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Aim: To investigate the frequency and risk factors of non-retinopathy ocular conditions in persons with diabetes., Methods: A population-based cross-sectional study of 3176 Malay persons aged between 40 and 79 years in Singapore was conducted. Cataract, glaucoma, refractive errors, age-related macular degeneration, dry eye, epiretinal membrane, ocular hypertension and retinal conditions were assessed based on standardized interviews, clinical examinations and laboratory investigations., Results: A total of 768 participants (24.2%) had diabetes. People with diabetes were more likely to have cortical cataract (52.1 vs. 37.3%, P < 0.001), ocular hypertension (10.9 vs. 7.4%, P = 0.002) and epiretinal membrane (17.2 vs. 10.1%, P < 0.001) compared with those without diabetes. The odds of having cortical cataract (odds ratio 1.63, 95% CI 1.20-2.20) and epiretinal membrane (among those with previous cataract surgery: odds ratio 1.63, 95% CI 1.20-2.20) were significantly higher in people with diabetes compared with those without. The population attributable risks for cortical cataract and epiretinal membrane because of diabetes were 8.7 and 9.0%, respectively. In persons with diabetes, hypertension and high cholesterol were the major risk factors associated with non-retinopathy eye complications such as ocular hypertension (odds ratio 1.18, 95% CI 1.04-1.33) and retinal emboli (odds ratio 1.99, 95% CI 1.05-3.80)., Conclusion: Our results allow clinicians to better inform patients with diabetes that they are more likely to have cortical cataract and epiretinal membranes (those with previous cataract surgery) in addition to diabetic retinopathy. Two modifiable risk factors-blood pressure and cholesterol associated with ocular hypertension and retinal emboli, respectively-are also risk factors for non-retinopathy ocular conditions in persons with diabetes., (© 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK.)

Background/aims: Low socio-economic status is increasingly being identified as a risk marker for chronic diseases, but few studies have investigated the link between socio-economic factors and age-related macular degeneration (AMD). The present study aimed to assess the association between socio-economic status and the prevalence of AMD., Methods: A population-based cross-sectional study of 3280 (78.7% response rate) Malay adults aged 40-80 years residing in 15 south-western districts of Singapore. AMD was graded from retinal photographs at a central reading centre using the modified Wisconsin AMD scale. Early and late AMD signs were graded from retinal photographs following the Wisconsin grading system. Socio-economic status including education, housing type and income were determined from a detailed interview., Results: Of the participants, 3265 had photographs of sufficient quality for grading of AMD. Early AMD was present in 168 (5.1%) and late AMD in 21 (0.6%). After adjusting for age, gender, smoking, hypertension, diabetes and body mass index, participants with lower educational levels were significantly more likely to have early AMD (multivariate OR 2.2, 95% CI 1.2 to 4.0). This association was stronger in persons who had never smoked (multivariate OR 3.6, 95% confidence CI 1.4 to 9.4). However, no association with housing type or income was seen., Conclusions: Low educational level is associated with a higher prevalence of early AMD signs in our Asian population, independent of age, cardiovascular risk factors and cigarette smoking.

Complement factor H (CFH) is a key regulator of the alternative pathway of complement and its mutations have been associated with membranoproliferative glomerulonephritis type II, atypical hemolytic uremic syndrome and age-related macular degeneration (AMD), suggesting that alternative pathway dysregulation is a common pathogenetic feature of these ocular and renal conditions. In this study we tested the hypothesis that common CFH variants have a global role in renal function in the Australian population-based Blue Mountains Eye Study (BMES). We replicated the association of I62V with estimated glomerular filtration rate (GFR; P=0.017) and creatinine clearance (CRCL; P=0.015). The minor allele of I62V (G) was deleterious: adding one copy of the G allele decreased GFR/CRCL by approximately 0.98 ml min(-1) per 1.73 m(2) (95% confidence interval (CI): 0.97, 0.99). We also replicated the association of Y402H with AMD and provided an unbiased estimate of population attributable risk (PAR). The minor allele of Y402H (C) was deleterious: the odds ratio estimate of CC genotype compared to TT was 1.87 (95% CI: 1.44, 2.45). The PAR of the C allele was estimated as 0.22 (95% CI: 0.15, 0.28). In summary, in the BMES population we confirmed the association between I62V and renal function, as measured by the estimated GFR, plus the association of Y402H with both early- and late-stage AMD.

