Five-year incidence of age-related maculopathy lesions: the Blue Mountains Eye Study

PURPOSE: To describe the 5-year incidence and progression of early and late age-related maculopathy (ARM) lesions. DESIGN: Population-based cohort study. PARTICIPANTS: Three thousand six hundred fifty-four noninstitutionalized residents, aged 49 years or older, living in the Blue Mountains area west of Sydney, Australia, participated in the study during 1992 to 1994. The cohort was reexamined after 5 years (1997-1999). Excluding 543 participants who died since the baseline, 2335 (75%) survivors attended 5-year follow-up examinations. METHODS: Retinal photographs from both examinations were graded using the Wisconsin ARM Grading System. Photographs of participants with any ARM lesions at either examination were regraded in detail using a modification of the side-by-side method developed for the Beaver Dam Eye Study. MAIN OUTCOME MEASURES: Incidence and progression of ARM lesions were defined in a similar manner to that used in the Beaver Dam Eye Study. RESULTS: Incidence rates for all ARM lesions increased significantly with age. For late ARM lesions (geographic atrophy and neovascular ARM), the overall 5-year incidence was 1.1%. The combined late ARM incidence was 0.0%, 0.6%, 2.4%, and 5.4% for participants aged 60 years and younger, 60 to 69 years, 70 to 79 years, and 80 years and older at baseline, respectively. After excluding participants with either early or late ARM in either eye at baseline, the overall 5-year incidence of early ARM was 8.7%, including 3.2%, 7.4%, 18.3%, and 14.8% for the corresponding age groups. The incidence of neovascular ARM in women was double that for men (P = 0.1). CONCLUSIONS: This study has documented the incidence of ARM lesions in an older Australian population. The slightly higher incidence of hyperpigmentation found in our population compared with the Beaver Dam Eye Study may be due to sample variability, or this could reflect real differences between the two populations. Our lower incidence of soft drusen could have resulted from our non-inclusion of intermediate soft drusen in the soft distinct and indistinct drusen categories.     

Cataract surgery and the 5-year incidence of late-stage age-related maculopathy: pooled findings from the Beaver Dam and Blue Mountains eye studies

PURPOSE: To assess whether cataract surgery in older persons increases risk for the development of late-stage age-related maculopathy (ARM). DESIGN: Combined analysis of longitudinal data from two population-based cohorts, the Beaver Dam Eye Study and Blue Mountains Eye Study. PARTICIPANTS: The Beaver Dam Eye Study examined 4926 persons aged 43 years or older at baseline and re-examined 3684 after 5 years. The Blue Mountains Eye Study examined 3654 persons aged 49 years or older at baseline and re-examined 2335 after 5 years. METHODS: The two studies used similar protocols for retinal photography and photographic grading. We defined incident late-stage ARM as the development of neovascular ARM or geographic atrophy in eyes without either lesion type at baseline that was confirmed by consensus between the study investigators. Nonphakic eyes included eyes that were aphakic or pseudophakic at baseline. Eye-specific data were analyzed. Age- and study site-adjusted relative risks were calculated using the Cochran-Mantel-Haenszel method. Multivariate-adjusted odds ratios (ORs) were also estimated using generalized estimating equation models. RESULTS: Of the 6019 participants examined after 5 years, 11,391 eyes were considered at risk for developing late-stage ARM, including 315 nonphakic and 11,076 phakic eyes. Late-state ARM (either neovascular ARM or geographic atrophy) developed in 6.0% to 7.5% of nonphakic eyes (10 of 168 right and 11 of 147 left eyes), compared with 0.7% of phakic eyes (40 of 5504 right and 37 of 5572 left eyes) during the 5-year period. Age- and study site-adjusted 5-year relative risks were 2.8 (95% confidence interval [CI], 1.6-5.1) for right and 3.7 (95% CI, 2.1-6.4) for left eyes. After further adjustment for gender, smoking, and the presence of indistinct or reticular drusen or pigmentary abnormalities at baseline, nonphakic eyes had a substantially higher risk for developing either late-stage ARM lesion compared with phakic eyes, OR = 5.7 (95% CI, 2.4-13.6). CONCLUSIONS: Pooled findings from these two large population-based cohorts support the hypothesis that cataract surgery in older persons may be associated with an increased subsequent risk for developing late-stage ARM, particularly neovascular ARM.     

