TES, apart for well-known risk factors for AMD like age, smoking, and cataract surgery, two novel behavioral risk factors for prevalent late AMD were suggested. Sleeping in the afternoon was associated with 60% decreased odds for late AMD and 67% decreased odds for neovascular AMD. Being divorced/separated compared to married was associated with 3-fold higher odds for late AMD. Large longitudinal population-based studies will be necessary to further establish the potential late AMD risk effects of these two novel factors, to demonstrate potential implications of underlying pathogenetic mechanisms, and to explore preventive measures and therapeutic targets.
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Affiliation(s)
- Eleftherios Anastasopoulos
- a Laboratory of Research and Clinical Applications in Ophthalmology (LARCAO), Department of Ophthalmology, School of Medicine , Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Anna Bettina Haidich
- b Department of Epidemiology, School of Medicine , Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Anne Louise Coleman
- c Stein Eye Institute, David Geffen School of Medicine at UCLA , University of California Los Angeles , Los Angeles , CA , USA
| | | | - Alon Harris
- e Eugene and Marilyn Glick Eye Institute, Department of Ophthalmology , Indiana University School of Medicine , Indianapolis , Indiana , USA
| | - Fei Yu
- f Department of Biostatistics , UCLA Fielding School of Public Health , Los Angeles , CA , USA
| | - Archimides Koskosas
- a Laboratory of Research and Clinical Applications in Ophthalmology (LARCAO), Department of Ophthalmology, School of Medicine , Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Theofanis Pappas
- a Laboratory of Research and Clinical Applications in Ophthalmology (LARCAO), Department of Ophthalmology, School of Medicine , Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Christina Keskini
- a Laboratory of Research and Clinical Applications in Ophthalmology (LARCAO), Department of Ophthalmology, School of Medicine , Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Pelagia Kalouda
- a Laboratory of Research and Clinical Applications in Ophthalmology (LARCAO), Department of Ophthalmology, School of Medicine , Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Georgia Karkamanis
- a Laboratory of Research and Clinical Applications in Ophthalmology (LARCAO), Department of Ophthalmology, School of Medicine , Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Fotis Topouzis
- a Laboratory of Research and Clinical Applications in Ophthalmology (LARCAO), Department of Ophthalmology, School of Medicine , Aristotle University of Thessaloniki , Thessaloniki , Greece
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Burkemper B, McKean-Cowdin R, Choudhury F, Klein R, Gauderman WJ, Jiang X, Hsu C, Torres M, Varma R. Factors Associated with Age-Related Macular Degeneration in Chinese American Adults: The Chinese American Eye Study (CHES). Ophthalmol Retina 2018; 2:209-216. [PMID: 31047588 DOI: 10.1016/j.oret.2017.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 06/29/2017] [Accepted: 07/03/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To assess associations between age-related macular degeneration (AMD) and multiple factors comprising a conceptual model of AMD risk in a population of Chinese Americans, and to draw comparisons with a similar risk assessment of a Latino population. DESIGN A cross-sectional population-based study. PARTICIPANTS We enrolled 4582 Chinese Americans aged ≥50 residing in Monterey Park, California. METHODS Participants completed a comprehensive eye examination, including stereoscopic fundus photography and ocular biometric measurements. Fundus images were graded using a modified version of the Wisconsin Age-Related Maculopathy Grading System. MAIN OUTCOMES AND MEASURES Odds ratios for factors significantly modifying the risk of AMD and its related retinal lesions. RESULTS Of the eligible participants, 4172 (72%) had fundus photographs gradable for AMD. Early AMD was present in 375 eyes (4.6%), and late AMD was present in 17 (0.2%). Shorter axial length, male sex, older age, and family history of AMD were identified as independent risk factors for prevalent AMD and its characteristic retinal lesions using a conceptual model of potential AMD risk factors. Of 4 AMD risk factors identified for Latinos, 3 (older age, male sex, shorter axial length) overlapped with those identified for Chinese Americans, with an association similar in magnitude and direction. Lower levels of education were a risk factor specific to Latinos. Based on a multivariable logistic regression model, the predicted probability of early AMD was 31% lower among Chinese Americans relative to Latinos (95% confidence interval [CI], 17%-43%). Chinese Americans also had statistically significantly lower odds of any AMD and 2 types of early retinal lesions symptomatic of AMD. CONCLUSIONS Factors associated with prevalent AMD are similar for Chinese Americans and Latinos. Chinese Americans who were older, were male, had a family history of AMD, and had a shorter axial length were at an increased risk for AMD compared with those without these risk factors. We observed a significantly lower predicted prevalence of AMD among Chinese Americans compared with Latinos, even after controlling for all relevant covariates, suggesting that additional genetic or lifestyle differences may play an important role in determining AMD risk.
