Abstract
Purpose
To report the age- and gender-adjusted prevalence rates of early and late age-related maculopathy (ARM) and associated risk factors in rural and urban Indian population.
Methods
A population-based cross-sectional study was carried out in South India between 2009 and 2011. Of the 6617 subjects ≥60 years enumerated ones, 5495 (83.04%) participated in the eye examination. A detailed history including data on demographic, socioeconomic, and ocular history was obtained. Participants underwent detailed ophthalmic evaluation including 30° 3-field photograph as per Age-Related Eye Disease Study protocol. The ARM was graded according to the International ARM Epidemiological Study Group.
Results
Age- and gender-adjusted prevalence of early ARM was 20.91% (20.86–20.94) in the rural population and 16.37% (16.32–16.42) in the urban population. Similarly, the prevalence of late ARM was 2.26% (2.24–2.29) and 2.32% (2.29–2.34) in the rural and urban population, respectively. In both rural and urban populations, risk factors that were related to both early and late ARM were age, per year increase (OR, range 1.00–1.08); middle socioeconomic status (OR, range 1.05–1.83); and smokeless tobacco (OR, range 1.11–2.21). Protective factor in both was the presence of diabetes mellitus in all ARM (OR, range 0.34–0.83). Risk factors, only in the rural arm, were female gender (OR, range 1.06–1.64), past smoker (OR, 1.14), and serum low-density lipoprotein cholesterol level (OR, 1.03).
Conclusions
The study reports smokessless tobacco as a risk factor for both early and late ARM and identified a higher prevalence of early ARM in the rural population compared with urban population.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
WHO, Tufts University School of Nutrition and Policy Keep Fit for Life: Meeting the Nutritional Needs of Older Persons. WHO: Geneva, Switzerland, 2002. Available at: http://whqlibdoc.who.int/publications/9241562102.pdf (last accessed on 24 September 2012).
Irudaya RS, Sarma PS, Mishra US . Demography of Indian Aging, 2001–2051. In: liebig PS, Irudaya RS (eds), An Aging India: Perspectives, Prospects, and Policies. Rawat Publications (Indian reprint): Jaipur, Rajasthan, India, 2005, pp 11–26.
Nangia V, Jonas JB, Kulkarni M, Matin A . Prevalence of age-related macular degeneration in rural central India: the Central India Eye and Medical Study. Retina 2011; 31: 1179–1185.
Krishnan T, Ravindran RD, Murthy GV, Vashist P, Fitzpatrick KE, Thulasiraj RD et al. Prevalence of early and late age-related macular degeneration in India: the INDEYE study. Invest Ophthalmol Vis Sci 2010; 51: 701–707.
Krishnaiah S, Das T, Nirmalan PK, Nutheti R, Shamanna BR, Rao GN et al. Risk factors for age-related macular degeneration: findings from the Andhra Pradesh eye disease study in South India. Invest Ophthalmol Vis Sci 2005; 46: 4442–4449.
Gupta SK, Murthy GVS, Morrison N, Dherani M, John N . Prevalence of early and late age-related macular degeneration in a rural population in Northern India: The INDEYE feasibility study. Invest Ophthalmol Vis Sci 2007; 48: 1007–1011.
Census of India 2001: Population projections for India and states 2001–2026. Available at: http://gujhealth.gov.in/basicstatastics/pdf/Projection_Report.pdf. last accessed on june 2009.
Handbook of Statistics on Indian Economy, 2011–2012; page 395, published by Reserve Bank of India. Available at: http://rbidocs.rbi.org.in/rdocs/Publications/PDFs/00HB130912LF.pdf. last accessed on October 2012.
Agarwal S, Raman R, Paul PG, Rani PK, Uthra S, Gayathree R et al. Sankara Nethralaya-Diabetic Retinopathy Epidemiology and Molecular Genetic Study (SN-DREAMS 1): study design and research methodology. Ophthalmic Epidemiol 2005; 12: 143–153.
The International ARM Epidemiological Study Group. An international classification and grading system for age related maculopathy and age related macular degeneration. Surv Ophthalmol 1995; 39: 367–374.
Klein R, Klein BE, Tomany SC, Meuer SM, Huang GH . Ten-year incidence and progression of age-related maculopathy: the Beaver Dam Eye Study. Ophthalmology 2002; 109: 1767–1779.
Wang JJ, Foran S, Smith W, Mitchell P . Risk of age-related macular degeneration in eyes with macular drusen or hyperpigmentation: the Blue Mountains Eye Study cohort. Arch Ophthalmol 2003; 121: 658–663.
Klein R, Meuer S, Myers C, Buitendijk GH, Rochtchina E, Choudhury F et al. Harmonizing the classification of age-related macular degeneration in the three continent ARM consortium. Ophthalmic Epidemiol 2014; 21 (1): 14–23.
