Nine-year incidence of visual impairment in the Barbados Eye Studies.

OBJECTIVE: To describe the 9-year incidence of visual impairment and primary causes of blindness among black participants of the Barbados Eye Studies (BES). DESIGN: Population-based prospective cohort study. PARTICIPANTS: The BES followed a nationally representative cohort selected by simple random sampling, aged 40 to 84 years at baseline, with reexaminations after 4 years (Barbados Incidence Study of Eye Diseases [BISED]) and 9 years (BISED II). BISED II included 2793 (81%) of those eligible. METHODS: Cumulative 9-year incidence rates were estimated by the Product-Limit approach. The study was reviewed and approved by the institutional review boards of collaborating institutions. MAIN OUTCOME MEASURES: Best-corrected visual acuity (VA) was assessed by the Ferris-Bailey chart, following a modified Early Treatment of Diabetic Retinopathy Study protocol. Low vision and blindness were defined by World Health Organization (WHO) criteria as VA <6/18 to 6/120, and <6/120, respectively, in the better eye, and by U.S. criteria as VA < or =20/40 and < or =20/200, respectively. Vision loss was defined as a decrease of 15 letters or more read correctly in the better eye between baseline and follow-up examinations. RESULTS: The 9-year incidence was 1.0% and 2.1% for blindness and 6.0% and 9.0% for low vision, by WHO and U.S. criteria, respectively. Older age at baseline was associated with higher incidence of low vision and blindness, reaching 23.0% (95% confidence interval [CI], 18.8-28.0) and 4.3% (95% CI, 2.7-6.9) at age 70 years or more, based on WHO criteria. The primary causes of incident bilateral blindness (U.S. criteria) in 126 eyes were age-related cataract (48.3%), open-angle glaucoma (OAG) (14.3%), combined cataract and OAG (6.3%), diabetic retinopathy (8.7%), and optic atrophy (7.1%). Age-related macular degeneration (2.4%) rarely caused blindness. CONCLUSIONS: Incident visual impairment is exceedingly high in this population. Cataract, OAG, and diabetic retinopathy remain the major causes of blindness, underpinning the clinical and public health significance of these conditions in this and similar populations.

Secondary ocular hypertension after intravitreal injection of 4 mg of triamcinolone acetonide: incidence and risk factors.

PURPOSE: To analyze the incidence of secondary ocular hypertension (SOH) after intravitreal triamcinolone acetonide (IVTA) injection and its risk predictors. METHODS: Retrospective review of charts for 219 consecutive patients receiving a 4-mg IVTA injection. RESULTS: One hundred fifty eyes of 150 patients who were followed for at least 3 months and met inclusion criteria were considered. Main indications for IVTA injection were neovascular age-related macular degeneration (79 eyes [52.7%]), choroidal neovascularization due to other etiologies (22 eyes [14.7%]), diabetic macular edema (14 eyes [9.3%]), central retinal vein occlusion (12 eyes [8.0%]), and branch retinal vein occlusion (8 eyes [5.3%]). SOH defined as intraocular pressure (IOP) of >or=21 mmHg was recorded for 32.0% of injected eyes at some point during a mean follow-up of 7.7 months. There was no association between SOH and age, sex, arterial hypertension, diabetes mellitus, indication for IVTA injection, prior cataract surgery, or concurrent photodynamic therapy. Although previous pars plana vitrectomy did not influence risk, peak IOP was lower in vitrectomized eyes (P = 0.044). Prior diagnosis of glaucoma was a significant risk factor for SOH (relative risk = 2.17; P = 0.004). In nonglaucomatous eyes, baseline IOP of >or=16 mmHg was associated with a higher risk of SOH (relative risk = 2.31; P = 0.003). Baseline IOPs of <12 mmHg, 12-14 mmHg, 15-17 mmHg, 18-20 mmHg, and >20 mmHg were associated with incidences of SOH of 11.1%, 25.4%, 40.0%, 46.2%, and 50.0% (P = 0.01), respectively. CONCLUSIONS: A 4-mg IVTA injection was associated with SOH in 32.0% of treated eyes. The risk of SOH was higher in eyes with previous glaucoma and higher baseline IOP. Peak IOP after IVTA injection was lower in vitrectomized eyes. Risk factor analysis may permit better individualization of the risk-benefit ratio for IVTA injection.

Open-angle glaucoma and mortality: The Barbados Eye Studies.

