Estimation of incidence, progression, and relative risk for early and late age-related macular degeneration in an older population in Germany accounting for different classification approaches

• Applicants: Dr. Caroline Brandl; Professorin Dr. Iris M. Heid
• Subject Area: Epidemiology and Medical Biometry/Statistics
• Term: from 2020 to 2024
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 434737162

Late age-related macular degeneration (AMD) is a severe ophthalmic disorder and the main cause of blindness in industrialized countries. Late AMD is typically preceded by early disease stages. Early and late AMD are most common in older populations. Important epidemiological measures are incidence of early and late AMD, progression from early to late AMD and their dependencies on risk factors. Current epidemiological research particularly on early AMD is hampered due to several uncertainties: (i) limited data from cohort studies in older populations, especially from Germany, (ii) different classification systems for early AMD with unknown effects on incidence, progression and risk factor estimates, (iii) novel multimodal imaging to improve AMD-endpoints, but no population-based data on re-classification or impact on incidence, progression and risk factor estimates. Moreover, multimodal imaging enables the determination of numerous parameters, which may provide new imaging biomarkers for disease development or progression. Our overall aim is to estimate incidence of early/late AMD and progression, to understand their dependencies on risk factors and to investigate multimodal imaging parameters for their potential role as imaging biomarkers.Our specific aims are (1) quantifying incidence and progression by age-group and genetic-risk-score-group for six classification systems for early AMD without/with multimodal imaging (multi-state-model for panel data), (2) comparing the classification systems for early AMD regarding their relation with each other (concordance, distance) and their prognostic validity (prediction of progression to late AMD, based on the estimates from aim1; prediction of visual function, mixed linear/logistic regression), (3) investigating the association of retinal layer thicknesses on incident early AMD to support their role as potential imaging biomarker (proportional-hazard-model for discrete observation times).Our approach is the longitudinal observation of an older population. For this, we will utilize our established AugUR-study, a cohort study in the population in/around Regensburg over 70 years of age with baseline examinations (n~2300) and partly available follow-up (n=788) Here, we apply for financing to complete the follow-up examinations (n~1350). Beyond this project, the generated data and analyses will contribute to joint European evaluations of lifestyle and metabolic parameters as risk factors for early and late AMD.

• DFG Programme: Research Grants