Thuan Quoc Pham

Relation of age-related macular degeneration and cognitive impairment in an older population.

Background: The aetiology of age-related macular degeneration (AMD) and cognitive impairment is poorly understood. A link between cognitive impairment and AMD has been proposed although only a weak association was found in population-based studies. Purpose: To assess cross-sectional associations between AMD and cognitive impairment in an older Australian population. Methods: The Blue Mountains Eye Study examined 3,509 persons aged 49+ years during 1997–2000. AMD lesions were assessed from retinal photographs using the Wisconsin System. Mini-mental state examination (MMSE), demographics, lifestyle factors and medical history were collected at interview. MMSE score was categorised as high-normal (28–30), low-normal (24–27) and impaired (<24). A modified MMSE excluded five vision related items and was dichotomised as normal (18–22) and impaired (0–17). Logistic regression was used to assess associations after adjusting for age, sex, visual impairment, stroke, current smoking status, hypertension, alcohol consumption and post-high-school qualification. Results: Prevalence rates for late and early AMD were 1.5% (n = 50) and 8.3% (n = 273), respectively. Cognitive impairment was present in 18.0% in persons with late AMD and 8.4% with early AMD, compared to 2.6% in persons without AMD. After multivariate adjustment, late AMD was associated with low normal MMSE (odds ratio (OR): 2.2, 95% confidence interval (CI): 1.1–5.0) and cognitive impairment (OR: 3.7, CI: 1.3–10.6). Using the modified MMSE, the multivariate association between late AMD and cognitive impairment remained (OR: 2.2, CI: 1.0–5.0). No significant association was found between cognitive impairment and early AMD. Conclusions: We found a significant, cross-sectional association between late AMD and cognitive impairment in a sample of older Australians that appeared to be independent of visual impairment. The association was weaker but remained significant after excluding vision-related items from the MMSE.

Age-related maculopathy and cataract surgery outcomes: visual acuity and health-related quality of life

PurposeTo assess visual acuity (VA) and health-related quality of life (HRQoL) outcomes in patients with and without age-related maculopathy (ARM) after cataract surgery.MethodsPatients aged 60+ years who had undergone cataract surgery at the Westmead Hospital during 2001–2003 were re-examined 1–3 years after surgery. Tests included VA and assessment of visual- and HRQoL using standardised questionnaires (VF-14, SF-12). Preoperative comorbidity data were collected from medical records. Poor surgical outcomes (VA<6/12; no VA improvement; lowest quintile of VF-14, SF-12 scores) were compared in patients with and without ARM, adjusting for age, sex, preoperative systemic comorbidities, ocular comorbidities and surgical or postoperative complications.ResultsOf 622 surviving patients, 454 (73%) were followed up for a mean period of 2.8 years. Similar proportions with VA≥6/12 were observed in patients with (80.2%) and without (88.8%) pre-existing ARM. Preoperative early ARM was only associated with slightly lower mean VF-14 scores (87.64 with vs92.58 without ARM, P=0.01). Increasing age and preoperative ocular comorbidities were associated with all poor outcomes measured. Low SF-12 scores were associated with preoperative systemic comorbidities.ConclusionOur study documents favourable cataract surgical outcomes 1–3 years after cataract surgery in patients with preoperative ARM.

Australian Prospective Study of Cataract Surgery and Age-Related Macular Degeneration: Rationale and Methodology

Background: Cataract surgery is the most frequently performed ophthalmic procedure worldwide. While benefits gained from cataract surgery outweigh surgical risks, there have been concerns that older persons may have an increased risk of developing age-related macular degeneration (AMD) after cataract surgery. Objective: The Australian Prospective Study of Cataract Surgery and Age-Related Macular Degeneration Study aims to assess the risk of AMD in a large cohort of older patients following cataract surgery. The current report describes the study rationale, design and methodology. Design: Longitudinal studyParticipants: Approximately 2000 cataract surgical patients aged 65 years or older are being recruited from both public and private sources in western Sydney, Australia.Methods: At study visits, participants are interviewed using standardized questionnaires to obtain information on demographic, medical, and ocular conditions and AMD risk factors, together with data on general health and vision-related quality of life. Eye examinations include visual acuity, intraocular pressure, keratometry and A-scan measurements, plus lens and retinal photography, following pupil dilatation. Retinal photographs taken before cataract surgery, and at 1, 6, 12, and 24 months after surgery are graded for early and late AMD lesions, using the Wisconsin age-related maculopathy grading system. The 1-month post-operative retinal photographs supplement the baseline macular assessment for cases in which cataract occludes a clear view of the macula pre-operatively. It is intended that study participants will be followed for up to five years post-operatively to clarify the question of whether aphakic or pseudophakic, compared to phakic eyes, have a greater risk of developing AMD.