OBJECTIVE: To evaluate the relationship between open-angle glaucoma (OAG) and mortality in a black population at 9-years' follow-up. DESIGN: Population-based cohort study of 4092 black participants (aged 40-84 years at baseline) in the Barbados Eye Studies. Open-angle glaucoma was defined by visual field defects and optic disc damage, based on standardized examinations and photograph gradings. Ocular hypertension was defined by an intraocular pressure greater than 21 mm Hg or treatment, without OAG damage. Mortality was ascertained from death certificates. Cox proportional hazards regression analyses determined associations with mortality. RESULTS: After 9 years, 764 (19%) participants were deceased. Mortality was unrelated to overall OAG at baseline (n = 300) after adjustment for confounders. However, cardiovascular mortality tended to increase in persons with previously diagnosed/treated OAG (n = 141; relative risk [RR], 1.38, P = .07) and was significantly higher with treatment involving timolol maleate (RR, 1.91, P = .04). Cardiovascular deaths also tended to increase in persons with ocular hypertension at baseline (n = 498; RR, 1.28, P = .06). CONCLUSIONS: In this black population, cardiovascular mortality tended to increase in persons with previously diagnosed/treated OAG and ocular hypertension. The excess mortality associated with timolol maleate treatment of OAG, also found in a white population, warrants further investigation.

Nine-year incidence of diabetic retinopathy in the Barbados Eye Studies.

OBJECTIVE: To estimate the 9-year incidence of diabetic retinopathy (DR) in a population with the same ancestry as African Americans. METHODS: Participants with diabetes mellitus and gradable photographs at the 9-year examination were evaluated (n = 436). The incidences of minimum/moderate/severe DR, clinically significant macular edema (CSME), and sight-threatening DR (severe DR plus CSME) were defined by the development of specific diabetic changes in persons without those conditions at baseline. Progression was defined as the development of severe/proliferative DR in persons with minimum/moderate DR at baseline. RESULTS: The 9-year DR incidence was 39.6% (38.0% for minimum, 9.0% for moderate, and 2.6% for severe/proliferative DR). Incidence tended to increase with diabetes duration and treatment. Of persons with preexisting DR at baseline, 8.2% progressed to proliferative DR. The CSME incidence was 8.7%, and it increased with diabetes duration, accounting for most of the overall incidence of sight-threatening DR. CONCLUSIONS: The study provides new data on long-term incidence among persons of African origin. Results suggest a possible lower risk of severe/proliferative DR than in whites, while CSME incidence seems comparable or higher. The main component of sight-threatening DR was CSME, highlighting the importance of DR as a cause of vision loss in this population.

Nine-year incidence of age-related macular degeneration in the Barbados Eye Studies.

OBJECTIVE: To provide 9-year incidence estimates of age-related macular degeneration (AMD) in a population of African descent. DESIGN: Population-based cohort study. PARTICIPANTS: Two thousand seven hundred ninety-three participants (81% of eligible) after 9 years' follow-up. MAIN OUTCOME MEASURES: Nine-year incidence of AMD-related features, based on fundus photographic gradings and/or clinical examinations. RESULTS: The overall incidence rate of early AMD was 12.6% (95% confidence interval [CI], 11.0%-14.1%), and that of late AMD was 0.7% (95% CI, 0.4%-1.1%). Both increased with age (P<0.05). For early AMD, incidence ranged from 10.7% at 40 to 49 years of age to 16.8% at > or =70 years. For late AMD, incidence increased from 0.1% to 2.3% in the same age groups. Late AMD was more likely to develop in eyes with pigment changes (risk ratio [RR], 5.8; 95% CI, 2.0-16.8) and retinal pigment epithelial atrophy (RR, 5.4; 95% CI, 1.9-15.8) at baseline. Crude RRs indicated significant associations of late AMD to elevated systolic blood pressure and diabetes history, but only the diabetes relationship was suggested after adjusting for age, with borderline statistical significance (age-adjusted RR, 2.7; P = 0.054). CONCLUSIONS: Nine-year data on natural history indicate that early AMD is common in this population of African origin, although late AMD is infrequent. These long-term observations provide further evidence for the lower AMD risk in black populations compared with white populations.

Hyperglycemia, blood pressure, and the 9-year incidence of diabetic retinopathy: the Barbados Eye Studies.

