Original article14-Year Incidence, Progression, and Visual Morbidity of Age-Related Maculopathy: The Copenhagen City Eye Study
Section snippets
Population
The study was approved by the Ethical Committee of Copenhagen, and informed consent was obtained from all participants. The Copenhagen City Eye Study is a population-based survey of vision and common eye diseases in a representative urban elderly population residing in the Copenhagen metropolitan area. The study population is an age-stratified and gender-stratified, random subsample of 1000 persons aged 60 to 80 years from the Copenhagen City Heart Study population that comprised a random
Statistical Analysis
The Statistical Analysis System40 was used for tabulations and most statistical analyses. Additionally, Stata software41 was used to calculate 1-step agreement (%), weighted κ estimates, and related standard errors.
The interobserver and intraobserver estimates were obtained by a 3-level comparison of ARM. The percentages of agreement, exact and within 1 step, were calculated, and unweighted and weighted κ scores were computed.42 Weights assigned were 1.0 for full agreement, 0.75 for
Inclusion and Exclusion of Participants Based on Fundus Photograph Gradability
To evaluate changes in lesions between visits, retinal photographs were necessary from corresponding eyes at both visits. Of the 359 subjects who participated in the baseline and follow-up studies, 330 had gradable photographs of 1 or both eyes at baseline (319 for both eyes, 11 for 1 eye). Of these, 327 subjects had gradable photographs at the follow-up visit (313 for both eyes, 14 for 1 eye).
Photographs of 82 eyes of 50 persons were unavailable. Of these, 66 eyes of 39 subjects lacked
Participants
The mean and median times between the baseline and the 14-year follow-up examinations were 14.5 years and 14.7 years, respectively. Of the 946 participants in the baseline examination, 577 died before the follow-up examination. Of the surviving 369 persons, 359 participated in the follow-up examination and 10 persons declined to participate. Of those examined at both visits, 87.2% (313/359) were included in the analyses with at least 1 eye gradable at both examinations (288 bilateral, 25
Discussion
No previous study has reported on a population this old with as long a follow-up period and low rates of declined participation. We used a standardized objective system for grading color fundus photographs for ARM.37, 38 Photos from the baseline and the follow-up examination were graded in a masked and randomized fashion by a single grader (HB). The mean period of time between gradings of photos of each participant was 20.3 days (SD, ±30.9 days). This makes bias an unlikely result of the same
Acknowledgments
The authors thank senior grader Maria Swift for her assistance in WARMGS manual training and reproducibility grading, and Dr Ronald Klein and Stacy Meuer for providing valuable advice, all individuals affiliated with the Ocular Epidemiology Reading Center as part of the Department of Ophthalmology and Visual Sciences at the University of Wisconsin. The authors also thank Henrik Scharling for providing extensive data handling and statistical assistance and The Copenhagen City Heart Study Group
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Manuscript no. 240452.
Supported by the Carl and Nicoline Larsens Foundation, Copenhagen, Denmark; The Danish Eye Research Foundation, Copenhagen, Denmark; and the Danish Velux Foundation of 1981, Copenhagen, Denmark.
The authors have no financial or commercial interests in the subject matter or materials mentioned herein.