Four-year incidence and progression of visual impairment in Latinos: the Los Angeles Latino Eye Study.

PURPOSE: To determine the 4-year incidence of visual impairment (VI) and blindness and worsening of visual acuity in adult Latinos and Hispanics aged 40 years and older. DESIGN: Population-based, longitudinal study. METHODS: Participants underwent a detailed ophthalmologic examination including assessing both presenting binocular visual acuity (PVA) and best-corrected distance visual acuity (BCVA) in both eyes using a standard Early Treatment Diabetic Retinopathy protocol. The main outcome measures are 4-year incidence of visual impairment and blindness based on PVA or BCVA in the better-seeing eye and defined as (1) baseline visual acuity (PVA or BCVA) of 20/40 or better and a follow-up PVA or BCVA of less than 20/40 but better than 20/200, and (2) baseline PVA better than 20/200 and a follow-up PVA of 20/200 or less, respectively. Monocular worsening was defined as a decrease of 5 or more, 10, and 15 letters in either eye. RESULTS: Four thousand six hundred fifty-eight participants were examined at baseline and the 4-year follow-up. The 4-year incidence of presenting binocular VI and blindness was 2.9% and 0.3%. The 4-year incidence of best-corrected VI and blindness was 1.2% and 0.3%. The 4-year incidence of monocular worsening by 5 or more, 10, and 15 letters was 24.8%, 8.5%, and 3.1%, respectively. The incidence of VI and blindness increased with age at baseline (P < .01). The incidence of VI in the second eye (12.2%) was significantly higher than the incidence of VI in the first eye (2.9%; P < .001). CONCLUSIONS: Overall, the annual incidence of VI in Latinos and Hispanics was higher than that reported in non-Hispanic white persons and the highest reported in a population-based study in the United States. Screening and intervention programs to reduce visual impairment and blindness should focus on the older Latino population.

Four-year incidence and progression of age-related macular degeneration: the Los Angeles Latino Eye Study.

PURPOSE: To estimate 4-year incidence and progression of early and advanced age-related macular degeneration (AMD). DESIGN: Population-based cohort study. METHODS: A comprehensive ophthalmologic examination including stereoscopic fundus photography was performed on adult Latinos at baseline and follow-up. Photographs were graded using a modified Wisconsin Age-Related Maculopathy Grading System. For estimations of incidence and progression of AMD, the Age Related Eye Disease Study Scale was used. Main outcome measures are incidence and progression of early AMD (drusen type, drusen size, and retinal pigmentary abnormalities) and advanced AMD (exudative AMD and geographic atrophy). RESULTS: A total of 4658 of 6100 subjects (76%) completed the follow-up examination. The 4-year incidence of early AMD was 7.5% (95% CI: 6.7, 8.4) and advanced AMD was 0.2% (95% CI: 0.1, 0.4). Progression of any AMD occurred in 9.2% (95% CI: 8.3, 10.1) of at-risk participants. Incidence and progression increased with age. Incidence of early AMD in the second eye (11.2%) was higher than incidence in the first eye (6.9%). Baseline presence of soft indistinct large drusen >or=250 microm in diameter was more likely to predict the 4-year incidence of pigmentary abnormalities, geographic atrophy, and exudative AMD than smaller or hard or soft distinct drusen. CONCLUSIONS: Age-specific incidence and progression of AMD in Latinos are lower than in non-Hispanic whites. While incident early AMD is more often unilateral, the risk of its development in the second is higher than in the first eye. Older people and those with soft indistinct large drusen had a higher risk of developing advanced AMD compared to those who were younger and did not have soft indistinct large drusen.

Four-year incidence and progression of lens opacities: the Los Angeles Latino Eye Study.