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Affiliation(s)
- Bruce Burkemper
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Roberta McKean-Cowdin
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Farzana Choudhury
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Ronald Klein
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - W James Gauderman
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Xuejuan Jiang
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Chunyi Hsu
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Mina Torres
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Rohit Varma
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, California.
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Ho JD, Xirasagar S, Kao LT, Lin HC. Neovascular age-related macular degeneration is associated with cataract surgery. Acta Ophthalmol 2018; 96:e213-e217. [PMID: 28671319 DOI: 10.1111/aos.13511] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 05/20/2017] [Indexed: 01/22/2023]
Abstract
PURPOSE This retrospective cohort study examines the association between cataract surgery and neovascular age-related macular degeneration (AMD) during 5-year follow-up using population-based claims data. METHODS We analysed data sourced from the Taiwan Longitudinal Health Insurance Database 2005. The study included 3465 patients who had undergone cataract operations and did not have a diagnosis of AMD before or on the surgery date (study group), and 10 395 age- and sex-matched comparison patients selected randomly from the remaining patients without an AMD diagnosis before the index date. We tracked the claims of each patient for a 5-year period to identify patients with a subsequent diagnosis of neovascular AMD. RESULTS The incidence rate of neovascular AMD was 0.88 (95% confidence interval (CI): 0.66-1.14) per 1000 person-years among all sampled patients, 1.60 (95% CI: 1.04-2.36) among the cataract surgery patients and 0.64 (95% CI: 0.43-0.91) among comparison patients (p < 0.001). Stratified Cox proportional analysis showed that relative to the comparison cohort, the adjusted hazard ratio for neovascular AMD during 5-year follow-up was 2.68 (95% CI: 1.55-4.66) for patients who had undergone cataract operation. We censored those who died during follow-up period and adjusted for patients' monthly income, geographical location, urbanization level, diabetes, hypertension, cardiovascular disease and hyperlipidaemia. CONCLUSION This study demonstrated epidemiological evidence of a link between cataract surgery and neovascular AMD during a 5-year follow-up period.
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Affiliation(s)
- Jau-Der Ho
- Department of Ophthalmology; Taipei Medical University Hospital; Taipei Taiwan
| | - Sudha Xirasagar
- Department of Health Services Policy and Management; Arnold School of Public Health; University of South Carolina; Columbia USA
| | - Li-Ting Kao
- Graduate Institute of Life Science; National Defense Medical Center; Taipei Taiwan
| | - Herng-Ching Lin
- School of Health Care Administration; Taipei Medical University; Taipei Taiwan
- Sleep Research Center; Taipei Medical University Hospital; Taipei Taiwan
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13
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Systemic, Ocular and Genetic Risk Factors for Age-related Macular Degeneration and Polypoidal Choroidal Vasculopathy in Singaporeans. Sci Rep 2017; 7:41386. [PMID: 28120909 PMCID: PMC5264642 DOI: 10.1038/srep41386] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 12/19/2016] [Indexed: 12/13/2022] Open
Abstract
To examine the association of systemic, ocular and genetic risk factors in neovascular age-related macular degeneration (nAMD) in a large cohort of Asian patients, and to further compare risk factors between those with typical AMD and polypoidal choroidal vasculoapthy (PCV) subtypes. We recruited 456 cases and 1,824 controls matched for age, gender and ethnicity. Data on systemic and ocular risk factors were collected on questionnaires. In a subgroup of subjects, we included genetic data on four AMD-associated single nucleotide polymorphisms (SNPs). Risk factors for nAMD and subtypes were analyzed. Systemic risk factors for nAMD included older age, male gender, higher BMI and higher HDL-cholesterol. Ocular risk factors included pseudophakic and shorter axial length. Risk factors common to both typical AMD and PCV subtypes included age, BMI and HDL-cholesterol. Shorter axial length was only associated with PCV, while male gender and pseudophakia were only associated with typical AMD. In the subgroup with genotype data, ARMS2 rs10490924 and CFH rs800292 were associated with nAMD. None of the risk factors were significantly different between PCV and typical AMD. Systemic, ocular and genetic risk factors were largely similar for typical AMD and PCV subtypes in this Asian population based in Singapore.
