Purpose: To estimate the incidence of age-related macular degeneration (AMD) and the association of smoking and alcohol in a population of older women. Design: Prospective cohort study. Methods: Subjects were women who attended the Study of Osteoporotic Fractures year-10 and year-15 follow-up clinic visits and had fundus photographs taken at both visits (n = 1958; 245 Black and 1713 White subjects; mean age at year 10 visit, 78.2 years). Forty-five degree stereoscopic fundus photographs were graded for AMD. Logistic regression was used to test whether risk factors were associated with incident AMD. Results: The overall 5-year AMD incidence was 24.1% (95% confidence interval [CI], 21.7 to 26.6) for early and 5.7% (95% CI, 4.6 to 6.8) for late. Early AMD incidence in White subjects ranged from 21.9% in those aged 74 to 79 years to 33.2% in those 80 to 84 years, but was observed at the slightly lower rate of 29.0% in subjects ≥85 years (trend P < .0001). After confounder adjustment, alcohol consumption was significantly associated with an elevated risk of incident early AMD (odds ratio [OR], 1.57; 95% CI, 1.18 to 2.11). There was an increased risk of early AMD among subjects aged 80 years or older who were smoking compared to those younger than 80 years who were not smoking (OR, 5.49; 95% CI, 1.57 to 19.20; P for interaction = .026). Conclusions: The magnitude of the greater-than-additive effect of smoking on the age-adjusted risk of AMD reinforces recommendations to quit smoking even for older individuals.
Bibliographical noteFunding Information:
This study was supported by the National Institutes of Health, Bethesda, Maryland (Grant No. EY013626-03), and Research to Prevent Blindness, New York, New York. The Study of Osteoporotic Fractures (SOF) is supported by Public Health Service research grants from the National Institutes of Health, Bethesda, Maryland (AG05407, AR35582, AG05394, AR35584, AR35583, R01 AG005407, R01 AG027576-22, 2 R01 AG005394-22A1, and 2 R01 AG027574-22A1). Dr Mangione was supported by the UCLA Center for Health Improvement in Minority Elders (CHIME)/Resource Centers for Minority Aging Research (RCMAR), Los Angeles, California, National Institutes of Health, National Institute of Aging, Bethesda, Maryland (AG-02-004). The authors indicate no financial conflict of interest. Involved in design and conduct of study (A.L.C., S.R.C., J.A.C., K.E.E., K.L.S., M.C.H., C.M.M.); collection and management of data (A.L.C., S.R.C., J.A.C., K.E.E., K.L.S., M.C.H., C.M.M.); analysis and interpretation of data (A.L.C., R.L.S., S.R.C., F.Y., J.A.C., K.E.E., K.L.S., M.C.H., K.L.P., E.L.T., C.M.M.); and preparation (A.L.C., R.L.S., F.Y.) and review and approval of the manuscript (A.L.C., R.L.S., S.R.C., F.Y., J.A.C., K.E.E., K.L.S., M.C.H., K.L.P., E.L.T., C.M.M.). Institutional Review Board approvals were obtained from UCLA; UCSF; the University of Maryland; the University of Minnesota; Kaiser Permanente Center for Health Research Northwest; and the University of Pittsburgh prior to the study. The study complied with the tenets of the Declaration of Helsinki related to the treatment of human subjects.