Prevalence and Risk Factors for Age-Related Macular Degeneration in an Adult Japanese Population: The Funagata Study

doi:10.1016/j.ophtha.2007.11.015

Ophthalmology

Volume 115, Issue 8, August 2008, Pages 1376-1381.e2

Presented in part at: Association for Research in Vision and Ophthalmology annual meeting, April 2006, Fort Lauderdale, Florida.

https://doi.org/10.1016/j.ophtha.2007.11.015 Get rights and content

Objective

To describe the prevalence and risk factors for age-related macular degeneration (AMD) in a Japanese population and to compare these with data from a white population.

Design

Population-based cross-sectional epidemiologic study.

Participants

A population-based sample of Japanese persons 35 years or older from Funagata, Japan.

Methods

The Funagata study is a population-based study of 1758 (43% of eligible) Japanese persons 35 years or older from Funagata, Japan. In 2000 to 2002, 1625 (92.4%) participants had a nonmydriatic fundus photograph of one eye with sufficient quality for grading of AMD lesions, using the Wisconsin protocol. Age-standardized prevalence rates compared with the Blue Mountains Eye Study (BMES) population, odds ratios (ORs), and 95% confidence intervals (CIs) were calculated. Risk factors were assessed by logistic regression.

Main Outcome Measures

Early and late AMD.

Results

Of 1625 participants, early AMD and late AMD were present in 3.5% and 0.5%, respectively. Age-standardized early AMD prevalence in right eyes was 4.1%, similar to the corresponding prevalence of 4.4% in the BMES. For men, age-standardized prevalences of late AMD in right eyes were 1.1% and 1.2% in the BMES; for women, the corresponding prevalences were 0.3% and 2.1%, respectively. Increasing age (per 10 years; gender-adjusted OR, 2.27; 95% CI, 1.10–4.67) and current cigarette smoking (age- and gender-adjusted OR, 5.03; 95% CI, 1.00–25.47) were associated with late AMD.

Conclusions

In this Japanese population, prevalence of early AMD was similar to that for whites in the BMES. Although the late AMD prevalence was lower in Japanese women, in Japanese men it was similar to that in whites. This could have resulted from the substantially high proportion of Japanese men who are smokers. Cigarette smoking and increasing age were the 2 principal factors found associated with late AMD.

Section snippets

Study Population

The Funagata Study is a population-based study among adult Japanese.16, 17, 18 The study population and methods are described in detail elsewhere.¹⁶ In brief, between June 2000 and June 2002, 4160 residents of Funagata, Japan 35 years or older were identified. After excluding 484 with severe disabilities such as hemiparesis after stroke, severe mental diseases, or dementia and individuals receiving treatment for diabetes, 3676 were identified as eligible subjects. Of those, 1961 (53.3% of

Results

Participants with adequate photographs were significantly younger (60.2 vs. 69.4 years, P<0.0001) than participants with poorer photographs. There were no differences in other risk factors between those included in the analyses and those excluded from them (data not shown). The age distribution of the participants is shown in Figure 1 (available at http://aaojournal.org).

The prevalence of early AMD was 3.5% among all participants 35 years and older or 4.3% among those 50 and over. Corresponding

Discussion

In this adult Japanese population, prevalences of early and late AMD, defined from right eyes only, were 3.5% and 0.5%, respectively, among those 35 years or older. Our study sample was weighted with relatively older persons, which may have led to an overestimation of AMD prevalence. After direct age standardization of our study sample to the BMES population, the prevalence of early AMD in our Japanese participants (4.1%) was quite similar to that in the right eyes of BMES participants (4.4%).

