Abstract
Purpose
To investigate alcohol consumption as a risk factor for the 15-year cumulative incidence and progression of age-related macular degeneration (AMD).
Design
Prospective population-based study in Beaver Dam, WI with four examinations at 5-year intervals initiated in 1988 (n=3,509 contributed data for this analysis).
Methods
History of alcohol consumption was obtained via questionnaire. Cumulative incidence of early AMD, exudative AMD, pure geographic atrophy and progression of AMD were assessed from fundus photographs taken at each examination.
Results
Heavy drinking (4 or more drinks daily) at baseline was related to the 15-year cumulative incidence of pure geographic atrophy in men (odds ratio: 9.2, 95% confidence interval: 1.7-51.2). There were no consistent associations with the amount of beer, wine or liquor consumption and the incidence or progression of AMD.
Conclusions
Alcohol consumption is unlikely to strongly increase (or decrease) the risk of AMD.
At the 10-year follow-up of the Beaver Dam Eye Study, history of heavy drinking increased the risk of developing exudative macular degeneration.1 Our previous observation involved a small number of heavy drinkers and incident exudative AMD cases. We extend our previous work with five additional years of follow-up.
Descriptions of the population, the examinations and AMD grading from retinal photographs have been presented in detail elsewhere.2-5 There were 3,842 persons between ages 43-86 years examined at baseline and contributed follow-up information. At each examination, photographs of the retina were taken and AMD was graded3. Fifteen year incidence of early AMD (soft indistinct drusen or pigment abnormalities in the presence of drusen), exudative AMD, and pure geographic atrophy were based on the event happening in the worse eye. Progression of AMD was based on progressing two or more steps along a 6-step scale or progressing from early to late AMD in either eye.5 History of alcohol intake and other medical and lifestyle characteristics was obtained.2 Heavy drinking was defined as 4 or more drinks daily. A drink was defined as any of the following: 12 ounce beer, 4 ounce glass of wine, or 1.5 ounces of liquor. SAS version 9 (Cary, NC) was used to compute multivariate adjusted odds ratios from discrete logistic hazard regression models. All data were collected with Institutional Review Board approval in conformity with all federal and state laws.
The distribution of baseline drinking characteristics is shown in Table 1. Men reported higher alcohol consumption than women in all categories, except for wine drinking. Baseline heavy drinking status and the incidence and progressed AMD is shown in Table 2. In men, after controlling for age, systolic blood pressure, vitamin use, and history of smoking, there were significantly higher odds of incident pure geographic atrophy among current compared to never heavy drinkers. There were no other significant relationships among women or for incidence and progression of other AMD outcomes.
Table 1.
Baseline drinking characteristics among men and women in the Beaver Dam Eye Study*
| Drinking Characteristic | Men (N=1538) | Women (N=1971) | P-value† |
|---|---|---|---|
| History of heavy drinking | <0.001 | ||
| Never | 70.1 | 94.4 | |
| Past | 25.4 | 5.2 | |
| Current | 4.5 | 0.5 | |
| Beer drinking (avg. per week) | <0.001 | ||
| None | 48.2 | 82.8 | |
| 1 to <2 | 7.9 | 5.0 | |
| 2 to <6 | 21.5 | 7.6 | |
| 6 or more | 22.5 | 4.6 | |
| Wine drinking (avg. per week) | 0.63 | ||
| None | 87.4 | 87.6 | |
| 1 to <2 | 6.2 | 5.1 | |
| 2 or more | 6.5 | 7.3 | |
| Liquor drinking (avg. per week) | <0.001 | ||
| None | 56.8 | 73.4 | |
| 1 | 10.9 | 8.8 | |
| >1 to <4 | 12.6 | 9.1 | |
| 4 or more | 19.6 | 8.7 | |
| Any alcohol drinking (avg. per week) | <0.001 | ||
| None to <1 | 32.1 | 60.3 | |
| 1 to <5 | 25.2 | 23.6 | |
| 5 to <7 | 9.7 | 4.6 | |
| 7 to <28 | 28.6 | 11.1 | |
| 28 or more | 4.5 | 0.5 |
Only includes persons with AMD data available for incidence or progression analysis
Cochran-Mantel-Haenszel test for gender difference adjusted for age
Table 2.
15-Year Cumulative Incidence and Progression of AMD by Heavy Drinking Status at the Baseline Examination, Beaver Dam Eye Study 1988-2005.
