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  • Mortality and Age-Related Eye Disease: AREDS2, Report 13

    By Lynda Seminara
    Selected By: Stephen D. McLeod, MD
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    Journal Highlights

    Ophthalmology, April 2018

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    Papudesu et al., of the Age-Related Eye Disease Study 2 (AREDS2) Research Group, looked at mortality in relation to visual impairment, age-related mac­ular degeneration (AMD), and cataract surgery. They found that mortality correlated strongly with late AMD, bilateral cataract surgery, and best-corrected visual acuity (BCVA) worse than 20/40.

    The authors’ study included patients with intermediate and late AMD enrolled in the AREDS2 randomized controlled trial of lutein plus zea­xanthin and/or omega-3 fatty acids for treatment of AMD and cataract. Baseline and annual eye exams includ­ed BCVA assessment, slit-lamp exam, and stereoscopic fundus photographs that were graded for development of late AMD (central geographic atrophy or neovascular AMD) or pseudopha­kia. Cause-specific mortality was determined from ICD codes. Risk of all-cause and cause-specific mortality was measured from Cox proportional hazards models that were adjusted for age, sex, BCVA, severity of AMD, history of cataract surgery, and the assigned AREDS2 treatment. Analyses included the baseline variables of race, education, smoking status, diabetes, and cardiovascular disease.

    Of the 4,203 AREDS2 participants, 368 (~ 9%) died during follow-up (median, 5 years). Risk of death was much higher for patients with neovascular AMD in 1 eye at baseline than for patients with no or few drusen. After adjusting for age, sex, and significant covariates, shorter survival rates showed a stronger correlation with pre-enrollment bilateral cataract surgery than with baseline bilateral unoperated crystalline lens and a stronger correla­tion with BCVA < 20/40.

    Patients who received anti-VEGF therapy for neovascular AMD had a lower mortality risk than those who did not. No significant correlations were found between all-cause mortality and the assigned oral supplementation regimen (overall or individually).

    The effect of ocular disorders on mortality may relate to factors that increase the risk of both eye disease and death, suggesting a systemic compo­nent, the authors said. Early detection of age-related eye disease may prevent deterioration of BCVA and improve quality of life.

    The original article can be found here.