References (32)

R. Klein et al.
Prevalence of age-related maculopathy: the Beaver Dam Eye Study
Ophthalmology
(1992)
P. Mitchell et al.
Prevalence of age-related maculopathy in Australia: the Blue Mountains Eye Study
Ophthalmology
(1995)
J.R. Vingerling et al.
The prevalence of age-related maculopathy in the Rotterdam Study
Ophthalmology
(1995)
D.S. Friedman et al.
Racial differences in the prevalence of age-related macular degeneration: the Baltimore Eye Survey
Ophthalmology
(1999)
R. Klein et al.
Age-related maculopathy in a multiracial United States population: the National Health and Nutrition Examination Survey III
Ophthalmology
(1999)
R. Varma et al.
Prevalence of age-related macular degeneration in LatinosThe Los Angeles Latino Eye Study
Ophthalmology
(2004)
R. Klein et al.
Prevalence of age-related macular degeneration in 4 racial/ethnic groups in the Multi-ethnic Study of Atherosclerosis
Ophthalmology
(2006)
R. Klein et al.
The epidemiology of age-related macular degeneration
Am J Ophthalmol
(2004)
N. Takei
Is Japan losing the fight against tobacco?
Lancet
(2000)
R. Kawasaki et al.
Cardiovascular risk factors and retinal microvascular signs in an adult Japanese populationThe Funagata Study
Ophthalmology
(2006)

N. Arawaka et al.

Correlation between change in body weight rather than current body weight and change in serum adiponectin levels in a Japanese population—the Funagata study

Metabolism

(2006)

R. Klein et al.

The Wisconsin Age-Related Maculopathy Grading System

Ophthalmology

(1991)

W. Smith et al.

Risk factors for age-related macular degeneration: pooled findings from three continents

Ophthalmology

(2001)

J.J. Wang et al.

Bilateral involvement by age related maculopathy lesions in a population

Br J Ophthalmol

(1998)

Y. Oshima et al.

Prevalence of age related maculopathy in a representative Japanese population: the Hisayama Study

Br J Ophthalmol

(2001)

Y. Li et al.

Prevalence of age-related maculopathy in the adult population in China: the Beijing Eye Study

Am J Ophthalmol

(2006)

