Changes in intraocular pressure after pharmacological pupil dilatation in an elderly Chinese population in Taiwan: The Shihpai eye study.

BACKGROUND: Mydriatic drugs are often used in ophthalmic clinics for pupil dilatation to assess the optic nerve and retina. Clinical studies have indicated that an increase in intraocular pressure (IOP) after pupil dilation is noted in open-angle glaucoma patients, those with narrow angles and in normal subjects. Asians are more likely to have narrow angles. Moreover, age-related cataract may increase the crowdedness of the angle. This study aimed to assess the effects of mydriatic pupil dilatation on IOP in an elderly Chinese population. METHODS: The Shihpai Eye Study was a community-based, cross-sectional survey of vision and eye diseases among noninstitutionalized subjects aged 65 years and older in Shihpai, Taipei, Taiwan. IOP was taken using noncontact tonometry. The pupil was dilated with 1% tropicamide. IOP was measured again after maximal pupil dilatation 1 hour after mydriasis. RESULTS: Of the 2045 participants, 1361 (66.6%) participated in both the questionnaire and eye examinations. The mean IOP before pupil dilatation was 12.9 ± 3.1 mmHg and was 12.8 ± 3.4 mmHg (range: 5-36 mmHg) after pupil dilatation. IOP higher than 21 mmHg after pupil dilation was noted in 17 (1.34%) participants, of whom IOP exceeded 30 mmHg in two (0.16%). Overall, the changes in IOP before and after pupil dilatation were insignificant ( p = 0.04). In the final regression analyses, refractive status toward hyperopia ( p < 0.01) was the only significant factor associated with an increase in IOP of at least 4 mmHg after pupil dilatation. CONCLUSION: Our results revealed that the increase in IOP after pharmacological pupil dilatation was minimal, and the incidence of acute angle-closure attack was insignificant. Hyperopic status was the only factor related to an increase in IOP of > 4 mmHg. Caution should be exercised if one is hyperopic or has a history of glaucoma and rechecking IOP in these subjects is suggested after pharmacological mydriasis.

Association between dry eye and depressive symptoms in an elderly Chinese population in Taiwan: the Shihpai Eye Study.

BACKGROUND: Dry eye may impact quality of life and daily activities and depression is a widespread illness. Many studies showed the two diseases often coexist. However, studies were limited to retrospective chart review. This study aimed to investigate the association between dry eye and depressive symptoms in an older Asian population. METHODS: The Shihpai Eye Study was a community-based, cross-sectional survey of vision and eye diseases among noninstitutionalized subjects 65 years of age and older in Shihpai, Taipei, Taiwan. Residents fulfilling these criteria were randomly selected to be invited to participate in the study, which included a questionnaire and an eye examination conducted between July 1, 1999 and December 31, 2000. RESULTS: Of the 2045 subjects recruited, 1361 (66.6%) completed the examination. 8.8% (95% confidence interval (CI): 7.3-10.3%) of the participants were diagnosed to have depressive symptoms. Under multivariate analysis, depressive symptoms were significantly associated with frequent symptoms of dry eye (odds ratio (OR): 1.97, 95% CI: 1.36-2.92; p < 0.001). None of the dry eye signs was associated with depressive symptoms. For participants reporting frequent symptoms, tear-film break-up time ≤ 10 s (OR: 2.06, 95% CI: 1.38-3.05; p < 0.001), Schirmer test score ≤ 5 mm (OR: 2.01, 95% CI: 1.33-3.03; p < 0.001), and meibomian gland disease (OR: 1.99, 95% CI: 1.31-3.01; p = 0.001) were significantly related to depressive symptoms. Fluorescein staining of the cornea was not correlated to depressive symptoms in participants with dry eye symptoms. CONCLUSIONS: Depressive symptoms are more highly correlated with dry eye symptoms than dry eye signs.

Changes in refractive status in an elderly Chinese population in a 7-year follow-up: The Shihpai Eye Study.

