Abstract
PURPOSE: To investigate the impact of physical activity (PA) on the incidence or progression of age-related macular degeneration (AMD) in the general population. DESIGN: Meta-analysis of longitudinal cohort studies. METHODS: We included 14,630 adults with no or early AMD at baseline from 7 population-based studies and examined associations of PA with AMD incidence and progression using multistate models (MSM) per study and subsequent random effects meta-analysis. Age effects were assessed using meta-regression. The main outcome measure was the hazard ratio (HR) for incident early or progression to late AMD. RESULTS: At baseline, mean age was 60.7 ± 6.9 to 76.4 ± 4.3 years, and prevalence of early AMD was 7.7% (range, 3.6%-16.9%) between cohorts. During follow-up, 1461 and 189 events occurred for early and late AMD, respectively. In meta-analyses, no or low to moderate PA (high PA as reference) was associated with an increased risk for incident early AMD (HR, 1.19; 95% CI, 1.01-1.40; P = .04), but not for late AMD. In subsequent meta-regression, we found no association of age with the effect of PA on incident AMD. CONCLUSIONS: Our study suggests high levels of PA to be protective for the development of early AMD across several population-based cohort studies. Our results establish PA as a modifiable risk factor for AMD and inform further AMD prevention strategies to reduce its public health impact.
| Original language | English |
|---|---|
| Pages (from-to) | 99-106 |
| Number of pages | 8 |
| Journal | American Journal of Ophthalmology |
| Volume | 236 |
| DOIs | |
| Publication status | Published - Apr 2022 |
Bibliographical note
Funding Information:Funding/Support: The Gutenberg Health Study is funded through the government of Rhineland-Palatinate (“Stiftung Rheinland-Pfalz für Innovation,” contract AZ 961-386261/733), the research programs “Wissenschafft Zukunft” and “Center for Translational Vascular Biology (CTVB)” of the Johannes Gutenberg-University of Mainz, and its contract with Boehringer Ingelheim and Philips Medical Systems, including an unrestricted grant for the Gutenberg Health Study. Funders were involved in the development of the study design as scientific consultants. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Philipp S. Wild is funded by the Federal Ministry of Education and Research (BMBF 01EO1503) and is the principle investigator of the German Center for Cardiovascular Research (DZHK). Alexander K. Schuster holds the professorship for ophthalmic health care research endowed by “Stiftung Auge” and financed by “Deutsche Ophthalmologische Gesellschaft” and “Berufsverband der Augenärzte Deutschland e.V.” The Alienor study was supported by Théa Pharma, Fondation Voir et Entendre, Retina France, Agence Nationale de la Recherche (ANR 2010-PRSP-011 VISA), CFSR Recherche (Club Francophone des Spécialistes de la Rétine), French Ministry of Health (PHRC, 2012, PHRC12_157 ECLAIR), and CNSA (Caisse Nationale pour la Solidarité et l'Autonomie). The POLA study was supported by the Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France; by grants from the Fondation de France, Department of Epidemiology of Ageing, Paris, the Fondation pour la Recherche Médicale, Paris, the Région Languedoc-Roussillon, Montpellier, France, and the Association Retina-France, Toulouse; and by financial support from Rhônes Poulenc, Essilor, Specia and Horiba ABX Montpellier, and the Centre de Recherche et d'Information Nutritionnelle, Paris. The sponsors and funding organizations played no role in the design or conduct of this research. The Rotterdam Study is funded by Erasmus Medical Center and Erasmus University, Rotterdam, Netherlands Organization for the Health Research and Development (ZonMw), the Research Institute for Diseases in the Elderly (RIDE), the Ministry of Education, Culture and Science, the Ministry for Health, Welfare and Sports, the European Commission (DG XII), and the Municipality of Rotterdam. Supported by the European Union Horizon 2020 grant No. 634479 (EYE-RISK) and Royal Dutch Academy of Sciences (Ammodo Award to Caroline C.W. Klaver). AugUR investigations and analyses are supported by grants from the German Federal Ministry of Education and Research (BMBF 01ER1206, BMBF 01ER1507 to Iris M. Heid) and by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation; HE 3690/7-1 to I.M.H., BR 6028/2-1 to Caroline Brandl). The Blue Mountains Eye Study was funded by the Australian National Health and Medical Research Council (Grant Nos. 974159, 991407, 211069, 262120, and 457349). Matthias Schmid received funding paid to the institution from Innovative Medicines Initiative (MACUSTAR project).
Funding Information:
Financial Disclosures: Alexander K. Schuster discloses research support from Allergan, Bayer Vital, and Novartis and receipt of equipment from PlusOptix, Heidelberg Engineering. Jean-Francois Korobelnik discloses consulting fees from Allergan-AbbVie, Bayer, Janssen, Kanghong, NanoRetina, Novartis, Novonordisk, Roche, Laboratoires Théa, and Carl Zeiss Meditec. Audrey Cougnard-Gregoire discloses travel fees from Laboratoires Théa. Cécile Delcourt discloses consulting fees from Allergan, Bausch and Lomb, Laboratoires Théa, and Novartis. Matthias Schmid discloses support for attending meetings and/or travel from Innovative Medicines Initiative and European Federation of Pharmaceutical Industries and Associations (as part of MACUSTAR activities) paid to his institution. Philipp S. Wild discloses grants and personal fees from Boehringer Ingelheim, Sanofi-Aventis, Bayer Health Care, Bayer Vital, Daiichy Sankyo, and Novartis Pharma; grants from Philips Medical Systems and Novartis Pharma; provision of laboratory assays from DiaSorin; and personal fees from AstraZeneca. Caroline Klaver discloses fees in connection with advisory board for Bayer and is a member of the European Society for Retinal Specialists Board. Robert Finger reports grants and personal fees from Novartis, and personal fees from Bayer, Santen, Opthea, Novelion, ProQR, Oxford Innovation, Roche, Alimera, Santhera, Inositec, and Ellex, outside the submitted work. The other authors indicate no financial support or conflicts of interest. All authors attest that they meet the current ICMJE criteria for authorship.