OBJECTIVES: To evaluate factors related to the incidence of diabetic retinopathy (DR) in a population of African descent, after 9 years of follow-up. DESIGN: Population-based cohort study; 81% participation after 9 years. PARTICIPANTS: Three hundred twenty-four participants of the Barbados Eye Studies, with diabetes mellitus (DM) at baseline and at risk for developing DR during follow-up. METHODS: Diabetes-related changes were assessed by masked gradings of baseline and follow-up photographs using a standardized system. The 9-year cumulative incidence of DR was based on participants with DM and free of retinopathy at baseline; incidence rates were estimated by the product-limit approach. Cox regression models for discrete-time data were used to evaluate risk factors associated with the 9-year incidence of DR. RESULTS: Multivariate analyses revealed that older age at DM onset decreased the 9-year risk of DR development; for each 10 years of older age at onset, the risk of DR decreased by 30% (risk ratio [RR], 0.7; 95% confidence interval [CI], 0.56-0.96). The risk of DR doubled among persons with DM duration between 5 and 9 years (RR, 2.1; 95% CI, 1.2-3.6) versus those with shorter durations; it also doubled in those treated with oral medications or insulin at baseline versus those treated with diet only. Antihypertensive treatment halved the risk of DR versus no treatment (RR, 0.5; 95% CI, 0.3-0.9) and high systolic or diastolic blood pressure (BP) increased risk. Thus, DR risk increased by 30% for every 10 mmHg of higher systolic BP at baseline (RR, 1.3; 95% CI, 1.1-1.4) or of BP increase from baseline to the 4-year follow-up (RR, 1.3; 95% CI, 1.1-1.4). Diabetic retinopathy risk similarly increased with each 1% of higher glycosylated hemoglobin level at baseline (RR, 1.3; 95% CI, 1.2-1.5). CONCLUSIONS: The long-term follow-up of persons with DM in this population of African origin, where disease prevalence is high, identified important potentially modifiable risk factors for DR. Findings suggest that efforts to achieve optimal glycemic and BP control may reduce the vision-threatening complications of DM.

Four-year incidence of macular changes in the Barbados Eye Studies.

OBJECTIVE: To describe longitudinal macular changes in a black population after 4 years of follow-up. DESIGN: Population-based incidence study. SETTING AND PARTICIPANTS: The Barbados Incidence Study of Eye Diseases (BISED) reexamined the Barbados Eye Study cohort, which was based on a random sample of the country's residents, 40 to 84 years. The BISED included 3427 persons, or 85% of the eligible cohort. MAIN OUTCOME MEASURES: Four-year incidence of macular changes, as determined by gradings of color stereoscopic macular photographs. RESULTS: Among black participants, the overall 4-year incidence of early macular changes (medium or large drusen or >20 small drusen with retinal pigment epithelium [RPE] atrophy or pigment) was 5.2% (95% confidence interval, 4.0%-6.6%) and tended to be higher in women (5.8%) than in men (4.1%). Incidence of related features was 5.2% for medium drusen (64-250 microm), 0.3% for drusen >250 microm, 1.1% for confluence, 0.5% for pigment, and 0.1% for RPE atrophy. Of the 2362 persons at risk for late macular changes (geographic atrophy, fluid, lipid, hemorrhage, disciform scar), exudative features developed in only 1 person in 4 years. Less than 1% of persons with early macular changes at baseline had disappearance of related features. CONCLUSIONS: After 4 years, the development of severe macular disease was rare in this black population, and the incidence of early macular changes also was lower than in other populations. Results are consistent with the low risk of macular degeneration in persons of African descent.

Four-year incidence of visual impairment: Barbados Incidence Study of Eye Diseases.