Background/aims: Age-related macular degeneration (AMD) and vascular disease share similar risk factors. Recent data suggest AMD may independently predict stroke or coronary heart disease. We prospectively assessed the relationship between AMD and risk of stroke- or cardiovascular-related death in an Australian population., Methods: Of 3654 baseline participants (1992-4) aged 49+ years, 2335 were re-examined after 5 years and 1952 after 10 years. Retinal photographs were graded using the Wisconsin System. History and physical examination provided data on possible risk factors. Deaths and cause of death were confirmed by data linkage with the Australian National Death Index. Risk ratios (RR) were estimated in Cox models., Results: Among persons aged <75 years at baseline, early AMD predicted a doubling of cardiovascular mortality (RR, 2.32; 95% confidence interval (CI), 1.03 to 5.19), over the next decade, after controlling for traditional cardiovascular risk factors. Late AMD predicted fivefold higher cardiovascular mortality (RR, 5.57; 95% CI, 1.35 to 22.99) and 10-fold higher stroke mortality (RR, 10.21; 95% CI, 2.39 to 43.60) after adjusting for age and sex only. These associations were not present when persons older than 75 were included., Conclusion: AMD predicted stroke and cardiovascular events over the long term in persons aged 49-75 years. This may have potential implications for new intravitreal anti-VEGF AMD therapies.

Purpose: To assess age-related maculopathy (ARM) in eyes of patients who had undergone cataract surgery for at least a year., Methods: Consecutive patients aged 60+ years who had undergone cataract surgery at Westmead Hospital, Sydney, Australia, during 2001-2003 were examined in 2004. Interview using standardized questionnaires and stereo retinal photography was performed. Retinal photographs were graded using the Wisconsin ARM grading system. The proportions with ARM were compared between surgical and nonsurgical eyes, and between this surgical cohort and the Blue Mountains Eye Study (BMES) population., Results: Of the 622 eligible patients, 454 (73%) were re-examined, with a mean follow-period of 2.8 years. Surgical eyes had a higher proportion of early ARM compared to nonsurgical eyes (15.2 vs10.3%, P=0.07) and to the early ARM prevalence found in BMES participants of similar age (14.5 vs6.9%, P<0.01), which persisted after age standardization to the BMES population (9.7 vs6.9%, P<0.05)., Conclusions: We found an increased prevalence of early ARM in surgical eyes of patients 1-3 years after cataract surgery. Whether this increased early ARM prevalence leads to an increased prevalence of late ARM in the long-term warrants further investigation.

Purpose: To assess visual acuity (VA) and health-related quality of life (HRQoL) outcomes in patients with and without age-related maculopathy (ARM) after cataract surgery., Methods: Patients aged 60+ years who had undergone cataract surgery at the Westmead Hospital during 2001-2003 were re-examined 1-3 years after surgery. Tests included VA and assessment of visual- and HRQoL using standardised questionnaires (VF-14, SF-12). Preoperative comorbidity data were collected from medical records. Poor surgical outcomes (VA<6/12; no VA improvement; lowest quintile of VF-14, SF-12 scores) were compared in patients with and without ARM, adjusting for age, sex, preoperative systemic comorbidities, ocular comorbidities and surgical or postoperative complications., Results: Of 622 surviving patients, 454 (73%) were followed up for a mean period of 2.8 years. Similar proportions with VA>or=6/12 were observed in patients with (80.2%) and without (88.8%) pre-existing ARM. Preoperative early ARM was only associated with slightly lower mean VF-14 scores (87.64 with vs 92.58 without ARM, P=0.01). Increasing age and preoperative ocular comorbidities were associated with all poor outcomes measured. Low SF-12 scores were associated with preoperative systemic comorbidities., Conclusion: Our study documents favourable cataract surgical outcomes 1-3 years after cataract surgery in patients with preoperative ARM.

Aim: To assess the cost effectiveness of high dose zinc and antioxidants for delaying and reducing the progression of early age related macular degeneration (AMD)., Background: AMD is the leading cause of severe vision impairment and blindness in older people throughout the developed world. It currently affects around 420 000 people in the United Kingdom., Methods: A cost utility analysis (CUA) was conducted to estimate the cost per quality adjusted life year (QALY) for screening a cohort of men and women, aged 55 years and over, for early AMD and then treating them with zinc and antioxidants. The incremental CUA was based on a decision analytic model, comparing screening with a no screening comparator (current practice). Extensive one way sensitivity analysis of parameters was conducted to determine the robustness of the model., Results: In this model the cost effectiveness of screening for early AMD was pound 22 722 per quality adjusted life year (QALY) saved. The cost per QALY decreased to pound 18 948 if photodynamic therapy with verteporfin savings were included., Conclusions: Screening for, and prophylactic treatment of, early AMD is estimated to cost around pound 22 700 per QALY saved. This cost falls within accepted levels to warrant further investigation. These findings have implications for ophthalmic practice and healthcare planning.

