Clinical Scorecard: AMD incidence may be higher in lupus

At a Glance

Key Highlights

• Overall AMD incidence was 49.1 per 10,000 person-years among patients with SLE and 26.7 among controls.
• Neovascular AMD incidence was 10.5 per 10,000 person-years in SLE and 3.3 in controls; dry AMD incidence was 38.6 and 23.4, respectively.
• Treatment-defined severe SLE was not associated with statistically significantly higher incidence of overall, dry, or neovascular AMD than nonsevere SLE.
• The SLE-control association with neovascular AMD persisted across hydroxychloroquine exposure-duration groups, but longer exposure was not significantly associated with higher neovascular AMD hazards in analyses restricted to SLE.
• The retrospective claims-based design cannot establish causality; differential eye-examination frequency and unmeasured confounding may have affected findings.

Guideline-Based Recommendations

Diagnosis

• Neovascular AMD identification required a diagnosis code and a copayment registration code indicating ophthalmologist-confirmed choroidal neovascularization.

Management

Monitoring & Follow-up

Risks

• Patients with SLE had higher observed incidence of overall, dry, and neovascular AMD than matched controls.
• The study authors cautioned that more frequent ophthalmic examinations, particularly during hydroxychloroquine treatment, could increase AMD detection.
• The study did not establish a causal effect of SLE or hydroxychloroquine on AMD.

Patient & Prescribing Data

The cohort included 9,496 Korean patients aged 45 years and older with incident SLE from 2011 to 2020 and 28,488 matched controls; mean follow-up was 6.7 and 7 years, respectively.

Compared with controls, patients with SLE exposed to hydroxychloroquine for less than 5 years had about 2.7 times the likelihood of neovascular AMD, and those exposed for at least 5 years had about 4 times the likelihood. Within the SLE cohort, longer exposure was not significantly associated with higher neovascular AMD hazards; exposure duration was an imperfect marker of ophthalmic surveillance.

Clinical Best Practices

• Interpret the reported associations as observational findings, not evidence that SLE or hydroxychloroquine causes AMD.
• Consider the study's limitations when applying its findings: it lacked smoking, body mass index, family history, genetic susceptibility, retinal imaging, visual acuity, and detailed AMD severity or progression data.
• Note that treatment-defined SLE severity was based on sustained intravenous cyclophosphamide or mycophenolate mofetil use for at least 6 months and did not directly measure disease activity.

Related Resources & Content

• Scientific Reports study described in the source article