OBJECTIVE: To describe the 4-year incidence of visual impairment and causes of blindness among black participants of the Barbados Eye Studies. DESIGN: Population-based incidence study. SETTING AND PARTICIPANTS: The Barbados Incidence Study of Eye Diseases (BISED) followed the cohort of the Barbados Eye Study (BES), a prevalence study based on a simple random sample of Barbadians 40 to 84 years of age. BISED included 3193 black participants from the original cohort (85% of those eligible). MAIN OUTCOME MEASURES: Best-corrected visual acuity (Ferris-Bailey chart) at baseline and follow-up was measured according to a modified Early Treatment of Diabetic Retinopathy Study protocol. By use of World Health Organization (WHO) criteria, low vision and blindness for an individual were defined as visual acuity (VA) <6/18 to 6/120 and <6/120, respectively, in the better eye. By commonly used US criteria, low vision and blindness were defined as VA < or = 20/40 and < or = 20/200, respectively. Vision loss was defined as a doubling of the visual angle (i.e., decrease of 15 letters or more read correctly between baseline and follow-up examinations). Progression was defined as vision loss among those with low vision at baseline. RESULTS: On the basis of WHO criteria, the overall 4-year incidence was 3.6% (95% confidence interval [CI], 3.0%-4.4%) for low vision and 0.6% (95% CI, 0.4%-1.0%) for blindness. Incidence rates were higher using US criteria: 5.3% (95 % CI, 4.5%-6.2%) and 1.5% (95% CI, 1.1%-2.0%), respectively, reaching 21.5% and 7.3% for persons aged 70 years or older at baseline. One tenth of the cohort had vision loss, and 28.6% of those with low vision progressed. About one half of incident blindness was due to age-related cataract. Nearly one fifth was caused by open-angle glaucoma (OAG) alone or combined with cataract, and approximately 10% was caused by diabetic retinopathy (DR). CONCLUSIONS: The incidence of visual impairment was high in this Afro-Caribbean population, particularly in older age groups, indicating the public health significance of visual loss for this and similar black populations. Cataract, OAG, and DR were among the leading causes of incident blindness, paralleling their high prevalence in this population.

Incidence of open-angle glaucoma. The Barbados Eye studies

OBJECTIVE: To measure the 4-year risk of open-angle glaucoma (OAG) in a black population. DESIGN: Population-based cohort study with 4 years of follow up. SETTING: Simple random sample of residents of Barbados, West Indies, aged 40 years or older. PARTICIPANTS: A total of 3427 members of the cohort (85 percent of those eligible). MAIN OUTCOME MEASURE: Development of glaucoma visual field defects and optic disc damage, confirmed by automated perimetry, independent fundus photographic gradings, and standardized opthalmologic examinations. RESULTS: The 4-year risk of OAG in black participants was 2.2 percent (95 percent confidence interval, 1.7 percent-2.8 percent), based on 67 newly developed cases of OAG. Incidence rates increased from 1.2 percent at ages 40 to 49 years to 4.2 percent at ages of 70 years or more, tending to be higher in men than women (2.7 percent vs 1.9 percent). About half of the incident cases were undiagnosed previously, and the rest were receiving OAG treatment. Of the 67 new cases of OAG, 32 had intraocular pressure of 21 mm HG or less at baseline (1.2 percent incidence) and 35 had higher pressures (9 percent incidence). Risk was the highest among persons classified as having suspect OAG at baseline (26.1 percent), followed by those with ocular hypertension (4.9 percent and lowest in the remining population (0.8 percent). CONCLUSIONS: This longitudinal study provides new information on OAG risk, as well as the first incidence measurement in a black population. Although intraocular pressure increased risk, about half of the new cases had baseline pressures of 21 mm Hg or less. Results substantiate the high OAG risk in the population of African origin, especially in older adults; the relative role of intraocular pressure; and the considerable underdetecion of new disease after 4 years of follow-up. (AU)

Diabetic retinopathy in a black population: the Barbados Eye Study

OBJECTIVE: The distribution of diabetic retinopathy in black populations is largely unknown. The authors present retinopathy data from the predominantly black participants of the Barbados Eye Study (BES). DESIGN AND PARTICIPANTS: Prevalence study of 4631 participants based on a random sample of the Barbados population 40 to 84 years of age (84 percent participation). MAIN OUTCOME MEASURES: Diabetes was defined as self-reported history of physician-diagnosed diabetes or glycosylated hemoglobin greater than 10 percent (>2 standard deviations above the population mean of persons without a diabetes history). Retinopathy was assessed by independent grading of 30 degrees color stereo fundus photographs of the disc and macula. RESULTS: Diabetes was present in 19.4 percent of black (n = 4314), 15.2 percent of mixed (black and white, n = 184), and 7.5 percent of white/other (n = 133) self-reported racial groups. In the black/mixed population, regardless of diabetes status, the prevalence of retinopathy was 5.9 percent. In the 636 black and mixed participants with diabetes, the prevalence of retinopathy was 28.5 percent: 19.8 percent had minimum changes, 7.7 percent had moderate changes, and 0.9 percent had severe retinopathy. Clinically significant macular edema (CSME) was found in 8.6 percent of those with diabetes. CONCLUSIONS: In the population of African origin, approximately 1 in 17 persons had retinopathy. Among those with diabetes, 28.5 percent had retinopathy and 8.6 percent had CSME. These results highlight the clinical and public health relevance of diabetic retinopathy in the black populaion.(AU)

