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. 2017 Mar;101(3):342-347.
doi: 10.1136/bjophthalmol-2016-308587. Epub 2016 May 6.

Age-related macular degeneration in patients with uveitis

Affiliations

Age-related macular degeneration in patients with uveitis

Austin R Fox et al. Br J Ophthalmol. 2017 Mar.

Abstract

Purpose: To evaluate the prevalence of large drusen in a uveitis clinic population.

Design: Retrospective, cohort study.

Methods: Patients with primary, non-infectious uveitis 55 years or older who were seen at the National Eye Institute of the National Institutes of Health from 2004 through August 2013 were reviewed using electronic medical records and photographic databases. Patients were classified as having age-related macular degeneration (AMD) if either eye had large drusen, geographic atrophy or neovascular AMD according to definitions used by the Eye Diseases Prevalence Research Group (EDPRG). The expected number of cases and standardised mortality ratio (SMR) for large drusen were estimated based on EDPRG estimates.

Results: We identified 177 patients aged ≥55 years as having primary non-infectious uveitis; 170 (96.0%) had gradable fundus photos. Average age was 65.0±7.5 years (range 55-87), and 87 were non-Hispanic white, 66 non-Hispanic black, 6 Hispanic white and 11 of other race/ethnicity. Large drusen were identified in four patients (2.4%; 95% CI 0.6 to 6.0). No patients were identified to have late AMD. In the uveitis cohort, the SMR for cases of large drusen, which was adjusted for age, was calculated to be 0.32 (95% CI 0.12 to 0.70) for the whole cohort, 0.28 (95% CI 0.09 to 0.79) for non-Hispanic whites and 0.46 (95% CI 0.14 to 1.29) for non-Hispanic blacks.

Conclusions: Large drusen prevalence among patients with uveitis ≥55 years of age appears less than the prevalence in the general US population after accounting for differences in age distribution, especially for non-Hispanic whites. Although the racial and gender distribution in this study population is not directly representative of the general US population, results of this study suggest possible sparing of patients with uveitis from AMD. A larger systematic study with greater power would be needed to confirm these findings.

Keywords: Degeneration; Immunology; Inflammation; Macula.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Comparison of age distribution: uveitis cohort versus US population ≥55 years. The age distribution between the uveitis cohort and US population was compared and shows that patients of the younger age subgroups were relatively overrepresented in the uveitis cohort, while patients of the older age subgroups were relatively underrepresented. Numbers based on age and race were calculated from 2000 US census data. Percentages represent the percentage that each age subgroup is represented among all individuals ≥55 in each respective population to allow for comparison.
Figure 2
Figure 2
Colour fundus photographs of four cases of large drusen in patients with uveitis. (A–D) Fundus photos of patients in whom large drusen were identified: (A) A 63-year-old non-Hispanic black female with anterior uveitis of 7 months duration, (B) A 82-year-old non-Hispanic black female with anterior uveitis of 3 years duration, (C) A 87-year-old non-Hispanic white female with panuveitis of 27 years duration and (D) A 61-year-old non-Hispanic white male with anterior uveitis of 34 years duration.
Figure 3
Figure 3
Optical coherence tomography (OCT) of four cases of large drusen in patients with uveitis. (A–D) OCT of patients in whom large drusen were identified: (A) A 63-year-old non-Hispanic black female with anterior uveitis of 7 months duration, (B) A 82-year-old non-Hispanic black female with anterior uveitis of 3 years duration, (C) A 87-year-old non-Hispanic white female with panuveitis of 27 years duration and (D) A 61-year-old non-Hispanic white male with anterior uveitis of 34 years duration.

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