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Though lipid and cholesterol dyshomeostasis is thought to contribute to the pathogenesis of age-related macular degeneration (AMD), there is no consensus regarding which elements of systemic lipid homeostasis are perturbed in AMD. In this systematic review and meta-analysis, an update to that performed by Wang et al in 2016, we characterized serum lipoprotein profiles in patients with AMD and its various stages.
These findings may identify novel therapeutic approaches for AMD, a leading cause of blindness among older adults in the industrialized world.
We used MEDLINE, Embase, and Web of Science to identify articles from database inception to May 2022 that reported blood/serum levels of lipid subspecies (triglycerides [TGs], total cholesterol [TC], low-density lipoprotein [LDL], and high-density lipoprotein [HDL]) in patients with AMD compared with controls. We meta-analyzed the data by generating multilevel random-effects models using restricted maximum likelihood estimation.
Our updated meta-analysis included 56 studies, almost 3 times as many studies as the 2016 meta-analysis with a total of 308 188 participants. There were no significant differences in serum TG, TC, LDL, or HDL between patients with AMD and non-AMD controls. Given significant heterogeneity, we performed subanalyses specifically in patients with early to intermediate nonexudative AMD, advanced nonexudative AMD, and advanced exudative AMD. Compared with non-AMD controls, patients with early to intermediate nonexudative AMD had significantly lower serum TG (standardized mean difference [SMD]: −0.03; 95% confidence interval [95% CI]: −0.06 to −0.01) and higher serum HDL (SMD: 0.07; 95% CI: 0.04–0.11). Patients with advanced exudative AMD had significantly higher serum LDL (SMD: 0.33; 95% CI: 0.04–0.62) compared with non-AMD controls. There were no other significant differences identified.
We found that there is significant heterogeneity in systemic lipoproteins in patients with AMD compared with non-AMD controls. The specific pattern of lipid dyshomeostasis appeared to be distinct based on AMD stage. These findings highlight both the underlying heterogeneity of AMD as well as the presence of distinct pathophysiological mechanisms involved at different stages or subtypes of AMD and may inform the development of novel therapeutic approaches.
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Incidence and Clinical Practice of Exudative Age-related Macular Degeneration: A Nationwide Population-Based Cohort Study
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To elucidate the incidence and treatment pattern of active exudative age-related macular degeneration (AMD).
A population-based cohort study conducted using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB), a national claims database managed by the Japanese Ministry of Health, Labour, and Welfare (MHLW).
The entire Japanese population aged 40 years or older (76 million people).
With the permission of the MHLW, we accessed the complete NDB dataset and identified patients with newly diagnosed active exudative AMD between 2011 and 2018. The incidence of active exudative AMD was categorized by age and sex per year between 2011 and 2018; moreover, details regarding first-line therapy and number of anti-vascular endothelial growth factor (VEGF) injections per elapsed year since initial treatment were obtained and changes in treatment pattern were investigated.
Incidence rate of active exudative AMD.
During the specified 8-year period, 246 064 incident cases of active exudative AMD were identified; 61.4% of these patients were men. The overall incidence rate was 40.66 per 100 000 person-years (95% confidence interval [CI], 40.49–40.82) in the general population aged 40 years or older, 53.22 (95% CI, 52.95–53.49) in men, and 29.78 (95% CI, 29.60–29.98) in women. Mean age of onset was lower in men than in women (72.51 ± 10.50 years vs. 73.90 ± 10.46 years). Among patients with newly diagnosed active exudative AMD, 92.9% received anti-VEGF injections for initial treatments, whereas 1.8% underwent combination therapy with photodynamic therapy. The number of anti-VEGF injections in the first year (0–12 months), second year (13–24 months), and third year (25–36 months) after the initial injection was 3.66 ± 2.30, 1.39 ± 2.20, and 1.23 ± 2.19, respectively. Patients who received fewer injections in the first year received fewer injections in subsequent years and vice versa.
This is a relatively large population-based study on the detailed epidemiology and actual treatment patterns of active exudative AMD in clinical practice. Our results can be a fundamental information source to ensure healthy eyes and promote well-being for all at all ages.
Population-Based Prevalence and 5-Year Change of Soft Drusen, Pseudodrusen, and Pachydrusen in a Japanese Population
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To elucidate the prevalence of soft drusen, pseudodrusen, and pachydrusen and their 5-year changes in a Japanese population.
Longitudinal population-based cohort study conducted from 2013 through 2017.
Residents 40 years of age or older.
Nonmydriatic color fundus photographs were used to grade drusen subtypes and retinal pigment epithelium (RPE) abnormalities according to the Three Continent Age-Related Macular Degeneration Consortium. The 5-year changes of each drusen were investigated.
