Aumento de detección de lesiones gástricas premalignas mediante protocolo Sydney en comparación con biopsias no protocolizadas / Increased detection of premalignant gastric lesions through Sydney protocol in comparison with non-protocolized gastric biopsies

Introduction: Gastric cancer (GC) is the leading cause of cancer mortality in Chile. The development ofgastric adenocarcinoma its preceded by a histopathologic cascade composed of gastric atrophy, intestinal metaplasia and gastric dysplasia. Sydney protocol has been proposed as the standard method for diagnosingthese conditions. The aim of this research study was to establish whether Sydney protocol increase thedetection of premalignant gastric lesions, as gastric atrophy and intestinal metaplasia, compared to non protocolizedendoscopies/biopsies. Methods: Upper gastroduodenal endoscopies (GDE) from Hospital Clí-nico Universidad Católica de Chile between April-May 2015 and April-May 2016 was analyzed. Patientswith histological study with 18 years-old or older were included. Patients with history of GC or malignantlesions at GDE where excluded. Detection of gastric atrophy, intestinal metaplasia and suggestive findingsof autoimmune gastritis where compared between Sydney protocol and non-protocolized endoscopies/biopsies...

Introducción: El cáncer gástrico (CG) es la principal causa de muertes por cáncer en Chile. El desarrollo del adenocarcinoma gástrico es precedido por una cascada histopatológica (gastritis; atrofia gástrica/AG; metaplasia intestinal/MI). Se ha propuesto la biopsia del cuerpo, ángulo y antro a través del protocolo de Sydney para la búsqueda de estas condiciones. Objetivo: Determinar la diferencia en la detección delesiones premalignas gástricas a través del protocolo de Sydney comparado con el estudio endoscópico habitual. Métodos: Se analizaron las endoscopias digestivas altas (EDA) realizadas en el Centro de Endoscopia Digestiva del Hospital Clínico de la Universidad Católica en los períodos entre abril y mayo del 2015 y 2016. Se incluyeron las EDA de pacientes mayores de 18 años con estudio histológico. Fueron excluidos los pacientes con antecedente personal de CG o lesiones de aspecto maligno macroscópicas. Se comparó la detección de AG, MI y gastritis autoinmune (GA) en el estudio histológico entre los pacientes con protocolo Sydney y el estudio endoscópico no protocolizado...

Medication use and the 5-year incidence of early age-related maculopathy: the Beaver Dam Eye Study.

OBJECTIVE: To evaluate incident early age-related maculopathy (ARM) after a 5-year interval with respect to medication use. DESIGN: Population-based incidence study. SETTING: Participants were adults aged 43 to 86 years living in Beaver Dam, Wis, when first examined in 1988-1990 (n = 4926); they were reexamined in 1993-1995 (n = 3684). METHODS: All participants were examined and interviewed and stereoscopic color fundus photographs were taken. All procedures were done by standard protocol at both examinations. Incidence of ARM was based on grading using the Wisconsin ARM Grading System. All prescribed and over-the-counter medications in current use were brought to the examination site and the names were recorded at that time. RESULTS: There were 678 drug preparations (active ingredients) being used at the baseline examination. No relations were found between most antihypertensive drugs, most central nervous system medications, aspirin and other nonsteroidal anti-inflammatory agents, estrogens, lipid-lowering agents, and incident early ARM over the 5-year period. Age- and sex-adjusted logistic regression analyses suggested possible associations (P<.10) between the use of phenothiazine antidopaminergics (odds ratio [OR], 2.83; 95% confidence interval [CI], 0.97-8.23; P =.06), desiccated thyroid hormones (OR, 2.32; 95% CI, 0.89-6.07; P =.09), and calcium channel blockers (OR, 1.70; 95% CI, 0.93-3.12; P =.08) with incident ARM. When additional information on past use was included in the regression model, the association remained for calcium channel blockers, but not for phenothiazines and desiccated thyroid hormones. A lower incidence of early ARM occurred in those who took antidepressants (OR, 0.34; 95% CI, 0.12-0.94; P =.04) at the baseline examination. CONCLUSION: Although many different medications were being used at the baseline examination in the Beaver Dam Eye Study cohort, there were no striking associations with the 5-year incidence of early ARM.

