scholarly journals Rare and Common Genetic Variants, Smoking and Higher Body Mass Index Are Associated with Earlier Age of Progression to Geographic Atrophy and Neovascular Advanced Stages of Macular Degeneration in a Prospective Analysis

2020 ◽  
Author(s):  
Johanna Seddon ◽  
Rafael Widjajahakim ◽  
Bernard Rosner
Keyword(s):  
Body Mass Index ◽  
Macular Degeneration ◽  
Body Mass ◽  
Genetic Variants ◽  
Geographic Atrophy ◽  
Smoking History ◽  
Behavioral Factors ◽  
Severity Scale ◽  
Age Related ◽  
The Impact

IMPORTANCE Genes and lifestyle factors influence progression to advanced age-related macular degeneration (AAMD). However, the impact of genetic and behavioral factors on age when this transition occurs has not been evaluated prospectively. OBJECTIVE To determine whether genetic and environmental factors are associated with age of progression to AAMD and to quantify the effect on age. DESIGN, SETTING, AND PARTICIPANTS Longitudinal progression to AAMD was based on the severity scale in the Age-Related Eye Disease Study database. Progression was defined as an eye that transitioned from non-advanced dry AMD without any evidence of geographic atrophy (GA) (levels 1-8) to any GA or evidence of neovascularization (NV) or both (levels ≥9) during 13 years follow up. Genotypes were determined from DNA samples. MAIN OUTCOME AND MEASURES A stepwise selection of genetic variants with the eye as the unit of analysis, using age as the time scale, yielded 11 genetic variants associated with overall progression, adjusting for sex, education, smoking history, BMI, baseline severity scale, and AREDS treatment. Multivariate analysis was also performed to calculate the effect of genetic and behavioral factors on age of progression. RESULTS Among 5421 eyes, 1206 progressed. Genetic variants associated with progression to AAMD were in the complement, immune, inflammatory, lipid, extracellular matrix, DNA repair and protein binding pathways. Three of these variants were significantly associated with earlier age of progression, adjusting for other covariates: CFH R1210C (P=0.019) with 4.7 years earlier age at progression among carriers of this mutation, C3 K155Q (P=0.011) with 2.44 years earlier for carriers, and ARMS2/HTRA1 A69S (P=0.012) with 0.67 years earlier per allele. Subjects who were smokers (P<.001) or had high BMI (P=0.006) also had an earlier age at progression (4.1 years and 1.4 years, respectively). CONCLUSIONS Carriers of rare variants in the complement pathway and a common risk allele in ARMS2/HTRA1 develop advanced AMD at an earlier age, and unhealthy behaviors including smoking and higher body mass index lead to earlier age of progression to AAMD.

scholarly journals Percentage of Foveal versus Total Macular Geographic Atrophy as a Predictor of Visual Acuity in Age-related Macular Degeneration

2019 ◽  
Author(s):  
Saghar Bagheri ◽  
Ines Lains ◽  
Rebecca Silverman ◽  
Ivana Kim ◽  
Dean Eliott ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Macular Degeneration ◽  
Fundus Autofluorescence ◽  
Cross Sectional Study ◽  
Geographic Atrophy ◽  
Age Related Macular Degeneration ◽  
Cross Sectional ◽  
Age Related ◽  
The Impact ◽  
Foveal Sparing

AbstractObjectivesTo investigate the relationship between visual acuity (VA), total area of geographic atrophy (GA) and percentage of foveal GA.MethodsMulticenter, retrospective cross-sectional study of patients with GA due to age-related macular degeneration. Demographics, VA, fundus autofluorescence (FAF) and optical coherence tomography (OCT) images were collected. Using FAF images aided by OCT, foveal sparing status, GA pattern, total GA size, and percentage of GA covering the foveal area - area within a 1.5 mm diameter circle centered on the fovea centralis - were assessed. Univariable and multiple linear regression analyses were performed.Results54 eyes (mean age 78.7 ±7.7 (SD), 60.0% female) were studied. Mean VA was 0.8 ± 0.6 logMAR, mean total GA 8.8 ± 6.7 mm2 and mean percentage of foveal GA was 71.5 ± 30.9%. Of all assessed eyes, 48.2% (n = 26) presented with multifocal GA, and 18.5% (n = 10) had foveal sparing. Multiple regression analysis revealed that, controlling for age and GA pattern, the percentage of foveal GA presented a statistically significant association with VA (ß = 0.41, P = 0.004). No significant associations were observed with mean total GA size, while controlling for the same variables (ß = 0.010, P = 0.440).ConclusionPercentage of foveal GA was significantly associated with VA impairment, while the same was not verified for total GA area. These findings suggest that percentage of foveal GA may represent a more useful tool for assessing the impact of GA on VA. Further validation is needed in larger cohorts.