Aims: To assess whether retinal arteriolar wall changes (focal narrowing and arteriovenous nicking) are associated with an increased 5 year risk of age related maculopathy (ARM)., Methods: The Blue Mountains Eye Study examined 3654 residents aged 49+ years living in a defined area, during 1992-4 (82.4% participation). After 5 years, 2335 surviving participants (75.1%) were re-examined during 1997-9. Retinal photographs were graded using the Wisconsin ARM grading system. Incident late (neovascular or atrophic) or early stage ARM was defined using a side by side grading method. Focal arteriolar narrowing (localised constricted arteriolar segments causing a sausage-like appearance), and arteriovenous (AV) nicking (constriction on both sides of the venule where crossed by an arteriole), were graded by comparison with standard photographs. All retinal vessels passing through a circumferential zone 0.5-1.0 disc diameters from the optic disc margin were measured from digitised images. Summarised estimates for central retinal arteriolar equivalent (CRAE) represent an average diameter of arterioles for that eye. Associations were assessed after adjusting for age, sex, smoking, mean arterial blood pressure, and other vascular risk factors., Results: Of 2314 baseline participants at risk of late stage ARM, either late stage lesion developed in 34 participants (1.5%). Of 2203 at risk of early stage ARM, this sign developed in 197 participants (8.9%). Focal arteriolar narrowing was present at baseline in at least one eye of 162 survivors (6.9%) and severe AV nicking was present in 187 people (8.1%). Over 5 years, 4.9% of subjects with and 1.2% of those without focal narrowing developed either late stage ARM lesion, age adjusted relative risk (RR) 2.3, 95% confidence interval (CI) 1.0 to 5.1, multivariate adjusted odds ratios (OR) 2.1 (95% CI 0.9 to 4.9). Similarly, 3.7% of subjects with and 1.3% of those without severe AV nicking developed late ARM lesions, age adjusted RR 2.1 (95% CI 0.9 to 5.1), multivariate adjusted OR 2.2 (95% CI 0.9 to 5.6). Corresponding age adjusted RR and multivariate adjusted OR for development of early stage ARM were 1.4 (95% CI 0.9 to 2.0) and 1.3 (95% CI 0.8 to 2.1) for focal arteriolar narrowing, and 1.6 (95% CI 1.0 to 2.3) and 1.8 (95% CI 1.1 to 2.9) for severe AV nicking, respectively. No associations between baseline CRAE and 5 year incident late or early stage ARM were found., Conclusions: Although of borderline statistical significance, the consistent associations found in this study suggest that structural retinal arteriolar changes may either contribute to ARM progression or may share common pathological pathways with ARM.

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.

Objective: To assess the prevalence and potential risk factors for late age-related macular degeneration (AMD) in three racially similar populations from North America, Europe, and AUSTRALIA:, Design: Combined analysis of population-based eye disease prevalence data., Participants: There were 14,752 participants with gradable photographs from the Beaver Dam Eye Study (n = 4756), Rotterdam Study (n = 6411), and Blue Mountains Eye Study (n = 3585)., Main Outcome Measures: AMD diagnosis was made from masked grading of stereo macular photographs. Final classification of AMD cases was agreed by consensus between study investigators., Results: AMD prevalence was strongly age related. Overall, AMD was present in 0.2% of the combined population aged 55 to 64 years, rising to 13% of the population older than 85 years. Prevalence of neovascular AMD (NV) increased from 0.17% among subjects aged 55 to 64 years to 5.8% for those older than 85 years. Prevalence of pure geographic atrophy (GA) increased from 0.04% to 4.2% for these age groups. There were no significant gender differences in the prevalence of NV or GA. Subjects in the Rotterdam population had a significantly lower age-adjusted and smoking-adjusted risk of NV than subjects in the Beaver Dam and Blue Mountains populations. Apart from age, tobacco smoking was the only risk factor consistently associated with any form of AMD in all sites separately and in pooled analyses over the three sites., Conclusions: These combined data from racially similar communities across three continents provide strong and consistent evidence that tobacco smoking is the principal known preventable exposure associated with any form of AMD.

