Pham Thuan Quoc, Rochtchina Elena, Mitchell Paul, Smith Wayne, Wang Jie Jin
Centre for Vision Research, Department of Ophthalmology, University of Sydney, Sydney, Australia.
Ophthalmic Epidemiol. 2009 Mar-Apr;16(2):136-41. doi: 10.1080/09286580701299395.
To examine the associations among iris, skin, or hair color, and skin sun sensitivity and the 10-year incidence of age-related maculopathy (ARM).
The Blue Mountains Eye Study (BMES) recruited 3654 participants aged 49+ years at baseline (1992-1994, 82.4% participation rate). Re-examinations of 2335 participants (75.1% of survivors) were done after 5 years (1997-1999) and 1952 (76.5% of survivors) after 10 years (2002-2004). Retinal photographs were graded using the Wisconsin ARM Grading System and incident ARM confirmed using the side-by-side grading method. Iris, skin, and hair color, and sun-related skin damage were assessed and skin sun-sensitivity questions were asked at baseline. Ten-year ARM incidence was calculated using Kaplan Meier methods and discrete logistic models were used to assess associations after adjusting for age, sex, and smoking.
After adjustment, no significant associations were found between iris or hair color and either late- or early-incident ARM. Compared to persons with fair skin, those with very fair skin had an increased risk of developing geographic atrophy (multivariate adjusted risk ratio, RR = 7.6; 95% confidence interval, CI = 3.0-19.6). In contrast, compared to persons with average skin sun sensitivity, persons who reported that their skin would usually burn and tan with difficulty had a reduced risk of neovascular ARM (RR = 0.2, 95% CI = 0.0-0.7). Sun-related skin damage was not associated with late or early ARM.
In this older cohort, we did not find a consistent pattern of association between sunlight-related factors and ARM incidence, except that persons with very fair skin might have an increased risk of geographic atrophy, consistent with our 5-year incidence data. The protective association between skin sensitivity to sun damage and neovascular ARM could have be the result of confounding by sun-avoidance behavior among persons sensitive to sunburn.
研究虹膜、皮肤或头发颜色与皮肤对阳光的敏感性以及年龄相关性黄斑病变（ARM）的10年发病率之间的关联。
蓝山眼研究（BMES）在基线时（1992 - 1994年）招募了3654名年龄在49岁及以上的参与者（参与率为82.4%）。5年后（1997 - 1999年）对2335名参与者（幸存者的75.1%）进行了复查，10年后（2002 - 2004年）对1952名参与者（幸存者的76.5%）进行了复查。使用威斯康星ARM分级系统对视网膜照片进行分级，并采用并排分级法确诊新发ARM。在基线时评估虹膜、皮肤和头发颜色以及与阳光相关的皮肤损伤情况，并询问皮肤对阳光敏感性的问题。使用Kaplan Meier方法计算10年ARM发病率，并在调整年龄、性别和吸烟因素后，使用离散逻辑模型评估关联。
调整后，未发现虹膜或头发颜色与晚期或早期新发ARM之间存在显著关联。与皮肤白皙的人相比，皮肤非常白皙的人发生地图样萎缩的风险增加（多变量调整风险比，RR = 7.6；95%置信区间，CI = 3.0 - 19.6）。相比之下，与皮肤对阳光平均敏感性的人相比，那些报告其皮肤通常容易晒伤且难以晒黑的人发生新生血管性ARM的风险降低（RR = 0.2，95% CI = 0.0 - 0.7）。与阳光相关的皮肤损伤与晚期或早期ARM无关。
在这个老年队列中，除了皮肤非常白皙的人可能发生地图样萎缩的风险增加（与我们的5年发病率数据一致）外，我们未发现与阳光相关的因素和ARM发病率之间存在一致的关联模式。皮肤对阳光损伤的敏感性与新生血管性ARM之间的保护关联可能是由于对晒伤敏感的人避免阳光照射行为造成的混杂结果。
