Suriya Foran

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.

Age-specific prevalence and causes of bilateral and unilateral visual impairment in older Australians: the Blue Mountains Eye Study.

Purpose: To report age‐specific prevalence and causes of bilateral and unilateral visual impairment in a representative older Australian population.

Unilateral visual impairment and health related quality of life: the Blue Mountains Eye Study

Background: There has been considerable recent interest in the impact of unilateral visual impairment on functional status and wellbeing, particularly in relation to second eye cataract surgery. Aim: To determine if unilateral visual impairment has a measurable impact on health related quality of life (HRQOL) in an older community, as assessed by the generic, multidimensional 36 item short form health survey (SF-36). Methods: All participants of the second cross sectional Blue Mountains Eye Study (n = 3508) were invited to attend comprehensive eye examinations and complete an SF-36 questionnaire. Unilateral visual impairment was defined as visual acuity (VA) <6/12 in the worse eye and ≥6/12 in the better eye. Mild visual impairment was defined as VA <6/12 but ≥6/24, moderate as VA <6/24 but ≥6/60, and severe (blindness) as VA <6/60 in the worse eye. Cases with amblyopia (n = 48) were excluded. Results: Complete data were available for 3108 participants; 227 (7.3%) had unilateral visual impairment (148 mild, 29 moderate, 50 severe). Moderate to severe non-correctable unilateral impairment was associated with poorer SF-36 profiles. After adjusting for age and sex, this group had significantly poorer scores than the unimpaired group in three of eight domains (p<0.05); limitations as a result of physical problems, social function, limitations because of emotional problems, and in the mental component score. Mental domains were more affected than physical domains. Unilateral impairment from undercorrected refraction did not measurably affect HRQOL. Conclusions: Moderate to severe non-correctable unilateral visual impairment caused by eye diseases such as cataract had a measurable impact on HRQOL.

Causes of visual impairment in two older population cross-sections: the Blue Mountains Eye Study.

AIMS To describe the causes of bilateral and unilateral blindness and visual impairment in two cross-sections of an older Australian population 6 years apart. METHODS The Blue Mountains Eye Study examined 3654 persons aged 49-97 years during 1992-1994 (population cross-section 1). Cohort survivors (2335) and 1174 persons who moved to the area or reached an eligible age were examined during 1997-2000, a total of 3509 persons (population cross-section 2). LogMAR visual acuity was measured after standardized refraction. Blindness and visual impairment were respectively defined by visual acuity <6/60 and <6/12. Causes were determined for the two temporal cross-sections. RESULTS Age-related macular degeneration (AMD) was the principal cause of bilateral and unilateral non-correctable blindness in both cross-sections. AMD caused 77% of bilateral blindness in Cross-section 1 and 50% in Cross-section 2. Cataract, glaucoma, corneal and neurological disease were next equally frequent causes (6% each) of bilateral blindness in Cross-section 1. In Cross-section 2, cataract ranked as the third most frequent principal cause (10%) after other retinal diseases (40%). The proportion of unilateral blindness with AMD as principal cause was very similar (around one-third of cases) in the two cross-sections; while in Cross-section 2 blindness was less frequently caused by cataract (19% vs. 13%). Cataract was the principal cause of both bilateral and unilateral visual impairment, responsible for 50% of bilateral (better eye) and 35-40% of unilateral (worse eye) impairment, with slightly lower rates found in Cross-section 2 than in Cross-section 1. AMD was consistently the second most frequent cause, causing one-third of bilateral and one-fifth of unilateral visual impairment. CONCLUSIONS These data indicate a relative stable pattern of causes for blindness and visual impairment, with AMD and cataract, respectively, dominating these two levels.

