Retinal Vessel Signs and 10-Year Incident Age-Related Maculopathy: The Blue Mountains Eye Study
Presented in part at: Association for Research in Vision and Ophthalmology Annual Meeting, May 2006, Fort Lauderdale, Florida.
Received 16 August 2005; accepted 26 January 2006. published online 06 July 2006.
Objective
To examine whether retinal vessel signs are independent predictors of the long-term development of age-related maculopathy (ARM).
Design
Prospective population-based cohort study.
Participants
Blue Mountains Eye Study participants aged ≥49 years (n = 3654) were examined during 1992 through 1994; 2335 (75% of survivors) were reexamined after 5 years and 1952 (76% of survivors) were reexamined after 10 years.
Methods
Baseline focal arteriolar narrowing and arteriovenous (AV) nicking were assessed and vessel calibers were measured from retinal photographs. A side-by-side grading method was used to assess ARM incidence. Eye-specific data were analyzed using generalized estimating equation models, adjusting for age, gender, smoking, and blood pressure.
Main Outcome Measures
Incident early ARM (soft indistinct or reticular drusen or combined soft distinct drusen and retinal pigment abnormality) was defined in eyes free of both early and late ARM at baseline. Incident late ARM (either geographic atrophy or neovascular macular degeneration) was defined in eyes free of these 2 lesions at baseline.
Results
Over a 10-year period, incident late ARM developed in 106/4745 eyes at risk of late ARM (2.2%). Eyes with mild (2.7%) or severe (4.6 %) AV nicking were more likely to develop late ARM than eyes without this sign (1.5%). The adjusted odds ratio (OR) was 1.4, 95% confidence interval (CI) 0.8 to 2.4 for mild and OR 2.6, 95% CI 1.2 to 5.5 for severe AV nicking. Eyes with focal narrowing were also more likely to develop late ARM (7.6% vs. 1.8%), adjusted OR 2.2, 95% CI 1.1 to 4.1. Incident early ARM developed in 398/4490 eyes at risk of early ARM (8.9%). Severe AV nicking, but not focal arteriolar narrowing, was associated with an increased long-term risk of early ARM (13.6% vs. 8.2%; OR 1.5; 95% CI 1.0–2.3). Neither arteriolar nor venular caliber was significantly associated with the incidence of either early or late ARM.
Conclusions
These 10-year incidence data confirm our previous observation that structural retinal arteriolar changes may either contribute to ARM progression or share common pathologic pathways with ARM, independent of traditional vascular risk factors.
Centre for Vision Research, Department of Ophthalmology and Westmead Millennium Institute, University of Sydney, Westmead, Australia.
Correspondence to Dr Jie Jin Wang, Centre for Vision Research, Department of Ophthalmology, University of Sydney, Westmead Hospital, Hawkesbury Road, Westmead, NSW Australia, 2145.
Manuscript no. 2005-1237.
Supported by the Australian National Health & Medical Research Council, Canberra, Australia (grant nos.: 974159, 211069).
The authors have no commercial or proprietary interest in products or companies mentioned in the article.
ABSTRACT