Five-year incidence of age-related maculopathy in relation to iris,skin or hair colour,and skin sun sensitivity: the Blue Mountains Eye Study

This study aimed to assess longitudinal associations between iris,hair and skin colour, plus skin sensitivity to sun and the 5-year incidence of age-related maculopathy (ARM). Of 3654 baseline Blue Mountains Eye Study participants (aged 49+ years), 2335 survivors (75.1%) were re-examined after 5 years. Retinal photographs were graded using the Wisconsin ARM Grading System and incident ARM lesions confirmed using side-by-side grading.Iris/skin/hair colour was assessed and skin sensitivity questions were asked at baseline. After adjusting for age, sex and smoking, no significant associations were found between iris or hair colour and incident late or early ARM. Compared to persons with fair skin, those with very fair skin had an increased risk of developing geographical atrophy (odds ratio [OR] 3.5,95% confidence interval [CI] 1.2-10.4).However, persons with sun-related skin damage were less likely than those without to develop indistinct soft drusen (OR 0.6, 95% CI 0.4-0.9). Longitudinal data provide no support for the previously reported cross-sectional association between iris colour and ARM.     

Dietary antioxidants and age-related maculopathy: the Blue Mountains Eye Study

OBJECTIVE: To assess associations between the stages of age-related maculopathy (ARM) and dietary intake of carotene, vitamin C, retinol, and zinc. DESIGN: Cross-sectional, population-based study. PARTICIPANTS: A total of 3654 subjects 49 years of age and older from a defined area, west of Sydney, Australia, participated. A total of 2900 participants (79.4%) completed accurate food records. INTERVENTION: Masked grading of stereoscopic macular photographs, detailed interviewer-administered questionnaire, and 145-item self-administered food frequency questionnaire. MAIN OUTCOME MEASURES: Late ARM and early ARM were diagnosed from photographic grading. RESULTS: The authors found no statistically significant associations between ARM and dietary intake of either carotene, zinc, or vitamins A or C, either from diet or supplements or from the combined intake from diet and supplements. Multivariate-adjusted odds ratios (95% confidence interval) were calculated comparing highest to lowest dietary intake quintiles. For late ARM, the odds ratios were carotene, 0.7 (range, 0.3-2.0); vitamin A, 1.2 (range, 0.5-3.3); vitamin C, 1.3 (range, 0.5-3.4); and zinc, 1.0 (range, 0.4-2.8). For early ARM, the odds ratios were carotene, 0.7 (range, 0.4-1.1); vitamin A, 1.2 (range, 0.7-2.0); vitamin C, 0.9 (range, 0.5-1.4); and zinc, 0.8 (range, 0.5-1.3). No significant trends were apparent. Adjustment for energy intake also showed no associations between these antioxidants and ARM. Further, no associations were found between increasing intake of foods high in antioxidant vitamins and decreasing prevalence of either late or early ARM. CONCLUSIONS: The authors found no associations between ARM and dietary antioxidants, either from diet alone or including supplements, or from selected foods, in the Blue Mountains Eye Study population.     

Refractive status and the 5-year incidence of age-related maculopathy: the Blue Mountains Eye Study

This study aimed to assess the longitudinal association between refraction and 5-year incident age-related maculopathy (ARM) in the Blue Mountains Eye Study population. The dataset included 3654 participants aged 49+ (82.4% of eligible) examined at baseline (1992-1994), and 2335 (75.1% of survivors) examined after 5 years. Retinal photograph grading followed the International ARM Classification. Incident ARM was assessed using a side-by-side comparison. Refraction was performed using autorefraction with subjective refinement. Spherical equivalent was calculated from spherical plus half the cylindrical power. After adjusting for age, sex and smoking, no association was found between baseline spherical equivalent and 5-year incident late or early ARM. Hyperopic right eyes had slightly higher incident rates for late (0.8%) and early (6.3%) ARM, compared with myopic (0.4% and 4.1%, respectively) or emmetropic (0.5% and 5.0%, respectively) right eyes. After multivariable adjustment, this study found no significant association between hyperopia and the 5-year incidence of late or early ARM. Left eyes or the combined data from both eyes had similar findings.     

