Elsevier

Ophthalmology

Volume 114, Issue 6, June 2007, Pages 1157-1163
Ophthalmology

Original Article
Cigarette Smoking and Age-Related Macular Degeneration in the EUREYE Study

https://doi.org/10.1016/j.ophtha.2006.09.022Get rights and content

Objective

To examine the association between cigarette smoking and age-related maculopathy (ARM) including age-related macular degeneration (AMD) in the European population.

Design

Cross-sectional study.

Participants

Four thousand seven hundred fifty randomly sampled ≥65-year-olds from 7 study centers across Europe (Norway, Estonia, United Kingdom, France, Italy, Greece, and Spain).

Methods

Participants underwent an eye examination and digital retinal photography. The images were graded at a single center. Smoking history was ascertained by a structured questionnaire administered by trained fieldworkers. Multinomial and binary logistic regressions were used to examine the association between smoking history and ARM grade and type of AMD, taking account of potential confounders and the multicenter study design.

Main Outcome Measures

Photographic images were graded according to the International Classification System for ARM and stratified using the Rotterdam staging system into 5 exclusive stages (ARM 0–3 and ARM 4, also known as AMD). Age-related macular degeneration also was classified as neovascular AMD or geographic atrophy (GA).

Results

One hundred fifty-eight cases were categorized as AMD (109 neovascular AMD and 49 GA); 2260 had no signs of ARM (ARM 0). Current smokers had increased odds of neovascular AMD (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.4–4.8) or GA (OR, 4.8; 95% CI, 2.1–11.1), whereas for ex-smokers the odds were around 1.7. Compared with people with unilateral AMD, those with bilateral AMD were more likely to have a history of heavy smoking in the previous 25 years (OR, 5.1; 95% CI, 1.3–20.0). The attributable fraction for AMD due to smoking was 27% (95% CI, 19%–33%). There was no consistent association with ARM grades 1 to 3 and smoking.

Conclusions

These findings highlight the need for increasing public awareness of the risks associated with smoking and the benefit of quitting smoking. Patients with unilateral disease who are current smokers should be advised of the risk of second-eye disease.

Section snippets

Materials and Methods

Methods have been described in detail elsewhere.10 Briefly, a population sample older than 65 years was drawn in each of the 7 centers: Bergen (Norway), Tallinn (Estonia), Belfast (United Kingdom), Paris–Créteil (France), Verona (Italy), Thessaloniki (Greece), and Alicante (Spain). People who were institutionalized, such as those living in nursing or residential homes, were included in the sample. A potential study participant was considered ineligible if the forms were returned specifying that

Results

Data were complete for 4752 study participants (45% response rate) from the 7 locations. A detailed report on participant demographics, participation rate, and prevalence of ARM and AMD is presented elsewhere.14 Two people had missing smoking data. Overall, just over half of all EUREYE Study participants (2260) were never smokers, and under a fifth (675) were current smokers. No significant interactions were found between country and association with smoking, for early ARM, type of AMD, or

Discussion

Results from the EUREYE Study regarding the association between AMD and current smoking history are highly consistent with those previously reported from other population-based studies (Table 5).5, 8, 15, 16, 17, 18, 19, 20, 21 Our estimates for ex-smoking are also of the same order of magnitude as those in other studies, although all studies show greater variability in the estimates for ex-smoking, probably because (as shown in the EUREYE Study) the association varies according to the time

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    Manuscript no. 2006-225.

    Financial support: European Commission Vth Framework, Brussels, Belgium (contract no. QLK6-CT-1999-02094). Additional funding for cameras was provided by the Macular Disease Society, Andover, United Kingdom. Prof Rahu was financed by the Ministry of Education and Science, Tallinn, Estonia (target funding no. 01921112s02). Additional funding in Alicante was received from the Fondo de Investigacion Sanitaria, Madrid, Spain (grant nos. FIS 01/1692E, RCESP C 03/09), and Oficina de Ciencia y Tecnologia Generalitat Valenciana, Valencia, Spain (grant no. CTGCA/2002/06). European Eye investigator meetings were supported by travel grants from Novartis, Basel, Switzerland, and Pfizer Inc., New York, New York.

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