BACKGROUND: Refractive error is the major cause of moderate and severe visual impairment. Visual impairment limits people's ability to perform daily tasks and affects their quality of life. Longitudinal data on the refractive status of the elderly was available only for whites and Africans. The purpose of this study was to report the 7-year incidence of myopia, hyperopia and refractive error change as well as their associated risk factors in a metropolitan elderly Chinese population. METHODS: The Shihpai Eye Study 2006 included 460/824 (55.8%) subjects (age range 72-94 years old) of 1361 participants in the 1999 baseline survey for a follow-up eye examination. Incidences were calculated for those who had emmetropia (-0.50D < spherical equivalent (SE) <+0.50D) at baseline. Refractive error change at 7 year was defined as (SE at the 7-year visit - SE at baseline). RESULTS: 90 (26.4%) subjects were emmetropic, 61 (17.9%) were myopic and 190 (55.7%) hyperopic. The mean refractive error was 0.49 ± 2.19 D and the average change in refractive error was -0.13 ± 1.03 D. The incidence of myopia at seven-year was 26.8 % [95% Confidence interval (C.I.): 22.8%-30.9%] and the incidence of hyperopia was 19.7% (95% C.I.: 16.1%-23.3%). Nuclear sclerosis (>Grade 2 vs. ≤Grade 2) [p < 0.0001; relative risk (RR): 8.94; 95% C.I.: 4.40-18.2], anterior chamber depth (mm) [p = 0.05; RR: 0.43; 95% C.I.: 0.18-1.01] and lens thickness (mm) [p < 0.01; RR: 2.35; 95% C.I.: 1.17-2.73] were significantly associated with myopic shift. On the other hand, hyperopic shift was significantly associated with cortical opacity (>Grade 2 vs. ≤Grade 2) (p = 0.02; RR: 1.21; 95% C.I.: 1.02-3.54). CONCLUSION: In this elderly Asian population, there was on average a slight myopic shift. The incidence of myopia was comparable to population-based studies of other ethnic groups, whereas the incidence of hyperopia was substantially higher.

The association of visual impairment and 3-year mortality among the elderly in Taiwan: the Shihpai Eye Study.

BACKGROUND: The association between visual impairment and mortality has been controversial. Moreover, literature on the relationship was very limited in the Asian population. The purpose of this study was to investigate whether visual impairment increases the 3-year risk of mortality in a cohort of urban Chinese elderly individuals. METHODS: Participants in the Shihpai Eye Study, who were aged ≥65 years, with a baseline examination conducted between July 1, 1999 and December 31, 2000, were recruited for the current study. The total number of possible participants identified was 4750. Of those, 3746 persons were eligible, and 2045 persons were randomly selected to be invited to participate in the study. Of those 2045 individuals, 1361 (66.6%) participated in both the questionnaire and eye examination. A follow-up of a fixed cohort was also conducted after 3 years. The death of any participants was confirmed through the household registration system. RESULTS: Of the 1361 participants included at baseline, 54 (3.97%) died before the 3-year follow-up. Multiple logistic regression analysis showed that mortality was significantly associated with a fall history [relative risk (RR): 2.12; 95% confidence intervals (CI): 1.08-3.98] and a history of diabetes (RR: 2.06; 95% CI: 1.03-3.95). Visual impairment was not a significant predictor of mortality after adjustment for confounders. CONCLUSION: After adjustments were made for age, sex, education, marital status, lifestyle factors, depression symptoms, fall history, and history of systemic diseases, visual impairment was not a significant predictor of 3-year mortality in elderly persons.

Seven-year incidence of age-related cataracts among an elderly Chinese population in Shihpai, Taiwan: The Shihpai Eye Study.

PURPOSE: To report the 7-year incidence of age-related cataracts in a metropolitan Chinese elderly population. METHODS: The Shihpai Eye Study 2006 included 460 (55.8%) of 1361 participants in the 1999 baseline survey for a follow-up eye examination. Cataract was graded by one ophthalmologist using the Lens Opacities Classification System III. RESULTS: The 7-year incidence of pure nuclear opacity was 18.5% (95% confidence interval [CI]: 12.7%-24.3%)]; 34.7% (95% CI: 27.6%-41.8%) for cortical opacity; and 0.6% (95% CI: 0%-1.8%) for posterior subcapsular opacity. On the other hand, 11.6% (95% CI: 6.8%-16.4%) participants developed both nuclear and cortical opacity, 3.5% (95% CI: 0.8%-6.2%) nuclear and posterior subcapsular opacity; and 1.7% (95% CI: 0%-3.6%) cortical and posterior subcapsular opacity. A total of 3.5% (95% CI: 0.8%-6.2%) of participants developed all three types of cataract. Nuclear cataract was significantly associated with current smoking (P = 0.04; relative risk [RR]: 2.05; 95% CI: 1.05-3.99). Males were almost half as likely (P = 0.04; RR: 0.57; 95% CI: 0.34-0.97) to develop cortical opacity, whereas participants with a history of diabetes were approximately twice as likely to develop cortical opacity (P = 0.05; RR 2.43; 95% CI: 1.02-5.81). A higher level of education (P = 0.03; RR: 0.40; 95% CI: 0.18-0.91) and a higher body mass index (P = 0.02; RR: 0.28; 95% CI: 0.10-0.79) was protective of posterior subcapsular cataract. CONCLUSIONS: This study indicated a high incidence of cortical opacities and lower incidence of nuclear opacities compared with Caucasians. Posterior subcapsular opacity incidence and cataract surgery rate were comparable.