Fifteen-year cumulative incidence of age-related macular degeneration
Fifteen-year cumulative incidence of age-related macular degeneration
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DOI：
10.1016/j.ophtha.2006.10.040
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发表时间：
2007-02-01
期刊：
影响因子：
13.7
通讯作者：
Gangnon, Ronald E.
中科院分区：
文献类型：
--
作者：
Klein, Ronald;Klein, Barbara E. K.;Gangnon, Ronald E.
目的：描述早期和晚期年龄相关性黄斑变性（AMD）体征的15年累积发病率。设计：基于人群的队列研究。参与者：我们纳入了3917人，在1988年至1990年的基线检查时年龄为43至86岁，并在1993年至1995年的随访中收集了信息，方法：采用威斯康星州黄斑相关性黄斑病变分级系统对立体眼底照片进行分级。主要结果测量：玻璃疣类型和大小、色素异常、地图样萎缩和渗出性AMD的累积发病率占死亡的竞争风险。15年累积发病率为14.3%的早期AMD（存在软模糊玻璃疣或存在色素异常与任何类型的玻璃疣）和3.1%的晚期AMD（存在渗出性AMD或地图状萎缩）。随着年龄的增长，AMD的发病率逐渐增高（P < 0.05）。基线时年龄>= 75岁的个体具有显著的（P < 0.01）以下特征的15年发生率高于43至54岁的人：较大玻璃疣（直径125 μ m，24.1%比10.6%），软而不明显的玻璃疣（18.7%vs 6.5%）、视网膜色素异常（20.2%vs 3.7%）、渗出性黄斑变性（4.4%vs 0.4%）和单纯地图样萎缩（3.2%vs 0%）。在控制年龄的情况下，与仅有少量硬玻璃疣（1-2个）的患者相比，仅有大量硬玻璃疣（>= 8个）的患者15岁时的软玻璃疣（16.3% vs 4.7%）和色素异常（10.6% vs 2.7%）的发病率增加。基线时有软的模糊玻璃疣或色素异常的眼睛在随访时比没有这些病变的眼睛更可能发展为晚期AMD（分别为17.8%和12.9%和1.7%）。结论：我们记录了老年人AMD体征的长期发病率和从小的硬玻璃疣到晚期AMD的连续性。>= 75岁人群中晚期AMD的15年累积发病率（8%）表明这是一个重要比例的公共卫生问题，因为美国该年龄段的人口预计在2005年至2025年期间将增加54%。
Purpose: To describe the 15-year cumulative incidence of signs of early and late age-related macular degeneration (AMD).Design: Population-based cohort study.Participants: We included 3917 persons, 43 to 86 years of age at the time of a baseline examination in 1988 through 1990 and with information collected in follow-up in 1993 through 1995, and/or 1998 through 2000, and/or 2003 through 2005.Methods: Grading of stereoscopic fundus photographs using the Wisconsin Age-Related Maculopathy Grading System.Main Outcome Measures: Cumulative incidence of drusen type and size, pigmentary abnormalities, geographic atrophy, and exudative AMD accounting for competing risk of death.Results: The 15-year cumulative incidence was 14.3% for early AMD (the presence of either soft indistinct drusen or the presence of pigmentary abnormalities together with any type of drusen) and 3.1% for late AMD (presence of exudative AMD or geographic atrophy). There was an increased incidence of AMD lesions with age (P < 0.05). Individuals >= 75 years of age at baseline had significantly (P < 0.01) higher 15-year incidences of the following characteristics than people 43 to 54 years of age: larger drusen (125 mu m in diameter, 24.1% vs 10.6%), soft indistinct drusen (18.7% vs 6.5%), retinal pigmentary abnormalities (20.2% vs 3.7%), exudative macular degeneration (4.4% vs 0.4%), and pure geographic atrophy (3.2% vs 0%). Controlling for age, compared with those with small numbers of only small hard drusen (1-2), those with large numbers of only hard drusen (>= 8) had an increased 15-year age-adjusted incidence of both soft indistinct drusen (16.3% vs 4.7%) and pigmentary abnormalities (10.6% vs 2.7%). Eyes with soft indistinct drusen or pigmentary abnormalities at baseline were more likely to develop late AMD at follow-up than eyes without these lesions (17.8% vs 1.2% and 12.9% vs 1.7%, respectively).Conclusions: We document the long-term incidence of signs of AMD and a continuum from small hard drusen to late AMD in older persons in the population. The 15-year cumulative incidence of late AMD in people >= 75 years of age (8%) indicates a public health problem of significant proportions because the United States population this age is expected to increase by 54% between 2005 and 2025.