Five-year incidence, progression, and risk factors for age-related macular degeneration: the age, gene/environment susceptibility study

Ophthalmology. 2014 Sep;121(9):1766-72. doi: 10.1016/j.ophtha.2014.03.013. Epub 2014 Apr 24.


Objective: To investigate the incidence and progression of age-related macular degeneration (AMD) and associated risk factors.

Design: Population-based, prospective, cohort study.

Participants: We included 2868 participants from the Age Gene/Environment Susceptibility-Reykjavik Study with retinal data at baseline and 5-year follow-up.

Methods: Digital macular photographs were graded for presence of AMD. Participants completed a questionnaire and extensive clinical battery. Biomarkers were assessed. Risk factors for AMD were analyzed using multivariate regression analysis with odds ratios (ORs) and 95% CIs.

Main outcome measures: We assessed AMD, defined as early or late.

Results: Among 2196 participants free of AMD at baseline, 14.9% developed incident AMD. In multivariate models, incident AMD was significantly associated with age (OR per year, 1.14; 95% CI, 1.11-1.17), current smoking (OR, 2.07; 95% CI, 1.38-3.11), former smoking (OR, 1.36; 95% CI, 1.04-1.79), plasma high-density lipoprotein (HDL) cholesterol level (OR, 1.62 per mmol/L; 95% CI, 1.19-2.22), and body mass index (BMI; OR, 1.04 per kg/m(2); 95% CI, 1.01-1.07). Among 563 participants with early AMD at baseline, 22.7% progressed to late AMD (11.0% pure geographic atrophy [GA] and 11.7% exudative AMD). On multivariate analyses, age was significantly associated with progression to GA (OR 1.14; 95% CI, 1.07-1.21) and exudative AMD (OR, 1.08; 95% CI, 1.01-1.14). Adjusting for age, female sex was associated with exudative AMD (OR, 2.10; 95% CI, 1.10-3.98) and plasma HDL cholesterol with GA (OR, 2.03 per mmol/L; 95% CI, 1.02-4.05).

Conclusions: By age 85, 57.4% of participants had signs of AMD. Age, smoking, plasma HDL cholesterol, BMI, and female sex are associated with AMD. Elevated HDL cholesterol is associated with GA development.

Publication types

  • Research Support, N.I.H., Intramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Biomarkers
  • Body Mass Index
  • Cholesterol, HDL / blood
  • Disease Progression
  • Female
  • Gene-Environment Interaction
  • Humans
  • Iceland / epidemiology
  • Incidence
  • Macular Degeneration* / epidemiology
  • Macular Degeneration* / etiology
  • Male
  • Multivariate Analysis
  • Prospective Studies
  • Risk Factors
  • Smoking / adverse effects


  • Biomarkers
  • Cholesterol, HDL