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Ronald Klein, MD, MPH; Barbara E. K. Klein, MD, MPH; Sandra C. Tomany, MS; Karen J. Cruickshanks, PhD

Arch Ophthalmol. 2003;121:674-678.

Objective  To examine the relationship of 2 diseases associated with systemic inflammatory response, emphysema and gout, and selected markers of systemic inflammation with the 10-year incidence of age-related maculopathy.

Design  Population-based cohort study.

Participants  We included persons aged 43 to 86 years at baseline examination from 1988 to 1990 living in Beaver Dam, Wis, of whom 3684 subjects participated in a 5-year follow-up examination and 2764 participated in a 10-year follow-up.

Methods  Standardized protocols for physical examination, blood collection, administration of a questionnaire, and stereoscopic color fundus photography to determine the presence of age-related maculopathy. Standard univariate and multivariate analyses were performed.

Main Outcome Measures  Incidence and progression of age-related maculopathy.

Results  While controlling for age, sex, and other factors (history of heavy drinking or smoking, systolic blood pressure, and vitamin use), a higher white blood cell count at baseline was associated with the 10-year incidence ofdrusen 125 µm or greater in diameter (risk ratio [RR] per 10⁶/µL = 1.10; 95% confidence interval [CI], 1.03-1.17), retinal pigment epithelial depigmentation (RR = 2.08; 95% CI, 1.01-1.16), and progression of age-related maculopathy (RR = 1.09; 95% CI, 1.03-1.15). A lower serum albumin level was associated with the incidence of exudative macular degeneration (RR per grams per deciliter = 0.31; 95% CI, 0.13-0.76). A history of emphysema at baseline was associated with the incidence of retinal pigment epithelial depigmentation (RR = 2.84; 95% CI, 1.40-5.78), increased retinal pigment (RR = 2.20; 95% CI, 1.11-4.35), and exudative macular degeneration (RR = 5.12; 95% CI, 1.63-16.06); a history of gout was associated with the incidence of pure geographic atrophy (RR = 3.48; 95% CI, 1.27-9.53).

Conclusions  These findings indicate modest relationships between both increased white blood cell count and emphysema and the increased 10-year incidence of lesions defining early and late age-related maculopathy. Further investigation of these relationships in other studies is needed.

From the Department of Ophthalmology and Visual Sciences (Drs R. Klein, B. Klein, and Cruickshanks and Ms Tomany) and Department of Population Health Sciences (Dr Cruickshanks), University of Wisconsin Medical School, Madison. The authors have no relevant financial interest in this article.

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