Five-year incidence and progression of diabetic retinopathy in a defined older population: the Blue Mountains Eye Study

AimsTo determine 5-year incidence and progression of diabetic retinopathy in an older Australian population-based cohort.MethodsDuring the period 1992–1994, the Blue Mountains Eye Study examined 3654 residents aged 49+years (82.4% of those eligible), living in two urban postcode areas, west of Sydney, Australia. Participants were subsequently invited to attend 5-year follow-up exams. After excluding 543 (14.8%) who died during the follow-up period, 2334 persons (75.0%) were re-examined during 1997–1999. The examination included a comprehensive questionnaire, blood pressure measurement, standardised refraction, Zeiss stereo retinal photographs, and estimation of fasting blood glucose. Diabetic retinopathy was graded from the retinal photographs, using the modified Early Treatment Diabetic Retinopathy Scale classification (15-step scale).ResultsOf participants with diabetes diagnosed at baseline, 150 were re-examined, including 139 with gradable fundus photographs. The cumulative 5-year incidence of diabetic retinopathy was 22.2% before 95% confidence interval (CI) 14.1–32.2%. Retinopathy progression (1+ steps) was documented in 25.9% (95% CI 18.8–34.0%) of participants with retinopathy and gradable photographs at both visits; in 58.3% of these cases, a 2+ -step progression was documented. Progression to proliferative retinopathy occurred in only 4.1% of those with retinopathy at baseline. The only baseline risk factors associated with retinopathy progression, after adjusting for age and gender, were increase in fasting blood glucose, odds ratio (OR) 1.2 (95% CI 1.1–1.4)/mmol/l, and increase in diabetes duration, OR 2.3 (95% CI 1.0–5.3)/10 years.ConclusionsThese data provide 5-year cumulative incidence of diabetic retinopathy in a defined older population. Increase in diabetes duration and elevated baseline fasting blood glucose level predicted retinopathy incidence.

Correctable visual impairment in an older population: the blue mountains eye study

PURPOSE To describe temporal changes in the characteristics of older persons with visual impairment in their better eye correctable by refraction. DESIGN Study of two cross sections of a community 6 years apart. METHODS The Blue Mountains Eye Study examined 3654 persons aged 49 to 97 during 1992 to 1994 (cross-section 1) and 3509 persons (2335 cohort survivors plus 1174 persons who moved to the area and age group) during 1997 to 2000 (cross-section 2). Logarithm of minimal angle of resolution visual acuity was measured before and after refraction. Correctable visual impairment was defined as visual impairment < 20/40 in the better eye before refraction that improved after refraction to no impairment (>/= 20/40). Factors associated with correctable visual impairment and persistent correctable impairment were determined. RESULTS Cross-sections 1 and 2 had similar age-gender distributions. In cross-section 1, 7.5% of participants had correctable visual impairment, 3.6% had noncorrectable visual impairment, and 88.9% had no impairment. Corresponding rates in cross-section 2 were 5.6%, 2.7%, and 91.7%. In both cross sections, similar proportions (around 68%) of those visually impaired had correctable visual impairment and similar sociodemographic measures predicted correctable visual impairment. Cross-section 1 participants who were married, owned their home, had high job prestige, gained qualifications after high school, or were current drivers were less likely to have correctable visual impairment after controlling for age and gender. Adjusted odds for correctable visual impairment increased in those living alone, using community support services, dependent on others, with myopia, wearing distance glasses, or with low perceived health and heart disease. Histories of stroke, cancer, and diabetes were similar between groups with correctable and no visual impairment. CONCLUSION Socioeconomic parameters, myopia, wearing distance glasses, reported health problems, and poor perceived health were associated with correctable visual impairment in this older population.

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; </=41 letters) and severe (visual acuity </=20/200; 0-5 letters) in keeping with the Beaver Dam Eye Study. Incident binocular visual impairment was defined as visual acuity </=20/40 in both eyes at follow-up, where visual acuity was >20/40 in both eyes at baseline. Incident binocular severe visual impairment was defined as visual acuity </=20/200 in both eyes at follow-up, where visual acuity was >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 </=20/40 occurred binocularly in 41 persons (1.9%) and monocularly in 150 persons (7.1%). Severe incident impairment </=20/200 occurred binocularly in 3 persons (0.1%) and monocularly in 44 persons (2.1%). Incident impairment <20/40 occurred binocularly in 37 persons (1.7%) and monocularly in 134 persons (6.3%). Impairment <20/70 occurred binocularly in 15 persons (0.7%) and monocularly in 84 persons (3.8%). Impairment <20/200 occurred binocularly in 3 persons (0.1%) and monocularly in 44 persons (1.9%). Women consistently had a higher incidence of visual impairment than men, although this was often not statistically significant after adjusting for age. Increasing age was a strong predictor of visual impairment. CONCLUSIONS This study has documented the 5-year incidence and causes of visual impairment in an older Australian population.

