Association of emphysema, gout, and inflammatory markers with long-term incidence of age-related maculopathy

Arch Ophthalmol. 2003 May;121(5):674-8. doi: 10.1001/archopht.121.5.674.


Objective: To examine the relationship of 2 diseases associated with systemic inflammatory response, emphysema and gout, and selected markers of systemic inflammation with the 10-year incidence of age-related maculopathy.

Design: Population-based cohort study.

Participants: We included persons aged 43 to 86 years at baseline examination from 1988 to 1990 living in Beaver Dam, Wis, of whom 3684 subjects participated in a 5-year follow-up examination and 2764 participated in a 10-year follow-up.

Methods: Standardized protocols for physical examination, blood collection, administration of a questionnaire, and stereoscopic color fundus photography to determine the presence of age-related maculopathy. Standard univariate and multivariate analyses were performed.

Main outcome measures: Incidence and progression of age-related maculopathy.

Results: While controlling for age, sex, and other factors (history of heavy drinking or smoking, systolic blood pressure, and vitamin use), a higher white blood cell count at baseline was associated with the 10-year incidence of drusen 125 microm or greater in diameter (risk ratio [RR] per 10(6)/ microL = 1.10; 95% confidence interval [CI], 1.03-1.17), retinal pigment epithelial depigmentation (RR = 2.08; 95% CI, 1.01-1.16), and progression of age-related maculopathy (RR = 1.09; 95% CI, 1.03-1.15). A lower serum albumin level was associated with the incidence of exudative macular degeneration (RR per grams per deciliter = 0.31; 95% CI, 0.13-0.76). A history of emphysema at baseline was associated with the incidence of retinal pigment epithelial depigmentation (RR = 2.84; 95% CI, 1.40-5.78), increased retinal pigment (RR = 2.20; 95% CI, 1.11-4.35), and exudative macular degeneration (RR = 5.12; 95% CI, 1.63-16.06); a history of gout was associated with the incidence of pure geographic atrophy (RR = 3.48; 95% CI, 1.27-9.53).

Conclusions: These findings indicate modest relationships between both increased white blood cell count and emphysema and the increased 10-year incidence of lesions defining early and late age-related maculopathy. Further investigation of these relationships in other studies is needed.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Biomarkers / analysis*
  • Cohort Studies
  • Female
  • Gout / blood
  • Gout / complications
  • Gout / epidemiology*
  • Humans
  • Incidence
  • Leukocyte Count
  • Macular Degeneration / blood
  • Macular Degeneration / epidemiology*
  • Macular Degeneration / etiology
  • Male
  • Middle Aged
  • Odds Ratio
  • Pulmonary Emphysema / blood
  • Pulmonary Emphysema / complications
  • Pulmonary Emphysema / epidemiology*
  • Retinal Drusen / epidemiology
  • Risk Factors
  • Serum Albumin / analysis
  • Wisconsin / epidemiology


  • Biomarkers
  • Serum Albumin