Prevalence and risk factors for age-related macular degeneration in a population-based cohort study of older adults in Northern Ireland using multimodal imaging: NICOLA Study

Ruth E Hogg, David M Wright, Nicola B Quinn, Katherine Alyson Muldrew, Barbra Hamill, Laura Smyth, Amy Jayne McKnight, Jayne Woodside, Mark A Tully, Sharon Cruise, Bernadette McGuinness, Ian S Young, Frank Kee, Tunde Peto, Usha Chakravarthy

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)
32 Downloads (Pure)


PURPOSE: To report prevalence and risk factor associations for age-related macular degeneration (AMD) and AMD features from multimodal retinal grading in a multidisciplinary longitudinal population-based study of aging in Northern Ireland.

STUDY DESIGN: Population-based longitudinal cohort study.

METHODS: Retinal imaging at the Norther Ireland Cohort for the Longitudinal Aging Study health assessment included stereo Colour Fundus Photography (CFP) (Canon CX-1, Tokyo, Japan) and Spectral-Domain Optical Coherence Tomography (SD-OCT) ((Heidelberg Retinal Angopgraph (HRA)+OCT; Heidelberg Engineering, Heidelberg, Germany). Medical history and demographic information was obtained during a home interview. Descriptive statistics were used to describe the prevalence of AMD and individual AMD features. Multiple imputation followed by multiple regression modelling was used to explore risk factor associations including relationships with AMD genetic risk score.

RESULTS: Retinal images from 3386 participants were available for analysis. Mean age of the sample was 63.4 (SD 9.01, range: 36-99). Population weighted prevalence of AMD using colour grading in those over 55 years was: no drusen: 6 0.4%; drusen <63 μm: 15.9%; drusen 63-125 µm: 13.7%; drusen >125 µm or pigmentary changes: 8.3%; late AMD: 1.6%. Prevalence of AMD features in those over 55 years was: OCT drusen 27.5%, complete outer retinal pigment epithelium and outer retinal atrophy (cRORA) on OCT was 4.3%, reticular drusen 3.2% and subretinal drusenoid deposits 25.7%. The genetic risk score was significantly associated with drusen and cRORA but less so for SDD alone and non-significant for hyperpigmentation or vitelliform lesions.

CONCLUSIONS: Multimodal imaging-based classification has provided evidence of some divergence of genetic risk associations between classical drusen and SDD. Our findings support an urgent review of current AMD severity classification systems.

Original languageEnglish
Article numberA84
Number of pages7
Early online date10 Oct 2022
Publication statusPublished online - 10 Oct 2022

Bibliographical note

Funding Information:
We are grateful to all the participants of the Northern Ireland Cohort for the Longitudinal Study of Aging (NICOLA) Study, and the whole NICOLA team, which includes nursing staff, research scientists, clerical staff, computer and laboratory technicians, managers and receptionists. The Atlantic Philanthropies, the Economic and Social Research Council, the UKCRC Centre of Excellence for Public Health Northern Ireland, the Centre for Ageing Research and Development in Ireland, the Office of the First Minister and Deputy First Minister, the Health and Social Care Research and Development Division of the Public Health Agency, the Wellcome Trust/Wolfson Foundation and Queen’s University Belfast provide core financial support for NICOLA. The authors alone are responsible for the interpretation of the data and any views or opinions presented are solely those of the authors and do not necessarily represent those of the NICOLA Study team. The ophthalmic component of the NICOLA study was funded by grants from the College of Optometrists. Diabetes UK, Macular Society, Guidedogs for the Blind, Thomas Pocklington Trust and the Belfast Association for the Blind, Bayer, Novartis and Optos plc.

Publisher Copyright:
© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.


  • epidemiology
  • imaging
  • macula
  • genetics
  • retina
  • Clinical science
  • 1506


Dive into the research topics of 'Prevalence and risk factors for age-related macular degeneration in a population-based cohort study of older adults in Northern Ireland using multimodal imaging: NICOLA Study'. Together they form a unique fingerprint.

Cite this