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Age-Related Macular Degeneration in Patients With Chronic Myeloproliferative Neoplasms
Marie Bak1, Torben Lykke Sørensen2, Esben Meulengracht Flachs3
1Department of Haematology, Zealand University Hospital, University of Copenhagen, Roskilde, Denmark.
Importance:
It has been suggested that systemic inflammation increases the risk of age-related macular degeneration (AMD). Given that chronic immune modulation is present in patients with myeloproliferative neoplasms (MPNs), the risk of AMD in these patients may be increased.
Objective:
To compare the risk of AMD in patients with MPNs with the risk of AMD in matched controls from the general population.
Design, Setting, And Participants:
A nationwide population-based cohort study using Danish registers was conducted of all patients in Denmark who received a diagnosis between January 1, 1994, and December 31, 2013, of essential thrombocythemia, polycythemia vera, myelofibrosis, or unclassifiable MPNs. For each patient, 10 age- and sex-matched controls were included. All patients without prior AMD were followed up from the date of diagnosis (or corresponding entry date for the controls) until the first AMD diagnosis, death or emigration, or December 31, 2013, whichever occurred first. Data analysis was performed from April 1, 2015, to October 31, 2016.
Main Outcomes And Measures:
Incidence of AMD recorded in specialized hospital-based care. The rates and absolute risk of AMD were calculated. Using Cox proportional hazards regression models, smoking and risk-time adjusted hazard ratios (HRs) between patients and controls were calculated. In addition, HRs of neovascular AMD after 2006 were calculated since antivascular endothelial growth factor treatment was introduced nationwide at hospitals thereafter.
Results:
A total of 7958 patients with MPNs (4279 women [53.8%] and 3679 men [46.2%]; mean [SD] age at diagnosis, 66.4 [14.3] years) were included in the study. The rate of AMD per 1000 person-years at risk was 5.2 (95% CI, 4.6-5.9) for patients with MPNs (2628 with essential thrombocythemia, 3063 with polycythemia vera, 547 with myelofibrosis, and 1720 with unclassifiable MPNs) and 4.3 (95% CI, 4.1-4.4) for the 77 445 controls, while the 10-year risk of AMD was 2.4% (95% CI, 2.1%-2.8%) for patients with MPNs and 2.3% (95% CI, 2.2%-2.4%) for the controls. The risk of AMD was increased overall for patients with MPNs (adjusted HR, 1.3; 95% CI, 1.1-1.5), with adjusted HRs for the subtypes of 1.2 (95% CI, 1.0-1.6) for essential thrombocythemia, 1.4 (95% CI, 1.2-1.7) for polycythemia vera, 1.7 (95% CI, 0.8-4.0) for myelofibrosis, and 1.5 (95% CI, 1.1-2.1) for unclassifiable MPNs. In addition, patients with MPNs had a higher risk of neovascular AMD (adjusted HR, 1.4; 95% CI, 1.2-1.6).
Conclusions And Relevance:
Our results suggest that patients with MPNs are at increased risk of AMD, supporting the possibility that systemic inflammation is involved in the pathogenesis of AMD.
Insights
Patients with myeloproliferative neoplasms (MPNs) have an increased risk of developing age-related macular degeneration (AMD). This finding supports the role of systemic inflammation in AMD development.
Area of Science:
- Ophthalmology
- Hematology
- Immunology
Background:
- Systemic inflammation is a potential risk factor for age-related macular degeneration (AMD).
- Myeloproliferative neoplasms (MPNs) are characterized by chronic immune modulation, suggesting a possible link to increased AMD risk.
Purpose of the Study:
- To investigate the association between MPNs and the risk of developing AMD.
- To compare AMD incidence in MPN patients versus the general population.
Main Methods:
- Nationwide population-based cohort study using Danish registers (1994-2013).
- Included 7,958 patients with MPNs and 77,445 matched controls.
- Utilized Cox proportional hazards regression to calculate adjusted hazard ratios (HRs) for AMD and neovascular AMD.
Main Results:
- Patients with MPNs showed an increased overall risk of AMD (adjusted HR, 1.3).
- Specific MPN subtypes also demonstrated elevated AMD risk, particularly polycythemia vera (adjusted HR, 1.4) and unclassifiable MPNs (adjusted HR, 1.5).
- A higher risk of neovascular AMD was observed in MPN patients (adjusted HR, 1.4).
Conclusions:
- MPN patients face a significantly higher risk of developing AMD.
- The findings support the hypothesis that systemic inflammation contributes to the pathogenesis of AMD.
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