Patient-, Caregiver-, and Eye Care Professional-reported Burden of Geographic Atrophy Secondary to Age-related Macular Degeneration

2019 ◽  
Vol 2 ◽  
pp. 1
Author(s):  
Rishi P. Singh ◽  
Sunil S. Patel ◽  
Jared S. Nielsen ◽  
Jordana K. Schmier ◽  
Yamina Rajput
Keyword(s):  
Macular Degeneration ◽  
Burden Of Illness ◽  
Geographic Atrophy ◽  
Age Related Macular Degeneration ◽  
Religious Activities ◽  
Eye Care ◽  
Long Distance ◽  
Age Related ◽  
Disease Costs ◽  
The Impact

Objective Geographic atrophy (GA) is a progressive, irreversible advanced form of age-related macular degeneration. There is limited information on the burden of illness of GA from patient, caregiver, and eye care professional perspectives. This study identifies key factors that should be included for assessment in future studies of patients with GA. Methods In this cross-sectional qualitative study, patients with symptomatic GA (n = 8), their caregivers (n = 6), and eye care professionals who treat patients with GA (n = 5) were interviewed at US sites. Interview guides were designed to evaluate the understanding of the disease, costs and burden of illness, use of vision aids or services, and impact on emotional or psychological well-being and on daily activities. Results Half of the patients mentioned social, psychological, or helplessness issues. Patients reported the impact of GA on sports and outdoor hobbies, meals or food preparation, religious activities, and long-distance travel. Patients reported having stopped driving or changing driving patterns as a major concern. 38% of all patients reported previously modifying their work schedules due to vision impairment. All patients reported the use of at least one vision aid, with 88% of patients purchasing the aids out of pocket. Caregivers reported modifying their schedules to provide assistance as needed and expressed frustration over their inability to improve patients’ health. Eye care professionals noted the emotional impact of vision loss, accidents, and injuries, and identified mental health as a key topic for patients with GA. Conclusions Although limited by size, this study indicates that GA has a major negative impact on patients’ and caregivers’ social functioning and health-related quality of life. This study has identified indirect resource use, including caregiving needs, and direct patient out-of-pocket costs as factors relevant to patients with GA. Future larger studies are needed to further characterize the burden of illness of GA for patients and caregivers.

Abstract 12918: The Association Between Central Obesity and Myocardial Ageing: Traditional Body Mass Index (bmi) Falls Short of Expectation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Yen How Tan ◽  
Jun Pei Lim ◽  
Wee Shiong Lim ◽  
Fei Gao ◽  
Loon Yee Teo ◽  
...  
Keyword(s):  
Older Adults ◽  
Body Mass Index ◽  
Waist Circumference ◽  
Body Mass ◽  
Central Obesity ◽  
Peak Velocity ◽  
Volume Index ◽  
Age Related ◽  
Velocity Flow ◽  
The Impact

Background: The Asian phenotype of central obesity is intriguing. Current data suggest links between central obesity and cardiovascular (CV) risks. However, age-related sarcopenia (resulting in loss of skeletal muscle) may falsely reduce body mass index (BMI), leading to inaccurate measures of obesity. We aim to determine how waist circumference (WC), would compare against BMI, in differentiating obesity, among older adults. Further, we explore the differential association between each obesity definition and myocardial ageing. Methods: We performed anthropometric and CV examinations on a cohort of asymptomatic aged adults. Myocardial ageing was defined by ratio of peak velocity flow in early diastole E (m/s) to peak velocity flow in late diastole by atrial contraction A (m/s). For BMI, a cut-off of 27.5kg/m 2 was used, and WC cut-offs of >90cm for males and >80cm for females. Results: Among n=970 adults (mean age 73±4 years, 432 (44%) males), 124 (12.8%) were obese by BMI definition while 347 (35.7%) were obese by WC definition. Inter-definitional agreement was fair between BMI and WC (cohen’s κ=0.345). More women (66% vs 50%, p<0.001) and older participants (63±14 vs 65±11 years, p=0.007) were defined as obese by WC definition, while age and gender did not differentiate obese versus non-obese as defined by BMI. There were more hypertension (p<0.001) and diabetes mellitus (p<0.001) among the obese as defined by both definitions, compared to non-obese. Based on either definition, obese participants had significantly lower E/A ratio [(1.13 ± 0.46 vs 0.98 ± 0.35; P < 0.001 using BMI), (1.17 ± 0.49 vs 1.00 ± 0.37; P < 0.001 using WC)] compared to non-obese. Left atrial volume index was larger in obese in both the BMI group (20.5 ± 7.43 vs 22.3 ± 7.90; P = 0.020) and WC group (20.0 ± 6.9 vs 22.1 ± 8.3; P < 0.001). By multivariate regression, WC, but not BMI, was independently associated with E/A (β=-0.114, SE -0.114±0.024, p<0.001). Conclusion: Obesity prevalence varies depending on the definition used. Among Asians, waist circumference identifies higher prevalence of obesity, possibly related to central adiposity. While impact of age-related sarcopenia and BMI in older adults require deeper study, WC may better characterize the impact of obesity on myocardial ageing.

