Rapid Assessment Of Risk For Age-related Macular Degeneration: The Stars Questionnaire

Purpose To describe a short questionnaire for a rapid assessment of risk factors for AMD, and assess its feasibility and relevance in a large-scale Italian study. Methods Risk factors having shown the most consistent associations with AMD in the literature were included in the STARS (Simplified Théa AMD Risk-assessment Scale) questionnaire, which was designed to be simple, quick and easy to fill in. Its feasibility and relevance were assessed in an Italian nationwide study. Between May and September 2010, all patients of both genders, aged 55 years or more, consulting the participating ophthalmologists during one week of consultations, were invited to take part in the study. Items on demography, medical history, and lifestyle were filled in by the patient. The ophthalmologist then performed the eye examinatio,and filled in the second part of the questionnaire (iris colour, cataract extraction, refraction, AMD classification). Patients affected by soft drusen and/or pigmentary abnormalities were classified as early AMD, whereas patients affected by geographic atrophy and/or neovascular AMD were classified as late AMD. Subjects with early and late AMD were compared to those without AMD using polytomous nominal logistic regression. Results One hundred and seventy-seven ophthalmologists prospectively recruited 12,639 subjects. Overall, 6061 (48.0%) were affected by early AMD, 1483 (11.7%) by late AMD, whereas 5095 (40.3%) were not affected by AMD. In the final multivariate model, age, female gender, North-African origin, family history of AMD, smoking, obesity, history of cardiovascular diseases,cataract surgery, myopia, hyperopia, living in a sunny area and usual solar protection were significantly associated with increased risk for both early and late AMD. High fruit consumption was associated with a significantly decreased risk for early and late AMD, while consumption of green vegetables and fish were not significantly associated with early or late AMD.Consumption of alcohol (beer or wine) and clear iris wereassociated with increased risk for early but not late AMD. Conclusions The STARS questionnaire can easily be implemented in the practice of ophthalmologists. It may prove useful as a screening tool, after improvement and further validation.