Korb Christina A, Kottler Ulrike B, Wolfram Christian, Hoehn René, Schulz Andreas, Zwiener Isabella, Wild Philipp S, Pfeiffer Norbert, Mirshahi Alireza
Department of Ophthalmology, University Medical Center, Johannes Gutenberg-University Mainz, Langenbeckstr.1, 55131, Mainz, Germany,
Graefes Arch Clin Exp Ophthalmol. 2014 Sep;252(9):1403-11. doi: 10.1007/s00417-014-2591-9. Epub 2014 Feb 25.
The aim of this study was to describe the sex- and age-specific prevalence of age-related macular degeneration (AMD) and its correlation with urban or rural residence in a large and relatively young European cohort.
We evaluated fundus photographs from participants in the Gutenberg Health Study (GHS), a population-based, prospective, observational, single-centre study in the Rhineland-Palatine region in midwestern Germany. The participants were 35-74 years of age at enrolment. The fundus images were classified as described in the Rotterdam Study and were graded independently by two experienced ophthalmologists (CK and UBK) based on the presence of hard and soft drusen, retinal pigmentary abnormalities, and signs of atrophic or neovascular age-related macular generation (AMD).
Photographs from 4,340 participants were available for grading. Small, hard drusen (<63 μm, stages 0b and 0c) were present in 37.4% of participants (95% confidence interval [CI], stage 0b, 31.6% [30.3-33.7]; stage 0c, 5.8% [5.1-6.5]). Early AMD (soft drusen, pigmentary abnormalities, stages 1-3) was present in 3.8% of individuals in the youngest age group (35-44 years) (95% CI, stage 1a, 0.4% [0.3-0.5%]; stage 1b, 3.2% [2.9-3.5%]; stage 2a, 0.1% [0.1-0.2%]; stage 2b, 0% [0-0.0%]; stage 3, 0.1% [0.1-0.2%]), whereas late AMD (stages 4a and 4b) did not appear in the youngest age group. In all age groups, signs of early AMD were detected in 11.9% of individuals (stage 1a, 2.1% [1.7-2.6]; stage 1b, 8.0% [7.2-8.8]; stage 2a, 1.0% [0.7-1.3]; stage 2b, 0.5% [0.3-0.7]; stage 3, 0.3% [0.2-0.6]). Late AMD (geographic atrophy or neovascular AMD) was found in 0.2% of individuals (stage 4a, 0.1 % [0.0-0.2]; stage 4b, 0.1% [0.0-0.2]). AMD increased significantly with age (odds ratio [OR], 1.09; 95% CI, 1.08-1.10). Sex, iris colour, and residence (rural vs. urban) were not associated with different rates of AMD.
In this study, the prevalence of AMD increased dramatically with age; however, although AMD is usually thought to occur after age 50, signs of early AMD were found in 3.8% of individuals in the youngest age group (younger than 45 years). This population-based sample is the first to provide substantial epidemiologic data from a large German cohort, including data on macular degeneration in younger age groups and incidence data after recall.
本研究旨在描述在一个规模较大且相对年轻的欧洲队列中，年龄相关性黄斑变性（AMD）的性别和年龄特异性患病率及其与城乡居住情况的相关性。
我们评估了古登堡健康研究（GHS）参与者的眼底照片，这是一项在德国中西部莱茵兰 - 普法尔茨地区开展的基于人群的前瞻性观察性单中心研究。参与者入组时年龄在35 - 74岁之间。眼底图像按照鹿特丹研究中的描述进行分类，并由两位经验丰富的眼科医生（CK和UBK）根据硬性和软性玻璃膜疣、视网膜色素异常以及萎缩性或新生血管性年龄相关性黄斑病变（AMD）的体征进行独立分级。
4340名参与者的照片可供分级。37.4%的参与者存在小的硬性玻璃膜疣（<63μm，0b和0c期）（95%置信区间[CI]，0b期，31.6%[30.3 - 33.7]；0c期，5.8%[5.1 - 6.5]）。最年轻年龄组（35 - 44岁）中3.8%的个体存在早期AMD（软性玻璃膜疣、色素异常，1 - 3期）（95%CI，1a期，0.4%[0.3 - 0.5%]；1b期，3.2%[2.9 - 3.5%]；2a期，0.1%[0.1 - 0.2%]；2b期，0%[0 - 0.0%]；3期，0.1%[0.1 - 0.2%]），而最年轻年龄组未出现晚期AMD（4a和4b期）。在所有年龄组中，11.9%的个体检测到早期AMD体征（1a期，2.1%[1.7 - 2.6]；1b期，8.0%[7.2 - 8.8]；2a期，1.0%[0.7 - 1.3]；2b期，0.5%[0.3 - 0.7]；3期，0.3%[0.2 - 0.6]）。0.2%的个体发现晚期AMD（地图样萎缩或新生血管性AMD）（4a期，0.1%[0.0 - 0.2]；4b期，0.1%[0.0 - 0.2]）。AMD患病率随年龄显著增加（优势比[OR]，1.09；95%CI，1.08 - 1.10）。性别、虹膜颜色和居住情况（农村与城市）与AMD的不同发生率无关。
在本研究中，AMD患病率随年龄急剧增加；然而，尽管通常认为AMD在50岁以后发生，但在最年轻年龄组（小于45岁）中3.8%的个体发现了早期AMD体征。这个基于人群的样本首次提供了来自一个大型德国队列的大量流行病学数据，包括年轻年龄组黄斑变性数据和随访后的发病率数据。
