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Original Investigation
Journal Club
June 22, 2017

Age-Related Macular Degeneration in Patients With Chronic Myeloproliferative Neoplasms

Journal Club PowerPoint Slide Download
Author Affiliations
  • 1Department of Haematology, Zealand University Hospital, University of Copenhagen, Roskilde, Denmark
  • 2Department of Ophthalmology, Zealand University Hospital, University of Copenhagen, Roskilde, Denmark
  • 3Department of Occupational and Environmental Medicine, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
  • 4Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark and Odense University Hospital, Odense, Denmark
  • 5National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
  • 6Department of Haematology, Odense University Hospital, Odense, Denmark
  • 7Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
JAMA Ophthalmol. Published online June 22, 2017. doi:10.1001/jamaophthalmol.2017.2011
Key Points

Question  Do patients with chronic myeloproliferative neoplasms have an increased risk of age-related macular degeneration compared with the general population?

Findings  In a large Danish registry-based nationwide cohort study including 7958 patients with myeloproliferative neoplasms and 77 445 age- and sex-matched controls, the risk of age-related macular degeneration was increased for patients with myeloproliferative neoplasms, after adjustment for smoking and risk time.

Meaning  These data suggest that patients with myeloproliferative neoplasms have a higher risk of age-related macular degeneration than the general population, supporting the possibility that systemic alterations may be involved in the pathogenesis of age-related macular degeneration.

Abstract

Importance  It has been suggested that systemic inflammation increases the risk of age-related macular degeneration (AMD). Given that chronic immune modulation is present in patients with myeloproliferative neoplasms (MPNs), the risk of AMD in these patients may be increased.

Objective  To compare the risk of AMD in patients with MPNs with the risk of AMD in matched controls from the general population.

Design, Setting, and Participants  A nationwide population-based cohort study using Danish registers was conducted of all patients in Denmark who received a diagnosis between January 1, 1994, and December 31, 2013, of essential thrombocythemia, polycythemia vera, myelofibrosis, or unclassifiable MPNs. For each patient, 10 age- and sex-matched controls were included. All patients without prior AMD were followed up from the date of diagnosis (or corresponding entry date for the controls) until the first AMD diagnosis, death or emigration, or December 31, 2013, whichever occurred first. Data analysis was performed from April 1, 2015, to October 31, 2016.

Main Outcomes and Measures  Incidence of AMD recorded in specialized hospital-based care. The rates and absolute risk of AMD were calculated. Using Cox proportional hazards regression models, smoking and risk-time adjusted hazard ratios (HRs) between patients and controls were calculated. In addition, HRs of neovascular AMD after 2006 were calculated since antivascular endothelial growth factor treatment was introduced nationwide at hospitals thereafter.

Results  A total of 7958 patients with MPNs (4279 women [53.8%] and 3679 men [46.2%]; mean [SD] age at diagnosis, 66.4 [14.3] years) were included in the study. The rate of AMD per 1000 person-years at risk was 5.2 (95% CI, 4.6-5.9) for patients with MPNs (2628 with essential thrombocythemia, 3063 with polycythemia vera, 547 with myelofibrosis, and 1720 with unclassifiable MPNs) and 4.3 (95% CI, 4.1-4.4) for the 77445 controls, while the 10-year risk of AMD was 2.4% (95% CI, 2.1%-2.8%) for patients with MPNs and 2.3% (95% CI, 2.2%-2.4%) for the controls. The risk of AMD was increased overall for patients with MPNs (adjusted HR, 1.3; 95% CI, 1.1-1.5), with adjusted HRs for the subtypes of 1.2 (95% CI, 1.0-1.6) for essential thrombocythemia, 1.4 (95% CI, 1.2-1.7) for polycythemia vera, 1.7 (95% CI, 0.8-4.0) for myelofibrosis, and 1.5 (95% CI, 1.1-2.1) for unclassifiable MPNs. In addition, patients with MPNs had a higher risk of neovascular AMD (adjusted HR, 1.4; 95% CI, 1.2-1.6).

Conclusions and Relevance  Our results suggest that patients with MPNs are at increased risk of AMD, supporting the possibility that systemic inflammation is involved in the pathogenesis of AMD.

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