Li Y, Xu L, Jonas JB, Yang H, Ma Y, Li J . Prevalence of age-related maculopathy in the adult population in China: the Beijing eye study. Am J Ophthalmol 2006; 142: 788–793.
Kawasaki R, Wang JJ, Ji GJ, Taylor B, Oizumi T, Daimon M et al. Prevalence and risk factors for age-related macular degeneration in an adult Japanese population: the Funagata study. Ophthalmology 2008; 115: 1376–1381.
Oshima Y, Ishibashi T, Murata T, Tahara Y, Kiyohara Y, Kubota T et al. Prevalence of age related maculopathy in a representative Japanese population: the Hisayama study. Br J Ophthalmol 2001; 85: 1153–1157.
Chen SJ, Cheng CY, Peng KL, Li AF, Hsu WM, Liu JH et al. Prevalence and associated risk factors of age-related macular degeneration in an elderly Chinese population in Taiwan: the Shihpai Eye Study. Invest Ophthalmol Vis Sci 2008; 49: 3126–3133.
Kawasaki R, Wang JJ, Aung T, Tan DT, Mitchell P, Sandar M et al. Prevalence of age-related macular degeneration in a Malay population: the Singapore Malay Eye Study. Ophthalmology 2008; 115: 1735–1741.
Yang K, Liang YB, Gao LQ, Peng Y, Shen R, Duan XR et al. Prevalence of age-related macular degeneration in a rural Chinese population: the Handan Eye Study. Ophthalmology 2011; 118: 1395–1401.
Mitchell P, Smith W, Attebo K, Wang JJ . Prevalence of age-related maculopathy in Australia. The Blue Mountains Eye Study. Ophthalmology 1995; 102 (10): 1450–1460.
Augood CA, Vingerling JR, de Jong PT, Chakravarthy U, Seland J, Soubrane G et al. Prevalence of age-related maculopathy in older Europeans: the European Eye Study (EUREYE). Arch Ophthalmol 2006; 124: 529–535.
Erke MG, Bertelsen G, Peto T, Sjølie AK, Lindekleiv H, Njølstad I . Prevalence of age-related macular degeneration in elderly Caucasians: the Tromso Eye Study. Ophthalmology 2012; 119: 1737–1743.
Klein R, Klein BE, Linton KL . Prevalence of age-related maculopathy. The Beaver Dam Eye Study. Ophthalmology 1992; 99: 933–943.
Friedman DS, Katz J, Bressler NM, Rahmani B, Tielsch JM . Racial differences in the prevalence of age-related macular degeneration: the Baltimore Eye Survey. Ophthalmology 1999; 106: 1049–1055.
Grassi MA, Fingert JH, Scheetz TE, Roos BR, Ritch R, West SK et al. Ethnic variation in AMD-associated complement factor H polymorphism p.Tyr402His. Hum Mutat 2006; 27 (9): 921–925.
Oshima Y, Ishibashi T, Murata T, Tahara Y, Kiyohara Y, Kubota T . Prevalence of age related maculopathy in a representative Japanese population: the Hisayama study. Br J Ophthalmol 2001; 85 (10): 1153–1157.
Piermarocchi S, Segato T, Scopa P, Masetto M, Ceca S, Cavarzeran F et al. The prevalence of age-related macular degeneration in Italy (PAMDI) study: report 1. Ophthalmic Epidemiol 2011; 18: 129–136.
Pagliarini S, Moramarco A, Wormald RP, Piguet B, Carresi C, Balacco-Gabrieli C et al. Age-related macular disease in rural southern Italy. Arch Ophthalmol 1997; 115: 616–622.
Klein BE, McElroy JA, Klein R, Howard KP, Lee KE . Nitrate–nitrogen levels in rural drinking water: Is there an association with age-related macular degeneration? J Environ Sci Health A Tox Hazard Subst Environ Eng 2013; 48: 1757–1763.
Leibowitz HM, Krueger DE, Maunder LR, Milton RC, Kini MM, Kahn HA et al. The Framingham Eye Study monograph: an ophthalmological and epidemiological study of cataract, glaucoma, diabetic retinopathy, macular degeneration, and visual acuity in a general population of 2631 adults, 1973–1975. Surv Ophthalmol 1980; 24: 335–610.
Schachat AP, Hyman L, Leske MC, Connell AM, Wu SY . Features of age-related macular degeneration in a black population. The Barbados Eye Study Group. Arch Ophthalmol 1995; 113: 728–735.
Thakur JS, Prinja S, Bhatnagar N, Rana S, Sinha DN . Socioeconomic inequality in the prevalence of smoking and smokeless tobacco use in India. Asian Pac J Cancer Prev 2013; 14: 6965–6969.