Purpose: To determine the prevalence of age-related maculopathy (ARM) lesions in residents of the state of Victoria, Australia., Design: Population-based cross-sectional study., Participants: Total of 5147 residential and institutionalized persons aged 40 years and older, living in Victoria., Methods: Participants were recruited through a cluster, stratified, random sampling from nine urban clusters and four rural clusters. The presence of ARM lesions was graded from color stereo fundus photographs as well as slit-lamp stereo biomicroscopy according to the International Classification and Grading System., Main Outcome Measures: The presence of ARM lesions., Results: The mean age of participants was 60.2 years, and 55% were females. Gradable fundus photographs were available for at least one eye in 4345 (92%) of the participants. The weighted prevalence of neovascular age-related macular degeneration (AMD) was 0.39% (95% confidence limits [CL] = 0.20, 0.58), atrophic AMD was 0. 27% (95% CL = 0.04, 0.50), and total AMD was 0.68% (95% CL = 0.30, 1. 1). Prevalence of AMD was strongly related to age (P < 0.001). Prevalence of early ARM was 15.1% (95% CL = 13.7, 16.4). Large drusen, 125 micrometer or more, were present in 6.3% of the participants. There was a higher prevalence of soft distinct drusen (7.5%) than soft indistinct drusen (4.3%). Retinal pigmentary abnormalities were present in 8.2% (95% CL = 7.2, 9.2). The prevalence of large drusen, soft drusen, and pigmentary abnormalities increased with age (P < 0. 001). Prevalence of retinal pigmentary abnormalities increased with increasing drusen size (P < 0.001). Soft indistinct drusen were more common in women aged 70 years or older (P < 0.001). Bilaterality of any ARM was strongly age related, and women appeared to have a higher risk of both bilateral early ARM and AMD., Conclusions: These data provide age- and gender-specific prevalence of ARM and its component lesions in an ethnically diverse Australian population. Early ARM and AMD prevalence rates increased sharply from ages 70 and 80 years, respectively, in all ethnic groups. These higher rates will continue to increase the importance of AMD as our population ages.

Purpose: To assess the relationship between different types of cataract or past cataract surgery and late or early age-related maculopathy (ARM) in an older population., Methods: A population-based survey examined 3,654 people aged >/=49 years, 82% of permanent residents of an area near Sydney, Australia. Participants had a detailed eye examination, including standardised dilated lens and stereo macular photographs. Presence of cataract and ARM was diagnosed from masked photographic grading using the Wisconsin Cataract and Age-related Maculopathy Grading Systems. Generalized Estimating Equation (GEE) and logistic regression models were used in the statistical analysis., Results: Higher prevalence was found for both late and early ARM in eyes with cataract or a past history of cataract surgery. However, after adjusting for age, sex and other ARM risk factors, no consistent association was found between presence of cortical, nuclear or posterior subcapsular (PSC) cataract or past history of cataract surgery and either late or early ARM. In the GEE model, the only statistically significant association found was between PSC and late ARM. Non-significant increased odds were found for late ARM in eyes with cortical cataract. However, detailed analyses of cortical cataract location failed to show a relationship., Conclusions: The co-existence of cataract and ARM was almost entirely explained by the age-related increase in prevalence of both conditions. We found no evidence of a consistent relationship between cortical, nuclear or PSC cataract or history of past cataract surgery and either late or early ARM, after adjusting for age and other potential ARM risk factors. The possibility of a relationship between PSC and late ARM or between cortical cataract and any ARM was not excluded. Long-term follow up data from this population will be useful.

Purpose: As diabetes is associated with other causes of visual loss (cataract, glaucoma) and elevated plasma fibrinogen, a risk factor for age-related maculopathy (ARM), our aim was to assess whether an association existed between diabetes and ARM., Methods: After exclusions, 3228 persons aged 49-97 years were studied. Diabetes was assessed from history or fasting glucose > or = 7.0mmol/L. Early and ate ARM were graded from stereoscopic photographs., Results: Late ARM (neovascular AMD or geographical atrophy) was found in 61 subjects (1.9%) while early ARM (large soft drusen and/or retinal pigment changes) was found in 171 (5.2%) subjects. Diabetes was present in 276 subjects (8.6%). Late ARM was present in 3.3% of subjects with and in 1.8% without diabetes. However, after adjusting for ARM risk factors, this difference was not statistically significant (OR 2.0; CI 0.9-4.6). Geographic atrophy was significantly associated with diabetes (OR 4.0; CI 1.6-10.3), but no association was found with either exudative ARM (OR 1.2; CI 0.4-3.5) or early ARM (OR 1.0; CI 0.5-1.8). No ARM associations were found with impaired fasting glucose., Conclusions: This study has found no consistent relationship between diabetes and ARM, apart from a statistically significant association with geographical atrophy alone.