PURPOSE: To estimate the 4-year incidence and progression of lens opacities. DESIGN: Population-based longitudinal study. METHODS: A total of 4658 adult Latinos from Los Angeles County were examined at baseline and 4-year follow-up. Examination included assessment of lens opacities using the Lens Opacities Classification System II (LOCS II). Incidences of cortical, nuclear, and posterior subcapsular opacities (with LOCS II scores >or=2) were defined as opacity development in persons without that opacity at baseline. Single and mixed opacities were defined in persons without any opacity at baseline. Incidence of all lens changes included development of at least 1 opacity or cataract surgery among those without any opacity at baseline. Four-year progressions were defined as increase of >or=2 in LOCS II score. RESULTS: The 4-year incidence of all lens opacities was 14.2%. Four-year incidence of cataract surgery was 1.48%. The incidences were 4.1% for cortical-only, 5.8% for nuclear-only, 0.5% for PSC-only, and 2.5% for mixed. The incidences for any opacities were 7.5% for cortical, 10.2% for nuclear, and 2.5% for PSC. Incidence increased with age (P < .0001 for all). The progressions were 8.5% for cortical, 3.7% for nuclear, and 2.9% for PSC opacities. CONCLUSIONS: Our Latino population had a higher incidence of nuclear than cortical opacities, but a greater progression of cortical than nuclear opacities. Incidence and progression of PSC was low. Additional understanding of the natural history and progression of various lens opacities will give us a better understanding of the pathogenesis and management of lens opacities.

Cardiovascular risk factors and age-related macular degeneration: the Los Angeles Latino Eye Study.

PURPOSE: To assess the association of cardiovascular risk factors and ocular perfusion pressure with early and advanced age-related macular degeneration (AMD) in Latinos. DESIGN: Population-based, cross-sectional study. METHODS: Data were collected from a population-based sample of self-identified adult Latinos using standardized protocols for assessing blood pressure and intraocular pressure (IOP) measurement and stereoscopic macular photography. Hypertension was defined as either a history of hypertension or systolic blood pressure (SBP) > 140 mm Hg +/- diastolic blood pressure (DBP) > or = 85 mm Hg. Ocular perfusion pressure (OPP) was defined as the difference between mean arterial blood pressure and IOP. AMD was diagnosed from photographic grading by masked trained graders. Logistic regression was used to assess associations. RESULTS: Gradable retinal photographs were available in 5,875 participants. After adjusting for age, gender, and cigarette smoking, higher DBP and uncontrolled diastolic hypertension were associated with exudative AMD (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.1 to 2.8; and OR, 3.3; CI, 1.2 to 9.3, respectively). Higher OPP was associated with a decreased risk of geographic atrophy (GA) (OR, 0.4 per 10 mm Hg; CI, 0.3 to 0.5). Low pulse pressure was associated with a lower risk of exudative AMD (OR, 0.2; CI, 0.1 to 0.6). Obesity was associated with increased retinal pigment (OR, 1.6; CI, 1.0 to 2.3). CONCLUSIONS: These data suggest that in Latinos cardiovascular risk factors may play a role in advanced AMD. Given that Latinos have a high prevalence of cardiovascular risk factors, an intervention aimed at reducing these risk factors may also have a beneficial impact on the risk of having early and advanced AMD.

Visual acuity and mortality in a chinese population. The Tanjong Pagar Study.

OBJECTIVE: To examine the relationship between visual acuity and mortality in a Chinese population. DESIGN: Population-based cohort study. PARTICIPANTS: Chinese persons in Singapore ages 40 to 79 years at baseline examination. METHODS: The Tanjong Pagar Study in Singapore examined 1232 persons (response rate, 71.8%) at the baseline examination in 1997 and 1998. Participants had measurements of presenting and best-corrected visual acuity (VA) using standardized protocols. Mortality data were obtained from the National Death Registry, which linked subjects who had died since the baseline examination. Cause of death was determined from the International Classification of Diseases 9 codes. Analysis was performed on 1225 (99.4%) participants with VA data. MAIN OUTCOME MEASURE: All-cause mortality. RESULTS: By December 31, 2004 (median follow-up, 6.8 years), 126 persons had died. Participants with presenting VA in the better eye worse than 20/40 (logarithm of the minimum angle of resolution [logMAR] score, 0.3) had a significantly higher mortality rate (hazard ratio [HR], 2.9; 95% confidence interval [CI], 1.4-6.3, adjusting for age, gender, hypertension, diabetes, smoking, heart attack, stroke, and income) as compared with participants with VA of 20/20 (logMAR, 0.0). Associations were similar for best-corrected VA in the better eye (HR, 2.7; 95% CI, 1.4-5.5). Among clinic participants with logMAR VA measurements, each 1-line difference in presenting VA (logMAR gain, 0.10) was associated with a 4-fold increased risk of mortality (HR, 4.4; 95% CI, 1.9-10.2). CONCLUSIONS: In this Chinese population in Singapore, visual impairment was associated independently with an increased risk of mortality.