Five year incidence of cataract surgery: the Blue Mountains Eye Study

Aims: To assess the 5 year incidence of cataract surgery in an older population based prospective cohort. Methods: 5 Year prospective follow up of the population based Blue Mountains Eye Study (BMES) performed in 1992. The follow up study examined 2335 survivors (75.1%) of the 3654 baseline participants. Baseline and 5 year slit lamp and retroillumination lens photographs were graded for presence of cortical, nuclear, or posterior subcapsular cataract using the Wisconsin cataract grading method and cataract surgery was documented from the history and the clinical examination. Results: An overall cataract surgery rate of 5.7% in first or both eyes was documented. The incidence was 0.3% in people aged 49–54 years at baseline, 1.7% for ages 55–64 years, 7.9% for ages 65 to 74 years, and 17.4% in people aged 75 years or older. The rate of surgery in first or both eyes was 6.0% in women and 5.2% in men, age adjusted p = 0.66. Bilateral cataract surgery was performed during follow up on 2.7% of participants, while 43.1% of unilateral phakic cases had second eye surgery. Presence of any posterior subcapsular (PSC) cataract, either alone or in combination with other cataract types, was the most likely type of cataract at baseline to be associated with incident cataract surgery. Baseline age was the most important non-ocular variable predicting incident cataract surgery. Conclusions: This study has documented age specific rates for 5 year incident cataract surgery in an older community. The finding of relatively similar incidence rates and ocular predictors of cataract surgery to those reported by the Beaver Dam Eye Study, Wisconsin, United States, is of interest, given previous documented similarities between these two populations.

Projected number of Australians with visual impairment in 2000 and 2030

This study aimed to project population‐based prevalence data associated with visual impairment, in order to estimate the number of affected older Australians (aged 50 or older) in the years 2000 and 2030. We used data from the Blue Mountains Eye Study (BMES) and Melbourne Visual Impairment Project (MVIP), together with Australian Bureau of Statistics population projections. Similar definitions for moderate (6 / 24–6 / 60 visual acuity) and severe (< 6 / 60 visual acuity) visual impairment were used. Combining age‐standardized data, we estimated that in the year 2000, 38 820 (0.73%) and 25 590 (0.48%) Australians aged 50 years or older will have moderate and severe visual impairment, respectively. By 2030, these rates will have more than doubled, to an estimated 85 910 (0.92%) and 57 930 (0.62%) Australians with moderate and severe visual impairment, respectively. Women aged 50 years or older will have a 1.8‐fold and four‐fold risk, respectively, of moderate and severe visual impairment compared to men. Visual impairment will affect an increasing proportion of older Australians. Newer approaches to therapy, rehabilitation and community support for persons with visual impairment will be needed to meet this challenge.

Prevalence and associations with ectropion in an older population: the Blue Mountains Eye Study.

The aim of this study was to describe the prevalence of eyelid ectropion and its associations with sunlight‐related and other ocular variables, plus systemic factors, in an older Australian population. The Blue Mountains Eye Study examined 3654 persons aged 49–97 years. Examination recorded ectropion and other ocular signs. The questionnaire assessed sunlight‐related and systemic variables. Ectropion was present in either eye of 143 subjects (3.9%) and was bilateral in 101 (70.6%). A marked age‐related increase in prevalence was observed with ectropion found in 0.3% of persons aged < 60 years, 1.2% of ages 60–69 years, 6.7% of ages 70–79 years and 16.7% of those aged 80 years or older. Ectropion prevalence was higher in men (5.1%) than women (3.0%), age‐adjusted odds ratio 2.1 (95% confidence interval 1.5–3.0). Statistically significant associations were found between ectropion and history of skin cancer removal, increased skin sun sensitivity, lighter iris colour and presence of pingueculum, as well as current smoking, hypertension, diabetes and stroke.