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14
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Wang CP, Lai CH, Huang EJC, Wu PL, Chen CL, Chen CY, King YC, Wu PC, Kuo CN. Axial length and subfoveal choroidal thickness in individuals with age-related macular degeneration. Taiwan J Ophthalmol 2015; 5:169-176. [PMID: 29018693 PMCID: PMC5602135 DOI: 10.1016/j.tjo.2015.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 10/15/2015] [Accepted: 10/19/2015] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To compare axial length (AL) and subfoveal choroidal thickness (SFCT) between individuals with age-related macular degeneration (AMD) and controls with no lesions. METHODS This was a case-control study. In total, 853 eyes of 484 patients (>65 years), including 397 eyes at various AMD stages and 456 eyes with no fundus lesions (controls) were recruited. Using color fundus photography, eyes were grouped according to AMD degree. AL was automatically measured using IOL Master and SFCT was manually measured by two independent observers. The associations among age, AL, SFCT, and each AMD grade were analyzed. RESULTS Out of 853 eyes, 456 had no lesions, 217 contained drusen only, 134 had early AMD, and 46 had late AMD. The eyes with late AMD were older (p = 0.007) and had longer AL (p ≥ 0.001) and thinner SFCT (p < 0.001) compared with groups of no fundus lesions, drusen only, and early AMD. SFCT in eyes with late AMD decreased by 19.20 μm (p = 0.049), 24.78 μm (p = 0.029), and 15.56 μm (p = 0.162) compared with groups of no fundus lesions, drusen only, and early AMD, respectively. SFCT decreased by 14.18 μm/mm increase in AL (p < 0.001). The odds ratio (OR) for late AMD by longer AL (≥25 mm) and thinner SFCT (<240 μm) was 4.54 (χ2 = 9.36; p = 0.002) and 4.86 (χ2 = 17.62; p < 0.001), respectively, and was 9.57 (χ2 = 18.07; p < 0.001) when both AL ≥ 25 ≥m and SFCT < 240 μm. CONCLUSION Eyes with late AMD have distinct reduced SFCT and elongated AL. Eyes with thinner SFCT and longer AL showed high ORs for late AMD and even higher ORs when both factors were simultaneously present. These findings illustrate the crucial pathophysiological role of these two important ocular fac tors and arouse our attention to patients with both characteristics, especially in Asian countries where the prevalence of myopia are disturbingly high.