The relationship between anterior chamber depth and the presence of diabetes in the Tanjong Pagar Survey.

PURPOSE: To examine the relationships of diabetes with anterior chamber depth, axial length, and refraction. DESIGN: Population-based cross-sectional study. METHODS: This analysis included 943 Singapore Chinese subjects ages 40 to 81 years from the Tanjong Pagar Survey. Diabetes was determined by self-report. A-mode ultrasound was used to measure axial dimensions. Refraction was performed with an autorefractor and refined subjectively. RESULTS: There were 140 (11.4%) participants with diabetes. After controlling for age and gender, participants with diabetes had shallower anterior chambers (2.78 vs 2.91 mm, P = .004) and thicker lenses (4.88 vs 4.75 mm, P = .003), but similar spherical equivalent refraction (-0.38 vs -0.47 diopters [D], P = .73), axial length (23.09 vs 23.19 mm, P = .40), and vitreous chamber depth (15.52 vs 15.59 mm, P = .53). CONCLUSIONS: In the Singapore Chinese population, persons with diabetes have shallower anterior chambers and thicker lenses than those without diabetes. Diabetes may be a risk factor for angle closure glaucoma (ACG).

Rationale and methodology for a population-based study of eye diseases in Malay people: The Singapore Malay eye study (SiMES).

PURPOSE: Although there are approximately 200 million people of Malay ethnicity living in Asia, the burden and risk factors of blinding eye diseases in this ethnic group are unknown. This study summarizes the rationale and study design of a population-based study of eye diseases among adult Malays in Singapore. METHODS: A population-based cross-sectional study of Malays was designed in Singapore. The sampling frame consisted of all Malays aged 40-79 living in designated study areas in southwestern Singapore. From a list of 16,069 names provided by the Ministry of Home Affairs, age-stratified random sampling was used to select 5,600 names (1,400 people from each decade of 40-49, 50-59, 60-69, and 70-79 years). The target sample size for this study was 3,150 persons. Selected individuals were invited to a centralized clinic by letters, telephone calls, and home visits. Participants underwent standardized interview and assessment of blood pressure, anthropometry, presenting and best-corrected visual acuity, subjective refraction, ocular biometry, Goldmann tonometry, slit-lamp biomicroscopy, optic disc imaging, digital lens, and retinal photography. Blood and urine samples were collected for biochemical analyses and further stored for future studies. Selected participants also had gonioscopic examination, visual fields test, and assessment of ankle and brachial blood pressure to detect presence of peripheral vascular disease. CONCLUSIONS: This study provides population-based data on the prevalence of and risk factors for age-related eye diseases in people of Malay ethnicity in Singapore. Data from this study allow further understanding of the etiology and impact of eye diseases in this ethnic group.

Hypermetropia, axial length, and hypertension: the Tanjong Pagar survey.

PURPOSE: To examine the relationship among hypermetropia, axial length, and hypertension in a Chinese population. DESIGN: Population-based cross-sectional study. METHODS: This study included 1213 Chinese individuals aged 40 to 81 years. Hypertension was defined as systolic blood pressure > or =140 mm Hg, diastolic blood pressure > or =90 mm Hg, or self-report history of antihypertension treatment. Refraction was determined with an autorefractor and refined subjectively. A-mode ultrasound scanning was used to measure axial length. RESULTS: The crude odds ratio of hypertension was 2.5 (95% CI, 1.4-4.6) for moderate hypermetropia (> or =+2.00 spheric equivalent diopters) vs high myopia (< or =-6.00 diopters), and 1.4 (95% CI, 0.9-2.1) for highest vs lowest axial length quintile. These associations were no longer significant after adjustment for age, gender, education, housing type, and income. CONCLUSIONS: These data provide no evidence that hypermetropia or shorter axial length is associated independently with hypertension in Chinese individuals.