Reduced endothelial nitric oxide synthase in lungs of chronically ventilated preterm lambs.

Nitric oxide (NO), produced in lung vascular endothelium and airway epithelium, has an important role in regulating smooth muscle cell growth and tone. Chronic lung disease, a frequent complication of premature birth, is characterized by excess abundance, tone, and reactivity of smooth muscle in the pulmonary circulation and conducting airways, leading to increased lung vascular and airway resistance. Whether these structural and functional changes are associated with diminished pulmonary expression of endothelial nitric oxide synthase (eNOS) protein is unknown. Both quantitative immunoblot analysis and semiquantitative immunohistochemistry showed that there was less eNOS protein in the endothelium of small intrapulmonary arteries and epithelium of small airways of preterm lambs that were mechanically ventilated for 3 wk compared with control lambs born at term. No significant differences were detected for other proteins (inducible NOS, alpha-smooth muscle actin, and pancytokeratin). Lung vascular and respiratory tract resistances were greater in the chronically ventilated preterm lambs compared with control term lambs. These results support the notion that decreased eNOS in the pulmonary circulation and respiratory tract of preterm lambs may contribute to the pathophysiology of chronic lung disease.

The relation of socioeconomic factors to the incidence of early age-related maculopathy: the Beaver Dam eye study.

PURPOSE: To investigate the relationship between socioeconomic factors and the 5-year incidence of age-related maculopathy. METHODS: The Beaver Dam Eye Study, a population-based cohort study, examined 3681 adults (range, 43-86 years of age at baseline) living in Beaver Dam, Wisconsin, at baseline and 5 years later. Standardized protocols for physical examination, including administration of a questionnaire that included questions regarding income, education level, and status and type of employment, and fundus photography to determine age-related maculopathy, were performed. RESULTS: While controlling for age and sex, less education, and being in a service-related occupation compared with a white collar professional occupation, was associated (P <.05) with the incidence of early age-related maculopathy. CONCLUSION: These data show an association of education and occupation but not income with the incidence of early age-related maculopathy that appears independent of smoking or vitamin supplement use status.

Measures of obesity and age-related eye diseases.

OBJECTIVE: To compare body mass index with waist-to-hip ratio as correlates of age-related eye disease. DESIGN: Population-based cross-sectional study. PARTICIPANTS: Participants of the Beaver Dam Eye Study at 5-year follow-up examinations. METHODS: Body mass index was computed from weight and height, and waist-to-hip ratio was computed from measurements all done at the 5-year examination. Presence of ocular lesions was based on gradings of standard photographs of the retina and lens. MAIN OUTCOME MEASURES: Presence of early and late age-related maculopathy and nuclear, cortical, and posterior subcapsular cataracts. RESULTS: In women, early age-related maculopathy was significantly associated with both body mass index and waist-to-hip ratio. The relationship between waist-to-hip ratio and late age-related maculopathy was of borderline significance. When analyzed as continuous measures, waist-to-hip ratio was more strongly associated with nearly every outcome compared to body mass index. In men, there was little difference between body mass index and waist-to-hip ratio as correlates of age-related eye diseases. The reason for differences between men and women is not clear, but is unlikely to be due to current exposure to estrogen. CONCLUSIONS: In women in our analyses, waist-to-hip ratio is more strongly associated with age-related eye disease than is body mass index. When adiposity is considered as a risk factor itself, or as a confounder of risk factors for age-related ocular disease, waist-to-hip ratio may be the better measure to use in women.

A short questionnaire on visual function of older adults to supplement ophthalmic examination.