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Affiliation(s)
- Chih-Ping Wang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chiayi, Taiwan.,College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Chien-Hsiung Lai
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chiayi, Taiwan.,College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.,Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Evelyn Jou-Chen Huang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chiayi, Taiwan.,College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Pei-Lun Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chiayi, Taiwan.,College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Ching-Lung Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chiayi, Taiwan.,College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Chau-Yin Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chiayi, Taiwan.,College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Yin-Chi King
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Pei-Chen Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chiayi, Taiwan.,College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Chien-Neng Kuo
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chiayi, Taiwan.,College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
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Kessel L, Erngaard D, Flesner P, Andresen J, Tendal B, Hjortdal J. Cataract surgery and age-related macular degeneration. An evidence-based update. Acta Ophthalmol 2015; 93:593-600. [PMID: 25601333 PMCID: PMC6680180 DOI: 10.1111/aos.12665] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 12/13/2014] [Indexed: 11/24/2022]
Abstract
Purpose Age‐related macular degeneration (AMD) and cataract often coexist in patients and concerns that cataract surgery is associated with an increased risk of incidence or progression of existing AMD has been raised. This systematic review and meta‐analysis is focused on presenting the evidence concerning progression of AMD in patients undergoing cataract surgery. Methods We performed a systematic literature search in the PubMed, Medline, Cochrane Library and CINAHL databases. Two randomized trials and two case–control trials were identified. Quality of the studies was assessed using the Cochrane risk of bias tool, data were extracted, and meta‐analyses were performed. Quality of the available evidence was evaluated using the GRADE system. Results We found that visual acuity at 6–12 months follow‐up was significantly better (6.5–7.5 letters) in eyes that had undergone cataract surgery than in unoperated eyes, but the included number of subjects was small, and hence, the quality of evidence was downgraded to moderate. We did not find an increased risk of progression to exudative AMD 6–12 months after cataract surgery [RR 3.21 (0.14–75.68)], but the included number of subjects was small, and thus, the quality of the evidence was moderate. Conclusion Cataract surgery increases visual acuity without an increased risk of progression to exudative AMD, but further research with longer follow‐up is encouraged.
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Affiliation(s)
- Line Kessel
- Department of Ophthalmology Copenhagen University Hospital Glostrup Glostrup Denmark
- Danish Health and Medicines Authority Copenhagen Denmark
| | - Ditte Erngaard
- Department of Ophthalmology Næstved Hospital Næstved Denmark
| | | | | | - Britta Tendal
- Danish Health and Medicines Authority Copenhagen Denmark
- The Nordic Cochrane Center Rigshospitalet Copenhagen Denmark
| | - Jesper Hjortdal
- Department of Ophthalmology Aarhus University Hospital NBG Aarhus Denmark
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16
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Sun HP, Lin Y, Pan CW. Iris color and associated pathological ocular complications: a review of epidemiologic studies. Int J Ophthalmol 2014; 7:872-8. [PMID: 25349810 DOI: 10.3980/j.issn.2222-3959.2014.05.25] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 01/08/2014] [Indexed: 11/02/2022] Open
Abstract
AIM To elucidate the associations of iris color with major eye diseases. METHODS A systematic search on Medline with coverage up to August 2013 was conducted. Assessment of the quality of studies based on their levels of evidence was in accordance with the Centre for Evidence-Based Medicine, Oxford, United Kingdom. RESULTS A relationship between darker iris color and an increased risk of age-related cataract has been reported from cross-sectional studies and prospective cohort studies. There was no consistent evidence supporting a major role of iris color in the development or progression of age-related macular degeneration. The association of iris color with ocular uveal melanoma has been confirmed by a meta-analysis of observational studies previously. The etiologic synergism between light iris color and environmental exposure such as UV the exposure of UV radiation was found. There were no studies evaluating the refractive associations with iris color but there may be a possible link between iris color and myopia. CONCLUSION Darker iris color is associated with an increased risk of cataract and a reduced risk of ocular uveal melanoma. The association of iris color with age-related macular degeneration is not confirmed. Ophthalmologists should be aware that the risk of ocular disorders appears to vary by differences in iris color.