scholarly journals Percentage of Foveal vs Total Macular Geographic Atrophy as a Predictor of Visual Acuity in Age-Related Macular Degeneration

2019 ◽  
Vol 3 (5) ◽  
pp. 278-282 ◽  
Author(s):  
Saghar Bagheri ◽  
Ines Lains ◽  
Rebecca F. Silverman ◽  
Ivana Kim ◽  
Dean Eliott ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Macular Degeneration ◽  
Fundus Autofluorescence ◽  
Cross Sectional Study ◽  
Geographic Atrophy ◽  
Age Related Macular Degeneration ◽  
Cross Sectional ◽  
Age Related ◽  
The Impact ◽  
Sd Oct

Purpose: This article investigates the relationship between visual acuity (VA), total area of geographic atrophy (GA), and percentage of foveal GA. Methods: A multicenter, retrospective, cross-sectional study was conducted of patients with GA due to age-related macular degeneration. Demographics, VA, fundus autofluorescence (FAF), and spectral-domain optical coherence tomography (SD-OCT) images were collected. Using FAF images aided by SD-OCT, fovea-sparing status, GA pattern, total GA size, and percentage of GA covering the foveal area—within a 1.5-mm-diameter circle centered on the fovea centralis—were assessed. Univariable and multiple linear regression analyses were performed. Results: Fifty-four eyes (mean age, 78.7 ±7.7 years [SD], 60.0% female) were studied. Mean VA was 0.8 ± 0.6 logarithm of the minimum angle of resolution (Snellen equivalent 20/126 ± 20/80), mean total GA 8.8 ± 6.7 mm2, and mean percentage of foveal GA was 71.5 ± 30.9%. Of all assessed eyes, 48.2% (n = 26) presented with multifocal GA, and 18.5% (n = 10) had foveal sparing. Multiple regression analysis revealed that, controlling for age and GA pattern, the percentage of foveal GA presented a statistically significant association with VA (ß = 0.41, P = .004). No significant associations were observed with mean total GA size, while controlling for the same variables (ß = 0.010, P = .440). Conclusions: Percentage of foveal GA was significantly associated with VA impairment, although the same was not verified for total GA area. These findings suggest that percentage of foveal GA may represent a more useful tool for assessing the impact of GA on VA. Further validation is needed in larger cohorts.

scholarly journals Prognostic value of intermediate age-related macular degeneration phenotypes for geographic atrophy progression

2020 ◽  
pp. bjophthalmol-2020-316004 ◽  
Author(s):  
Sarah Thiele ◽  
Jennifer Nadal ◽  
Maximilian Pfau ◽  
Marlene Saßmannshausen ◽  
Monika Fleckenstein ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Prognostic Value ◽  
Retinal Pigment ◽  
Geographic Atrophy ◽  
Age Related Macular Degeneration ◽  
Progression Rate ◽  
Precursor Lesions ◽  
Pigment Epithelial ◽  
Age Related ◽  
The Impact

BackgroundTo characterise early stages of geographic atrophy (GA) development in age-related macular degeneration (AMD) and to determine the prognostic value of structural precursor lesions in eyes with intermediate (i) AMD on the subsequent GA progression.MethodsStructural precursor lesions for atrophic areas (lesion size at least 0.5 mm² in fundus autofluorescence images) were retrospectively identified based on multimodal imaging and evaluated for association with the subsequent GA enlargement rates (square-root transformed, sqrt). A linear mixed-effects model was used to account for the hierarchical nature of the data with a Tukey post hoc test to assess the impact of the local precursor on the subsequent GA progression rate.ResultsA total of 39 eyes with GA of 34 patients with a mean age of 74.4±6.7 (±SD) years were included in this study. Five precursor lesions (phenotypes 1–5) preceding GA development were identified: large, sub-retinal pigment epithelial drusen (n=19), reticular pseudodrusen (RPD, n=10), refractile deposits (n=4), pigment epithelial detachment (n=4) and vitelliform lesions (n=2). Precursor lesions exhibited a significant association with the subsequent (sqrt) GA progression rates (p=0.0018) with RPD (phenotype 2) being associated with the fastest GA enlargement (2.29±0.52 (±SE) mm/year.ConclusionsThe results indicate the prognostic relevance of iAMD phenotyping for subsequent GA progression highlighting the role of structural AMD features across different AMD stages.

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