Systemic use of anti-inflammatory medications and age-related maculopathy: the Blue Mountains Eye Study

Purpose To assess whether an association exists between systemic use of anti-inflammatory medications at baseline and the prevalence or incidence of either late or early age-related maculopathy (ARM) in a population-based cohort. Methods 3654 participants of the Blue Mountains Eye Study baseline examination (1992–94) were followed during 1997–99. Use of anti-inflammatory medication was recorded during the baseline interview. After excluding 543 persons who died since baseline, 2334 (75% of the surviving participants) attended 5-year follow-up examinations. Retinal photographs taken during both examinations were graded using the Wisconsin Age-Related Maculopathy Grading System. Prevalence refers to the proportion of participants having ARM at baseline. Incidence refers to the proportion of participants without ARM at baseline who developed it over the 5-year period. Known ARM risk factors were adjusted for when assessing the relationship between use of anti-inflammatory medications and ARM. Results At baseline, 1010 (27.6%) of 3654 participants were current users of non-steroidal anti-inflammatory drugs (NSAIDs), 514 (14.1%) were past users and 1282 (35.1%) were ever users. The corresponding numbers of subjects reporting current, past or ever use of corticosteroids (including inhaled steroids) were 225 (6.2%), 519 (14.2) and 564 (15.4), respectively. Late ARM was present in 72 participants (2.0%) and early ARM was present in 171 participants (4.9%) at the baseline examination. During the follow-up period, 25 participants (1.1%) developed incident late ARM and 192 (8.7%) developed incident early ARM. After adjusting for age, sex, family history of ARM and smoking, no significant associations were evident for the use of NSAIDs or corticosteroids and the prevalence of either late or early ARM. There were also no associations found between use of these medications at baseline and the 5-year incidence of either late or early ARM. Conclusions No association was found between use of systemic anti-inflammatory medications and either the cross-sectional prevalence or longitudinal incidence of ARM in this population.     

Intake of zinc and antioxidant micronutrients and early age-related maculopathy lesions

BACKGROUND: Macular degeneration, the end stage of age-related maculopathy (ARM), is the leading cause of legal blindness worldwide, and few modifiable risk factors are known. The high concentration of carotenoids in the macula, plus evidence linking oxidative stress to ARM and carotenoids to antioxidation, generated the hypothesis that higher antioxidant intakes can prevent ARM. Results of observational and intervention studies have been inconsistent. OBJECTIVE: To evaluate associations between intakes of zinc and antioxidant micronutrients and early ARM. METHODS: Between 1993 and 1995, ARM was assessed in 398 Boston-area women aged 53-74 y using the Wisconsin Age-related Maculopathy System of grading retinal fundus photographs. The women were a subset of the Nurses' Health Study cohort. Micronutrient intake was assessed by semi-quantitative food frequency questionnaires administered four times between 1980 and the baseline eye examinations. RESULTS: After multivariate adjustment for potential confounders, 1980 energy-adjusted intakes of alpha-carotene, beta-carotene, lycopene, total retinol, total vitamin A, and total vitamin E were significantly inversely related to the prevalence of pigmentary abnormalities (PA). Furthermore, increasing frequency of consuming foods high in alpha-or beta-carotene was associated with lower odds of PA; compared to women consuming these foods < 5 times/wk, odds ratios (95% CI) were 0.7 (0.3-1.6) for 5-6 times/wk, 0.6 (0.2-1.3) for 7-9.5 times/wk, and 0.3 (0.1-0.7)for > or =10 times/wk. Lutein/zeaxanthin intakes and more recent intakes of most carotenoids were unrelated to PA, and intakes of zinc and antioxidant micronutrients were unrelated to having large or intermediate drusen alone.     

Dietary macronutrient intake and five-year incident cataract: the blue mountains eye study

