Bastawrous Andrew, Mathenge Wanjiku, Peto Tunde, Shah Nisha, Wing Kevin, Rono Hillary, Weiss Helen A, Macleod David, Foster Allen, Burton Matthew, Kuper Hannah
International Centre for Eye Health, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, England.
Rwanda International Institute of Ophthalmology and Dr Agarwal's Eye Hospital, Kigali, Rwanda.
JAMA Ophthalmol. 2017 Jun 1;135(6):631-638. doi: 10.1001/jamaophthalmol.2017.1109.
The incidence of age-related macular degeneration (AMD) is unknown in Africa.
To estimate the 6-year cumulative incidence and progression of AMD in older adults (≥50 years old) in Nakuru, Kenya.
DESIGN, SETTING, AND PARTICIPANTS: This study assessed a population-based cohort with 6-year follow-up of 4414 participants who had a complete assessment. Random cluster sampling with probability proportionate to size procedures was used to select a representative, cross-sectional sample of adults 50 years and older from January 26, 2007, through November 11, 2008. A 6-year follow-up was undertaken from January 7, 2013, through March 12, 2014. On both occasions, a comprehensive ophthalmic examination was performed that included logMAR visual acuity, digital retinal photography, and grading of images at Moorfields Eye Hospital Reading Centre. Data were collected on general health and risk factors.
Incident AMD in participants with no AMD at baseline and progression from early to late AMD.
A total of 1453 of the 2900 individuals (50.1%) at risk for AMD were followed up after 6 years (mean [SD] age, 60.7 [8.2] years; 635 female [49.5%]; 799 Kikuyu [62.3%], 324 Kalenjin [25.3%], and 159 other [12.4%]); 1282 had data on AMD status at follow-up. Of these, 202 developed early AMD, and no participants developed late AMD. The 6-year weighted (for loss to follow-up) cumulative incidence of early AMD was 164.2 per 1000 persons (95% CI, 136.7-195.9 per 1000 persons). Two individuals with baseline early AMD from the 142 at risk had developed late AMD at follow-up, with a 6-year cumulative incidence of progression from early to late AMD of 24.5 per 1000 persons (95% CI, 5.0-111.7 per 1000 persons). Cumulative incidence of AMD increased with age (≥80 years old vs 50-59 years old: 1.8; 95% CI, 0.9-3.5) and was higher in women (female vs male: 1.6; 95% CI, 1.2-2.1) and persons with diabetes (diabetes vs no diabetes: 1.7; 95% CI, 1.0-2.8).
In Kenya, more than 100 000 estimated new cases of AMD, mainly early AMD, will develop every year in individuals 50 years or older, although a 50% loss to follow-up and wide CIs for progression to late AMD limit definitive conclusions from these findings.
非洲年龄相关性黄斑变性（AMD）的发病率尚不清楚。
评估肯尼亚纳库鲁地区老年人（≥50岁）AMD的6年累积发病率及病情进展情况。
设计、地点和参与者：本研究对4414名接受了全面评估的参与者进行了为期6年的基于人群的队列研究。采用按规模大小概率抽样的随机整群抽样方法，从2007年1月26日至2008年11月11日选取了具有代表性的50岁及以上成年人横断面样本。2013年1月7日至2014年3月12日进行了为期6年的随访。两次检查均进行了全面的眼科检查，包括logMAR视力、数字视网膜摄影以及在穆尔菲尔德眼科医院阅片中心对图像进行分级。收集了一般健康状况和风险因素的数据。
基线时无AMD的参与者发生AMD以及早期AMD进展为晚期AMD的情况。
2900名有AMD风险的个体中，共有1453人（50.1%）在6年后接受了随访（平均[标准差]年龄为60.7[8.2]岁；女性635人[49.5%]；基库尤族799人[62.3%]，卡伦金族324人[25.3%]，其他族159人[12.4%]）；1282人有随访时的AMD状态数据。其中，202人发生了早期AMD，无参与者发生晚期AMD。早期AMD的6年加权（考虑失访因素）累积发病率为每1000人164.2例（95%CI，每1000人136.7 - 195.9例）。142名有风险的基线早期AMD个体中，有2人在随访时进展为晚期AMD，早期AMD进展为晚期AMD的6年累积发病率为每1000人24.5例（95%CI，每1000人5.0 - 111.7例）。AMD的累积发病率随年龄增加而升高（≥80岁与50 - 59岁相比：1.8；95%CI，0.9 - 3.5），女性更高（女性与男性相比：1.6；95%CI，1.2 - 2.1），糖尿病患者也更高（糖尿病患者与非糖尿病患者相比：1.7；95%CI，1.0 - 2.8）。
在肯尼亚，50岁及以上个体中每年估计有超过10万例新的AMD病例发生，主要为早期AMD，尽管50%的失访率以及进展为晚期AMD的宽泛置信区间限制了这些研究结果得出确定性结论。
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