Exposure-wide approaches identifying modifiable factors for age-related macular degeneration

The present study aimed to systematically investigate modifiable factors for age-related macular degeneration (AMD) using novel exposure-wide strategies in a large cohort, and then assess the preventability of AMD.

Using data from the UK Biobank (UKB), a total of 331 modifiable factors from seven categories were included. Exposures were first screened using Cox proportional hazards models with each examined individually, and associated exposures were then tested in a mutually adjusted model for final validation. We calculated joint effect scores by combining validated exposures based on the category and tested the joint associations with AMD. We eventually estimated population attributable fraction to assess the overall preventability of AMD.

A total of 478 867 UKB participants were included. After a median of 13.63 years of follow-up, 10 903 (2.28%) were diagnosed with incident AMD. Among all 331 modifiable factors, 177 passed the exposure-wide association scan, with 34 exposures remaining statistically significant after mutual adjustment, distributed in 5 categories. Joint effects of these categories were significantly associated with AMD even among populations with higher AMD Polygenic Risk Score. Overall, we estimated that 30.4%-45.1% of AMD cases could be prevented by intervening in these factors.

Modifiable factors across multiple categories are associated with AMD, and active interventions targeting these factors can reduce AMD incidence by 30.4%-45.1%. This study also underscores the need for a systematic approach in uncovering modifiable factors and providing population-level knowledge basis for disease prevention.