PURPOSE: To estimate frequency of self-reported visual dysfunction in specific life situations. METHODS: Performance-based measures of visual function were obtained during the 5-year follow-up examination of the Beaver Dam Eye Study cohort. During the subsequent yearly follow-up telephone call, four questions concerning visual abilities in specific situations were administered. RESULTS: Visual difficulties in everyday life situations were commonly reported by adults aged 48 to 91 years, with only 17% to 35% of persons reporting excellent or very good vision in the four specific situations related to visual function. Visual acuity, near vision, and contrast sensitivity measures do not reflect the visual difficulties encountered in common daily activities in our study population (Spearman correlation coefficients all less than 0.35). CONCLUSIONS: A few simple questions about visual function in common daily activities may give a clinician insights into patient complaints. It may be that environmental changes could improve self-reported visual function.

Retinal emboli and stroke: the Beaver Dam Eye Study.

OBJECTIVE: To describe the prevalence at baseline and the 5-year incidence of retinal emboli, associated risk factors, and the relationship of retinal emboli at baseline to stroke and ischemic heart disease mortality. METHODS: The Beaver Dam Eye Study is a large (N = 4926) population-based study of persons aged 43 to 86 years at the baseline examination. Retinal emboli were detected at baseline (1988-1990) and at a 5-year follow-up (1993-1995) by grading of stereoscopic 30 degrees color fundus photographs using standardized protocols. Cause-specific mortality was determined from death certificates. RESULTS: The prevalence of retinal arteriolar emboli was 1.3%, and the 5-year incidence was 0.9%. After adjustments were made for age and sex, the prevalence of retinal emboli was associated with higher pulse pressure, hypertension, diabetes mellitus, past and current smoking, cardiovascular disease, and the presence of retinopathy. After adjustments were made for age and sex, the incidence of retinal emboli was associated with past and current smoking and a history of coronary artery bypass surgery. After age, sex, and systemic factors were controlled for, people with retinal emboli had a significantly higher hazard of dying with a mention of stroke on the death certificate (hazard ratio = 2.61, 95% confidence interval = 1.12-6.08) than those without retinal emboli. CONCLUSIONS: Persons with retinal emboli are at an increased risk of stroke-related death. Data also show an association of smoking, hypertension, and cardiovascular disease with the prevalence of retinal emboli. CLINICAL RELEVANCE: Data from this population-based study suggest that after discovery of retinal emboli in the asymptomatic patient, referral for possible medical intervention to control hypertension, if present, may be beneficial.

Age-related maculopathy in a multiracial United States population: the National Health and Nutrition Examination Survey III.

OBJECTIVE: To investigate the prevalence of and risk factors for age-related maculopathy (ARM) in three racial/ethnic groups: non-Hispanic whites, non-Hispanic blacks, and Mexican-Americans. DESIGN: A nationally representative population-based, cross-sectional study. PARTICIPANTS: A total of 8270 persons 40 years of age or older, a sample of the Third National Health and Nutrition Examination Survey. MAIN OUTCOME MEASURES: Age-related maculopathy was determined by the grading of fundus photographs using a standardized protocol. RESULTS: The prevalence of any ARM in the civilian noninstitutionalized United States population including those 40 years of age or older was 9.4% (95% confidence interval [CI], 8.2, 10.6) as estimated from the sample. After adjusting for age, there was no difference in the prevalence of early ARM (defined largely by the presence of soft drusen) by ethnic/racial group. However, for the less frequent component lesions of early ARM (increased retinal pigment and retinal pigment epithelial depigmentation), the odds ratios (95% CIs) comparing non-Hispanic blacks to non-Hispanic whites were 0.47 (0.31, 0.74) and 0.59 (0.33, 1.04), respectively, and for comparing Mexican-Americans to non-Hispanic whites, they were 0.41 (0.21, 0.81) and 0.72 (0.44, 1.19), respectively. For late ARM, the odds ratio (95% CI) for non-Hispanic blacks compared to non-Hispanic whites was 0.34 (0.10, 1.18) and for Mexican-Americans compared to non-Hispanic whites, it was 0.25 (0.07, 0.90). Other than age, none of the personal, medical, or physiologic variables studied were statistically significantly associated with any of the ARM endpoints in any of the three races/ethnic groups. CONCLUSION: Overall, rates of any ARM (including all early and late lesions) are not significantly different among non-Hispanic blacks, Mexican-Americans, and non-Hispanic whites. However, the rates of individual lesions suggest that non-Hispanic whites and Mexican-Americans may be protected against retinal pigment abnormalities and lesions associated with late ARM. There appears to be little influence of personal, medical, and environmental factors studied on these results. Further studies in larger populations of older persons in these ethnic groups would likely clarify these relations.