PURPOSE: To investigate the relationships between dietary macronutrient intake at baseline and the five-year incidence of the three main types of cataract in older people. DESIGN: Population-based cohort study. METHODS: Settings: An urban community near Sydney, Australia. STUDY POPULATION: The Blue Mountains Eye Study (BMES) examined 3,654 predominantly Caucasian participants aged 49+ years during 1992 to 1994, and then 2,335 survivors (71.5%) after five years. Of these 2,335 subjects, 1988 (85%) completed a Willett-derived food frequency questionnaire (FFQ) at baseline. OBSERVATION PROCEDURES: A 145-item FFQ was used to assess nutrient intakes and lens photography was used to assess the presence of cataract at both time points. MAIN OUTCOME MEASURES: Incidence of cortical, nuclear, and posterior subcapsular (PSC) cataract was assessed via lens photographic grading following the Wisconsin cataract grading method. RESULTS: After adjusting for multiple known cataract risk factors, higher dietary intakes of omega-3 polyunsaturated fatty acids (n-3 PUFA) were associated with a reduced incidence of nuclear cataract. The odds ratio (OR) for subjects in the highest quintile of intake compared to those in the lowest quintile was 0.58 (95% confidence interval [CI] 0.35 to 0.97), P(trend) = .027. Similarly, for PSC cataract, higher dietary intakes of protein were protective (OR 0.28; 95% CI 0.10 to 0.76), P(trend) = .015. Dietary macronutrient intake was not associated with incident cortical cataract. CONCLUSIONS: Higher dietary intakes of n-3 PUFA may decrease the five-year risk of nuclear cataract, whereas higher dietary intakes of protein may decrease risk for PSC cataract.     

Five-year change in visual acuity following cataract surgery in an older community: the Blue Mountains Eye Study

AIMS: To assess the change in visual acuity following cataract surgery in the Blue Mountains Eye Study (BMES) population. Change in visual acuity was assessed by age, sex, baseline cataract type, and baseline visual acuity. METHODS: A 5-year prospective follow-up of the population-based BMES cohort, who were initially examined in 1992. After 5 years, 2335 survivors of 3654 (75.1%) baseline BMES participants were re-examined. Slit-lamp and retro-illumination lens photographs were graded for the presence of incident cataract and evidence of cataract surgery. Visual acuity was measured using a logMAR chart, read at 2.4 m. The main outcome measure was change in the number of logMAR letters correctly identified by eyes that underwent cataract surgery during the 5-year follow-up period. RESULTS: In a multiple linear regression model, age (P<0.0001) and early age-related maculopathy (ARM) at baseline (P<0.0001) were found to affect adversely the postoperative visual acuity following the cataract surgery. As expected, eyes with any baseline cataract showed the greatest improvement in visual acuity after cataract surgery (right eyes: mean +/- s.e. change of 3.75 +/- 1.34 letters; left eyes: mean change +/- s.e. of 6.7 +/- 0.99 letters). There was also a statistically significant improvement in vision after cataract surgery in eyes with no significant lens opacity graded as present at baseline (right eyes: mean +/- s.e. change of 3.78 +/- 1.85 letters; left eyes: mean change +/- s.e. of 2.68 +/- 1.33 letters). CONCLUSIONS: Age and baseline cataract or ARM status, and baseline visual acuity were determinants of the postoperative visual outcome in older persons who underwent cataract surgery in this community.     

The relation of retinal microvascular characteristics to age-related eye disease: the Beaver Dam eye study

PURPOSE: To examine the relationship between microvascular characteristics (central retinal artery equivalent [CRAE], central retinal vein equivalent [CRVE], arteriole-to-venule ratio [AVR], focal retinal arteriolar narrowing, arteriovenous [A/V] nicking, and retinopathy) associated with systemic hypertension and ocular disease (age-related maculopathy [ARM], three types of cataract, and open-angle glaucoma). DESIGN: Population-based cohort study. METHODS: Standardized grading of microvascular characteristics was performed at baseline on fundus photographs taken on 4,926 persons aged 43 to 86 years who participated in the Beaver Dam Eye study at the baseline examination. Age-related maculopathy, cataract, and glaucoma status were determined at baseline; ARM and cataract were again determined at 5-year and 10-year follow-up examinations using standard protocols. RESULTS: While controlling for age and sex, generalized retinal arteriolar narrowing (lowest quintile of CRAE) was associated with the 10-year cumulative incidence of retinal pigment epithelial (RPE) depigmentation (risk ratio [RR] 1st vs 5th quintile, 1.93; 95% confidence interval [CI], 1.11, 3.34) and, inversely, with incident nuclear cataract (RR, 0.71; 95% CI, 0.50, 0.99). Arteriovenous nicking was associated with the incidence of early ARM (RR, 2.39; 95% CI, 1.02, 5.57). Otherwise, there were no statistically significant associations of focal arteriolar narrowing or retinopathy with incident ARM or any type of age-related cataract and no relation of CRAE, focal arteriolar narrowing, A/V nicking, or retinopathy with the prevalence of glaucoma. CONCLUSION: These data show that retinal vascular characteristics associated with hypertension are related to the incidence of ARM and nuclear cataract but not to prevalent glaucoma. Relationships, however, were weak and inconsistent.     

