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Propensity-Matched Analysis of the Risk of Age-Related Macular Degeneration with Systemic Immune-Mediated
Priya Shukla1, Matthew W Russell2, Justin C Muste2
1Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio; Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio; Case Western Reserve University School of Medicine, Cleveland, Ohio.
Insights
Patients with immune-mediated inflammatory diseases (IMIDs) have a higher risk of developing age-related macular degeneration (AMD). This study found associations between AMD and conditions like rheumatoid arthritis and lupus, highlighting a significant link for vision health.
Area of Science:
- Ophthalmology
- Immunology
- Rheumatology
Background:
- Age-related macular degeneration (AMD) is a leading cause of vision loss, linked to complement system dysregulation.
- Systemic immune-mediated inflammatory diseases (IMIDs) also involve complement aberrations.
- The relationship between AMD and IMIDs is not well-established.
Purpose of the Study:
- To investigate the association between AMD and IMIDs.
- To determine the risk of AMD in patients diagnosed with specific IMIDs.
Main Methods:
- Utilized deidentified national database data from 2006-2023.
- Employed cross-sectional and cohort study designs with propensity score matching.
- Analyzed International Classification of Diseases 10 codes to identify IMIDs and compared AMD risk.
Main Results:
- AMD demonstrated associations with systemic lupus erythematosus, Crohn's disease, ulcerative colitis, rheumatoid arthritis, psoriasis, sarcoidosis, scleroderma, and vasculitis.
- Patients with rheumatoid arthritis, lupus, Crohn's disease, ulcerative colitis, psoriasis, vasculitis, scleroderma, and sarcoidosis exhibited a significantly higher risk of developing AMD.
- Risk ratios (RRs) for AMD development ranged from 1.40 to 1.73 across these associated IMIDs.
Conclusions:
- Patients with rheumatoid arthritis, systemic lupus erythematosus, Crohn's disease, ulcerative colitis, psoriasis, vasculitis, scleroderma, and sarcoidosis face an elevated risk of developing AMD.
- These findings underscore a potential link between systemic inflammation and AMD pathogenesis.
Purpose:
The pathogenesis of age-related macular degeneration (AMD) involves aberrant complement activation and is a leading cause of vision loss worldwide. Complement aberrations are also implicated in many systemic immune-mediated inflammatory diseases (IMIDs), but the relationship between AMD and these conditions remains undescribed. The aim of this study is to first assess the association between AMD and IMIDs, and then assess the risk of AMD in patients with specific IMIDs associated with AMD.
Design:
Cross-sectional study and cohort study.
Subjects And Controls:
Patients with AMD were compared with control patients with cataracts and no AMD to ensure evaluation by an ophthalmologist. Patients with IMIDs were compared with patients without IMIDs but with cataracts.
Methods:
This study used deidentified data from a national database (2006-2023), using International Classification of Diseases 10 codes to select for IMIDs. Propensity score matching was based on patients on age, sex, race, ethnicity, and smoking. Odds ratios were generated for IMIDs and compared between AMD and control patients. For IMIDs associated with AMD, the risk of AMD in patients with the IMID versus patients without IMIDs was determined utilizing a cohort study design.
Main Outcome Measures:
Odds ratio of IMID, risk ratios (RRs), and 95% confidence intervals (CIs) of AMD diagnosis, given an IMID.
Results:
After propensity score matching, AMD and control cohorts (n = 217 197 each) had a mean ± standard deviation age of 74.7 ± 10.4 years, were 56% female, and 9% of patients smoked. Age-related macular degeneration showed associations with systemic lupus erythematosus (SLE), Crohn's disease, ulcerative colitis, rheumatoid arthritis (RA), psoriasis, sarcoidosis, scleroderma, giant cell arteritis, and vasculitis. Cohorts for each positively associated IMID were created and matched to control cohorts with no IMID history. Patients with RA (RR, 1.40; 95% CI, 1.30-1.49), SLE (RR, 1.73; 95% CI, 1.37-2.18), Crohn's disease (RR, 1.42; 95% CI, 1.20-1.71), ulcerative colitis (RR, 1.45; 95% CI, 1.29-1.63), psoriasis (RR, 1.48; 95% CI, 1.37-1.60), vasculitis (RR, 1.48; 95% CI, 1.33-1.64), scleroderma (RR, 1.65; 95% CI, 1.35-2.02), and sarcoidosis (RR, 1.42; 95% CI, 1.24-1.62) showed a higher risk of developing AMD compared with controls.
Conclusions:
The results suggest that there is an increased risk of developing AMD in patients with RA, SLE, Crohn's disease, ulcerative colitis, psoriasis, vasculitis, scleroderma, and sarcoidosis compared with patients with no IMIDs.
Financial Disclosure(S):
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