| Heavy Drinking History | Men | Women | Both Genders | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| N | Ev | % | OR (95% CI)* | N | Ev | % | OR (95% CI)* | N | Ev | % | OR (95% CI)* | ||
| Incidence of Early AMD | Never | 964 | 113 | 13.0 | referent | 1615 | 232 | 16.2 | referent | 2579 | 345 | 15.0 | referent |
| Past | 345 | 26 | 8.4 | 0.70 (0.45, 1.09) | 87 | 11 | 14.9 | 1.38 (0.72, 2.65) | 432 | 37 | 9.7 | 0.85 (0.58, 1.23) | |
| Current | 60 | 7 | 12.9 | 1.11 (0.49, 2.53) | 7 | 2 | 33.3 | 1.94 (0.42, 9.02) | 67 | 9 | 15.6 | 1.42 (0.69, 2.91) | |
| Progression on 6-step scale | Never | 1212 | 101 | 9.8 | referent | 2016 | 250 | 14.5 | referent | 3228 | 351 | 12.7 | referent |
| Past | 450 | 30 | 7.8 | 0.92 (0.60, 1.41) | 112 | 9 | 9.2 | 0.91 (0.45, 1.83) | 562 | 39 | 8.1 | 0.91 (0.63, 1.31) | |
| Current | 80 | 9 | 13.1 | 1.75 (0.82, 3.73) | 9 | 0 | 0.0 | 89 | 9 | 11.6 | 1.51 (0.74, 3.10) | ||
| Incidence of Exudative AMD | Never | 1201 | 10 | 1.0 | referent | 1995 | 43 | 2.6 | referent | 3196 | 53 | 2.0 | referent |
| Past | 448 | 5 | 1.3 | 1.42 (0.47, 4.29) | 112 | 3 | 3.3 | 1.90 (0.56, 6.43) | 560 | 8 | 1.7 | 1.63 (0.72, 3.71) | |
| Current | 77 | 2 | 3.4 | 3.20 (0.61, 16.8) | 9 | 0 | 0.0 | 86 | 2 | 3.0 | 3.00 (0.67, 13.5) | ||
| Incidence of Pure Geographic Atrophy | Never | 1197 | 9 | 0.9 | referent | 1983 | 22 | 1.4 | referent | 3180 | 31 | 1.2 | referent |
| Past | 447 | 5 | 1.4 | 2.44 (0.79, 7.58) | 110 | 1 | 1.3 | 1.36 (0.17, 11.1) | 557 | 6 | 1.4 | 1.94 (0.73, 5.15) | |
| Current | 78 | 2 | 2.6 | 9.23 (1.66, 51.2)† | 9 | 0 | 0.0 | 87 | 2 | 2.3 | 7.21 (1.50, 34.6) † | ||
Abbreviations: AMD=age-related macular degeneration; N=number at risk; Ev=Number of cumulative events; %=15-year cumulative incidence (adjusted for competing risk of death); OR= odds ratio; CI = confidence interval
adjusted for baseline age categorically (43-54, 55-64, 65-74, 75-86 years), systolic blood pressure, vitamin use, smoking history and gender (where appropriate)
P-value = 0.01
Multivariate adjusted increasing trends among categories of baseline history of beer, wine, liquor, and total drinking are shown in Figure 1. History of beer and liquor drinking were not related to any of the incident AMD outcomes. History of increased wine drinking was inversely related to the incidence of early AMD among women and directly related to the incidence of pure geographic atrophy among men. History of increased alcohol drinking among women was inversely related to exudative AMD. We also tested for non-linear effects in drinking amounts and found no significant relationships (data not shown). In an analysis combining incident AMD with progression of AMD, there was no relationship with any of the alcohol variables (data not shown).
Figure 1.
Multivariate adjusted 15-year cumulative incidence and progression of age-related macular degeneration (AMD) by baseline drinking status, Beaver Dam Eye Study 1988-2005.
Odds ratios and 95% confidence intervals adjusted for baseline age categorically (43-54, 55-64, 65-74, 75-86 years), systolic blood pressure, vitamin use, smoking history and gender (where appropriate) are plotted for a 1-step increase in the drinking variable for men, women, and men and women combined (labeled all on the graph). The categories for beer, wine, liquor and all alcohol drinking combined can be found in Table 1.
We had previously reported a relationship of a history of heavy drinking with the 10-year incidence of exudative AMD.1 This was attenuated and no longer statistically significant at the time of the 15-year follow-up. However, we did detect an increased risk in developing pure geographic atrophy among heavy drinkers at the baseline examination compared to never heavy drinkers. The confidence interval was wide because of small numbers suggesting the possibility of a chance finding. Biologically, heavy drinking may cause oxidative damage to the retina leading to the development of AMD.6
There were few relationships investigating beer, wine, and liquor drinking separately. Increased wine drinking among women showed a reduction in the risk of incident early AMD. The antioxidant and anti-platelet aggregation properties in wines have been hypothesized to explain this relationship.7 However, this relationship was not consistent among men or for other AMD outcomes.
This study was limited by the relatively infrequent amount of drinking reported in this cohort as well as the infrequency of late AMD. In addition, under-reporting of heavy or moderate drinking may have resulted in misclassification, affecting our findings. In summary, there was not consistent evidence for protective effects (e.g., moderate wine drinking) or detrimental effects (e.g., heavy drinking) with the incidence or progression of AMD.
ACKNOWLEDGEMENT
The National Eye Institute provided funding for entire study including collection and analyses and of data EY06594 (R. Klein, B.E.K. Klein); RPB provided further additional support for data analyses. None of the authors have any proprietary interests. Ronald and Barbara E. K. Klein were involved in design and conduct of the study, collection, management, analysis, and interpretation of the data, and preparation, and review of manuscript. Michael Knudtson was involved in conduct of the study, collection and analyses and interpretation of the data and preparation, and review of manuscript.
Footnotes
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References
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