Cigarette smoking and age-related macular degeneration in the EUREYE study
Cigarette smoking and age-related macular degeneration in the EUREYE study
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DOI：
10.1016/j.ophtha.2006.09.022
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发表时间：
2007-06-01
期刊：
影响因子：
13.7
通讯作者：
Fletcher, A. E.
中科院分区：
文献类型：
--
作者：
Chakravarthy, U.;Augood, C.;Fletcher, A. E.
目的：研究吸烟与欧洲人群中年龄相关性黄斑病变（ARM）包括年龄相关性黄斑变性（AMD）之间的关系。设计：横断面研究。参与者：从欧洲7个研究中心（挪威、爱沙尼亚、英国、法国、意大利、希腊和西班牙）随机抽取的4750名65岁的老人。方法：参与者进行眼部检查和数码视网膜摄影。这些图像在一个单一的中心被分级。吸烟史由训练有素的现场工作人员通过结构化问卷调查确定。考虑到潜在的混杂因素和多中心研究设计，采用多项和二元logistic回归来检验吸烟史与ARM分级和AMD类型之间的关系。主要结果测量：摄影图像按照国际分级系统进行分级，并使用鹿特丹分级系统分层为5个单独的阶段（ARM 0-3和ARM 4，也称为AMD）。年龄相关性黄斑变性也被归类为新生血管性AMD或地理萎缩（GA）。结果：黄斑变性158例，其中新生血管性黄斑变性109例，GA 49例；2260没有ARM的迹象（ARM 0）。当前吸烟者患新生血管性AMD（比值比[OR]， 2.6； 95%可信区间[CI]， 1.4-4.8）或GA （OR, 4.8； 95%可信区间[CI]， 2.1-11.1）的几率增加，而戒烟者的比值约为1.7。与单侧AMD患者相比，双侧AMD患者在过去25年内更有可能有重度吸烟史（OR, 5.1; 95% CI, 1.3-20.0）。吸烟引起的AMD的归因比例为27% （95% CI, 19%-33%）。ARM 1至3级与吸烟没有一致的联系。结论：这些发现强调需要提高公众对吸烟相关风险和戒烟益处的认识。目前吸烟的单侧疾病患者应被告知患第二眼疾病的风险。
Objective: To examine the association between cigarette smoking and age-related maculopathy (ARM) including age-related macular degeneration (AMD) in the European population.Design: Cross-sectional study.Participants: Four thousand seven hundred fifty randomly sampled >= 65-year-olds from 7 study centers across Europe (Norway, Estonia, United Kingdom, France, Italy, Greece, and Spain).Methods: Participants underwent an eye examination and digital retinal photography. The images were graded at a single center. Smoking history was ascertained by a structured questionnaire administered by trained fieldworkers. Multinomial and binary logistic regressions were used to examine the association between smoking history and ARM grade and type of AMD, taking account of potential confounders and the multicenter study design.Main Outcome Measures: Photographic images were graded according to the International Classification System for ARM and stratified using the Rotterdam staging system into 5 exclusive stages (ARM 0-3 and ARM 4, also known as AMD). Age-related macular degeneration also was classified as neovascular AMD or geographic atrophy (GA).Results: One hundred fifty-eight cases were categorized as AMD (109 neovascular AMD and 49 GA); 2260 had no signs of ARM (ARM 0). Current smokers had increased odds of neovascular AMD (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.4-4.8) or GA (OR, 4.8; 95% CI, 2.1-11.1), whereas for ex-smokers the odds were around 1.7. Compared with people with unilateral AMD, those with bilateral AMD were more likely to have a history of heavy smoking in the previous 25 years (OR, 5.1; 95% CI, 1.3-20.0). The attributable fraction for AMD due to smoking was 27% (95% CI, 19%-33%). There was no consistent association with ARM grades 1 to 3 and smoking.Conclusions: These findings highlight the need for increasing public awareness of the risks associated with smoking and the benefit of quitting smoking. Patients with unilateral disease who are current smokers should be advised of the risk of second-eye disease.