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. 2014 Oct;121(10):1949-55.
doi: 10.1016/j.ophtha.2014.04.040. Epub 2014 Jun 20.

Cigarette smoking and the natural history of age-related macular degeneration: the Beaver Dam Eye Study

Chelsea E Myers  1 , Barbara E K Klein  2 , Ronald Gangnon  3 , Theru A Sivakumaran  4 , Sudha K Iyengar  5 , Ronald Klein  2
Affiliations

Cigarette smoking and the natural history of age-related macular degeneration: the Beaver Dam Eye Study

Chelsea E Myers et al. Ophthalmology. 2014 Oct.

Abstract

Purpose: To examine the association of current cigarette smoking and pack-years smoked with the incidence and progression of age-related macular degeneration (AMD) and to examine the interactions of current smoking and pack-years smoked with complement factor H (CFH, rs1061170) and age-related maculopathy susceptibility 2 (ARMS2, rs10490924) genotype.

Design: A longitudinal population-based study of AMD in a representative American community. Examinations were performed every 5 years over a 20-year period.

Participants: A total of 4439 participants in the population-based Beaver Dam Eye Study (BDES).

Methods: Age-related macular degeneration status was determined from grading retinal photographs. Multi-state models were used to model the relationship of current smoking and pack-years smoked and interactions with CFH and ARMS2 with the incidence and progression of AMD over the entire age range.

Main outcome measures: Incidence and progression of AMD over a 20-year period and interactions between current smoking and pack-years smoked with CFH and ARMS2 genotype.

Results: The incidence of early AMD over the 20-year period was 24.4%, and the incidence of late AMD was 4.5%. Current smoking was associated with an increased risk of transitioning from minimal to moderate early AMD. A greater number of pack-years smoked was associated with an increased risk of transitioning from no AMD to minimal early AMD and from severe early AMD to late AMD. Current smoking and a greater number of pack-years smoked were associated with an increased risk of death. There were no statistically significant multiplicative interactions between current smoking or pack-years smoked and CFH or ARMS2 genotype.

Conclusions: Current smoking and a greater number of pack-years smoked increase the risk of the progression of AMD. This has important health care implications because smoking is a modifiable behavior.

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Conflict of interest statement

Conflict of Interest Disclosures: No conflicting relationship exists for any author.

Figures

Figure 1
Figure 1
The 3-Continent Consortium five-step severity scale for age-related macular degeneration (AMD). Arrows indicate possible transitions along the scale. Hazard ratios indicate the hazard of making the transition indicated by the arrow for a current smoker compared to a non-current smoker (HR1) and per 5 pack-years smoked (HR2), adjusted for age and sex. AMD, age-related macular degeneration; HR, hazard ratio.
Figure 2
Figure 2
Distribution of current smoking by age and sex in the Beaver Dam Eye Study.
Figure 3
Figure 3
Distribution of pack-years smoked by age and sex in the Beaver Dam Eye Study.
See this image and copyright information in PMC

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