Alcohol consumption and the 5-year incidence of age-related maculopathy: the Beaver Dam eye study.

OBJECTIVE: This study evaluated alcohol consumption as a risk factor for incidence of age-related maculopathy (ARM). DESIGN: Persons aged 43 to 86 years in 1988 in Beaver Dam, Wisconsin, were examined from 1988 through 1990 and 1993 through 1995, n = 3684. The presence and severity of ARM at both examinations were determined from gradings of stereoscopic fundus photographs using the Wisconsin Age-related Maculopathy Classification System. Alcohol consumption was determined by self-report. RESULTS: Men drinking at least 78 g/week of alcohol from beer had a higher 5-year age-adjusted incidence of early ARM (10.6%) than did men who did not drink beer (6.9%), but the test for trend was only borderline significant (P = 0.08). However, incidence of soft indistinct drusen (P = 0.01), increased drusen area (P < 0.01), and confluent drusen (P = 0.02) are all associated with beer drinking in men. Increased retinal pigment and retinal pigment epithelial depigmentation are not associated with beer drinking in men or women nor are any lesions associated with total alcohol consumption or consumption from liquor or wine in either men or women. CONCLUSIONS: Except for an association of beer drinking with retinal drusen in men, consumption of alcoholic beverages is not likely to be an important risk factor for incidence of ARM.

The relationship of ocular factors to the incidence and progression of age-related maculopathy.

OBJECTIVE: To examine the association between ocular factors and the incidence and progression of age-related maculopathy. PARTICIPANTS: A population of 3684 adults (43-86 years of age at baseline) living in Beaver Dam, Wis, studied at baseline and 5 years later. METHODS: Standardized protocols for refraction and determination of iris color, administration of a questionnaire, and slitlamp and retroillumination photographs of the lenses to determine cataract type and stereoscopic color fundus photographs to determine presence and severity of age-related maculopathy. Standard univariate and multivariate analyses were performed. MAIN OUTCOME MEASURES: Incidence and progression of age-related maculopathy. RESULTS: After controlling for age, eyes that had undergone cataract surgery before baseline were more likely to have progression of age-related maculopathy (odds ratio, 2.71; 95% confidence interval [CI], 1.69-4.35) and to develop signs of late age-related maculopathy (odds ratio, 2.80; 95% CI, 1.03-7.63) than were eyes that were phakic at baseline. These relationships remained after controlling for other risk factors in multivariate analyses. There was no relationship of nuclear cataract, cortical cataract, or iris color to the incidence and progression of age-related maculopathy. CONCLUSION: These findings indicate a relationship between cataract surgery and increased risk of progression of age-related maculopathy.

The relation of cardiovascular disease and its risk factors to the 5-year incidence of age-related maculopathy: the Beaver Dam Eye Study.

