Prevalence of Age-Related Macular Degeneration in a Malay Population: The Singapore Malay Eye Study

doi:10.1016/j.ophtha.2008.02.012

Ophthalmology

Volume 115, Issue 10, October 2008, Pages 1735-1741

https://doi.org/10.1016/j.ophtha.2008.02.012 Get rights and content

Objective

To describe the prevalence of age-related macular degeneration (AMD) in an Asian Malay population.

Design

Population-based cross-sectional study.

Participants

An age-stratified random sample of Malay persons aged 40 to 80 years living in Singapore.

Methods

Participants were invited to a central clinic for a comprehensive examination.

Main Outcome Measures

Early and late AMD signs were graded from retinal photographs following the Wisconsin grading system.

Results

Of 3280 participants who participated (78.7% response rate), 3265 had photographs of sufficient quality for grading of AMD signs. Early and late AMD were present in 160 (4.9%) and 23 (0.70%) participants, respectively. After age standardization, the prevalence of early AMD in Malay persons aged 40 to 80 years was estimated to be 3.5% (95% confidence interval [CI], 2.9%–4.1%) and that of late AMD was 0.34% (95% CI, 0.20%–0.49%). Early AMD was more prevalent in men than in women (6.1% vs. 3.8%); this was significant despite adjusting for age and smoking (odds ratio [OR], 1.56; 95% CI, 1.11–2.20). Late AMD also was more prevalent in men than in women (1.0% vs. 0.4%), although this was not statistically significant after adjusting for age and smoking (OR, 1.39; 95% CI, 0.52–3.68). The prevalence of early and late AMD was similar to that reported in the Blue Mountains Eye Study among white persons.

Conclusions

The prevalence of AMD in Asian Malay people is similar to that in white persons from the Blue Mountains Eye Study. Early AMD signs were more frequent in men compared with women, an association that was not fully explained by the higher smoking rates in men.

Financial Disclosure(s)

The authors have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Study Populations

The Singapore Malay Eye Study, a population-based cross-sectional study of Malay adults aged 40 to 80 years living in Singapore, was conducted to investigate prevalence and risk factors of eye diseases. The study design and details of population sampling of the Singapore Malay Eye Study have been described elsewhere.13, 14 In brief, participants of this study were selected using an age-stratified (by 10-year age group) random sampling procedure from Malay people. Overall, 4168 randomly selected

Results

Demographic characteristics of the study population by gender are shown in Table 1. Men were significantly older and had a higher prevalence of being current smokers compared with women. Also, diastolic blood pressure, frequency of history of myocardial infarction, alcohol consumption, outdoor work, and final education level were higher in men than in women (Table 1).

Crude prevalence of early AMD in men, women, and total participants was 6.1%, 3.8%, and 4.9%, respectively (Table 2). Crude

Discussion

This population-based study reports on the prevalence of AMD in an Asian Malay population in Singapore and shows that early AMD was present in 4.9% and late AMD in 0.70 % of the study sample. After age standardization to the Singapore 2000 population, the prevalence of early and late AMD in Malays aged 40 to 80 years was estimated to be 3.5% and 0.34%, respectively. After adjustment for age, smoking status, and other potential confounders, Malay men were 66% more likely to have early AMD and

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Cited by (91)