Funding Information:
Funding/Support: The Gutenberg Health Study is funded through the government of Rhineland-Palatinate (“Stiftung Rheinland-Pfalz für Innovation,” contract AZ 961-386261/733), the research programs “Wissenschafft Zukunft” and “Center for Translational Vascular Biology (CTVB)” of the Johannes Gutenberg-University of Mainz, and its contract with Boehringer Ingelheim and Philips Medical Systems, including an unrestricted grant for the Gutenberg Health Study. Funders were involved in the development of the study design as scientific consultants. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Philipp S. Wild is funded by the Federal Ministry of Education and Research (BMBF 01EO1503) and is the principle investigator of the German Center for Cardiovascular Research (DZHK). Alexander K. Schuster holds the professorship for ophthalmic health care research endowed by “Stiftung Auge” and financed by “Deutsche Ophthalmologische Gesellschaft” and “Berufsverband der Augenärzte Deutschland e.V.” The Alienor study was supported by Théa Pharma, Fondation Voir et Entendre, Retina France, Agence Nationale de la Recherche (ANR 2010-PRSP-011 VISA), CFSR Recherche (Club Francophone des Spécialistes de la Rétine), French Ministry of Health (PHRC, 2012, PHRC12_157 ECLAIR), and CNSA (Caisse Nationale pour la Solidarité et l'Autonomie). The POLA study was supported by the Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France; by grants from the Fondation de France, Department of Epidemiology of Ageing, Paris, the Fondation pour la Recherche Médicale, Paris, the Région Languedoc-Roussillon, Montpellier, France, and the Association Retina-France, Toulouse; and by financial support from Rhônes Poulenc, Essilor, Specia and Horiba ABX Montpellier, and the Centre de Recherche et d'Information Nutritionnelle, Paris. The sponsors and funding organizations played no role in the design or conduct of this research. The Rotterdam Study is funded by Erasmus Medical Center and Erasmus University, Rotterdam, Netherlands Organization for the Health Research and Development (ZonMw), the Research Institute for Diseases in the Elderly (RIDE), the Ministry of Education, Culture and Science, the Ministry for Health, Welfare and Sports, the European Commission (DG XII), and the Municipality of Rotterdam. Supported by the European Union Horizon 2020 grant No. 634479 (EYE-RISK) and Royal Dutch Academy of Sciences (Ammodo Award to Caroline C.W. Klaver). AugUR investigations and analyses are supported by grants from the German Federal Ministry of Education and Research (BMBF 01ER1206, BMBF 01ER1507 to Iris M. Heid) and by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation; HE 3690/7-1 to I.M.H. BR 6028/2-1 to Caroline Brandl). The Blue Mountains Eye Study was funded by the Australian National Health and Medical Research Council (Grant Nos. 974159, 991407, 211069, 262120, and 457349). Matthias Schmid received funding paid to the institution from Innovative Medicines Initiative (MACUSTAR project). Financial Disclosures: Alexander K. Schuster discloses research support from Allergan, Bayer Vital, and Novartis and receipt of equipment from PlusOptix, Heidelberg Engineering. Jean-Francois Korobelnik discloses consulting fees from Allergan-AbbVie, Bayer, Janssen, Kanghong, NanoRetina, Novartis, Novonordisk, Roche, Laboratoires Théa, and Carl Zeiss Meditec. Audrey Cougnard-Gregoire discloses travel fees from Laboratoires Théa. Cécile Delcourt discloses consulting fees from Allergan, Bausch and Lomb, Laboratoires Théa, and Novartis. Matthias Schmid discloses support for attending meetings and/or travel from Innovative Medicines Initiative and European Federation of Pharmaceutical Industries and Associations (as part of MACUSTAR activities) paid to his institution. Philipp S. Wild discloses grants and personal fees from Boehringer Ingelheim, Sanofi-Aventis, Bayer Health Care, Bayer Vital, Daiichy Sankyo, and Novartis Pharma; grants from Philips Medical Systems and Novartis Pharma; provision of laboratory assays from DiaSorin; and personal fees from AstraZeneca. Caroline Klaver discloses fees in connection with advisory board for Bayer and is a member of the European Society for Retinal Specialists Board. Robert Finger reports grants and personal fees from Novartis, and personal fees from Bayer, Santen, Opthea, Novelion, ProQR, Oxford Innovation, Roche, Alimera, Santhera, Inositec, and Ellex, outside the submitted work. The other authors indicate no financial support or conflicts of interest. All authors attest that they meet the current ICMJE criteria for authorship. Acknowledgments: The authors are grateful to the study participants, the staff from the Rotterdam Study, and the participating general practitioners and pharmacists.
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