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Age-Related Macular Degeneration in Patients With Chronic Myeloproliferative Neoplasms

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  • Marie Bak, University of Copenhagen
  • ,
  • Torben Lykke Sorensen, University of Copenhagen
  • ,
  • Esben Meulengracht Flachs, Univ Copenhagen, Aarhus University, University of Copenhagen, Bispebjerg Hosp, Dept Occupat & Environm Med
  • ,
  • Ann-Dorthe Zwisler, Odense Univ Hosp, Odense University Hospital, Clin Pharmacol
  • ,
  • Knud Juel, Univ Southern Denmark, University of Southern Denmark, Natl Inst Publ Hlth
  • ,
  • Henrik Frederiksen
  • Hans Carl Hasselbalch, University of Copenhagen

IMPORTANCE It has been suggested that systemic inflammation increases the risk of age-related macular degeneration (AMD). Given that chronic immune modulation is present in patients with myeloproliferative neoplasms (MPNs), the risk of AMD in these patients may be increased.

OBJECTIVE To compare the risk of AMD in patients with MPNs with the risk of AMD in matched controls from the general population.

DESIGN, SETTING, AND PARTICIPANTS A nationwide population-based cohort study using Danish registers was conducted of all patients in Denmark who received a diagnosis between January 1, 1994, and December 31, 2013, of essential thrombocythemia, polycythemia vera, myelofibrosis, or unclassifiable MPNs. For each patient, 10 age-and sex-matched controls were included. All patients without prior AMD were followed up from the date of diagnosis (or corresponding entry date for the controls) until the first AMD diagnosis, death or emigration, or December 31, 2013, whichever occurred first. Data analysis was performed from April 1, 2015, to October 31, 2016.

MAIN OUTCOMES AND MEASURES Incidence of AMD recorded in specialized hospital-based care. The rates and absolute risk of AMD were calculated. Using Cox proportional hazards regression models, smoking and risk-time adjusted hazard ratios (HRs) between patients and controls were calculated. In addition, HRs of neovascular AMD after 2006 were calculated since antivascular endothelial growth factor treatment was introduced nationwide at hospitals thereafter.

RESULTS A total of 7958 patients with MPNs (4279 women [53.8%] and 3679men [46.2%]; mean [SD] age at diagnosis, 66.4 [14.3] years) were included in the study. The rate of AMD per 1000 person-years at risk was 5.2 (95% CI, 4.6-5.9) for patients with MPNs (2628 with essential thrombocythemia, 3063 with polycythemia vera, 547 withmyelofibrosis, and 1720 with unclassifiable MPNs) and 4.3 (95% CI, 4.1-4.4) for the 77 445 controls, while the 10-year risk of AMD was 2.4%(95% CI, 2.1%-2.8%) for patients with MPNs and 2.3%(95% CI, 2.2%-2.4%) for the controls. The risk of AMD was increased overall for patients with MPNs (adjusted HR, 1.3; 95% CI, 1.1-1.5), with adjusted HRs for the subtypes of 1.2 (95% CI, 1.0-1.6) for essential thrombocythemia, 1.4 (95% CI, 1.2-1.7) for polycythemia vera, 1.7 (95% CI, 0.8-4.0) formyelofibrosis, and 1.5 (95% CI, 1.1-2.1) for unclassifiable MPNs. In addition, patients with MPNs had a higher risk of neovascular AMD (adjusted HR, 1.4; 95% CI, 1.2-1.6).

CONCLUSIONS AND RELEVANCE Our results suggest that patients with MPNs are at increased risk of AMD, supporting the possibility that systemic inflammation is involved in the pathogenesis of AMD.

Original languageEnglish
JournalJAMA Ophthalmology
Pages (from-to)835-843
Number of pages9
Publication statusPublished - Aug 2017

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