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Affiliation(s)
- Hong-Peng Sun
- School of Public Health, Medical College of Soochow University, Suzhou 215123, Jiangsu Province, China
| | - Yi Lin
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent 9000, Belgium
| | - Chen-Wei Pan
- School of Public Health, Medical College of Soochow University, Suzhou 215123, Jiangsu Province, China ; Singapore Eye Research Institute, Singapore 168751, Singapore
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17
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Klein BEK, Howard KP, Iyengar SK, Sivakumaran TA, Meyers KJ, Cruickshanks KJ, Klein R. Sunlight exposure, pigmentation, and incident age-related macular degeneration. Invest Ophthalmol Vis Sci 2014; 55:5855-61. [PMID: 25125603 DOI: 10.1167/iovs.14-14602] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Examine potential effects of sunlight exposure, hair color, eye color, and selected gene single-nucleotide polymorphisms (SNPs) on incidence of AMD. METHODS Subjects participated in up to five examinations over a 20-year period. Eye color, self-reported hair color as a teenager, and sunlight exposure were ascertained at the baseline examination. Presence and severity of AMD and its lesions were determined via fundus photographs. Genetic data were available on a subset of participants. The SNPs CFH Y402H rs1061170 and ARMS2 A69S rs10490924 were used to analyze genetic risk of AMD; OCA2 rs4778241 and HERC2 rs12913832 represented genetic determinants of eye color. RESULTS Incidence of early AMD was higher in blond/red-haired persons compared with brown/black-haired persons (hazard ratio [HR] 1.25, P = 0.02) and in persons with high sun exposure in their thirties (HR 1.41, P = 0.02). However, neither was significant after adjustment for multiple comparisons. Eye (HR 1.36, P = 0.006) and hair color (HR 1.42, P = 0.003) were associated with incidence of any retinal pigmentary abnormalities (RPAs). Both remained significant after adjustment for multiple comparisons. Neither presence of alleles for light-colored eyes nor those associated with high risk of late AMD altered the association of eye or hair color with early AMD. None of the characteristics studied were significantly associated with late AMD. CONCLUSIONS Modest associations of eye color, hair color, and HERC2 genotype with any RPAs were found. Genes for AMD did not affect these associations. Eye color phenotype was more strongly associated with outcomes than HERC2 or OCA2 genotype.
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Affiliation(s)
- Barbara E K Klein
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Kerri P Howard
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Sudha K Iyengar
- Departments of Epidemiology & Biostatistics, Genetics & Genome Sciences and Ophthalmology & Visual Sciences, Case Western Reserve University, Cleveland, Ohio, United States
| | - Theru A Sivakumaran
- Departments of Epidemiology & Biostatistics, Genetics & Genome Sciences and Ophthalmology & Visual Sciences, Case Western Reserve University, Cleveland, Ohio, United States Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Kristin J Meyers
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Karen J Cruickshanks
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Ronald Klein
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
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18
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Li Y, Wang J, Zhong X, Tian Z, Wu P, Zhao W, Jin C. Refractive error and risk of early or late age-related macular degeneration: a systematic review and meta-analysis. PLoS One 2014; 9:e90897. [PMID: 24603619 PMCID: PMC3946285 DOI: 10.1371/journal.pone.0090897] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 02/05/2014] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To summarize relevant evidence investigating the associations between refractive error and age-related macular degeneration (AMD). DESIGN Systematic review and meta-analysis. METHODS We searched Medline, Web of Science, and Cochrane databases as well as the reference lists of retrieved articles to identify studies that met the inclusion criteria. Extracted data were combined using a random-effects meta-analysis. Studies that were pertinent to our topic but did not meet the criteria for quantitative analysis were reported in a systematic review instead. MAIN OUTCOME MEASURES Pooled odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between refractive error (hyperopia, myopia, per-diopter increase in spherical equivalent [SE] toward hyperopia, per-millimeter increase in axial length [AL]) and AMD (early and late, prevalent and incident). RESULTS Fourteen studies comprising over 5800 patients were eligible. Significant associations were found between hyperopia, myopia, per-diopter increase in SE, per-millimeter increase in AL, and prevalent early AMD. The pooled ORs and 95% CIs were 1.13 (1.06-1.20), 0.75 (0.56-0.94), 1.10 (1.07-1.14), and 0.79 (0.73-0.85), respectively. The per-diopter increase in SE was also significantly associated with early AMD incidence (OR, 1.06; 95% CI, 1.02-1.10). However, no significant association was found between hyperopia or myopia and early AMD incidence. Furthermore, neither prevalent nor incident late AMD was associated with refractive error. Considerable heterogeneity was found among studies investigating the association between myopia and prevalent early AMD (P = 0.001, I2 = 72.2%). Geographic location might play a role; the heterogeneity became non-significant after stratifying these studies into Asian and non-Asian subgroups. CONCLUSION Refractive error is associated with early AMD but not with late AMD. More large-scale longitudinal studies are needed to further investigate such associations.
