Generational Differences in AMD Incidence
By Lynda Seminara
Selected By: Neil M. Bressler, MD, and Deputy Editors
JAMA Ophthalmology, December 2017
Cruickshanks et al. set out to determine whether the 5-year risk of AMD is changing as longevity increases and found that the risk has declined over time.
For their assessment, the authors obtained longitudinal data from 2 Beaver Dam eye studies in which the 5-year incidence of AMD was measured. A total of 4,819 participants (baseline mean age, 54 years) were at risk for AMD based on findings from the fundus images obtained at baseline. Fundus images were graded for AMD using the Wisconsin age-related maculopathy grading system, and AMD incidence was determined from 5-year follow-up results.
AMD was identified by the presence of pure geographic atrophy, exudative macular degeneration, any type of drusen with pigmentary abnormalities, or soft indistinct drusen without pigmentary abnormalities.
The 5-year incidence of AMD, adjusted for age and sex, was 8.8% for those born from 1901-1924, 3% for those born from 1925-1945, 1% for those born 1946-1964, and 0.3% for those born 1965-1984.
Each generation was > 60% less likely to experience AMD than the preceding generation, and this association remained significant after adjusting for age, sex, smoking status, education level, amount of exercise, selected lipid levels, and high-sensitivity C-reactive protein levels, and use/nonuse of nonsteroidal anti-inflammatory drugs, statins, and multivitamins.
Although the 5-year risk of AMD declined throughout the 20th century, factors responsible for the decline were not apparent from this study. However, the results do suggest that modifiable factors contribute to the etiology of AMD and that the current epidemic of AMD among the oldest generation may diminish with time. Prospective epidemiologic studies are warranted to confirm the findings. (Also see related commentary in the same issue by Raphael R. Goldacre, MSc, and Tiaran D.L. Keenan, PhD.)
The original article can be found here.