OBJECTIVE: The purpose of the study is to examine the association between cardiovascular disease and its risk factors and the incidence of age-related maculopathy. PARTICIPANTS: A population of 3583 adults (range, 43-86 years of age at baseline) living in Beaver Dam, Wisconsin, was studied at baseline and 5 years later. METHODS: Standardized protocols for physical examination, blood collection, administration of a questionnaire, and stereoscopic color fundus photography to determine age-related maculopathy were used. Standard univariate and multivariate analyses were performed. MAIN OUTCOME MEASURES: Incidence and progression of age-related maculopathy were measured. RESULTS: After controlling for age and gender, the authors found both higher systolic blood pressure (odds ratio [OR] per 10 mmHg, 1.16; 95% confidence interval [CI] 1.05, 1.27) and uncontrolled treated hypertension (OR 1.98, 95% CI 1.00, 3.94) were related to the incidence of retinal pigment epithelial depigmentation. After controlling for age and gender, the authors found that both blood pressure and uncontrolled treated hypertension were not significantly associated with an increased risk of having exudative macular degeneration develop (for systolic blood pressure, OR 1.18, 95% CI 0.95, 1.45; for uncontrolled treated hypertension, OR 2.10, 95% CI 0.54, 8.11). After controlling for age and gender, the authors found higher pulse pressure was significantly associated with increased incidence of retinal pigment epithelial depigmentation (OR per 10 mmHg 1.27, 95% CI 1.14, 1.42) and exudative macular degeneration (OR per 10 mmHg 1.29, 95% CI 1.02, 1.65). These relations remained significant after controlling for other risk factors in multivariable analyses. CONCLUSIONS: These findings indicate modest relations between higher pulse pressure (a presumed indicator of atherosclerotic vascular disease) and uncontrolled hypertension with increased 5-year incidence of retinal pigment epithelial depigmentation. Overall, however, data from this study show neither consistent nor strong relations between cardiovascular disease and most of its risk factors with the incidence of lesions associated with age-related maculopathy.

Changes in the optic disc over a five-year interval: the Beaver Dam Eye Study.

PURPOSE: To determine the relationship of change in vertical optic disc cupping to change in intraocular pressure over a five-year interval. METHODS: Non-simultaneous stereoscopic photographs were taken of optic discs of participants in the baseline and follow-up examinations of The Beaver Dam Eye Study cohort. Optic discs and cups were measured and other disc features were graded according to a standard protocol by trained graders. Intraocular pressures were measured by Goldmann applanation tonometry. RESULTS: Change in pressure was significantly associated with change in vertical cup-to-disc ratio. Incident disc hemorrhage, flattened temporal rim, notching, cup reaching disc margin, and undercutting were not significantly associated with change in intraocular pressure. CONCLUSION: Change in intraocular pressure in this adult population was associated with increased optic disc cupping. This finding, if confirmed, would lend support to the practice of periodic follow-up of older adults who have shown changes in their intraocular pressure.

The five-year incidence and progression of age-related maculopathy: the Beaver Dam Eye Study.

PURPOSE: The aim of the study was to describe the incidence and progression of retinal drusen, retinal pigmentary abnormalities, and signs of late age-related maculopathy. POPULATION: A population of 3583 adults (range, 43-86 years of age at baseline) living in Beaver Dam, Wisconsin, was studied during a 5-year period. METHODS: Characteristics of drusen and other lesions typical of age-related maculopathy were determined by grading stereoscopic color fundus photographs using the Wisconsin Age-Related Maculopathy Grading System. RESULTS: There was a statistically significant increased incidence of age-related maculopathy lesions with age (P < 0.05). Individuals 75 years of age or older had a significantly (P < 0.01) higher 5-year incidence of the following characteristics than people 43 to 54 years of age: larger sized drusen (125-249 microm, 17.6% vs. 2.1%; > or = 250 microm, 6.5% vs. 0.2%), soft indistinct drusen (16.3% vs. 1.8%), retinal pigment abnormalities (12.9% vs. 0.9%), exudative macular degeneration (1.8% vs. 0%), and pure geographic atrophy (1.7% vs. 0%). After adjusting for age, the incidence of early age-related maculopathy was 2.2 times (95% confidence interval 1.6, 3.2) as likely in women 75 years of age or older compared with men this age. At follow-up, late age-related macular degeneration was more likely to develop in eyes with soft indistinct drusen (6.5% vs. 0.1%) or retinal pigmentary abnormalities (7.1% vs. 0.1%) at baseline than in eyes without these lesions. CONCLUSIONS: These population-based estimates document the high incidence of signs of age-related maculopathy in people 75 years of age or older, and in women compared with men that age. The findings demonstrate that the presence of soft drusen and pigmentary abnormalities significantly increases the risk for the development of geographic atrophy and exudative macular degeneration.