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Affiliation(s)
- Ying Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - JiWen Wang
- Department of Neurosurgery and Pituitary Tumor Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - XiaoJing Zhong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Zhen Tian
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Peipei Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Wenbo Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Chenjin Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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Michalska-Małecka K, Nowak M, Gościniewicz P, Karpe J, Słowińska-Łożyńska L, Łypaczewska A, Romaniuk D. Results of cataract surgery in the very elderly population. Clin Interv Aging 2013; 8:1041-6. [PMID: 23966774 PMCID: PMC3741036 DOI: 10.2147/cia.s44834] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIM The aim of our study was to retrospectively evaluate the effectiveness and safety of cataract surgery and intraocular lens implantation (IOL) for patients aged 90 years or older, whom we define as "very elderly." METHODS The study involved a total number of 122 patients (122 eyes) with senile cataracts. The mean age of patients was 91.2 ± 2.3 years (range 90-100 years old). Phacoemulsification (phaco) was done on 113 of 122 eyes, and 9 of 122 eyes had extracapsular cataract extraction (ECCE). Postoperative visual acuity and intraocular pressure (IOP) were analyzed on the first postoperative day, 3 months after surgery, and 6 months after surgery. RESULTS Best corrected visual acuity (BCVA) improved in 100 of 122 eyes (82.0%). BCVA remained the same in 20 of 122 eyes (16.4%) and decreased in 2 of 122 eyes (1.6%), mainly because of coexisting age-related macular degeneration (AMD). The BCVA 3 months after surgery was ≥0.8 in 23 of 122 eyes (18.9%), between 0.5 and 0.7 in 28 of 122 eyes (22.3%), and between 0.2 and 0.4 in 33 of 122 eyes (27.1%). We found significant implications of cataract surgery on decreasing IOP in the studied group of patients suffering from glaucoma compared to the patients without glaucoma. CONCLUSION Advanced age is not a contraindication for cataract surgery. The results of the study showed that when systemic conditions are stable, both phaco and ECCE with IOL for very elderly patients are effective and safe.
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Brockmann C, Brockmann T, Dawczynski J. Influence of seasonal sunlight intensity and iris color on the anti-VEGF therapy for neovascular age-related macular degeneration. Eye (Lond) 2013; 27:1169-73. [PMID: 23907626 DOI: 10.1038/eye.2013.159] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 06/27/2013] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To investigate the influence of seasonal light intensity and patients' iris color on the visual recovery after anti-vascular endothelial growth factor (VEGF) therapy with ranibizumab or bevacizumab for neovascular age-related macular degeneration (AMD). METHODS The visual acuity of 555 eyes (529 patients) with neovascular AMD was evaluated after intravitreal injections of either ranibizumab or bevacizumab in respect to global radiation intensity and iris color. RESULTS The functional results during anti-VEGF therapy revealed a seasonal oscillation with a negative correlation between visual recovery and global radiation intensity (R(2)=-0.756, P=0.004). Although the influence of the sunlight intensity on the visual recovery was significant after the first injection, this effect vanished within the continuous course of treatment. Regarding the improvement of functional recovery depending on iris color, dark-colored eyes (16.0%) gained 8.5 ± 10.0 letters after the first injection and 9.9 ± 12.8 letters after the second injection, compared with 3.4 ± 8.6 letters and 4.4 ± 11.0 letters in light-colored eyes (84.0%), respectively (P=0.005 and P=0.019). CONCLUSIONS Our results indicate that seasonal sunlight intensity and iris color might influence the visual recovery of neovascular AMD patients undergoing anti-VEGF therapy. Our findings may be used as suggestions to refine individual anti-VEGF therapy regimens, especially in patients with light-colored eyes.