Sunlight-related factors and the 10-year incidence of age-related maculopathy.

Purpose: To examine the associations among iris, skin, or hair color, and skin sun sensitivity and the 10-year incidence of age-related maculopathy (ARM). Methods: The Blue Mountains Eye Study (BMES) recruited 3654 participants aged 49+ years at baseline (1992–1994, 82.4% participation rate). Re-examinations of 2335 participants (75.1% of survivors) were done after 5 years (1997–1999) and 1952 (76.5% of survivors) after 10 years (2002–2004). Retinal photographs were graded using the Wisconsin ARM Grading System and incident ARM confirmed using the side-by-side grading method. Iris, skin, and hair color, and sun-related skin damage were assessed and skin sun-sensitivity questions were asked at baseline. Ten-year ARM incidence was calculated using Kaplan Meier methods and discrete logistic models were used to assess associations after adjusting for age, sex, and smoking. Results: After adjustment, no significant associations were found between iris or hair color and either late- or early-incident ARM. Compared to persons with fair skin, those with very fair skin had an increased risk of developing geographic atrophy (multivariate adjusted risk ratio, RR = 7.6; 95% confidence interval, CI = 3.0–19.6). In contrast, compared to persons with average skin sun sensitivity, persons who reported that their skin would usually burn and tan with difficulty had a reduced risk of neovascular ARM (RR = 0.2, 95% CI = 0.0–0.7). Sun-related skin damage was not associated with late or early ARM. Conclusions: In this older cohort, we did not find a consistent pattern of association between sunlight-related factors and ARM incidence, except that persons with very fair skin might have an increased risk of geographic atrophy, consistent with our 5-year incidence data. The protective association between skin sensitivity to sun damage and neovascular ARM could have be the result of confounding by sun-avoidance behavior among persons sensitive to sunburn.

Systemic and ocular comorbidity of cataract surgical patients in a western Sydney public hospital

Background: This study aimed to assess the frequency of major systemic and ocular comorbidities among cataract surgical patients attending a large general public hospital.

Cataract surgery in patients with age‐related maculopathy: preoperative diagnosis and postoperative visual acuity

Purpose:  To report the reliability in detecting age‐related maculopathy (ARM) lesions before cataract surgery and postoperative visual acuity (VA) in cataract surgery patients with ARM.

Early age-related maculopathy in eyes after cataract surgery

PurposeTo assess age-related maculopathy (ARM) in eyes of patients who had undergone cataract surgery for at least a year.MethodsConsecutive patients aged 60+ years who had undergone cataract surgery at Westmead Hospital, Sydney, Australia, during 2001–2003 were examined in 2004. Interview using standardized questionnaires and stereo retinal photography was performed. Retinal photographs were graded using the Wisconsin ARM grading system. The proportions with ARM were compared between surgical and nonsurgical eyes, and between this surgical cohort and the Blue Mountains Eye Study (BMES) population.ResultsOf the 622 eligible patients, 454 (73%) were re-examined, with a mean follow-period of 2.8 years. Surgical eyes had a higher proportion of early ARM compared to nonsurgical eyes (15.2 vs10.3%, P=0.07) and to the early ARM prevalence found in BMES participants of similar age (14.5 vs6.9%, P<0.01), which persisted after age standardization to the BMES population (9.7 vs6.9%, P<0.05).ConclusionsWe found an increased prevalence of early ARM in surgical eyes of patients 1–3 years after cataract surgery. Whether this increased early ARM prevalence leads to an increased prevalence of late ARM in the long-term warrants further investigation.