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Risk of Age-Related Macular Degeneration in Eyes With Macular Drusen or Hyperpigmentation
The Blue Mountains Eye Study Cohort
Jie Jin Wang, MMed, MApplStat, PhD;
Suriya Foran, MBBS, MPH, PhD;
Wayne Smith, MBBS, MPH, PhD;
Paul Mitchell, MD, PhD, FRACO
Arch Ophthalmol. 2003;121:658-663.
Objective To quantify the 5-year risk of age-related macular degeneration (AMD) in eyes with different macular drusen characteristics (ie, size, type, location, and total area) or hyperpigmentation in a population-based cohort.
Methods The Blue Mountains Eye Study examined 3654 residents during 1992-1994; 2335 (75.1% of survivors) were reexamined during 1997-1999. Retinal photographs were graded using the Wisconsin Age-Related Maculopathy Grading System. Incident AMD lesions were defined by development of neovascular AMD or geographic atrophy in eyes without these lesions at baseline (eyes at risk). Age-adjusted relative risks (RRs) were determined. Generalized estimating equation models were used to estimate odds ratios, adjusting for the correlation between eyes and other AMD risk factors.
Main Outcome Measure Incidence of AMD.
Results Of the 4634 eyes at risk, 52 (1.1%) developed neovascular or atrophic AMD lesions over 5 years. In right eyes, presence vs absence of the following macular signs predicted AMD: drusen that were 125 µm or larger (13.9 vs 0.6%; age-adjusted RR, 5.7; 95% confidence interval [CI], 3.6-9.0), indistinct soft or reticular drusen (23.2% vs 0.4%; RR, 9.9; 95% CI, 6.4-15.4), total drusen area of half the disc area or more (31.4% vs 0.6%; RR, 13.5; 95% CI, 8.0-22.8), and hyperpigmentation (14.4% vs 0.5%; RR, 8.0; 95% CI, 5.4-11.9). After adjusting for age, sex, and smoking status, eyes with these signs at baseline had a high likelihood of developing AMD. Eyes with Age-Related Eye Disease Study categories 3 and 4 were 5 times more likely to develop AMD compared with eyes in categories 1 and 2.
Conclusion This study quantifies the 5-year risk of AMD in eyes with macular drusen and hyperpigmentation.
From the Department of Ophthalmology, the Centre for Vision Research, and the Save Sight and Westmead Millennium Institutes, University of Sydney, Sydney, Australia (Drs Wang, Foran, and Mitchell); and the National Centre for Epidemiology and Population Health, Australian National University, Canberra (Dr Smith). Dr Smith is now with the Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle, Australia. The authors have no relevant financial interest in this article.
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