Use of vitamin and zinc supplements and age-related maculopathy: The Blue Mountains Eye Study

purpose To investigate relationships between vitamin and zinc supplement use and age-related maculopathy in a population-based sample. methods We studied 2873 (79%) of the 3654 participants aged 49– 97 years who attended the cross-sectional Blue Mountains Eye Study and completed a detailed food frequency questionnaire, including type, dose and duration of supplement use. ARM was assessed during a masked grading of macular photographs. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using logistic regression. results After adjusting for multiple confounders, we found that no vitamin or zinc supplements were significantly associated with reduced prevalence of any ARM lesions in either eye. The OR for use of any vitamin supplement was 1.3 (CI 0.9–1.7, p = 0.11) for individuals with any retinal pigment changes. It was 1.1 (CI 0.8–1.5, p = 0.59) for those with any soft (large) drusen and 1.5 (CI 0.7–3.0, p = 0.31) for those with late ARM lesions. The lack of association between supplement intake and ARM persisted regardless of their duration of use, dose or the smoking status of participants. The Breslow-Day test for heterogeneity was 0.24 with an OR for early ARM lesions among smokers of 0.7 (CI 0.4–1.3, p = 0.27), and 1.2 (CI 0.9–1.5, p = 0.24) among non-smokers. conclusions This cross-sectional population-based study investigated associations between vitamin and zinc supplement use and the prevalence of ARM lesions. Our findings provide no support for a protective association between vitamin and zinc supplement use and lesions indicating early ARM. The small numbers of subjects with late ARM lesions precluded any detailed investigation of benefits from supplement use on the prevalence of these lesions.     

Intake of Zinc and Antioxidant Micronutrients and Early Age-Related Maculopathy Lesions

Background: Macular degeneration, the end stage of age-related maculopathy (ARM), is the leading cause of legal blindness worldwide, and few modifiable risk factors are known. The high concentration of carotenoids in the macula, plus evidence linking oxidative stress to ARM and carotenoids to antioxidation, generated the hypothesis that higher antioxidant intakes can prevent ARM. Results of observational and intervention studies have been inconsistent. Objective: To evaluate associations between intakes of zinc and antioxidant micronutrients and early ARM. Methods: Between 1993 and 1995, ARM was assessed in 398 Boston-area women aged 53–74 y using the Wisconsin Age-related Maculopathy System of grading retinal fundus photographs. The women were a subset of the Nurses' Health Study cohort. Micronutrient intake was assessed by semi-quantitative food frequency questionnaires administered four times between 1980 and the baseline eye examinations. Results: After multivariate adjustment for potential confounders, 1980 energy-adjusted intakes of alpha-carotene, beta-carotene, lycopene, total retinol, total vitamin A, and total vitamin E were significantly inversely related to the prevalence of pigmentary abnormalities (PA). Furthermore, increasing frequency of consuming foods high in alpha-or beta-carotene was associated with lower odds of PA; compared to women consuming these foods < 5 times/wk, odds ratios (95% CI) were 0.7 (0.3–1.6) for 5–6 times/wk, 0.6 (0.2–1.3) for 7–9.5 times/wk, and 0.3 (0.1–0.7)for ≥10 times/wk. Lutein/zeaxanthin intakes and more recent intakes of most carotenoids were unrelated to PA, and intakes of zinc and antioxidant micronutrients were unrelated to having large or intermediate drusen alone.     

