• Incidence and Risk Factors Associated With Idiopathic Macular Hole

    By Lynda Seminara and selected by Neil M. Bressler, MD, and Deputy Editors

    Journal Highlights

    JAMA Ophthalmology, April 2017

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    To help clarify the pathophysiology of idiopathic macular hole (MH) and identify potential new methods to treat and prevent it, Ali et al. determined the incidence and risk factors associated with this condition in a large-scale longitudinal study. Female gender and older age were the most obvious risk factors, as noted in previous research.

    Study enrollees were at least 40 years old and had participated continuously in a nationwide managed care plan for at least 3 years. Of the 659,357 individuals, an MH requiring vitrectomy occurred in 144 (0.02%), 105 (72.9%) of whom were female. After adjusting for confounding factors, the risk was found to be 64% higher for women (adjusted hazard ratio [aHR], 1.64; p = .01 vs. men), and the effect of gender varied by age. The cumulative overall incidence of MH was 41.1 cases per 100,000 person-years (men, 34.1; women, 55.9). Cases per 100,000 person-years in the different age groups were as follows: 40-49 years, 6.0 cases; 50-59 years, 30.3 cases; 60-69 years, 98.2 cases; 69 years and older, 77.1 cases.

    The risk of MH in Asian Americans was 177% higher than in whites (aHR, 2.77; p = .01). In the study, 109 affected individuals were white, 16 were black, 7 were Asian, and 4 were Latino (8 were of other races or were missing race/ethnicity data).

    Cataract was associated with an 86% greater risk of MH (aHR, 1.86; p = .001 vs. those without cataract). The risk of MH among individuals with hypertension, myocardial infarction, cerebrovascular accident, hyperlipidemia, or congestive heart failure did not differ significantly from that of individuals without these conditions.

    The authors’ work confirmed that the greatest risk factors for MH are older age and female gender. If future studies affirm that menopausal changes in estrogen levels contribute to the higher risk of MH among older women, such information may guide the development of treatments targeting the vitreoretinal interface that may prevent or reduce the risk of this vision-impairing condition.

    The original article can be found here.