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Risk Factors for Age-Related Maculopathy
The Visual Impairment Project
Catherine A. McCarty, PhD, MPH;
Bickol N. Mukesh, PhD;
Cara L. Fu, GradDip (IT);
Paul Mitchell, FRACO;
Jie Jin Wang, Mmed, MBBS;
Hugh R. Taylor, MD, FRACO
Arch Ophthalmol. 2001;119:1455-1462.
Objective To describe the risk factors and associated population attributable
risk for age-related maculopathy (ARM) and age-related macular degeneration
(AMD) in Australians aged 40 years and older.
Methods Residents were recruited from 9 randomly selected urban clusters and
4 randomly selected rural clusters in Victoria, Australia. At locally established
test sites, the following information was collected: visual acuity, medical
and health history, lifetime sunlight exposure, dietary intake, and fundus
photographs. Age-related maculopathy and AMD were graded from the fundus photographs
using an international classification and grading system. Backwards logistic
regression was used to identify the independent risk factors for ARM and AMD.
Results The participation rate was 83% (n = 3271) among the urban residents
and 92% (n = 1473) among the rural residents. Gradable fundus photographs
of either eye were available for 4345 (92%) of the 4744 participants. There
were 656 cases of ARM, giving a weighted prevalence of 15.1% (95% confidence
limit [CL], 13.8, 16.4); and there were 30 cases of AMD, giving a weighted
prevalence of 0.69% (95% CL, 0.33, 1.03). In multiple logistic regression,
the risk factors for AMD were as follows: age (odds ratio [OR], 1.23; 95%
CL, 1.17, 1.29), smoked cigarettes for longer than 40 years (OR, 2.39; 95%
CL, 1.02, 5.57), and ever taken angiotensin-converting enzyme inhibitors (OR,
3.26; 95% CL, 1.33, 8.01). The magnitude of all of these risk factors was
slightly less for ARM, and having ever taken blood cholesterol–lowering
medications was also significant (OR, 1.67; 95% CL, 1.12, 2.47; P = .001).
Conclusion Smoking is the only modifiable risk factor for ARM and AMD, among the
many environmental and systemic factors that were assessed.
From the Centre for Eye Research Australia, University of Melbourne,
East Melbourne (Drs McCarty, Mukesh, and Taylor and Ms Fu); and the Department
of Ophthalmology and the Save Sight Institute, University of Sydney, Westmead
Hospital, Sydney, Australia (Drs Mitchell and Wang).
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