Extremely Discordant Sib-Pair Study Design to Determine Risk Factorsfor Neovascular Age-Related Macular Degeneration

Abstract

Objective: To search for factors that contribute to the development of neovascular age-related macular degeneration (AMD). Methods: In a matched-pair case-control study, we studied sib pairs in which the index sibling had neovascular AMD in at least 1 eye and the unaffected sibling had normal maculae (or at most only a few small drusen) and was past the age at which the index case was diagnosed. Factors studied included sex, iris color, education, alcohol consumption, body mass index, vitamin use, smoking history, hypercholesterolemia, aspirin use, hypertension, other cardiovascular disease, any autoimmune disease, and non-insulin-dependent diabetes mellitus. Conditional logistic regression was performed to identify predictors of neovascular AMD. Results: On the basis of 73 sib pairs, multivariate regression analysis revealed a statistically significant 2% increase in risk of neovascular AMD with each pack-year of smoking (odds ratio, 1.02; 95% confidence interval, 1.01-1.04; P=.007). Suggestive but nonsignificant associations were also observed for mean lifetime alcohol consumption, adult lifetime body mass index, and hypertension in multivariate regression analyses. Conclusion: Using extremely discordant sib pairs to study risk factors for AMD, a novel approach in epidemiological design, we found evidence that smoking is a risk factor for neovascular AMD.

Efficacy of Selective Laser Trabeculoplasty after iStent Implantation in Primary Open-Angle Glaucoma

“…In this multivariate analysis, we found that both iStent (p < 0.0001) and the number of medications pre-operation (p < 0.001) were statistically associated with the outcome of medication reduction at p < 0.05 (Table 6). We then completed a multivariate analysis with all of the variables of interest, including, age, gender, race/ethnicity, iStent, and pre-SLT IOP [35][36][37][38][39][40]. We found that in the complete multivariate analysis only the initial IOP pre-operation (p < 0.0001) was statistically associated with the outcome of percent IOP reduction post-SLT at p < 0.05 (Table 6).…”

“…We then completed a multivariate analysis with all of the variables of interest, including, age, gender, race/ethnicity, iStent, and pre-SLT IOP [ 35 , 36 , 37 , 38 , 39 , 40 ]. We found that in the complete multivariate analysis only the initial IOP pre-operation ( p < 0.0001) was statistically associated with the outcome of percent IOP reduction post-SLT at p < 0.05 ( Table 6 ).…”

Efficacy of Selective Laser Trabeculoplasty after iStent Implantation in Primary Open-Angle Glaucoma

“…In this multivariate analysis, we found that both iStent (p < 0.0001) and the number of medications pre-operation (p < 0.001) were statistically associated with the outcome of medication reduction at p < 0.05 (Table 6). We then completed a multivariate analysis with all of the variables of interest, including, age, gender, race/ethnicity, iStent, and pre-SLT IOP [35][36][37][38][39][40]. We found that in the complete multivariate analysis only the initial IOP pre-operation (p < 0.0001) was statistically associated with the outcome of percent IOP reduction post-SLT at p < 0.05 (Table 6).…”

“…We then completed a multivariate analysis with all of the variables of interest, including, age, gender, race/ethnicity, iStent, and pre-SLT IOP [ 35 , 36 , 37 , 38 , 39 , 40 ]. We found that in the complete multivariate analysis only the initial IOP pre-operation ( p < 0.0001) was statistically associated with the outcome of percent IOP reduction post-SLT at p < 0.05 ( Table 6 ).…”

Is aspirin use associated with age-related macular degeneration? A meta-analysis

“…In the remaining of 22 potentially eligible articles which met all the inclusion criteria, nine articles were excluded because of the effect of other medicine and three articles were excluded because of updated records . After qualitative analysis, finally, there were 10 studies included in this meta‐analysis.…”

“…Most of these researches were conducted in the USA and Europe except two studies . Among these included articles, four of them were case–control studies and the remaining ones were two RCTs, two cohort studies and two cross‐sectional studies . The diagnosis of AMD and the exposure duration as well as the dosage of aspirin were different from each other.…”

Association Between Aspirin Use and Age-Related Macular Degeneration: A Meta-Analysis

“…This selection bias might dilute the association between aspirin use and AMD toward null, if any association existed. Conversely, in the several studies 18,26,61,63 among participants from clinic populations, who are typically likely to have other diseases, or when unrecognized confounders like smoking were present, this would enhance the association. In any case, our subgroups based on population source and adjusted for smoking did not reveal contradictory results, implying that these limitations were unlikely to cause large bias.…”

