Prevalence of Age-Related Macular Degeneration in Europe: The Past and the Future.

PURPOSE: Age-related macular degeneration (AMD) is a frequent, complex disorder in elderly of European ancestry. Risk profiles and treatment options have changed considerably over the years, which may have affected disease prevalence and outcome. We determined the prevalence of early and late AMD in Europe from 1990 to 2013 using the European Eye Epidemiology (E3) consortium, and made projections for the future. DESIGN: Meta-analysis of prevalence data. PARTICIPANTS: A total of 42 080 individuals 40 years of age and older participating in 14 population-based cohorts from 10 countries in Europe. METHODS: AMD was diagnosed based on fundus photographs using the Rotterdam Classification. Prevalence of early and late AMD was calculated using random-effects meta-analysis stratified for age, birth cohort, gender, geographic region, and time period of the study. Best-corrected visual acuity (BCVA) was compared between late AMD subtypes; geographic atrophy (GA) and choroidal neovascularization (CNV). MAIN OUTCOME MEASURES: Prevalence of early and late AMD, BCVA, and number of AMD cases. RESULTS: Prevalence of early AMD increased from 3.5% (95% confidence interval [CI] 2.1%-5.0%) in those aged 55-59 years to 17.6% (95% CI 13.6%-21.5%) in those aged ≥85 years; for late AMD these figures were 0.1% (95% CI 0.04%-0.3%) and 9.8% (95% CI 6.3%-13.3%), respectively. We observed a decreasing prevalence of late AMD after 2006, which became most prominent after age 70. Prevalences were similar for gender across all age groups except for late AMD in the oldest age category, and a trend was found showing a higher prevalence of CNV in Northern Europe. After 2006, fewer eyes and fewer ≥80-year-old subjects with CNV were visually impaired (P = 0.016). Projections of AMD showed an almost doubling of affected persons despite a decreasing prevalence. By 2040, the number of individuals in Europe with early AMD will range between 14.9 and 21.5 million, and for late AMD between 3.9 and 4.8 million. CONCLUSION: We observed a decreasing prevalence of AMD and an improvement in visual acuity in CNV occuring over the past 2 decades in Europe. Healthier lifestyles and implementation of anti-vascular endothelial growth factor treatment are the most likely explanations. Nevertheless, the numbers of affected subjects will increase considerably in the next 2 decades. AMD continues to remain a significant public health problem among Europeans.

Cardiovascular risk factors associated with age-related macular degeneration: the Tromsø Study.

PURPOSE: To examine associations between cardiovascular risk factors and age-related macular degeneration (AMD). METHODS: A population-based, cross-sectional study of Caucasians aged 65-87 years was conducted in Norway in 2007/2008. Retinal photographs were graded for AMD. Multivariable logistic regression analyses were performed based on questionnaires addressing habits of smoking, alcohol consumption, physical activity, health and medication; and physical examination comprising anthropometric measurements, blood pressure and blood sampling. Cardiovascular disease status was obtained from a validated end-point registry. RESULTS: Gradable photographs were available for 2631 participants, of whom 92 (3.5%) subjects had late AMD. In the multivariable analysis of late AMD, significant interactions were found between sex and the variables age, triglyceride level, use of lipid-lowering drugs and physical exercise. Current daily smoking was significantly related to late AMD in both sexes (odds ratio (OR) 4.06, 95% confidence interval (CI) 1.69-9.76 and OR 3.59, 95% CI 1.17-11.04, women and men, respectively) compared with never smokers. Higher number of pack years was associated with the presence of large drusen (>125 µm) (OR 1.04, 95% CI 1.01-1.09 per 5 years). Higher systolic blood pressure (OR 1.06, 95% CI 1.01-1.12 per 5 mmHg), overweight (OR 2.87, 95% CI 1.13-7.29) and obesity (OR 2.92, 95% CI 1.06-8.03), physical exercise duration (OR 0.41, 95% 0.18-0.96 for 30 min or more compared with less) and frequency (OR 0.46, 95% CI 0.23-0.92 for weekly or more often compared to less) were associated with late AMD in women only. CONCLUSIONS: Smoking was strongly associated with AMD, in line with results from other populations. Also, late AMD was related to higher systolic blood pressure, physical inactivity, overweight and obesity in women.

Lactation, female hormones and age-related macular degeneration: the Tromsø Study.

OBJECTIVE: Some risk factors for age-related macular degeneration (AMD) have been shown to act differently in women and men. The present study aims to investigate this disparity by examining associations between female hormones, reproductive history and AMD. METHODS: Women aged 65-87 years were invited to this cross-sectional, population-based study in Norway. Participants underwent physical examination, retinal photography, answered questionnaires and had blood samples taken. RESULTS: The sample included 1512 women, of whom 48 (3.2%) had late AMD and 378 (25%) had large drusen >125 µm phenotype. Length of breast feeding per child was significantly associated with late AMD (OR per month 0.80, 95% CI 0.68 to 0.94) in multivariable regression analysis. We observed no associations between late AMD or drusen >125 µm and contraceptives, oral hormonal replacement therapy, parity, age at first childbirth, age of menarche, age of menopause, number of menstruating years or the reason for menopause. CONCLUSIONS: Longer duration of lactation was associated with lower frequency of maternal late AMD when controlled for confounders. Other reproductive factors and hormone replacement therapy were not significantly associated with AMD.

