Refractive error and smoking habits in exudative age-related macular degeneration in a hospital-based setting

Abstract

Purpose To assess and compare refractive error and smoking habits in patients with exudative age-related macular degeneration (AMD) in a clinical setting. Methods The clinical comparative study included 379 patients (379 eyes) who underwent intravitreal application of an antivascular growth factor drug for the treatment of exudative AMD, and 191 patients without exudative macular degeneration and who underwent surgery for age-related cataract. Smoking status was compared with an agematched control group of the German population described in the census of 2003. The main outcome measures were refractive error, axial length, and data from a questionnaire on smoking habits. Results The AMD group compared with the cataract group showed a significantly shorter axial length (23.31 ± 0.75 vs 24.20 ± 1.56 mm; Po0.001) and was significantly more hyperopic (0.65 ± 2.14 vs À1.71 ± 4.57 dioptres; Po0.001). After the exclusion of pseudophakic AMD patients and matching by age and gender, the difference of refractive error and axial length between both groups remained to be statistically significant (Po0.001). The AMD group and the matched population group did not vary significantly in smoking history (age group: 55-75 years, current smokers: 18.4% vs 16.8% (P ¼ 0.64); former smokers: 23.2% vs 24.9% (P ¼ 0.66); age group 475 years, current smokers: 6.3% vs 6.4% (P ¼ 0.97); former smokers: 19.7% vs 22.8% (P ¼ 0.25)). Conclusions In our setting, an association was found between short axial length and AMD. We were not able to confirm the previously reported link between smoking and AMD. Eye Keywords: exudative age-related macular degeneration; hyperopia; smoking; macular degeneration; visual impairment Population-based studies, such as the Rotterdam Study, the Beaver Dam Study, and the Blue Mountains Eye Study have shown that smoking is a major risk factor for age-related macular degeneration (AMD). [1][2][3][4][5][6][7][8][9][10][11][12] In contrast, the findings of an association between hyperopia and AMD have been inconclusive so far. Although the Rotterdam Study, the AgeRelated Eye Disease Study, the Blue Mountains Eye Study, the French DMLA Study, and the Beijing Eye Study found an association between hyperopia and AMD, other large-scaled population-based investigations did not detect a correlation between both parameters.

Five-Year Incidence of Age-related Macular Degeneration

“…21 The finding that incident early AMD was associated with hyperopia confirms previous prevalence studies in which hyperopia, besides age, was the strongest risk factor for AMD, such as in the Rotterdam Study, 22 the French Les Préventions de la Dégénérescence Maculaire Liée à l'Age (DMLA) Study, 23 the Beijing Eye Study, 24 the Age-Related Eye Disease Study, 25 and in some hospital-based studies. 26,27 It also confirms previous studies in which shorter axial length was significantly associated with the prevalence of AMD, such as in the Singapore Malay Eye or the Central India Eye and Medical Study. 28,29 In contrast, the Beaver Dam Eye Study did not report an association between refractive errors and either the 5-or 10-year incidence of AMD.…”

Association between asymmetry in cataract and asymmetry in age-related macular degeneration. The Beijing Eye Study

“…The list of risk factors for the development and progression of AMD includes smoking, genetic factors such as an association with the complement factor H gene complex, family history, and ethnic background [6][7][8][9][10][11][12][13][14][15][16][17][18][19]. There has been controversy whether cataract, cataract progression, and cataract surgery are related to AMD [20][21][22][23][24][25][26][27][28][29].…”

Drusen prevalence and pigmentary changes in Caucasians aged 18–54 years

“…This may explain the lower drusen prevalence in the older age-group, although the association between hyperopia and AMD is still under debate, with some cohort studies finding supportive evidence and others not. [31][32][33] It is worth noting that a significant proportion of the general population is not emmetropic: in the Beaver Dam study, in the age-group 43-54 years, 22.1% of individuals were hyperopic and 43% were myopic. Our findings are not generalisable to the general population and should be considered frequency estimates rather than as prevalence data, but they are at least indicative of drusen prevalence in individuals with refractive errors, which account for over 60% of the population.…”