Purpose: To assess associations between refractive error (hyperopia, myopia, and spherical equivalent [SEq]) and age-related maculopathy (ARM) in an older population., Methods: A population-based survey examined 3654 people aged 49 years or older, 82% of whom were permanent residents in an area west of Sydney, Australia. Participants had a detailed eye examination, including standardized refraction and stereo macular photographs. ARM was diagnosed from blinded photographic grading. Autorefractor measurements and subjective refraction were used to assess SEq refractive error for each eye in diopters. Mean SEq of the two eyes was used to define emmetropia, myopia, and hyperopia in each person., Results: After known ARM risk factors (age, sex, ARM family history, current smoking) had been adjusted for, no association was found between mean SEq (two eyes) and late ARM (odds ratio [OR], 1.0; 95% confidence interval [CI], 0.9-1.1). However, a statistically significant increased risk of early ARM was found for each diopter of increase in mean SEq (OR, 1.1; CI, 1.0-1.2). In logistic regression models, moderate to high hyperopia was significantly associated with increased early ARM risk (OR, 2.0; CI, 1.2-3.4). When a generalized estimating equation model (GEE), which assessed the relationship at eye level while accounting for the correlation between the two eyes, was used, this association was marginally insignificant (OR, 1.3; CI, 0.9-1.9). No significant associations were found between myopia and any ARM stage with either model., Conclusions: These population-based data suggest a weak association between hyperopia and early ARM.

Objective: The purpose of the study was to assess relationships between age-related maculopathy (ARM) and iris color, skin sun sensitivity, and other sunlight-related factors., Design: Cross-sectional population-based study., Participants: The Blue Mountains Eye Study performed a detailed eye examination of 3654 residents living in the Blue Mountains area, west of Sydney, Australia., Main Outcome Measures: Subjects with late age-related macular degeneration (late AMD), early ARM, and large drusen (> or = 125 microns diameter) were identified using masked grading of retinal photographs. Iris color was graded using standard photographs, and interviewers collected questionnaire data on sunlight-related factors. Logistic regression, adjusting for age, sex, AMD family history, and current smoking, was used to assess associations., Results: Blue iris color was significantly associated with an increased risk of both late AMD (odds ratio [OR], 1.69) and early ARM (OR, 1.45). An increased risk of late AMD, but not early ARM, was associated with both high (OR, 2.54) and low (OR, 2.18) skin sun sensitivity, as assessed using the Fitzpatrick sun-sensitivity scale. These associations remained after adjusting for the presence of sun-related skin damage. Neither history (or treatment) of skin cancer lesions, signs of sun-induced skin damage, or number of severe sunburns was associated with either late AMD or early ARM., Conclusions: Blue iris color was associated with an increased risk of both late AMD and early ARM in this population. Abnormal skin sensitivity to sunlight was also associated with an increased risk of late AMD.

Aims: To describe the influences of age and sex on the frequency of bilateral age related macular degeneration (AMD) and age related maculopathy (ARM) lesions., Methods: The Blue Mountains Eye Study examined 3654 older Australians, 82% of permanent residents living in an area west of Sydney. Stereo macular photographs were graded for AMD (neovascular maculopathy and geographic atrophy) and early ARM lesions (soft drusen, reticular drusen, hyperpigmentation, and hypopigmentation)., Results: Among 230 gradable cases of AMD or early ARM, 183 (80%) were bilateral. For AMD, 39/69 cases (57%) were bilateral, while for early ARM, 123/161 cases (77%) had signs in both eyes. Of the individual lesions, reticular drusen (91%) and indistinct soft drusen (79%) were most frequently present in both eyes. Geographic atrophy was bilateral in 56%, neovascular AMD in 40%, and distinct soft drusen in 47%, while hyperpigmentation was bilateral in 38% and hypopigmentation in only 28% of cases. A consistent age related increase in bilateral distribution was observed for most lesions. After adjusting for effects of age, current smoking, and AMD family history AMD and ARM component lesions, except for soft drusen, were more frequently bilateral in women. This sex difference was significant only for neovascular AMD, odds ratio 7.7 (95% confidence intervals 1.3-46.7). An AMD family history was more frequently reported in cases with bilateral involvement., Conclusions: This study has documented differences in the age related bilaterality of individual ARM components with higher bilateral rates for reticular or indistinct soft drusen compared with other lesions. The increased bilaterality of most ARM lesions among women is likely to contribute to the increased age adjusted risk of AMD blindness found in women.

