Eye research leverages VA database to enhance global health care knowledge

In 2024, the U.S. Department of Veterans Affairs announced it had enrolled one million Veterans in the Million Veteran Program. This milestone came after 12 years of collecting data and recruiting Veterans for the Million Veteran Program (MVP). Locally, the VA Northeast Ohio Healthcare System has participated in a multi-institutional research study into the complex “biobank” data stored in the MVP and a few smaller datasets yields findings that could improve health care for AMD patients worldwide.

In a recent study, published Dec. 2 in Nature Genetics and summarized in a recent news release, a team of scientists relied on a large cohort of patient data for more than 400,000 individuals, of which more than 67 percent were from the MVP, to conduct a comprehensive review of genetic, behavioral/lifestyle and other risk factors related to age-related macular degeneration. This vision disorder affects about 200 million people worldwide. It can impair the area of the eye, the retina, which is relied on for reading, driving and countless other daily tasks, resulting in legal blindness.

Neal Peachey, VANEOHS’ associate chief of staff for research and professor of ophthalmic research at the Cleveland Clinic Cole Eye Institute, obtained special grant support for the cooperative research from the VA Office of Research and Development. 

“This research, relying on our VA MVP dataset, is an outstanding example of how VA doctors and researchers contribute to healthcare knowledge that has implications far beyond just our Veteran community, but benefits the continued development of healthcare practices benefiting all Americans,” Peachey said.

Genetic factors associated with increased risk included being female and possessing European ancestry. Increasing age also was found to correlate to increased AMD risk, as did lifestyle habits such as smoking and heavy drinking. “All put together, if you are an older, European-descent woman who smokes and drinks, you are at higher risk - and that risk will increase over time as you get older,” said researcher Dr. Sudha Iyengar, professor and vice chair of research in the Department of Population and Quantitative Health Sciences at the Case Western Reserve University School of Medicine. 

Launched in 2011, the MVP national research program seeks to gather one of the largest research datasets ever conceived to examine how genes, lifestyle, military experiences and related exposures affect health and wellness in Veterans. It is an extensive research program and includes comprehensive individual data gathered from volunteer Veteran participants numbered among America’s 16 million Veterans. To date, the MVP biobank has facilitated more than 100 research projects by more than 700 researchers and produced more than 400 publications.

For the recent AMD research, the MVP provided data on more than 287,000 Veterans, constituting a large biobank of Veterans recruited at more than 60 national VA medical centers, to aid examination of demographic, lifestyle, clinical and genetic risk profiles.

“An important aspect of our study is the inclusion of Veterans of African or Hispanic ancestry in the MVP - groups that have not been well-studied in prior genetic studies of AMD,” Iyengar said. “This diverse population is a unique resource for identifying clues to develop therapeutics for AMD, a condition for which few effective treatments are available.” 

The collective human genome shared by all ancestral groups worldwide was identified as containing discrete signatures for higher AMD risk in individuals of European descent compared to those of African or Hispanic ancestry.  Analysis found that African American Veterans had a 57 percent reduction in risk, and Hispanic American Veterans had a 26 percent reduction in risk, for example, relative to European-American Veterans.  The extensive MVP dataset allowed statistical analysis of many genetic markers make more modest but potentially critical biological contributions to the likelihood that a given individual will develop AMD or not.

Researchers also confirmed earlier beliefs that a history of smoking or alcohol use increases the likelihood of developing AMD. The large cohort dataset also allowed researchers to confirm before observations that women are more susceptible to AMD than men, even though about 90 percent of the MVP enrollees are male.

Since its founding by the VA more than 10 years ago, the MVP has helped researchers understand health impacts and well-being across a variety of conditions, from traumatic brain injury to dietary habits and from type 2 diabetes to dementia, general mental health and brain structure. Rich data on hundreds of thousands of patients related to genetic ancestry, health history, lifestyle and demographics allows for insights not typically available in research relying on smaller cohort sizes.