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Affiliation(s)
- C Brockmann
- Department of Ophthalmology, Charité - University Medicine Berlin, Berlin, Germany
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αA crystallin may protect against geographic atrophy-meta-analysis of cataract vs. cataract surgery for geographic atrophy and experimental studies. PLoS One 2012; 7:e43173. [PMID: 22916220 PMCID: PMC3423426 DOI: 10.1371/journal.pone.0043173] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 07/20/2012] [Indexed: 11/29/2022] Open
Abstract
Background Cataract and geographic atrophy (GA, also called advanced “dry” age-related macular degeneration) are the two major causes of visual impairment in the developed world. The association between cataract surgery and the development of GA was controversial in previous studies. Methods/Principal Findings We performed a meta-analysis by pooling the current evidence in literature and found that cataract is associated with an increased risk of geographic atrophy with a summary odds ratio (OR) of 3.75 (95% CI: 95% CI: 1.84–7.62). However, cataract surgery is not associated with the risk of geographic atrophy (polled OR = 3.23, 95% CI: 0.63–16.47). Further experiments were performed to analyze how the αA-crystallin, the major component of the lens, influences the development of GA in a mouse model. We found that theαA-crystallin mRNA and protein expression increased after oxidative stress induced by NaIO3 in immunohistochemistry of retinal section and western blot of posterior eyecups. Both functional and histopathological evidence confirmed that GA is more severe in αA-crystallin knockout mice compared to wild-type mice. Conclusions Therefore, αA-crystallin may protect against geographic atrophy. This study provides a better understanding of the relationship between cataract, cataract surgery, and GA.
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Meng W, Butterworth J, Calvas P, Malecaze F. Myopia and iris colour: A possible connection? Med Hypotheses 2012; 78:778-80. [DOI: 10.1016/j.mehy.2012.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Accepted: 03/06/2012] [Indexed: 10/28/2022]
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Iris color and visual functions. Graefes Arch Clin Exp Ophthalmol 2012; 251:195-202. [DOI: 10.1007/s00417-012-2006-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Revised: 03/16/2012] [Accepted: 03/19/2012] [Indexed: 10/28/2022] Open
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Risk factors for four-year incidence and progression of age-related macular degeneration: the los angeles latino eye study. Am J Ophthalmol 2011; 152:385-395. [PMID: 21679916 DOI: 10.1016/j.ajo.2011.02.025] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2010] [Revised: 02/23/2011] [Accepted: 02/26/2011] [Indexed: 11/21/2022]
Abstract
PURPOSE To identify risk factors for 4-year incidence and progression of age-related macular degeneration (AMD) in adult Latinos. DESIGN Population-based prospective cohort study. METHODS Participants, aged 40 or older, from The Los Angeles Latino Eye Study (LALES) underwent standardized comprehensive ophthalmologic examinations at baseline and at 4 years of follow-up. Age-related macular degeneration was detected by grading 30-degree stereoscopic fundus photographs using the modified Wisconsin Age-Related Maculopathy Grading System. Multivariate stepwise logistic regression was used to examine the independent association of incidence and progression of AMD and baseline sociodemographic, behavioral, clinical, and ocular characteristics. RESULTS Multivariate analyses revealed that older age (OR per decade of age: 1.52; 95% CI: 1.29, 1.85) and higher pulse pressure (OR per 10 mm Hg: 2.54; 95% CI: 1.36, 4.76) were independently associated with the incidence of any AMD. The same factors were associated with early AMD, soft indistinct drusen, and retinal pigmentary abnormalities. Additionally, presence of clinically diagnosed diabetes mellitus was independently associated with increased retinal pigment (OR: 1.66; 95% CI: 1.01, 2.85), and male gender was associated with retinal pigment epithelial depigmentation (OR 2.50; 95% CI: 1.48, 4.23). Older age (OR per decade of age: 2.20; 95% CI: 1.82, 2.67) and current smoking (OR: 2.85; 95% CI: 1.66, 4.90) were independently associated with progression of AMD. CONCLUSIONS Several modifiable risk factors were associated with 4-year incidence and progression of AMD in Latinos. The results suggest that interventions aimed at reducing pulse pressure and promoting smoking cessation may reduce incidence and progression of AMD, respectively.
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Boltz A, Lasta M, Schmidl D, Kaya S, Garhöfer G, Schmetterer L. Risikofaktoren der altersbedingten Makuladegeneration. SPEKTRUM DER AUGENHEILKUNDE 2010. [DOI: 10.1007/s00717-010-0445-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Jang SY, Kim SW. Reply. Am J Ophthalmol 2010. [DOI: 10.1016/j.ajo.2010.06.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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