Diabetic retinopathy in Barbados: the Barbados eye study

OBJECTIVE: Diabetic retinopathy is an important cause of visual loss in Barbados and the Caribbean region. The Barbados Eye Study (BES) provides the largest source of population based data on diabetic retinopathy in black adults. METHODS: This is a prevalence study of 4,631 participants based on a random sample of the Barbados population aged 40-84 years (84 percent participation). Diabetes was defined as self-reported history of physician diagnosed diabetes and/or glycosylated haemoglobin > 10 percent (2 standard deviations above the population mean of persons without a diabetes history). Retinopathy was assessed by independent gradings of 30 degrees colour stereo fundus photographs of the disk and macula. RESULTS: Diabetes was present in 19.4 percent of blacks (n=4,313), 15.2 percent of mixed black and white; n=184), and 7.5 percent of white/other (n=133) self reported racial groups. Type 1 diabetes was infrequent. In the overall black/mixed study population regardless of diabetes status, the prevalence of retinopathy was 5.9 percent. In the 636 black and mixed participants with diabetes and gradable fundus photographs, the prevalence of retinopathy was 28.5 percent; 19.8 percent had minimum background changes, 7.7 percent had moderate changes and 0.9 percent had severe retinopathy. Clinically significant macular oedema (CSME) was found in 8.6 percent of those with diabetes. CONCLUSION: In the Afro-Caribbean population over 40 years of age, about 1 in 17 persons had retinopathy. Among those with diabetes, 28.5 percent had retinopathy and 8.6 percent had CSME. These results highlight the clinical and public health relevance of diabetic retinopathy in the region (AU)

Diabetes, hypertension, and central obesity as cataract risk factors in a black population. The Barbados Eye Study

OBJECTIVE: The increased cataract prevalence of black populations, especially of cortical cataract, remains unexplained. The authors evaluate the relationships of diabetes, hypertension, and obesity patterns to lens opacities, by age, among 4314 black participants in the Barbados Eye Study. DESIGN AND PARTICIPANTS: Prevalence study of a random sample of the Barbados population, ages 40 to 84 years (84 percent participation). MAIN OUTCOME MEASURES: Associations with age-related lens changes (grade > or = 2 in the Lens Opacities Classification System II at the slit lamp) were evaluated in logistic regression analyses by age (persons < 60 years and > or = 60 years). Results are presented as odds ratios (OR) with 95 percent confidence intervals. RESULTS: Of the 1800 participants with lens changes, most had cortical opacities. Diabetes history (18 percent prevalence) was related to all lens changes, especially at younger ages (age < 60 years: OR = 2.23 [1.63, 3.04]; age > or = 60 years: OR = 1.63 [1.22, 2.17]). Diabetes also increased the risk of cortical opacities (age < 60 years: OR = 2.30 [1.63, 3.24]; age > or = 60 years: OR = 1.42 [1.03, 1.96]); additional risk factors were high diastolic blood pressure (age < 60 years: OR = 1.49 [1.00, 2.23] and higher waist/hip ratio (all ages: OR = 1.49 [1.00, 1.84]). Diabetes was also related to posterior subcapsular opacities. Glycated hemoglobin levels were positively associated with cortical and posterior subcapsular opacities. Overall, 14 percent of the prevalence of lens changes could be attributed to diabetes. CONCLUSIONS: The high prevalence of cortical opacities was related to diabetes, hypertension, and abdominal obesity, which also are common in this and other black populations. Interventions to modify these risk factors, especially in populations which they are highly prevalent, may have implications to control visual loss from cataract, which is the first cause of blindness worldwide.(Au)