Efficacy of Selective Laser Trabeculoplasty after iStent Implantation in Primary Open-Angle Glaucoma

“…In this multivariate analysis, we found that both iStent (p < 0.0001) and the number of medications pre-operation (p < 0.001) were statistically associated with the outcome of medication reduction at p < 0.05 (Table 6). We then completed a multivariate analysis with all of the variables of interest, including, age, gender, race/ethnicity, iStent, and pre-SLT IOP [35][36][37][38][39][40]. We found that in the complete multivariate analysis only the initial IOP pre-operation (p < 0.0001) was statistically associated with the outcome of percent IOP reduction post-SLT at p < 0.05 (Table 6).…”

“…We then completed a multivariate analysis with all of the variables of interest, including, age, gender, race/ethnicity, iStent, and pre-SLT IOP [ 35 , 36 , 37 , 38 , 39 , 40 ]. We found that in the complete multivariate analysis only the initial IOP pre-operation ( p < 0.0001) was statistically associated with the outcome of percent IOP reduction post-SLT at p < 0.05 ( Table 6 ).…”

Is aspirin use associated with age-related macular degeneration? A meta-analysis

“…In the remaining of 22 potentially eligible articles which met all the inclusion criteria, nine articles were excluded because of the effect of other medicine and three articles were excluded because of updated records . After qualitative analysis, finally, there were 10 studies included in this meta‐analysis.…”

“…Most of these researches were conducted in the USA and Europe except two studies . Among these included articles, four of them were case–control studies and the remaining ones were two RCTs, two cohort studies and two cross‐sectional studies . The diagnosis of AMD and the exposure duration as well as the dosage of aspirin were different from each other.…”

Association Between Aspirin Use and Age-Related Macular Degeneration: A Meta-Analysis

“…This selection bias might dilute the association between aspirin use and AMD toward null, if any association existed. Conversely, in the several studies 18,26,61,63 among participants from clinic populations, who are typically likely to have other diseases, or when unrecognized confounders like smoking were present, this would enhance the association. In any case, our subgroups based on population source and adjusted for smoking did not reveal contradictory results, implying that these limitations were unlikely to cause large bias.…”

Efficacy of Selective Laser Trabeculoplasty after iStent Implantation in Primary Open-Angle Glaucoma

“…In this multivariate analysis, we found that both iStent (p < 0.0001) and the number of medications pre-operation (p < 0.001) were statistically associated with the outcome of medication reduction at p < 0.05 (Table 6). We then completed a multivariate analysis with all of the variables of interest, including, age, gender, race/ethnicity, iStent, and pre-SLT IOP [35][36][37][38][39][40]. We found that in the complete multivariate analysis only the initial IOP pre-operation (p < 0.0001) was statistically associated with the outcome of percent IOP reduction post-SLT at p < 0.05 (Table 6).…”

“…We then completed a multivariate analysis with all of the variables of interest, including, age, gender, race/ethnicity, iStent, and pre-SLT IOP [ 35 , 36 , 37 , 38 , 39 , 40 ]. We found that in the complete multivariate analysis only the initial IOP pre-operation ( p < 0.0001) was statistically associated with the outcome of percent IOP reduction post-SLT at p < 0.05 ( Table 6 ).…”

Is aspirin use associated with age-related macular degeneration? A meta-analysis

“…In the remaining of 22 potentially eligible articles which met all the inclusion criteria, nine articles were excluded because of the effect of other medicine and three articles were excluded because of updated records . After qualitative analysis, finally, there were 10 studies included in this meta‐analysis.…”

“…Most of these researches were conducted in the USA and Europe except two studies . Among these included articles, four of them were case–control studies and the remaining ones were two RCTs, two cohort studies and two cross‐sectional studies . The diagnosis of AMD and the exposure duration as well as the dosage of aspirin were different from each other.…”

Association Between Aspirin Use and Age-Related Macular Degeneration: A Meta-Analysis

“…This selection bias might dilute the association between aspirin use and AMD toward null, if any association existed. Conversely, in the several studies 18,26,61,63 among participants from clinic populations, who are typically likely to have other diseases, or when unrecognized confounders like smoking were present, this would enhance the association. In any case, our subgroups based on population source and adjusted for smoking did not reveal contradictory results, implying that these limitations were unlikely to cause large bias.…”