Journal List > J Korean Ophthalmol Soc > v.51(4) > 1008782

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Park, Song, Lee, Yoon, Koh, Kim, Kim, Kang, Kim, Lee, Nam, Lee, Kim, Kim, Kim, Kim, Kim, Huh, Oh, Kim, Lee, Kim, Kim, Lee, Joe, Lee, Chang, Kim, Joe, Bae, Lee, Kim, Oum, Yoon, Kwon, Moon, Yu, Yoon, Chang, Lee, Lee, Park, Ohn, Kwon, Chang, Yang, Lee, Lee, Kim, Lee, Moon, Ahn, Joe, Choi, Joe, Kim, Park, Nam, Joe, Kim, Chung, and Kang: The Results of Nation-Wide Registry of Age-related Macular Degeneration in Korea
Original Article

J Korean Ophthalmol Soc 2010;51(4):516-523.

Published online: 25 September 2010

DOI: https://doi.org/10.3341/jkos.2010.51.4.516

The Results of Nation-Wide Registry of Age-related Macular Degeneration in Korea

Kyu Hyung Park, MD, Su Jeong Song, MD, Won Ki Lee, MD, Hee Sung Yoon, MD, Hyoung Jun Koh, MD, Chul Gu Kim, MD, Yun Young Kim, MD, Se Woong Kang, MD, Ha Kyoung Kim, MD, Byung Ro Lee, MD, Dong Heun Nam, MD, Pill Young Lee, MD, Hyoung Su Kim, MD, Hyeoung Chan Kim, MD, Si Yeol Kim, MD, In Young Kim, MD, Gwang Su Kim, MD, Kuhl Huh, MD, Jae Ryung Oh, MD, Shin Dong Kim, MD, Sang Jun Lee, MD, Young Duk Kim, MD, Soon Hyun Kim, MD, Tae Gon Lee, MD, Sung Won Joe, MD, Dong Cho Lee, MD, Mu Hwan Chang, MD, Si Dong Kim, MD, Young Wok Joe, MD, Sun Ryang Bae, MD, Ju Eun Lee, MD, Jong In Kim, MD, Boo Sup Oum, MD, Ill Han Yoon, MD, Soon Ill Kwon, MD, Sang Woong Moon, MD, Hyeong Gon Yu, MD, Young Hee Yoon, MD, Gwang Yul Chang, MD, Sung Chul Lee, MD, Sung Jin Lee, MD, Tae Kwan Park, MD, Young Hun Ohn, MD, Oh Woong Kwon, MD, Woo Hyok Chang, MD, Yeon Sik Yang, MD, Suk Jun Lee, MD, Su Young Lee, MD, Chang Ryong Kim, MD, Jung Hee Lee, MD, Yeon Sung Moon, MD, Jae Kyoun Ahn, MD, Nam Chun Joe, MD, Gwang Ju Choi, MD, Young Joon Joe, MD, Sang Kook Kim, MD, Sung Pyo Park, MD, Woo Hoo Nam, MD, Hee Yoon Joe, MD, Jun Hyun Kim, MD, Hum Chung, MD, Jae Hoon Kang, MD

The Korean Retinal Society, Korea

Address reprint requests to Hum Chung, MD Department of Ophthalmology, Seoul National University College of Medicine #28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea Tel: 82-2-2072-3230, Fax: 82-2-741-3187, E-mail: chungh@snu.ac.kr

Received 13 August 2009       Accepted 22 December 2009

Copyright © 2010 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the incidence and clinical features of age-related macular degeneration (AMD) in Korea

Methods

Web-based (www.armd-nova.or.kr) registration was conducted for AMD patients aged 50 or more who were newly diagnosed by retinal specialists in Korea from August 20, 2005 to August 20, 2006. Patient data including ophthalmologic examination, fundus photography, fluorescein angiogram and/or indocyanin green angiogram (ICG), past medical history, behavioral habit, combined systemic diseases were uploaded.

