COVID-19 Morbidity and Severity in Patients With Age-Related Macular Degeneration: A Korean Nationwide Cohort Study - 13/06/22

Doi : 10.1016/j.ajo.2021.05.024

Jee Myung Yang ^a,^b,^c, Sung Yong Moon ^c, Joo Yong Lee ^a, Dritan Agalliu ^d, Dong Keon Yon ^c,^e,^{^{1
Dong Keon Yon and Seung Won Lee contributed equally as corresponding authors},}^⁎ , Seung Won Lee ^c,^f,^{^{1
Dong Keon Yon and Seung Won Lee contributed equally as corresponding authors},}^⁎
^a From Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine (J.M.Y, J.Y.L)
^b Department of Ophthalmology, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
^c Department of Data Science, Sejong University College of Software Convergence, Seoul, Republic of Korea (S.Y.M, D.K.Y, S.W.L)
^d Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA (D.A)
^e Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, Republic of Korea (D.K.Y)
^f Department of Precision Medicine, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea (S.W.L)

^⁎Inquiries to Dong Keon Yon, Kyung Hee University College of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, South Korea; and Seung Won Lee, Department of Data Science, Sejong University College of Software Convergence, 209 Neungdong-ro, Gwangjin-gu, Seoul, 05006, South Korea.Inquiries to Dong Keon Yon, Kyung Hee University College of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, South Korea; and Seung Won Lee, Department of Data Science, Sejong University College of Software Convergence, 209 Neungdong-ro, Gwangjin-gu, Seoul05006South Korea

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HIGHLIGHTS

•	The first study showing an association between ophthalmologic comorbidities and risk of susceptibility to COVID-19 infection and severe COVID-19 outcomes.
•	A large nationwide cohort study with strong statistical evidence including patients aged ≥40 years who underwent SARS-CoV-2 testing in South Korea (total n = 135,435).
•	Well-designed statistical analysis using robust propensity-score matching increased the generalizability and reliability of the results.

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Résumé

Purpose

To determine the potential association between age-related macular degeneration (AMD), a representative chronic age-related degenerative disease of the retina associated with inflammation and aging, and susceptibility to SARS-CoV-2 infection and severe COVID-19 outcomes.

Design

Nationwide cohort study with propensity-score matching.

Methods

A population-based nationwide cohort in Korea was examined. Data were obtained from the Health Insurance Review & Assessment Service of Korea, including all patients aged ≥40 years who underwent SARS-CoV-2 testing in South Korea between January 1, 2020 and May 15, 2020 (excluding self-referral). The primary outcome was SARS-CoV-2 test positivity and the secondary outcome was severe clinical outcome of COVID-19.

Results

The unmatched cohort consisted of 135,435 patients who were tested for SARS-CoV-2: 4531 patients (3.3%) tested positive for SARS-CoV-2 and 5493 (4.1%) had AMD. After propensity score matching, exudative AMD was associated with an increased likelihood of susceptibility to SARS-CoV-2 infection (adjusted odds ratio [aOR], 1.50; 95% confidence interval [CI], 1.03-2.25), and a considerably greater risk of severe clinical outcomes of COVID-19 (aOR, 2.26; 95% CI, 1.02-5.26), but not any AMD and non-exudative AMD.

Conclusions

In a Korean nationwide cohort, data suggest that clinicians should be aware of the greater risk of susceptibility to severe clinical outcomes of COVID-19 in patients with exudative AMD. These findings provide an improved understanding of the relationship between the pathogenesis of COVID-19 and chronic neurological disorders.

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Keywords : COVID-19, age-related macular degeneration, exudative age-related macular degeneration, susceptibility, severity