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Original Investigation
May 2018

Incidence of and Risk Factors Associated With Age-Related Macular DegenerationFour-Year Follow-up From the ALIENOR Study

Author Affiliations
  • 1Université de Bordeaux, INSERM, Bordeaux Population Health Research Center, Team Lifelong Exposures, Health, and Aging (LEHA), UMR 1219, Bordeaux, France
  • 2Service d’Ophtalmologie, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
  • 3Université de Lille, INSERM U1167, Centre Hospitalier Universitaire de Lille, Institut Pasteur de Lille, DISTALZ Laboratoire d’Excellence, Lille, France
JAMA Ophthalmol. 2018;136(5):473-481. doi:10.1001/jamaophthalmol.2018.0504
Key Points

Question  What are the incidence and risk factors of age-related macular degeneration (AMD) in a French population older than 72 years?

Findings  In this population-based cohort study of 659 French patients 73 years or older, the incidence of early and advanced AMD was 79.9 and 18.6, respectively, per 1000 person-years over a mean follow-up of 3.8 years. Progression from early to advanced AMD was significantly associated with early AMD stage in fellow eye, smoking, and genetic background, while incident early AMD was associated with early AMD stage in the fellow eye and a higher plasma high-density lipoprotein cholesterol level.

Meaning  This study confirms that risk factors appear different for progression from early to advanced AMD compared with incident early AMD and suggests a high risk for incident early AMD in individuals with high plasma high-density lipoprotein cholesterol levels.


Importance  While the prevalence of age-related macular degeneration (AMD) differs according to continents and races/ethnicities, its incidence in the European continent has been scarcely documented.

Objective  To describe the incidence and associated risk factors of AMD in elderly French individuals.

Design, Setting, and Participants  This population-based cohort study of 963 residents of Bordeaux, France, who were 73 years or older at baseline and participated in the Antioxydants, Lipides Essentiels, Nutrition et Maladies Oculaires (ALIENOR) Study between October 2, 2006, and December 21, 2012. Of 829 participants at risk for incident AMD, 659 (79.5%) were observed for a mean (SD) duration of 3.8 (1.1) years. Data were analyzed from August 2016 to March 2017.

Main Outcomes and Measures  Age-related macular degeneration was graded from retinal photographs and spectral-domain optical coherence tomography into 5 exclusive stages: no AMD, early AMD1, early AMD2, late atrophic AMD, and late neovascular AMD.

Results  Of the 659 eligible participants, 413 (62.7%) were women, and the mean (SD; range) age was 79.7 (4.4; 73-94) years. A total of 120 incident cases of early AMD and 45 incident cases of advanced AMD were recorded. Incidence rates of early and advanced AMD were 79.9 (95% CI, 66.8-95.5) per 1000 person-years and 18.6 (95% CI, 13.9-24.9) per 1000 person-years, respectively, corresponding to 5-year risks of 32.9% and 8.9%. Incidence of advanced AMD per 1000 eye-years was 1.5 in eyes without any AMD at baseline, 42.4 in those with early AMD1, and 85.1 in those with early AMD2. In multivariate analysis without correction for multiple testing, progression from early to advanced AMD was associated with AMD grade in the fellow eye (hazard ratio [HR] according to grade, 13.0 [95% CI, 2.8-61.2] to 22.5 [95% CI, 2.6-195.9]), having smoked at least 20 pack-years (calculated as number of smoking years × mean number of cigarettes per day / 20; HR, 3.0; 95% CI, 1.4-6.5), and complement factor H (CFH) Y402H genotype (CC genotype: HR, 2.3; 95% CI, 1.0-5.3; TC genotype: HR, 1.5; 95% CI, 0.6-3.7). Incidence of early AMD was associated with early AMD in the fellow eye (early AMD1: HR, 2.6; 95% CI, 1.6-4.2; early AMD2: HR, 5.6; 95% CI, 3.3-9.4) and high plasma high-density lipoprotein cholesterol levels (HR, 1.2; 95% CI, 1.0-1.4).

Conclusions and Relevance  In this cohort, AMD incidence rates were similar to those observed in other European populations. This study suggests a high risk for incident early AMD in individuals with high plasma high-density lipoprotein cholesterol levels while confirming the high risk for progression from early to advanced AMD in heavy smokers and carriers of CFH Y402H at-risk genotypes.