Results

Among finally enrolled 1,141 newly diagnosed AMD patients, 690 patients (60.5%) were male and 451 patients (39.5%) were female. The average age of AMD patients was 69.7±8.0. Early AMD was observed in 190 patients and 951 patients had late AMD. Classic choroidal neovascular membrane (CNVM) was observed in 18.6% of exudative AMD patients and 63.4 % had occult CNVM. Subfoveal CNVM was observed in 80.4% of the patients with CNVM. Among the 580 exudative AMD eyes that performed indocyanin green angiography (ICG), 184 eyes (31.7%) had polypoidal choroidal vasculopathy (PCV) and 36 eyes (6.2%) showed retinal angiomatous proliferation (RAP). Age, male gender, smoking, diabetes and hypertension significantly increased the risk of the AMD among Koreans.

Conclusions

Because of the low rate of participation by retinal specialists, definite incidence of AMD was not obtainable. However, the estimated 1-year AMD incidence in the Pusan area of Korea is at least 0.4%. In contrast to Western people, 31.7% of exudative AMD cases were revealed to be PCV and 6.2% were revealed to be RAP. This discrepancy between ethnic groups should be considered in the diagnosis and treatment modality selection of Korean AMD patients.

Keywords: Age-related macular degeneration, Choroidal neovascular membrane, Korean, Polypoidal choroidal vasculopathy

References

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Figure 1.
Registry homepage (www.armd-nova.or.kr) of the Korean Retina Society for uploading the data of patients with age-related macular degeneration.
jkos-51-516f1.tif
Table 1.
Demographics and clinical features of age-related macular degeneration (AMD) in Korea
  AMD patient (n=1,141)
Age 69.7 ± 8.0
Gender: Male: Female (%) 690 (60.5): 451 (39.5)
Family History: Yes /Unknown /No 20 /169 /952
Insurance: Yes /No 1069 /72
Education: ≥ College graduate 198
      High school graduate 354
      Middle school graduate 212
      ≤ Elementary graduate 377
Smoking: Current smoker 213
      Ex smoker 267
      No 661
Vitamin: Yes / No 260 / 881
Alcohol: Yes / No 448 / 693
Vegetable: every day 676
      2–3 times/week 349
      Once a week 83
      Over once a week 33
Fish: every day 110
      2–3 times/week 540
      Once a week 355
      Over once a week 136
Occupation: Indoor job 416
      Outdoor job 332
      Mixed 131
      None 262
Body Mass Index 23.3±2.8
Systemic disease  
      DM 190
      Hypertension 366
      Hypercholesterolemia Hx. 37
      Cardiovascular Hx. 79
Table 2.
Age distribution and subtypes of age-related macular degeneration (AMD) in Korea
Age Early AMD Exudative AMD Geographic atrophy Total
50∼59 22 106 1 129 (11.3)
60∼69 85 336 13 434 (38.0)
70∼79 66 361 20 447 (39.2)
80∼ 17 111 3 131 (11.5)
total 190 914 37 1141
Table 3.
Phenotypic characteristics of the age-related macular degeneration (AMD) in Korea
  Rt Lt Total
Soft drusen 252 209 461
      Center 154 134  
      Inner circle 56 45  
      Outer circle 31 21  
      extramacula 11 9  
Geographic atrophy 40 27 67
      Center 34 25  
      Inner 6 2  
Pigment epithelial detachment 198 204 402
      Drusenoid 2 2  
      Serous 155 161  
      Hemorrhagic 41 41  
Subretinal hemorrhage 183 176 359
      Massive SRH 5 6 11
Disciform scar 64 78 142
Table 4.
Location of choroidal neovascularization in korean age-related macular degeneration (AMD) patients
location Predominantly classic CNV* Minimally classic CNV Occult CNV Total (%)
Subfovea 140 (15.9) 129 (14.7) 593 (67.5) 862 (80.4)
Juxtafovea 36 (35.3) 17 (16.7) 45 (44.1) 98 (9.1)
Extrafovea 28 (23.9) 26 (22.2) 58 (49.6) 112 (10.5)
Total (%) 204 (18.6) 172 (15.7) 696 (63.4) 1072 (100.0)

* CNV=choroidal neovascular membrane.