The Tromsø Eye Study: study design, methodology and results on visual acuity and refractive errors.

PURPOSE: To describe the study design and methodology of the Tromsø Eye Study (TES), and to describe visual acuity and refractive error in the study population. METHODS: The Tromsø Eye Study is a sub-study of the Tromsø Study, a population-based multipurpose longitudinal study in the municipality of Tromsø, Norway. The Tromsø Eye Study was a part of the sixth survey of the Tromsø Study, conducted from October 2007 through December 2008. The eye examination included information on self-reported eye diseases, assessment of visual acuity and refractive errors, retinal photography and optical coherence tomography. Retinal images were graded for diabetic retinopathy and age-related macular degeneration, and with computer-assisted measurements of arteriolar and venular diameters. In addition, TES researchers have access to the large comprehensive Tromsø Study database including physical examination results, carotid artery ultrasound, electrocardiogram, bone densitometry, cognitive tests, questionnaires, DNA, blood and urine samples and more from the present and the five previous surveys. RESULTS: Visual acuity was assessed in 6459 subjects and refraction in 6566 subjects aged 38-87 years. Snellen visual acuity <20/60 was found in 1.2% (95% CI 0.95-1.5) of the participants and there was no gender difference. Visual impairment increased with age, and in the age group 80-87 years, the overall visual acuity <20/60 was 7.3% (95% CI 3.3-11.2). Spherical equivalent showed an increasing trend with age and there was no clinically relevant difference between men and women. Retinal photography was performed in 6540 subjects. CONCLUSION: Prevalence of visual impairment was low but increased with age. There was a trend towards hyperopia with age and no clinically relevant difference in refraction between the sexes. TES aims to provide epidemiological research on several eye and eye-related diseases. Owing to a comprehensive data collection, it has the opportunity to explore issues related to environmental factors, cognition and their interaction with diseases in this community.

Prevalence of age-related macular degeneration in elderly Caucasians: the Tromsø Eye Study.

PURPOSE: To describe the sex- and age-specific prevalence of drusen, geographic atrophy, and neovascular age-related macular degeneration (AMD). DESIGN: Population-based, cross-sectional study. PARTICIPANTS: Caucasian adults aged 65 to 87 years from the 6th Tromsø Study, a population-based study conducted in 2007-2008 in the municipality of Tromsø, Norway. METHODS: Digital color fundus photographs were graded for predominant phenotype based on drusen size, geographic atrophy, and neovascular AMD. MAIN OUTCOME MEASURES: Age-related macular degeneration. RESULTS: A total of 3025 subjects participated; 89% of those were invited to the eye examinations. Gradable photographs were available for 2631 persons (mean age 72.3 years). Drusen 63-125 µm as the predominant phenotype were found in 34.9% of participants (95% confidence interval [CI], 33.1-36.8), drusen >125 µm were found in 24.1% (95% CI, 22.5-25.8), geographic atrophy was found in 1.0% of participants (95% CI, 0.6-1.4), and neovascular AMD was found in 2.5% of participants (95% CI, 1.9-3.1). Bilateral involvement of late AMD was present in 1.1% of the sample. Eyes with late AMD had a significantly lower refractive error (spherical equivalent 0.078 vs. 0.99 diopters, P<0.0001), and 42.5% of eyes had Snellen visual acuity ≤ 0.32. CONCLUSIONS: The prevalence of AMD among the elderly persons in this study was similar to rates in other Caucasian populations. Late AMD was present in 10.9% of subjects aged 80 years or more. No sex differences in prevalence rates of large drusen or late AMD were observed. Lower refractive error was observed in eyes with late AMD than in eyes without late AMD.

Patients with non-seminoma germ cell tumours treated in a minor oncology department: the importance of multi-institutional protocols and research collaboration.

The purpose was to review all patients with non-seminomatous germ cell tumours (NSGCT) treated at a single institution in order to evaluate the management and outcome. Patients were prospectively registered. Completed SWENOTECA forms and medical records of all 132 NSGCT patients treated between January 1985 and December 2000 were reviewed. Data on demographic, clinical, histological and biochemical characteristics as well as patient treatment and outcome were registered. The minimum follow-up was 2.2 years (median 8.3 years). In stage I, there was an overall relapse rate of 21%. These relapses were all treated successfully. Among stage II-IV patients, post treatment RPLND/surgical resections were performed in 31 patients (50%), and residual malignant disease was found in 23%. Relapse (N=3) in metastatic disease patients, were seen in stage IV only. In stage II-IV, 5 died from germ cell malignancy of whom 3 never achieved CR. Five-year overall and disease-specific survivals were 95% and 96%. For stage I, II, III, and IV, the 5-year disease-specific survivals were 100%, 98%, 100%, and 69% respectively. Grouped according to the International Germ Cell Consensus Classification, the 5-year overall survivals were 100%, 92%, and 60% for the good, intermediate, and poor prognosis groups of stage II-IV patients, respectively. This report is a complete review of NSGCT patients treated in our minor university clinic. Survival rates are comparable to recently published data, due to a commitment to multicentre protocol and research collaboration.