Prevalence and Pattern of Geographic Atrophy in Asia: The Asian Eye Epidemiology Consortium
2020, Ophthalmology
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.
Prevalence of GA per 1000 persons.
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.
Copy number variation in VEGF gene as a biomarker of susceptibility to age-related macular degeneration
2018, Egyptian Journal of Medical Human Genetics
Several studies in various populations have been conducted to determine candidate genes that could contribute to age-related macular degeneration (AMD) pathogenesis.
The present study was undertaken to determine the association of high temperature requirement A-1 (HTRA1), vascular endothelial growth factor (VEGF) and very-low-density receptor (VLDR) genes with wet AMD subjects in Malaysia.
A total of 125 subjects with wet AMD and 120 subjects without AMD from the Malaysian population were selected for this study. Genomic DNA was extracted and copy number variations (CNVs) were determined using quantitative real-time Polymerase Chain Reaction (qPCR) and comparison between the two groups was done. The demographic characteristics were also recorded. Statistical analysis was carried out using software where a level of P < 0.05 was considered to be statistically significant.
Statistically significant associations of the VEGF gene were observed in mean copy differences between case and control subjects (P < 0.05). The consistency of both unadjusted and age-adjusted data at Copy Number CN gain (CN = 3 and CN = 4) suggested that VEGF could increase the risk of wet AMD disease (P < 0.05). None of CNVs of HTRA1 and VLDR genes showed associations with the wet AMD disease based on comparisons of the frequencies of mean (P > 0.05).
Observations of an association between CNVs of VEGF gene and wet AMD have revealed that the CNVs of VEGF gene appears to be a possible contributor to wet AMD subjects in Malaysia.
Association of copy number variations in complement factor H-Related genes among age-related macular degenerative subjects
2017, Kaohsiung Journal of Medical Sciences
Citation Excerpt :
This finding is consistent with the results of other population-based studies such as from Taiwan [23] and America [24]. The prevalence rates of wet AMD among Asians were 0.34%, 1.9%, 0.87% 1.9% and 1.9% among the Singapore Malay [19], Taiwanese [23], Japanese [25], Chinese [18,26] and Indian [27] populations respectively. The prevalence of AMD is expected to increase due to population aging in Malaysia [28].
Age-related macular degeneration (AMD) is the most widely recognised cause of irreversible vision loss and previous studies have suggested that the advancement of wet AMD is influenced by both modifiable and non-modifiable elements. Single nucleotide polymorphism (SNPs) and copy number of variations (CNVs) have been associated with AMD in various populations, however the results are conflicting. Our aim is to determine the CNVs of Complement Factor H-Related genes among Malaysian subjects with wet AMD. 130 patients with wet AMD and 120 healthy controls were included in this research. DNA was extracted from all subjects and CNVs of CFH, CFHR1 and CFHR3 genes; determined using quantitative real-time PCR and were compared between the two groups. A consistent association was observed between CFH gene and wet AMD susceptibility (P < 0.05). The age-adjusted data suggests a possible increased risk of AMD disease (P < 0.05). No correlation was detected between CNVs and wet AMD for the remaining genes after we compared the frequencies of mean for that gene. An association was observed between CFH CNVs and wet AMD in the Malaysian population, however, strong evidence of a link with wet AMD was not found. Further investigative studies are needed using larger sample sizes to elucidate the role of CNVs in AMD pathogenesis.
Six-Year Incidence of Age-Related Macular Degeneration in Asian Malays: The Singapore Malay Eye Study
2017, Ophthalmology
Citation Excerpt :
The same grading system also used in the BMES. Details of the photographic grading for AMD lesions have been reported previously.13,14,18,23,24 All photographs were graded initially in a masked manner.
To determine the 6-year incidence of early and late age-related macular degeneration (AMD) in a Singaporean Malay population and to validate the Age-Related Eye Disease Study (AREDS) simplified severity scale in Asians.
Prospective, population cohort study.
The Singapore Malay Eye Study baseline participants (age, ≥40 years; 2006–2008) were followed up in 2011 through 2013, and 1901 of 3280 of eligible participants (72.1%) took part.
Fundus photographs were graded using the Wisconsin AMD grading system.
Incidence of early and late AMD.
Gradable fundus photographs were available for 1809 participants who attended both baseline and 6-year follow-up examinations. The age-standardized incidences of early and late AMD were 5.89% (95% confidence interval [CI], 4.81–7.16) and 0.76% (95% CI, 0.42–1.29), respectively. The 5-year age-standardized incidence of early AMD (calculated based on the 6-year incidence) was lower in our population (5.58%; 95% CI, 4.43–7.01) compared with the Beaver Dam Eye Study population (8.19%). The incidence of late AMD in our population was similar to that of the Beaver Dam Eye Study population (0.98% [95% CI, 0.49–1.86] vs. 0.91%), the Blue Mountains Eye Study population (1.10% [95% CI, 0.52–9.56] vs. 1.10%), and the Hisayama Study population (1.09% [95% CI, 0.54–4.25] vs. 0.84%). The incidence of late AMD increased markedly with increasing baseline AREDS score (step 0, 0.23%; step 4, 9.09%).
This study documented the incidence of early and late AMD in a Malay population. The AREDS simplified severity scale is useful in predicting the risk of late AMD development in Asians.
Increased Burden of Vision Impairment and Eye Diseases in Persons with Chronic Kidney Disease - A Population-Based Study
2016, EBioMedicine
Chronic kidney disease (CKD) has been shown to be associated with diabetic retinopathy (DR) and age-related macular degeneration (AMD), leading causes of blindness in elderly adults in previous studies. However, the association of CKD with visual impairment (VI) is not clear. We aimed to examine the association of CKD with VI and other age-related ocular diseases in a population-based sample of Asian adults.
We analyzed data from 10,033 adults aged 40–80 years who participated in the Singapore Epidemiology of Eye Diseases (SEED, 2004–11) Study. CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m² from serum creatinine. VI was defined as best-corrected visual acuity < 20/40 in the better eye. Cataract, retinopathy, DR, glaucoma and AMD were assessed using standardized ocular examination, retinal photography and visual field assessments. The associations of CKD with VI and ocular conditions were examined using logistic regression models adjusted for age, sex, race, smoking, alcohol intake, education status, body mass index, systolic blood pressure, diabetes mellitus, cholesterol levels and cardiovascular disease.
The prevalence of VI and ocular disease were significantly higher in participants with CKD (36.1% and 84.7%) than in those without (12.9% and 54.3%, both p < 0.001). In multivariable models, CKD was significantly associated with VI (odds ratio [95% confidence interval] = 1.34 [1.14–1.58]), any ocular disease (1.28 [1.03–1.61]), cataract (1.24 [1.01–1.52]), any retinopathy (1.77 [1.45–2.15]), and DR (1.94 [1.47–2.54]).
The burden of VI and eye diseases is high among persons with CKD. Our findings suggest that it may be useful to screen for ocular disease and VI in persons with CKD.
Geo-Epidemiology of Age-Related Macular Degeneration: New Clues into the Pathogenesis
2016, American Journal of Ophthalmology
To evaluate the demographic, geographic, and race-related variables that account for geographic variability in prevalence rates of age-related macular degeneration (AMD).
Systematic review, meta-regression, and decision-tree analysis.
A systematic literature review of PubMed, Medline, Web of Science, and Embase databases identified population-based studies on the prevalence of AMD published before May 2014. Only population-based studies that took place in a spatially explicit geographic area that could be geolocalized, and used retinal photographs and standardized grading classifications, were included. Latitude and longitude data (geolocalization) and the mean annual insolation for the area where survey took place were obtained. Age-standardized prevalence rates across studies were estimated using the direct standardization method. Correlations between the prevalence of AMD and longitude and latitude were obtained by regression analysis. A hierarchical Bayesian meta-regression approach was used to assess the association between the prevalence of AMD and other relevant factors. We further investigated the interplay between location and these factors on the prevalence of AMD using regression based on conditional-inference decision trees.
We observed significant inverse correlations between latitude or longitude, and crude or age-standardized prevalence rates, of early and late AMD (P < .001). Metaregression analysis showed that insolation, latitude, longitude, age, and race have a significant effect on the prevalence rates of early and late AMD (P < .001). Decision-tree analysis identified that the most important predictive variable was race for early AMD (P = .002) and insolation for late AMD (P = .001).
Geographic position and insolation are key factors in the prevalence of AMD.

