Ophthalmology science · 2026
Plasma Vitamin D and Intermediate Age-Related Macular Degeneration: Insights from the Longitudinal ALIENOR Study.
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Larsen Petra P, Delyfer Marie-Noëlle, Korobelnik Jean-François, Delcourt Cécile, Merle Bénédicte M J
Аннотация
OBJECTIVE: Age-related macular degeneration (AMD) is a leading cause of vision loss in older adults, with limited options to prevent disease progression. Vitamin D may influence AMD pathogenesis through anti-inflammatory, antioxidative, and antiangiogenic effects. This study aims to investigate the association between deseasonalized plasma 25-hydroxyvitamin D [25(OH)D] levels and the risk of incident AMD, as well as longitudinal changes in macular layer thickness in an elderly population.
DESIGN: Population-based cohort study.
PARTICIPANTS: Seven hundred eyes from 429 participants aged ≥65 years from the ALIENOR Study, followed up over 18 years.
METHODS: Baseline deseasonalized plasma 25(OH)D levels were measured and categorized as sufficient (≥50 nmol/l), insufficient (25-49 nmol/l), or deficient (<25 nmol/l). Cox proportional hazards models adjusted for demographic, lifestyle, and clinical covariates were used to estimate the risk of incident AMD. Longitudinal linear mixed-effects models assessed changes in outer retinal layer thicknesses derived from OCT imaging.
MAIN OUTCOME MEASURES: Incident intermediate and advanced AMD based on fundus color photographs and OCT.
RESULTS: The mean baseline deseasonalized plasma 25(OH)D level was 37.9 ± 14.9 nmol/l. Vitamin D deficiency (<25 nmol/l) was significantly associated with increased risk of incident intermediate AMD compared to sufficient levels (≥50 nmol/l, hazard ratio [HR] = 2.34; 95% confidence interval [CI]: 1.19-4.61; P = 0.01), while insufficiency (25-49 nmol/l) showed a borderline increased risk (HR = 1.74; 95% CI: 0.98-3.08; P = 0.06). No significant associations were observed with advanced AMD. Vitamin D-deficient participants also experienced a significant increase in retinal pigment epithelium-Bruch membrane (RPE-BM) complex thickness over time (β = 0.07 μm/year; 95% CI: 0.01-0.13; P = 0.02), while other outer retinal layers showed no significant change.
CONCLUSIONS: Low deseasonalized plasma 25(OH)D levels were associated with a higher risk of developing intermediate AMD and progressive thickening of the RPE-BM complex, a key retinal structure implicated in AMD pathogenesis. These findings support an association hypothesis and highlight vitamin D status as a candidate modifiable factor worthy of further investigation.
FINANCIAL DISCLOSURES: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
DESIGN: Population-based cohort study.
PARTICIPANTS: Seven hundred eyes from 429 participants aged ≥65 years from the ALIENOR Study, followed up over 18 years.
METHODS: Baseline deseasonalized plasma 25(OH)D levels were measured and categorized as sufficient (≥50 nmol/l), insufficient (25-49 nmol/l), or deficient (<25 nmol/l). Cox proportional hazards models adjusted for demographic, lifestyle, and clinical covariates were used to estimate the risk of incident AMD. Longitudinal linear mixed-effects models assessed changes in outer retinal layer thicknesses derived from OCT imaging.
MAIN OUTCOME MEASURES: Incident intermediate and advanced AMD based on fundus color photographs and OCT.
RESULTS: The mean baseline deseasonalized plasma 25(OH)D level was 37.9 ± 14.9 nmol/l. Vitamin D deficiency (<25 nmol/l) was significantly associated with increased risk of incident intermediate AMD compared to sufficient levels (≥50 nmol/l, hazard ratio [HR] = 2.34; 95% confidence interval [CI]: 1.19-4.61; P = 0.01), while insufficiency (25-49 nmol/l) showed a borderline increased risk (HR = 1.74; 95% CI: 0.98-3.08; P = 0.06). No significant associations were observed with advanced AMD. Vitamin D-deficient participants also experienced a significant increase in retinal pigment epithelium-Bruch membrane (RPE-BM) complex thickness over time (β = 0.07 μm/year; 95% CI: 0.01-0.13; P = 0.02), while other outer retinal layers showed no significant change.
CONCLUSIONS: Low deseasonalized plasma 25(OH)D levels were associated with a higher risk of developing intermediate AMD and progressive thickening of the RPE-BM complex, a key retinal structure implicated in AMD pathogenesis. These findings support an association hypothesis and highlight vitamin D status as a candidate modifiable factor worthy of further investigation.
FINANCIAL DISCLOSURES: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.