The Incidence and Progression of Age-Related Macular Degeneration in Blacks and Whites: Salisbury Eye Evaluation (SEE) Project
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Objective
To describe the prevalence of age-related maculopathy (ARM) in blacks and whites and its relation to macrovascular disease and risk factors thereof in a population studied for cardiovascular disease risk factors and outcomes.Population
A biracial population of 11,532 adults (ranging from 48-72 years of age; 8984 whites and 2548 blacks) living in 4 US communities (Forsyth County, North Carolina; the city of Jackson, Miss; selected suburbs of Minneapolis, Minn; and Washington County, Maryland) were examined during the interval from 1993 to 1995.Methods
Drusen and other lesions typical of ARM were identified by examining a 45° color fundus photograph of 1 eye of each participant and classified by means of a modification of the Wisconsin Age-Related Maculopathy Grading System.Results
The overall prevalence of any ARM was lower in blacks (3.7%) than whites (5.6%). After controlling for age and sex, the odds ratio for any ARM in blacks compared with whites was 0.73 (95% confidence interval, 0.58-0.91;P=.006). Few associations between atherosclerosis and its risk factors and the presence of early ARM or its component lesions were found. After adjusting for age, race, and sex, carotid artery plaque (odds ratio, 1.77; 95% confidence interval, 1.18-2.65) and focal retinal arteriolar narrowing (odds ratio, 1.79; 95% confidence interval, 1.07-2.98) were associated with retinal pigment epithelial depigmentation.Conclusions
This population-based study documents the higher prevalence of early ARM in whites compared with blacks. Measures of atherosclerosis and its risk factors were generally unrelated to ARM and do not explain these racial differences.Age-related maculopathy
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To evaluate risk factors for the incidence and progression of age-related macular degeneration (AMD) in a racially heterogeneous, geriatric population.Subjects (n = 2240) aged 65 to 84 years underwent 2 examinations separated by 2 years, of which 1937 subjects (85%) were included in this report. Fundus photographs were performed at each examination and were graded by trained readers. Multivariate logistic regression models adjusted for age, sex, race, and clustering between eyes were used to evaluate risk factors for AMD incidence and progression.Smoking was a strong, dose-dependent, risk factor for progression from medium size drusen to large drusen or pigmentary abnormalities within the central 1500-microm macular zone. Smoking was also a strong risk factor for development of incident focal pigmentation within 3000 microm of the foveal center. White participants were significantly more likely than blacks to develop large drusen and focal pigmentation and to progress from medium- to large-sized drusen or pigment abnormalities within the central 1500 microm macular zone. However, whites did not have an increased risk of progression from large drusen or pigment abnormalities within the central 1500-microm perimacular zone to foveal GA or CNV when compared with blacks.Smoking and race are important risk factors for progression from medium to large drusen or to pigment abnormalities within the central 1500-microm macular zone. Limitations in the power of this study preclude assessment of the roles of smoking and race on the ultimate progression to foveal GA or CNV once central large drusen or pigment abnormalities are present.
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Objective
To determine differences in the prevalence of age-related macular degeneration (AMD) and its fundus manifestations in a population-based sample of older black and white Americans.Design
Cross-sectional population-based study of 2520 participants of whom 1854 are white and 666 are black. Mean age was 73.5 years. Stereoscopic color fundus photographs were graded for presence, severity, and location of drusen, retinal pigment epithelium abnormalities, and choroidal neovascularization or disciform scarring.Results
Drusen at least 64 μm in size were identified in 56% of black and white individuals within 3000 μm of the foveal center, but drusen larger than 125 μm were more common among white participants (16% white vs 11% black individuals). Drusen at least 250 μm in size, confluent drusen, or a larger area (> 10%) occupied by drusen were each more common among white participants. White individuals were 3 times more likely to have focal hyperpigmentation than black individuals. Racial differences were most pronounced for features within the central 1500-μm macular zone. Neovascular AMD was present in 1.7% of white participants and 1.1% of black participants (age-adjusted,P = .38), whereas geographic atrophy was more common in white than black individuals (1.8% vs 0.3%; age-adjusted,P = .02).Conclusions
White persons are generally more likely than black persons to have medium or large drusen, focal pigment abnormalities, and advanced AMD. Racial differences were prominent for nonneovascular AMD features only when present in the central zone. These data suggest that black individuals may have a mechanism for protection in the central zone against these critical fundus features, which themselves convey high risk of progression to advanced AMD.Drusen
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Objective
To examine if racial differences exist in longitudinal care patterns for Medicare beneficiaries with glaucoma.Methods
We analyzed national longitudinal Medicare claims data from January 1, 1991, through December 31, 1999 in 21 644 Medicare beneficiaries linked to the National Long-Term Care Survey. Logistic regression was used to predict whether a person underwent an eye examination or eye surgery during the year, and negative binomial regression was used to predict the number of eye examinations and surgical procedures for glaucoma per year. Annual use of eye examinations was nearly identical for black persons (1.85 per year) and white persons (1.89 per year), whereas surgery rates were higher among blacks (0.15) than whites (0.08,P<.001).Results
Blacks were more likely than whites to have glaucoma diagnosed, but rates among whites were higher than in prior population-based studies. When we controlled for other factors, blacks were not significantly less likely to undergo eye examination during the year; however, blacks were 78% more likely to undergo surgery (P< .001) and had 76% higher rates of surgical procedures (P< .001).Conclusions
No systematic pattern was found of underuse among blacks relative to whites after glaucoma diagnosis. Higher rates of surgery among blacks may indicate delayed onset of care and/or greater disease severity.Cite
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