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: Manuscript no. 2007-1619.

: Financial Disclosure(s): The authors have no conflicts of interest and no proprietary interests related to this article.

: Supported by the National Medical Research Council (grant nos.: 0796/2003, 0863/2004, and CSI/0002/2005); and the Biomedical Research Council (grant no. 501/1/25-5); with additional support from the Singapore Tissue Network and the Ministry of Health, Singapore, Republic of Singapore; and Pfizer, Inc., Singapore, Singapore. The sponsors had no role in the study design, acquisition of data, statistical analysis and interpretation, and the final presentation and publication of the study.

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Original articlePrevalence of Age-Related Macular Degeneration in a Malay Population: The Singapore Malay Eye Study

Objective

Design

Participants

Methods

Main Outcome Measures

Results

Conclusions

Financial Disclosure(s)

Section snippets

Study Populations

Results

Discussion

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ann Epidemiol

Am J Ophthalmol

Am J Ophthalmol

The epidemiology of age related eye diseases in Asia

Br J Ophthalmol

Features of age-related macular degeneration in a black population

Arch Ophthalmol

The prevalence of age-related maculopathy by geographic region and ethnicity: the Colorado-Wisconsin Study of Age-Related Maculopathy

Arch 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 of Age-Related Macular Degeneration in a Malay Population: The Singapore Malay Eye Study