The prevalence of each drusen subtype and the 5-year changes of each drusen.
Among 1731 participants, 1660 participants had gradable photographs that were assessed. The age-adjusted prevalence of soft drusen, pachydrusen, and pseudodrusen was 4.3% (95% confidence interval [CI], 3.2%–5.8%), 7.7% (95% CI, 6.2%–9.7%), and 2.8% (95% CI, 1.7%–4.2%), respectively. Pachydrusen accounted for 82.0% (n = 50) of the extramacular drusen (n = 61). Pigment abnormalities were seen in 28.3% and 8.3% of eyes with soft drusen and pachydrusen, respectively (P < 0.0001). Longitudinal changes were investigated in 1444 participants with follow-up examinations, which showed an increase in size in 8.3% and 3.7% and regression in 1.7% and 5.5% for eyes with soft drusen and pachydrusen, respectively. No participants demonstrated RPE atrophy after pachydrusen regression.
The prevalence of pachydrusen was higher than that of soft drusen and pseudodrusen combined. Pachydrusen may regress over time and typically is not associated with RPE atrophy as detected using color fundus photographs.
Prevalence and Pattern of Geographic Atrophy in Asia: The Asian Eye Epidemiology Consortium
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In the INDEYE study, illiterate participants signified assent by a witnessed thumbprint.11 In this analysis, investigators participating in the AEEC contributed data from 22 population-based studies: China (3 studies),7-9 India (5 studies),10-14 Japan (5 studies),15-18,42 Korea (1 study),19 Nepal (1 study),20 Russia (1 study),21 Singapore (3 studies),22-25 Taiwan (1 study),26 Hong Kong (1 study),27 and Thailand (1 study).28 Participants were recruited between 1995 and 2018.
Although there have been many population-based studies of age-related macular degeneration (AMD), only limited information is available in Asia on the epidemiology of geographic atrophy (GA). We aimed to determine the prevalence and patterns of GA through an analysis of multiple studies conducted within the Asian Eye Epidemiology Consortium (AEEC).
Cross-sectional meta-analyses.
A total of 97 213 individuals aged 40 years and older.
Data from 22 population-based studies from countries belonging to the AEEC were included. In all studies, AMD was defined on the basis of standardized grading systems. Geographic atrophy was defined as an area of pallor in the fundus with visibility of the underlying choroidal blood vessels and sharply defined borders. Random-effects meta-analysis was performed to estimate overall and age-, gender-, and region-specific pooled prevalence of GA.
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The mean age was 60.8 ± 10.0 years, and 42 673 (43.9%) were male. Overall, a total of 223 individuals (0.2%) had GA. The pooled overall prevalence of GA was 1.57 per 1000 persons (95% confidence interval [CI], 1.04–2.10), which was 3 times less than that of neovascular AMD of 5.20 per 1000 persons (95% CI, 3.97–6.43). Compared with those aged 50 to 59 years, the prevalence of GA increased from 0.34 per 1000 persons (95% CI, 0.07–0.62) to 2.90 per 1000 persons (95% CI, 1.55–4.25) in those aged ≥70 years. The GA prevalence per 1000 persons was similar between urban (2.22; 95% CI, 1.22–3.23) and rural residents (1.33; 95% CI, 0.70–1.96). Geographic atrophy was more prevalent in South Asia (based on studies from India and Nepal, 3.82 per 1000 persons; 95% CI, 1.72–5.93) compared with East Asia (based on studies from China, Korea, Hong Kong, Taiwan, and Japan, and the Singapore Chinese Eye Study, 0.76 per 1000 persons; 95% CI, 0.31–1.22, P = 0.005).
Geographic atrophy is uncommon in Asian populations compared with those of European ancestry. Even within Asia, geographic differences in GA prevalence were seen. The findings of this meta-analysis suggest that better dissection of risk factors in the Asian population for GA may provide insights into the biological pathways that drive these late-stage manifestations, thus suggesting better targets for prevention.
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: Manuscript no. 2007-1103.

: Partially supported by the 21st Century Center of Excellence project no. F03 (Molecular Epidemiological Study Utilizing the Regional Characteristics, Yamagata University) funded by the Japanese Society for the Promotion of Science, Tokyo, Japan, and Pfizer Japan, Tokyo, Japan (Prevalence and Incidence of Age-Related Macular Degeneration-Funagata-Machi Study [HY, YT]).

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Original articlePrevalence and Risk Factors for Age-Related Macular Degeneration in an Adult Japanese Population: The Funagata Study

Objective

Design

Participants

Methods

Main Outcome Measures

Results

Conclusions

Section snippets

Study Population

Results

Discussion

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Am J Ophthalmol

Lancet

Ophthalmology

Metabolism

Ophthalmology

Ophthalmology

Br J Ophthalmol

Prevalence of age related maculopathy in a representative Japanese population: the Hisayama Study

Br J Ophthalmol

Prevalence of age-related maculopathy in the adult population in China: the Beijing Eye Study

Am J Ophthalmol

Original article
Prevalence and Risk Factors for Age-Related Macular Degeneration in an Adult Japanese Population: The Funagata Study