A recent study published in Retina evaluated the relationship between atopic dermatitis (AD) and the risk of developing age-related macular degeneration (AMD).
Give me some background.
AD is a common, chronically relapsing inflammatory skin disease with a relatively high prevalence of 2.4% globally and 4.9% in American adults.
- Moreover: The prevalence of AD in children is as high as 20% in some countries—such as Sweden.
The inflammatory skin condition can cause systemic inflammation, complement activation, and increased oxidative stress.
- Note: These are all factors involved in the pathogenesis of AMD.
However: The study authors explained that studies on the rates of retinal diseases in patients with AD remain limited.
Now talk about the study.
In this retrospective cohort study, investigators utilized two large databases to determine the incidence of AMD in patients with AD:
- TriNetX Research network (based in the U.S.): 46,018 patients with AD aged ≥ 50 years, spanning 2005-2021
- Taiwan’s National Health Insurance Research Database (NHIRD): 9,513 patients with AD aged ≥ 50 years, spanning 2003-2017
Additional analyses examined the risk of dry and wet AMD, with stratified assessments based on:
- Age
- Sex
- Ethnicity
- Race
- AD activity
Findings?
Adults with AD demonstrated a significantly elevated risk of developing AMD in both cohorts:
- TriNetX cohort: hazard ratio (HR): 1.97, 95% confidence interval (CI): 1.78-2.19
- NHIRD cohort: HR: 1.25, 95% CI: 1.11-1.41
Individual outcome analyses confirmed a heightened risk for both dry and wet AMD associated with AD.
- Moreover: This increased risk was consistent across various groups stratified by demographic factors and AD activity.
Anything else?
In the TriNetX analysis, the white and Black subgroups demonstrated that AD was linked to an increased risk of both dry (HR: 1.99) and wet AMD (HR: 1.82).
- Note: Asian individuals comprised less than 5% of the population in the TriNetX cohort.
Conversely: In the NHIRD analysis (which was predominantly an Asian population) there was a higher risk of dry AMD (HR: 1.26) but not wet AMD (HR: 1.08).
- Plus: A significantly higher risk of AMD was found specifically in individuals with predominantly active AD.
Finally: In the TriNetX cohort, there was no increased risk of AMD in participants receiving dupilumab or Janus kinase (JAK) inhibitors—potentially due to the anti-inflammatory properties of the therapies.
Expert opinion?
On top of the role of systemic inflammation, the study authors highlighted that eye rubbing—a common symptom in AD patients—could also have an impact on the eye by causing mechanical trauma.
Take home.
The big picture: This data suggests that AD in adulthood is linked to a greater likelihood of developing AMD.
Moreover: These findings underscore the importance of regular funduscopic evaluations and proactive management of AMD in AD patients as well as combined efforts between dermatologists and optometrists to detect AMD early in these patients.