Five-year incidence of age-related maculopathy: the Visual Impairment Project

PURPOSE: To describe the 5-year incidence of age-related maculopathy (ARM) and the progression of the early stages of ARM lesions in Melbourne, Australia. DESIGN: Population-based cohort study. PARTICIPANTS: A total of 3271 participants aged 40 years and older from Melbourne, Victoria, Australia. MAIN OUTCOME MEASURES: The 5-year incidence and progression of ARM lesions. METHODS: Participants were recruited through a cluster random sampling from 9 urban clusters. Baseline examinations were conducted from 1992 through 1994, and the follow-up data were collected from 1997 through 1999. Presence of ARM lesions was graded from color stereo fundus photographs according to the International Classification and Grading System. RESULTS: The overall cumulative 5-year incidence of age-related macular degeneration (AMD) was 0.49% (95% confidence interval [CI], 0.2-0.8) and that of early ARM was 17.3% (95% CI, 8.7-26.0). The incidence of all ARM lesions increased with age (all P<0.001). The 5-year incidence of AMD was 0%, 0.69%, 1.7%, and 6.3% and that of early ARM was 13%, 22.7%, 29.8%, and 20% for participants aged 60 years and younger, aged 60 to 69 years, aged 70 to 79 years, and aged 80 years and older at baseline, respectively. People with soft indistinct drusen with pigmentary abnormalities had a 9.5 times (95% CI, 1.9-45.6) higher risk of developing AMD compared with people with soft drusen or pigmentary abnormalities. After adjusting for age, people with unilateral early ARM at baseline were 3 times (95% CI, 0.98-8.0) as likely to have early ARM in their second eye when compared with people with no ARM in both eyes. CONCLUSIONS: These data suggest that 1 in 3 persons aged 70 years or older will have ARM lesions over a 5-year period and that the disease will progress to a more severe form after the age of 80 years. The presence of soft indistinct drusen with pigmentary abnormalities significantly increased the risk for development of AMD.     

Five-year change in visual acuity and incidence of visual impairment: the Blue Mountains Eye Study

PURPOSE: To describe the 5-year change in visual acuity and the incidence of visual impairment in a population-based cohort. DESIGN: Population-based epidemiologic study. PARTICIPANTS: Of the 3654 participants of the Blue Mountains Eye Study (BMES I) baseline examination (aged 49 years+ during 1992-1994), 2335 were reexamined during the 5-year follow-up examinations from 1997 to 1999 (BMES II), and 543 persons had died since BMES I. METHODS: Visual acuity was measured using a logarithm of the minimum angle of resolution chart in both eyes separately before and after standardized refraction. Pupils were dilated and a detailed examination was performed. MAIN OUTCOME MEASURES: Visual impairment, after best refractive correction, was defined as any (visual acuity 20/40 in both eyes at baseline. Incident binocular severe visual impairment was defined as visual acuity 20/200 in both eyes at baseline. The incidence for three other levels of visual impairment is also given: <20/40, <20/70, and <20/200. Monocular visual impairment was defined as impairment in one eye only at follow-up, where both eyes were unimpaired at baseline. Incident doubling and halving of the visual angle were calculated. RESULTS: Incidence rates for visual impairment increased significantly with age. Any incident impairment 相似文献   

Pterygium/pinguecula and the five-year incidence of age-related maculopathy

PURPOSE: To assess the relationship between baseline pterygium and pinguecula and the five-year incidence of age-related maculopathy (ARM). DESIGN: Population-based longitudinal study. METHODS: The Blue Mountains Eye Study examined 3654 residents aged 49+ years during 1992 to 1994 and then re-examined 2335 (75.1% of survivors) after five years. Retinal photographs were graded using the Wisconsin Age-Related Maculopathy Grading System. Slit-lamp examination recorded pterygium and pinguecula. Eye-specific data were analyzed using generalized estimating equation models. RESULTS: After adjusting for age, gender, and smoking, eyes with pterygium or previous pterygium surgery had a higher risk of incident late ARM, odds ratio (OR) 3.3, 95% confidence interval (CI) 1.1 to 10.3, early ARM (OR 1.8, CI 1.1 to 2.9) and soft drusen (OR 2.0, CI 1.9 to 3.4), than eyes without pterygium. We found no association between pinguecula and incident ARM. CONCLUSIONS: This study found that pterygium was associated with a two- to threefold increased risk of incident late and early ARM.     

