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Factors associated with increased mortality in AMD

05 Dec 2017

Survival in age-related macular degeneration (AMD) may be reduced in patients with late disease, bilateral cataract surgery and poor visual acuity, according to data from the Age-Related Eye Disease Study 2 (AREDS2). Moreover, oral supplementation with omega-3 fatty acids, lutein plus zeaxanthin, zinc or beta-carotene does not significantly affect mortality.

AREDS2 randomized 4,203 patients with at least intermediate AMD to receive lutein/zeaxanthin and/or omega-3 fatty acids for treatment of AMD and cataract. Baseline and annual assessments included best-corrected visual acuity (BCVA), slit-lamp examinations and stereoscopic fundus photographs that were centrally graded for development of late AMD (central geographic atrophy or neovascular AMD) or pseudophakia.

Of the patients, 368 died during a median follow-up of 5 years. In Cox proportional hazards models, mortality was elevated in patients with neovascular AMD in one eye at baseline than in those with no or few drusen (hazard ratio [HR], 1.56; 95 percent CI, 1.21 to 2.01; p<0.001).

Survival was also poor for patients with bilateral cataract surgery before enrolment than for those with baseline bilateral phakia (HR, 1.63; 1.29 to 2.07; p<0.001), as well as for patients with BCVA of <20/40 vs those with ≥20/40 (HR, 1.56; 1.06 to 2.30; p=0.024).

On the other hand, mortality was lower in patients who received antivascular endothelial growth factor therapies for neovascular AMD than in those who did not (HR, 0.71; 0.57 to 0.88; p=0.002).

The association between all-cause mortality and AREDS2 treatment did not significantly differ whether assessing the main or individual treatment effect (omega-3 fatty acids main effect: HR, 1.18; 0.96 to 1.45; p=0.12; lutein/zeaxanthin main effect: HR, 1.04; 0.85 to 1.28; p=0.71).

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Most Read Articles
4 days ago
The types of bariatric surgery differentially affect the risk of developing acute pancreatitis postoperatively, such that the risk is greater in patients who undergo vertical sleeve gastrectomy vs Roux-en-Y gastric bypass surgery, according to a study. Risk factors include younger age and presence of gallstones.
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Concomitant use of psyllium fibres, taken before meals, appears to enhance the cholesterol-lowering effects of statins, according to a recent meta-analysis.
5 days ago
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6 days ago
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