Distribution of intraocular pressure: the Barbados Eye Study

OBJECTIVE: To provide data on the distribution of intraocular pressure (IDP) in a predominantly black population, which has a high prevalence of open-angle glaucoma. DESIGN: Population-based prevalence study. SETTING AND PARTICIPANTS: Participants (N = 4601) (age range, 40-84 years) who had undergone applanation tonometry measurements in the Barbados Eye Study. Self-reported race was 93 percent black, 4 percent mixed (black and white), and 3 percent white or other. DATA COLLECTION: A standardized protocol included applanation tonometry and other ocular measurements, fundus photography, demographic data, and an interview. MAIN OUTCOME MEASURES: The average of 3 IDP measurements at the Barbados Eye Study visit was used to compare IDP by self-reported race. Descriptive data on IDP by age, sex, glaucoma status, and cup-disc ratio were examined in the black population. RESULTS: The IDP was highest in the population of African origin. The mean (+/-SD) IDP values for black, mixed, and white participants were 18.7 +/- 5.2, 18.2 +/-3.8, and 16.5 +/- 3.0 mm Hg, respectively. An IDP greater than 21 mm Hg was present in 18.4 percent, 13.6 percent and 4.6 percent of the black, mixed and white participants, respectively. In analyses that were adjusted for age, sex, and glaucoma status, such values were 5 times as likely in black than white participants and 3.5 times as likely in mixed race participants (p < .01). Among the black participants, the mean IDP increased approximately 1 mm Hg for every increase in 10 years of age. After excluding persons with any type of glaucoma, suspected glaucoma, or a history of glaucoma treatment, women had significantly (P < .01) higher IDP values; however, no significant IDP trends by sex were evident in the group with glaucoma. The IDP was also positively associated (P < .05) with vertical cup-disc ratios. After 2 visits, the IDP remained 21 mm Hg or less in 21 percent of the persons with glaucoma vs 64 percent of those without glaucoma. CONCLUSIONS: In the black participants, the IDP was higher than in the white participants. The IDP was also associated with age and cup-disc ratios. The results showed that open-angle glaucoma and a high IDP alone have a different distribution by sex; although open-angle glaucoma was more frequent in men, ocular hypertension was more frequent in women. These data have implications for the detection and causation of open-angle glaucoma in this high-risk population.(AU)

Prevalence of lens opacities in the Barbados Eye Study

OBJECTIVE: To present population-based data on type and extent of age-related lens opacities in the predominantly black population of the Barbados Eye Study. DESIGN: Prevalence study. SETTING AND PARTICIPANTS: The Barbados Eye Study included 4709 participants (84 percent of those eligible), who were identified from a random sample of Barbadian-born citizens aged 40 to 84 years. DATA COLLECTION: Lens gradings at the slit lamp, obtained with the use of the Lens Opacities Classification System II. MAIN OUTCOME MEASURE: Prevalence of posterior subcapsular, nuclear, and cortical opacities (defined as a grade > or = 2 in either eye), as well as prevalence of any lens changes (including history of previous cataract surgery and/or cataract too advanced to grade). RESULTS: Overall, 41 percent of the Barbados Eye Study population had any lens change, including 3 percent with aphakia or an intraocular lens. Among the population of African descent, cortical opacities (34 percent) were most prevalent, followed by nuclear (19 percent) and posterior subcapsular (4 percent) opacities. Prevalence of all opacity types increased with age (P < .001). Cortical and nuclear opacities were more frequent in women than men. When prevalence of a single kind of opacity was considered, 21 percent of participants had cortical only, 6 percent had nuclear only, and 0.4 percent and posterior subcapsular only; 13 percent had mixed opacities. Visual acuity loss to worse than 20/40 in the more affected eye was present in 48 percent, 26 percent, and 18 percent of nuclear only, posterior subcapsular only, and cortical only types, respectively, and in 53 percent of mixed opacities. CONCLUSIONS: The Barbados Eye Study provides the first prevalence data on different types of lens opacities in a large, predominantly black population. Whereas nuclear opacities are most common in white populations, cortical opacities were the most frequent type in the Barbados Eye Study, a finding of possible etiologic relevance. Other results highlight a higher frequency of opacities in women than men and a high prevalence of visual acuity loss in affected eyes.(AU)