Velilla S, García-Medina JJ, García-Layana A, Dolz-Marco R, Pons-Vázquez S, Pinazo-Durán MD et al. Smoking and age-related macular degeneration: review and update. J Ophthalmol 2013; 2013: 895147.
Varghese SB, Reid JC, Hartmann EE, Keyser KT . The effects of nicotine on the human electroretinogram. Invest Ophthalmol Vis Sci 2011; 52 (13): 9445–9451.
Zhang X, Cotch MF, Ryskulova A, Primo SA, Nair P, Chou CF et al. Vision health disparities in the United States by race/ethnicity, education, and economic status: findings from two nationally representative surveys. Am J Ophthalmol 2012; 154: S53–S62.
Fraser-Bell S, Wu J, Klein R, Azen SP, Varma R, Eye Study Group. Smoking, alcohol intake, estrogen use and age-related macular degeneration in Latinos: The Los Angles Latino Eye Study. Am J Ophthalmol 2006; 141: 79–87.
Adams MK, Chong EW, Williamson E, Aung KZ, Makeyeva GA, Giles GG et al. 20/20—Alcohol and age-related macular degeneration: the Melbourne Collaborative Cohort Study. Am J Epidemiol 2012; 176 (4): 289–298.
Kumar SG, Premarajan KC, Sunitha L, Suguna E, Vinayagamoorthy, Kumar V . Prevalence and pattern of alcohol consumption using Alcohol Use Disorders Identification Test (AUDIT) in Rural Tamil Nadu, India. J Clin Diagn Res 2013; 7 (8): 1637–1639.
Evans JR . Risk factors for age-related macular degeneration. Prog Retin Eye Res 2001; 20 (2): 227–253.
Chakravarthy U, Wong TY, Fletcher A, Piault E, Evans C, Zlateva G et al. Clinical risk factors for age-related macular degeneration: a systematic review and meta-analysis. BMC Ophthalmol 2010; 10: 31.
Dutta A, Ray MR, Banerjee A . Systemic inflammatory changes and increased oxidative stress in rural Indian women cooking with biomass fuels. Toxicol Appl Pharmacol 2012; 261 (3): 255–262.
Reynolds R, Rosner B, Seddon JM . Serum lipid biomarkers and hepatic lipase gene associations with age-related macular degeneration. Ophthalmology 2010; 117 (10): 1989–1995.
Kim JH, Lee SJ, Kim KW, Yu YS, Kim JH . Oxidized low density lipoprotein-induced senescence of retinal pigment epithelial cells is followed by outer blood–retinal barrier dysfunction. Int J Biochem Cell Biol 2012; 44 (5): 808–814.
Choi JK, Lym YL, Moon JW, Shin HJ, Cho B . Diabetes mellitus and early age-related macular degeneration. Arch Ophthalmol 2011; 129: 196–199.
Topouzis F, Anastasopoulos E, Augood C, Bentham GC, Chakravarthy U, de Jong PT et al. Association of diabetes with age-related macular degeneration in the EUREYE study. Br J Ophthalmol 2009; 93: 1037–1041.
Borrone R, Saravia M, Bar D . Age related maculopathy and diabetes. Eur J Ophthalmol 2008; 18: 949–954.
Sander B, Larsen M, Moldow B, Lund-Andersen H . Diabetic macular edema: passive and active transport of fluorescein through the blood–retina barrier. Invest Ophthalmol Vis Sci 2001; 42: 433–438.
Nirmalan PK, Katz J, Robin AL, Tielsch JM, Namperumalsamy P, Kim R et al. Prevalence of vitreoretinal disorders in a rural population of southern India: the Aravind Comprehensive Eye Study. Arch Ophthalmol 2004; 122: 581–586.
Acknowledgements
This work was funded by Jamshetji Tata trust, Mumbai.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Additional information
Supplementary Information accompanies this paper on Eye website
Rights and permissions
About this article
Cite this article
Raman, R., Pal, S., Ganesan, S. et al. The prevalence and risk factors for age-related macular degeneration in rural–urban India, Sankara Nethralaya Rural–Urban Age-related Macular degeneration study, Report No. 1. Eye 30, 688–697 (2016). https://doi.org/10.1038/eye.2016.14
Received:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/eye.2016.14
This article is cited by
-
Evaluation of the effect of smokeless tobacco (Maras powder) on choroidal and retinal blood flow: an optical coherence tomography angiography study
International Ophthalmology (2020)
-
Prevalence and causes of low vision and blindness in an elderly population in Nepal: the Bhaktapur retina study
BMC Ophthalmology (2018)
-
Age-related macular degeneration in a South Indian population, with and without diabetes
Eye (2017)
-
Prevalence and the risk factors for visual impairment in age-related macular degeneration
Eye (2017)