Five-year incidence and progression of vascular retinopathy in persons without diabetes: the Blue Mountains Eye Study

PURPOSE: To assess the 5-year incidence of vascular retinopathy and its associations in an older nondiabetic population. METHODS: The Blue Mountains Eye Study examined 3654 residents aged 49+ years (82.4% response rate) during 1992-1994, and re-examined 2335 (75.1% of survivors) during 1997-1999. Retinopathy lesions (microaneurysms, haemorrhages, hard or soft exudates) were assessed from 6-field retinal photographs in persons without diabetes. Incident retinopathy was assessed in those at risk. Hypertensive status was defined following the WHO/International Society of Hypertension guidelines. RESULTS: Of the 2335 re-examined, 195 had retinopathy lesions at baseline and 1725 were at risk of retinopathy after excluding subjects with diabetes (n=261), retinal vein occlusion (n=52) or missing/un-gradable photographs (n=102). The cumulative 5-year incidence was 9.7% (95% confidence intervals (CI) 8.3-11.1%). Age was the only factor significantly associated with incident retinopathy (Pfor trend=0.012). Neither fasting blood glucose (age-sex-adjusted P=0.147) nor hypertension (adjusted Pfor trend=0.43) was associated with incident retinopathy. Of the 195 with retinopathy lesions at baseline, 3.5% developed diabetes, 13.3% progressed, and 72.3% regressed/disappeared over 5 years. Progression was positively associated with elevated blood pressure (BP) (adjusted odds ratio (OR) 1.3, 95% CI 1.1-1.6 per 10 mmHg systolic BP) and inversely associated with fasting glucose level (OR 0.36, CI 0.14-0.92 per mmol/l increase). Aspirin use was weakly associated with regression (OR 2.4, CI 1.0-6.0). CONCLUSIONS: Over 5 years, retinopathy developed in 10% of older people without diabetes, while 72% of baseline lesions regressed. Age was significantly associated with the development of these lesions.     

The relationship between iris color,hair color,and skin sun sensitivity and the 10-year incidence of age-related maculopathy: the Beaver Dam Eye Study

PURPOSE: To examine the association between iris color, hair color, and skin sun sensitivity and the 10-year incidence of age-related maculopathy (ARM). DESIGN: Population-based cohort study. PARTICIPANTS: A population of 4926 adults (range, 43-86 years of age at baseline) living in Beaver Dam, Wisconsin, was studied at baseline (1988-1990); of these, 3684 and 2764 subjects, respectively, participated in 5-year and 10-year follow-up examinations. METHODS: Data on hair color at age 15 years and skin responsiveness to sun exposure were obtained from a standardized questionnaire administered at the baseline examination. Iris color was determined with penlight illumination during the baseline examination by using photographic standards. Age-related maculopathy status was determined by grading stereoscopic color fundus photos with the Wisconsin Age-Related Maculopathy Grading System. MAIN OUTCOME MEASURES: Incidence and progression of ARM. RESULTS: When controlling for age and gender, people with brown eyes were significantly more likely to develop soft indistinct drusen (risk ratio [RR], 1.53; 95% confidence interval [CI], 1.19-1.97; P < 0.01) than were people with blue eyes. However, people with brown eyes were significantly less likely to develop retinal pigment epithelial depigmentation (RR, 0.58; 95% CI, 0.41-0.82; P < 0.01) than were people with blue eyes. When compared with persons with blond hair, persons with brown hair were at decreased risk of developing pigmentary abnormalities (RR, 0.73; 95% CI, 0.53-1.00; P = 0.05). Iris color, hair color, and skin sun sensitivity were not associated with the development of late ARM. CONCLUSION: Iris color and hair color were found to be associated with the 10-year incidence of pigmentary abnormalities. Iris color seems to be inconsistently related to the 10-year incidence of early ARM lesions and the progression of ARM.     

Refractive errors and 10-year incidence of age-related maculopathy

PURPOSE: To describe the relationship of refractive errors to the 10-year incidence of age-related maculopathy (ARM) in a defined white population. METHODS: Persons aged 43 to 86 years of age in Beaver Dam, Wisconsin, were invited for a baseline examination from 1988 through 1990, and follow-up examinations 5 and 10 years later (n = 3684). Refraction was measured at baseline, with myopia defined as a spherical equivalent of -1.00 D or less, emmetropia as -0.75 to +0.75 D and hyperopia as +1.00 D or more. At each examination, signs of ARM were ascertained from grading stereoscopic color fundus photographs based on a standard protocol. The association between baseline refractive status and the 10-year incidence and progression of ARM was analyzed. RESULTS: The 10-year cumulative incidence for early ARM was 7.1%, 7.7%, and 11.7%, in eyes with myopia, emmetropia, and hyperopia, respectively. The corresponding 10-year cumulative incidence for late ARM was 0.3%, 0.8%, and 2.2%. When age was controlled for, there was no association between myopia and incident early (relative risk [RR] 1.0, 95% confidence interval [CI], 0.7-1.3) and late (RR 0.5, 95% CI, 0.2-1.5) ARM. Similarly, after controlling for age, hyperopia was not associated with incident early (RR 0.9, 95% CI, 0.7-1.1) or late (RR 1.2, 95% CI, 0.6-2.3) ARM. CONCLUSIONS: These prospective population-based data provide no evidence of an association between refractive errors and risk of ARM.     