Risk factors for open-angle glaucoma: the Barbados eye study

The objective was to evaluate risk factors for open-angle glaucoma among black participants in the Barbados Eye Study. The design was a population-based study of demographic, medical, ocular, familial, and other factors possibly related to open-angle glaucoma. The setting and participants: The Barbados Eye Study included 4709 Barbados residents identified by a simple random sample of Barbadian-born citizens, 40 to 84 years of age; participation was 84 percent. This report is based on the 4314 black participants examined at the study site; 302 (7 percent) met the Barbados Eye Study criteria for open-angle glaucoma. Data collection included a standardized protocol included applanation tonometry, Humphrey perimetry, fundus photography, blood pressure, anthropometry, and an interview. An ophthalmologic examination was performed for participants who met specific criteria. Main outcome measures: open-angle glaucoma was defined by the presence of both characteristics visual field defects and optic disc damage. Association of open-angle glaucoma with specific factors was evaluated in logistic regression analysis. Results: age, male gender, high intraocular pressure, and family history of open-angle glaucoma were major risk factors; the latter association was stronger in men than women. Lean body mass and cataract history were the only other factors related to open-angle glaucoma. Although hypertension and diabetes were common in Barbados Eye Study participants, they were unrelated to the prevalence of open-angle glaucoma. However, associations were found with low diastolic blood pressure-intraocular pressure differences and low systolic and diastolic blood pressure/intraocular pressure ratios. The Conclusions: In the Barbados Eye Study black population, persons most likely to have open-angle glaucoma were older men and had a family history of open-angle glaucoma, high intraocular pressure, lean body mass, and cataract history. These results suggest the importance of possible genetic or familial factors in open-angle glaucoma. The role of vascular risk factors is consistent with our finding of low blood pressure to intraocular pressure relationships, but the results could be explained by the high intraocular pressure in open-angle glaucoma (AU)

The Barbados eye study

OBJECTIVE: To describe the design of the Barbados Eye Study and report of the prevalence of open angle glaucoma (OAG) in a predominantly black study population. DESIGN: Population-bases prevalence study. SETTING AND PARTICIPATION: Residents of Barbados, West Indies, identified from a simple random sample of Barbadian-born citizens 40 through 84 years old. DATA COLLECTION: Participants had a comprehensive study visit that included automated perimetry, applanation tonometry, and fundus photography; persons with specific findings, as well as a 10 percent sample of participants, were referred for an ophthalmologic exanimation and additional tests. OUTCOME: A diagnosis of OAG required both visual field and optic disc criteria for glaucoma damage after excluding other causes. RESULTS: The 4709 participants (83.5 percent of those eligible) had demographic characteristics that were similar to the census population. Of the 4631 participants who were tested at the study site, 95 percent completed Humphrey automated perimetry and 97 percent had photographic or clinical disc gradings; 93 percent of those referred completed the ophthalmologic examination. In the adult population, the prevalence of OAG by self-reported race was 7.0 percent (302/4314) in black, 3.3 percent (6/184) in mixed race, and 0.8 percent (1/1`33) in white or other participants. In black and mixed-race participants, the prevalence reached 12 percent at age 60 years and older and was higher in men (8.3 percent) than in women (5.7 percent), with and age-adjusted male-female ratio of 1.4. In addition, over 3 percent of the participants were classified as having suspect OAG. CONCLUSIONS: To our knowledge, the Barbados Eye Study is the largest glaucoma study ever conducted in a black population and identified more people with OAG than did any previous population study. The prevalence of OAG was high, especially at older ages and in men. Among participants 50 years old or older, one in 11 had OAG, and prevalence increased to one in six at age 70 years or older. The results highlights the public health importance of OAG in the Afro-Caribbean region and have implications for other populations. (AU)

Comparison of diabetic retinopathy detection by clinical examinations and photograph gradings. Barbados (West Indies) eye study group

OBJECTIVE: To compare the use of clinical examination and fundus photograph gradings in detecting diabetes. DESIGN: Population-based epidemiologic study. SETTING: Sir Winston Scott Polyclinic, Bridgetown, Barbados,West Indies. PARTICIPANTS; Subset of a random sample of the country's population aged 40 to 86 years. RESULTS: Among 1168 black persons with fundus photograph evaluations, opthalmologic examinations, diabetes history, and glycated hemoglobin data, 21 percent reported a history of diabetes: 9.5 percent had definite diabetes (glycated hemoglobin > 11.5 percent ); and 13.3 percent had a diabetes history and glycated hemoglobin value less than or equal to 11.5 percent. The frequency of diabetic retinopathy in this group was 7.7 percent (90/1168) by clinical examination, 8.7 percent (102/1168) by photograph gradings, and 6.7 percent (78/1168) by both methods. CONCLUSION: These results suggest that in certain populations that include diabetics and nondiabetics, a clinical examination by an ophthalmologist will detect most cases of diabetic retinopathy identified by disc and macula photographs read by skilled graders. However, it will lead to an underestimate of prevalence. Staff availability and cost, issues not examined in this study, should determine which approach is selected (AU)