Propensity matched analysis of the risk of age-related macular degeneration with systemic immune-mediated inflammatory disease.

PURPOSE: The pathogenesis of age-related macular degeneration (AMD) involves aberrant complement activation and is a leading cause of vision loss worldwide. Complement aberrations are also implicated in many systemic immune-mediated inflammatory diseases (IMIDs), but the relationship between AMD and these conditions remains undescribed. The aim of this study is to first assess the association between AMD and IMIDs, and then assess the risk of AMD in patients with specific IMIDs associated with AMD.

DESIGN: Cross-sectional study and cohort study SUBJECTS AND CONTROLS: Patients with AMD were compared to control patients with cataracts and no AMD to ensure evaluation by an ophthalmologist. Patients with IMIDs were compared to patients without IMIDs but with cataracts.

METHODS: This study used de-identified data from a national database (2006-2023), using ICD-10 codes to select for IMIDs. Propensity score matching was based on patients on age, sex, race, ethnicity, and smoking. Odds ratios were generated for IMIDs and compared between AMD and control patients. For IMIDs associated with AMD, the risk of AMD in patients with the IMID versus patients without IMIDs was determined utilizing a cohort study design.

MAIN OUTCOME MEASURES: Odds ratio of IMID, risk ratios (RR) and 95% confidence intervals (CI) of AMD diagnosis given an IMID.

RESULTS: After propensity-score matching, AMD and control cohorts (n = 217,197 each) had a mean age of 74.7+/- 10.4 years were 56% female and 9% of patients smoked. AMD showed associations with systemic lupus erythematosus (SLE), Crohn's disease, ulcerative colitis (UC), rheumatoid arthritis, psoriasis, sarcoidosis, scleroderma, giant cell arteritis (GCA), and vasculitis. Cohorts for each positively associated IMID were created and matched to control cohorts with no IMID history. RA (RR 1.40, 95% CI 1.30-1.49), SLE (RR 1.73, 1.37-2.18), Crohn's (RR 1.42, 1.20-1.71), UC (RR 1.45, 1.29-1.63), psoriasis (RR 1.48, 1.37-1.60), vasculitis (RR 1.48, 1.33-1.64), scleroderma (RR 1.65, 1.35-2.02), and sarcoidosis (RR 1.42, 1.24-1.62) showed a higher risk of developing AMD compared to controls.

CONCLUSION: The results suggest that there is an increased risk of developing AMD in patients with RA, SLE, Crohn's disease, UC, psoriasis, vasculitis, scleroderma, and sarcoidosis compared to patients with no IMIDs.