A recently published article in the Journal of the American Geriatrics Society reported an inverse association between consumption of wine and risk of age-related macular degeneration (AMD) (1). The authors evaluated a sub-sample of people participating in the first National Health and Nutrition Examination Survey (NHANES-1) which was conducted on a large population-based representative sample during 1971-1975. The sub-sample consisted of people aged 45-74 who were given detailed eye examinations (1971-72) in addition to the general survey and medical history questionnaire. Of the NHANES-1 participants, 3072 were within the 45-74 age range, had been given detailed fundus exams and had responded to the group of alcohol consumption questions. They were divided into cases (having AMD) and controls (no evidence of AMD). Ophthalmologists from the National Eye Institute verified ocular diagnoses and supervised quality control.

Results:

Alcohol consumption was categorized by usage during the year (Y/N), frequency of use, most frequent alcohol type and usage during 24 hours. It was found that 4% of wine drinkers had AMD compared with 9% of people who drank no alcohol at all. Bivariate logistic regression was used to determine the relative risk of AMD between alcohol users and non-users. Drinking wine was associated with decreased risk of AMD as shown below. The risk was decreased by 34% among those drinking wine, by 34% for those drinking beer and wine, and by 26% for those drinking wine and liquor (p<0.001 for all 3 comparisons). Multiple logistic regression was also used to control for other confounding factors such as age , sex, income, history of congestive heart failure, and hypertension. Age is strongly associated with AMD and the other factors are associated with alcohol consumption. When these adjustments were included only wine drinking remained significantly associated with decreased risk of AMD (19% lowered risk, p=0.028). Obisesan and coauthors discussed their findings cautiously. They pointed out that the study had some limitations in design; it was cross sectional rather than prospective and it excluded people over 74. Alcohol use was determined very loosely based on any uses within the previous year. Furthermore most studies of this type will underestimate alcohol use (alcohol recall bias). The NEI issued a statement regarding the interpretation of the study (2). The statement reiterated these cautionary comments with respect to any inference of a causal relationship.

Clearly there is limited information regarding the relationship between alcohol consumption and AMD. In a study of the Beaver Dam Eye population, Ritter, et al found no statistically significant associations but presented data suggesting a weak positive association between exudative AMD and beer consumption (3). The Eye Disease Case Control Study found no association between AMD and alcohol consumption (4). Both these studies also have the methodologic problems inherent in alcohol consumption studies. Obisesan points out that the statistically significant inverse relationship between AMD and wine consumption in the NHANES-1 study is consistent with the known anti-oxidative role of red wine polyphenols in protecting against heart disease. They also point out that epidemiological reviews suggest that AMD and heart disease may both be associated in some fashion with certain common factors and that it would be worthwhile to further study a possible protective role for moderate wine consumption.

While data on this subject is very limited, it should be recognized that some patients in this age range do consume modest levels of wine to help protect against heart attack and that some take the antioxidant red wine polyphenol supplements to avoid the alcoholic content. While information is limited, it is possible that this practice could add some protective effect for AMD.

References

1. Obisesan TO, Hirsch R, Kosodo O, et al. Moderate Wine Consumption is Associated with Decreased Odds of Developing Age-Related Macular Degeneration in NHANES-1. J Am Geriatr Soc 1998; 46:1-7.
2. NEI Statement: Statement on Study Associating Moderate Wine Consumption with Decreased Risk of Age-Related Macular Degeneration. National Institutes of Health, National Eye Institute January 5, 1998.
3. Ritter LL, Klein R, Klein BE et al. Alcohol use and age-related maculopathy in Beaver Dam Eye Study. AJO 1995; 120:190-196.
4. The Eye Disease Case-Control Study Group. Risk Factors For Age-Related Macular Degeneration. Arch Ophthalmol 1992; 110:1701-1708.