Objective: To assess the relationship between stages of age-related maculopathy (ARM) and cardiovascular disease and cardiovascular disease risk factors, including serum lipid and plasma fibrinogen levels, smoking, cardiovascular events, systemic hypertension, diabetes mellitus, and obesity., Design: A cross-sectional study of 3654 subjects from a defined geographic area identified subjects with late age-related macular degeneration (ARMD) and early ARM from the masked grading of retinal photographs. The history, physical examination findings, and fasting blood samples provided data on possible risk factors. Logistic regression, adjusting for age, sex, and possible confounders, and 2-way analysis of variance were used to assess associations., Results: The only factors significantly associated with ARM included the 2 established risk factors, smoking and family history of ARMD (odds ratios, 4.1 and 4.2, for late ARMD, respectively), and the 2 variables, body mass index (odds ratio, 1.78 for obese compared with normal body mass index for early ARM) and plasma fibrinogen level (odds ratio, 6.7 for a fibrinogen level of >4.5 g/L [highest quartile] compared with a fibrinogen level of <3.4 g/L [lowest quartile] for late ARMD)., Conclusions: These findings support the concepts that associations exist between plasma fibrinogen levels and late ARMD, a body mass index outside the normal range, and early ARM, and between the family history and smoking and any ARM. We found no other significant associations with any history of cardiovascular disease or other risk factors for cardiovascular disease.

Purpose: To determine whether females have a higher age-specific age-related maculopathy prevalence than males; whether there is an increased risk of age-related macular degeneration (AMD) with early menopause; and whether there is a decreased risk of AMD with use of hormone replacement therapy (HRT)., Methods: Pooled data from three study populations that have used similar AMD diagnostic criteria were used to answer the first hypothesis: the Beaver Dam Eye Study (BDES), the Rotterdam study of the elderly, and the Blue Mountains Eye Study (BMES). The BMES population was used to answer the second and third hypotheses. This population included residents aged 49 or older with 2072 women participating, of whom 1899 postmenopausal women answered questions about menopause, menarche and HRT. AMD was diagnosed from graded retinal photographs using modified international criteria., Results: The overall pooled odds ratio (OR) for association between sex and AMD revealed a significant increase in AMD prevalence among females compared with males, adjusting for 10-year age categories, OR = 1.15 (1.10-1.21), with no significant heterogeneity between studies. A significant decrease in the odds of early AMD with increasing years from menarche to menopause was observed., Conclusions: The results suggest that females may have a higher risk of AMD. The significant decrease in early AMD with increasing years from menarche to menopause supports the concept that a shorter duration of oestrogen production may increase risk of AMD.

Purpose: To examine the prevalence of age-related maculopathy (drusen and retinal pigmentary abnormalities) and end-stage age-related macular degeneration lesions (neovascular maculopathy or geographic atrophy) in a defined older Australian urban population., Subjects: All noninstitutionalized residents 49 years of age or older who were identified in a door-to-door census of two postcode areas west of Sydney, Australia., Methods: All participants received a detailed eye examination, including stereoscopic photographs of each macula. Two trained graders used the Wisconsin Age-related Maculopathy Grading System to assess the presence and severity of typical lesions., Results: A marked age-related increase in all typical lesions of age-related maculopathy and macular degeneration was observed. End-stage age-related macular degeneration was present in 1.9% of the population, rising from 0% among people younger than 55 years of age to 18.5% among those 85 years of age or older. Soft drusen were found in 13.3% of people, with distinct drusen more frequent than indistinct soft drusen. Retinal pigmentary abnormalities were found in 12.6% of people. For end-stage lesions and soft drusen, females had higher age-specific prevalence rates than males, whereas retinal pigmentary abnormalities were more frequent in males, although most of these differences were not significant. Prevalence rates for all lesions were lower (statistically significant for retinal pigmentary abnormalities and soft drusen) than for the United States Beaver Dam Eye Study which examined a similar population., Conclusions: These data provide detailed prevalence rates for most components of ARM in an Australian population and reinforce the Beaver Dam Eye Study findings for the relative age-specific frequency of age-related macular degeneration components.