Inactivity Increases Risk for
Progression of Macular Degeneration
In patients with early or intermediate
stages of age-related macular degeneration (AMD),
being overweight or obese appears to increase
the risk for disease progression, while physical
activity may decrease that risk, investigators
at Harvard Medical School report.
In their report in the Archives of Ophthalmology
for June, Dr. Johanna M. Seddon and colleagues
point out that previous epidemiological studies
looked at the onset or diagnosis of AMD, but not
progression. Therefore, they conducted their prospective
cohort study to evaluate the relationship between
obesity, physical activity, cigarette smoking
and cardiovascular disease (CVD) and development
of geographic atrophy and exudative neovascular
disease.
The 261 subjects were at least 60 years old when
they enrolled between 1989 and 1998. Average follow-up
time was 4.6 years, with 22% followed for 7 years
or longer. During the course of the study, 101
patients progressed to advanced AMD, as documented
by standardized ophthalmologic examination and
fundus photography.
The risk for progression was more than doubled
by having a body mass index > 25 compared with
leaner counterparts (p = 0.007 for trend), after
adjusting for age, gender, carotenoid intake,
initial AMD grade and education. Higher waist
circumference and higher waist/hip ratio -- measures
of abdominal adiposity -- were also significantly
associated with progression.
There was a relative risk of progression of approximately
0.75 associated with vigorous activity - "enough
to work up a sweat" - 3 times per week compared
with no activity (p = 0.05 to p = 0.07). Although
there was also a trend toward increased risk with
smoking, the relationship did not reach statistical
significance. Hypertension and history of CVD
were not related to progression.
"Results provide new information regarding
modifiable factors for individuals with the early
or intermediate stages of this disease,"
Dr. Seddon's group concludes. Arch Ophthalmol
2003;121:785-792.
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