Epidemiology of age-related maculopathy

In 1875, Pagenstecher and Gentll provided the first description of age-related maculopathy (ARM). Nowadays, hundred and twenty years after the first description, ARM is one of the major causes of severe irreversible visual loss in the elderly in western countries. It has been estimated that there are 640000 people aged 75 years or older in the United States who have signs of the endstage of this disease. Still, Olll' knowledge about the etiology of ARM is very limited and treatment is only possible in a minority of patients. The Framingham Eye Study was the first population-based study that provided information about prevalence and risk factors for ARM. Since then, several epidemiologic studies on the disease have been performed, most of them in the USA. A review of the epidemiological knowledge obtained in these studies is given in chapter 2 of this thesis. Since until recently a uniform classification of ARM has not been available, comparison of the results of different studies has for years been a problem. Chapter 3 presents the results of several international meetings of six research groups with the aim to develop a uniform classification system for ARM. Little information was available on the prevalence of ARM in the Netherlands. The Rotterdam Study, however, provided an excellent opportunity to answer several research questions into the epidemiology of the disease. The results of the prevalence study are presented in chapter 4. The remainder of this thesis focuses on risk factors of the late stages of the disease, atrophic and neovascular agerelated macular degeneration (AMD). In chapter 5, the associations of various indicators of atherosclerosis and the late stages of the disease are described. Chapter 6 presents the association between smoking and AMD and in chapter 7 the relation with age of menopause and is described. Methodological issues related to the presented studies are discussed in chapter 8, together with a review of the results of these studies and suggestions for future research.