老年性黄斑病变危险因素的14年随访研究:哥本哈根眼科研究

Purpose: To examine the association between potential risk factors and the 14 -year incidence of age-related maculopathy (ARM). Design: Population-based co hort study. Participants: At baseline, 946 volunteers participated in the study during 1986-88. These subjects were between 60 and 80 years of age and lived in the terbro district of Copenhagen. Excluding participants who had died since baseline, 359 subjects (97.3%of survivors) were reexamined 14 years later, duri ng 2000-2002. A total of 31.8%(301/946) of the original material was included in the risk factor analyses. Methods: Participants underwent an ophthalmological examination at Rigshospitalet, the National University Hospital of Copenhagen. Similar standardized protocols for physical examination were used at the baselin e and follow-up examinations. Age-relatedm- aculopa-thy lesionswere determined by the same grader grading colour fundus p hotographs from both examinations using a modification of the Wisconsin Age-rel ated Maculopathy Grading System protocol. Results: Of the 359 participants, 94 h ad incident early ARM and 52 had incident late ARM at follow-up in either eye. In logistic regression, the risk factors for early ARM or worse were as follows: cataract (odds ratio [OR] 2.8, 95%confidence interval [CI] 1.2-6.2); fami ly h istory of ARM (OR 4.5, 95%CI 1.3-15.5), and alcohol consumption >250 g/week (O R 4.6, 95%CI 1.1-19.2). High levels of apolipoprotein B ( > 100 mg/1) decrease d the risk of development of early ARM or worse (OR 0.4, 95%CI 0.2-0.8), while high levels of apolipoprotein A1 (≥150 mg/1) increased the risk of late ARM (O R 2.5, 95%CI 1.2-5.3). Advanced age at baseline was also associated with the i ncidence of late ARM(OR2.0, 95%CI 1.4-2.9). Conclusions: These findings indica te a direct correlation between age, cataract, family history, alcohol consumpti on, the apolipoproteins A1 and B and the 14-year incidence of ARM.

老年性黄斑病变:女性生存率下降的危险指征:哥本哈根市眼科研究

Purpose: To examine patient survival in age- related maculopathy in a 14- year follow- up study. Design: Population- based 14- year cohort study. Participants: Nine hundred forty- six residents, aged 60 to 80 years, living in the sterbro district of Copenhagen, Denmark, participated in the first examination conducted from 1986 to 1988. These participants were followed until death or until May 1, 2002, whichever came first. Methods: Participants underwent an extensive ophthalmologic examination at Rigshospitalet, the National University Hospital of Copenhagen. Standardized protocols for physical examination, blood samples, and data from the National Central Person Register, the National Death Register, and the National Patient Register were used. Main Outcome Measures: Mortality and age- related maculopathy. Results: By May 1, 2002, 60.9% (577 of 946) of the participants of the baseline study cohort had died. The adjusted 14- year cumulative mortality hazard ratio for subjects with early and late age- related maculopathy at baseline was 1.26 (95% confidence interval [CI], 1.06- 1.51). We identified a strong correlation between mortality and agerelated maculopathy among women (relative risk, 1.59; 95% CI, 1.23- 2.07) but not among men. Conclusions: When adjusting for survival- related factors, age- related maculopathy is a significant risk indicator for poorer survival in women and may be amarker of underlying serious systemic factors or aging processes specific to women.

老年性黄斑变性的14年发病率、病程进展及视力改变:哥本哈根市眼病研究

Purpose: To describe the 14-year incidence of age-relatedmaculopathy (ARM) lesions and the related visual loss. Design: Population-based cohort study. Participants: Nine hundred forty-six residents (age range, 60-80 years) of Copenhagen participated in the study from 1986 through 1988. Excluding participants who had died since baseline, 359 persons (97.3%of survivors)were reexamined from 2000 through 2002. Methods: Participants underwent extensive ophthalmologic examinations. Age-related maculopathy lesions were determined by grading color fundus photographs from the examinations using a modified Wisconsin Age-Related Maculopathy Grading System. Main Outcome Measures: Incidence of drusen type and size, pigmentary abnormalities, pure geographic atrophy, exudative ARM, visual impairment, and blindness. Results: The 14-year incidences of early and late ARM were 31.5%and 14.8%, respectively. Individuals 75 to 80 years of age at baseline had significantly (P≤0.05) higher 14-year incidences of the following lesions than those aged 60 to 64 years: medium or large drusen (≥125 μm; 34.2%vs. 12.8%, respectively), soft drusen (45.2%vs. 21.4%), pigmentary abnormalities (31.4%vs. 17.0%), pure geographic atrophy (17.4%vs. 1.0%), and exudative ARM (23.3%vs. 5.7%). Severe drusen type, large drusen, and retinal pigmentary abnormalities at baseline were important predictors of incident late ARM. The 14-year incidences of visual impairment (< 20/40 but > 20/200) or legal blindness from late ARM were 6.0%and 3.4%, respectively. Late ARMcaused 35.7%of all visual impairment and 66.7%of all blindness. Conclusions: There is a high incidence of ARM lesions in this elderly white population. Severe drusen type and size or a combination of drusen and pigmentary abnormalities significantly increases the risk of developing late ARM, the most frequent cause of legal blindness in this population.