Table 5.
Subgroup analysis of choroidal neovascularization in age-related macular degeneration (AMD) patients; Analysis of 580 eyes of exudative AMD patients who underwent indocyanin green angiogram
Lesions Number (%)
Choroidal neovascular membrane 360 (62.1)
Polypoidal choroidal vasculopathy 184 (31.7)
Retinal angiomatous proliferation 36 (6.2)
Total 580 (100.0)
Table 6.
Laterality of the korean patients with age-related macular degeneration (AMD)
Phenotype   Early AMD Late AMD
Exudative AMD Geographic atrophy
Laterality unilateral 73 (38.4) 728 (79.6) 26 (70.3)
  bilateral 117 (61.6) 186 (20.4) 11 (29.7)
Total   190 914 37
Table 7.
Comparison of characteristics between normal control and early and late age-related macular degeneration (AMD) patients
Risk factors Control (n=3,135) Early AMD (n=190) Late AMD (n=951) P-value
Age (years) 65.04±4.31 68.77±7.63 69.88±8.10 <0.001
Gender (M/F) 1698/1437 (54.2%) 85/105 (44.7%) 605/346 (63.6%) <0.001
Smoking* 1039/2096 (33.14%) 58/132 (30.5%) 422/529 (44.3%)    0.022
Drinking (yes/no) 1248/1887 (39.8%) 62/128 (32.6%) 384/567 (40.4%)    0.388
Diabetes (yes/no) 132/3003 (4.2%) 44/146 (22.2%) 141/810 (14.8%) <0.001
Hypertension (yes/no) 396/2739 (12.6%) 69/121 (36.3%) 297/654 (31.2%) <0.001
BMI (kg/m2) 24.27±2.89 23.04±2.93 23.41±2.80 <0.001
Cerebral or Cardiovascular disease (yes/no) 256/2879 (8.2%) 21/169 (11.1%) 91/860 (9.6%)    0.086

Data are mean± standard deviation (SD). ANOVA for continuous variables; Chi-square test for categorical variables, as appropriate

* smoking=current smoker/ex-smoker or never smoked.

Table 8.
Associations with early and late age-related macular degeneration (AMD)
  AMD vs. Control OR (95% CI) P-value Early AMD vs. Control OR (95% CI) P-value Late AMD vs. Control OR (95% CI) P-value
Age (yrs)            
   50∼60 1.0 (referent)   1.0 (referent)   1.0 (referent)  
   61∼70 7.84 (6.17–9.98) 0.000 11.20 (6.94–18.09) 0.000 7.65 (5.88–9.95) 0.000
   >71 44.04(33.53–57.84) 0.000 35.94 (21.22–60.85) 0.000 46.90 (35.07–62.72) 0.000
Male gender 1.55 (1.22–1.97) 0.000 0.74 (0.46–1.20) 0.23 1.85 (1.43–2.40) 0.000
Smoking* 2.66 (2.09–3.38) 0.000 3.76 (2.32–6.08) 0.000 2.68 (2.07–3.46) 0.000
Alchol (2–3 times/week) 0.99 (0.81–1.20) 0.882 1.14 (0.74–1.75) 0.55 0.98 (0.79–1.21) 0.85
Diabetes (yes/no) 3.22 (2.39–4.34) 0.000 5.71 (3.55–9.16) 0.000 2.93 (2.13–4.04) 0.000
Hypertension (yes/no) 2.36 (1.91–2.92) 0.000 3.14 (2.13–4.61) 0.000 2.27 (1.82–2.85) 0.000
CVA History† (yes/no) 0.89 (0.66–1.21) 0.46 0.99 (0.54–1.80) 0.97 0.89 (0.64–1.24) 0.49
BMI (kg/m2)            
   <18.5 1.0 (referent)   1.0 (referent)   1.0 (referent)  
   18.5∼22.9 1.20 (0.80–1.80) 0.39 0.58 (0.29–1.16) 0.13 1.32 (0.84–2.06) 0.23
   23∼25 1.35 (0.89–2.05) 0.16 0.50 (0.24–1.03) 0.06 1.56 (0.99–2.47) 0.058
   >25 9.74 (6.10–15.55) 0.000 2.89 (1.30–6.42) 0.009 11.56 (6.93–19.30) 0.000

* Smoking=current vs. ex-smoker or never smoked

† CVA History=cerebral or cardiovascular disease history; Analysis was performed with binary logistic regression.

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