The 5-year incidence and risk factors for age-related maculopathy in a general Japanese population: the Hisayama study

PURPOSE: To estimate the 5-year incidence and risk factors for age-related maculopathy (ARM) in a representative older Japanese population. METHODS: A population-based cohort study was conducted in 1998 on 1482 Hisayama residents aged 50 years or older, and 961 of these subjects attended the 5-year follow-up examinations in 2003. At both time points, the characteristics of ARM were determined by grading color fundus photographs according to the Wisconsin Age-Related Maculopathy Grading System. Using these cohort data, logistic regression analyses were performed to determine the risk factors for ARM. Nine possible risk factors were examined: age, sex, hypertension, diabetes, hyperlipidemia, smoking, alcohol intake, body mass index, and white blood cell count. RESULTS: The 5-year incidence of early ARM was 8.5%, and that of late ARM was 0.8%. Men were found to have a significantly higher incidence of late ARM than did women. The incidence of both early and late ARM increased significantly with age. Multiple logistic regression analysis showed that age and smoking were significantly associated with early and late ARM. CONCLUSIONS: The results suggest that the overall 5-year incidence of early ARM is 8.0% and that of late ARM is 0.8% in the general Japanese population and that higher age and smoking are relevant risk factors for early and late ARM in the Japanese.     

Five-year cumulative incidence and progression of epiretinal membranes: the Blue Mountains Eye Study

PURPOSE: To describe the 5-year cumulative incidence and change in epiretinal membranes in a defined older Australian population. DESIGN: Population-based cohort study. PARTICIPANTS: Three thousand six hundred fifty-four persons 49 years of age or older, living in the Blue Mountains area, west of Sydney, Australia, participated in the baseline survey during 1992 to 1994. The cohort was reexamined after 5 years in 1997 to 1999. Excluding persons (543) who died since the baseline, 75% of survivors (n = 2335) attended the follow-up examination. METHODS: All participants underwent a detailed eye examination, including stereo retinal photography. Epiretinal membranes were diagnosed from grading of baseline and 5-year retinal photographs. MAIN OUTCOME MEASURES: Epiretinal membranes were classified as either preretinal macular fibrosis (PMF), with retinal folds, or as a less severe form, termed cellophane macular reflex (CMR), without retinal folds. The incidence of epiretinal membranes was determined if either lesion was found in eyes with no preexisting epiretinal membrane at baseline. Progression was defined if the area of involvement increased by more than 25%, regression if it decreased by more than 25%, and stable if it changed by less than 25%. RESULTS: Epiretinal membranes developed in the first eye of 108 of 2030 participants who had no sign of this condition in either eye at baseline, 5.3%, 95% confidence interval (CI) 4.4 to 6.4. Five-year cumulative incidence rates for PMF and CMR were 1.5% and 3.8%, respectively. Of those participants with epiretinal membranes in one eye at baseline, 18 of 133 (13.5%) developed this sign in their second eye after 5 years. New epiretinal membranes (mostly CMR) occurred in 15 of 165 subjects (9.1%; CI, 5.2-14.6) who had undergone cataract surgery since the Blue Mountains Eye Study I. This rate was significantly higher than in the nonsurgical group, 92 of 1861 (4.9%; CI, 4.0-6.0) of whom developed epiretinal membranes. Progression from CMR to PMF was observed in 17 of 183 eyes (9.3%). Existing epiretinal membranes progressed, regressed, or remained stable in 28.6%, 25.7%, and 38.8% of eyes, respectively. CONCLUSIONS: This study has documented the 5-year cumulative incidence and the natural history of epiretinal membranes in an older population.