Pattern of age-related maculopathy in the macular area. The Beaver Dam Eye Study.

PURPOSE: To describe the distribution of lesions associated with age-related maculopathy by location in the macula in a population of adult Americans. METHODS: Four thousand nine hundred twenty-six persons ranging in age from 43 to 84 years and living in Beaver Dam, Wisconsin, at the time of a census (1987-1988) were examined from 1988 to 1990. Lesions typical of age-related maculopathy were determined by masked grading of stereoscopic color fundus photographs using the Wisconsin Age-Related Maculopathy Grading System. The extent and prevalence of different types of lesions were determined for each of nine macular subfield regions: central, inner superior, inner nasal, inner inferior, inner temporal, outer superior, outer nasal, outer inferior, and outer temporal. RESULTS: Lesions associated with early age-related maculopathy were distributed in specific patterns. Soft indistinct drusen were more prevalent in the temporal and superior quadrants than in the nasal and inferior quadrants, whereas pigmentary abnormalities associated with age-related maculopathy were more prevalent in the superior or nasal quadrants than in the inferior or temporal quadrants. After weighting for subfield area, all types of lesions were most prevalent in the central macular region. CONCLUSION: Various lesions associated with early age-related maculopathy were located in specific patterns in the macula. It is not known whether these patterns resulted from environmental, anatomic, or physiologic factors.

Visual sensitivity and age-related eye diseases. The Beaver Dam Eye Study.

OBJECTIVE: To evaluate the relationships between visual sensitivity and age-related ocular disorders. DESIGN: Prevalence survey of age-related eye diseases. SETTING: Beaver Dam, Wisconsin. PARTICIPANTS: A total community sample of persons 43-84 at the time of the census (1987-1988) was invited to participate (n = 5.926). MAIN OUTCOME MEASURE: Visual sensitivity was measured by a perimeter. Sensitivities were evaluated with regard to age, sex and age-related eye diseases. RESULTS: Sensitivity was inversely associated with age and was lower in women in each age stratum. Central cataract, cataract surgery, and late age-related maculopathy were significantly related to decreased sensitivity in multivariate analyses. CONCLUSIONS: Visual sensitivity, an indication of the ability of the eye to detect a light stimulus, was diminished in those with central cataract, cataract surgery, and late age-related maculopathy. This may be related to diminished vision in environmental conditions of low illumination. Since visual sensitivity is relative easy to determine, this test may have use as a surrogate to assess functional vision loss. Also, although cataract surgery often leads to improved high contrast acuity, there may be a loss in low contrast settings.

Treatment and control of hypercholesterolemia and hypertension in persons with and without diabetes.

Our object was to examine whether the frequency of medical treatment for hypercholesterolemia or hypertension and the frequency of control of these conditions were different in persons with and without known diabetes. Subjects 43-86 years of age with (n = 376) and without (n = 4,420) known diabetes participated in the Beaver Dam Eye Study. Hypercholesterolemia was defined as a serum cholesterol of > or = 6.2 mmol/L or use of lipid-lowering agents, and hypertension was defined as a systolic blood pressure > or = 140 mm Hg or diastolic blood pressure > or = 90 mm Hg or use of antihypertensive medications. Those subjects with diabetes had a similar frequency of hypercholesterolemia (42.8% versus 43.3%, P = .22) and a significantly higher frequency of hypertension (73.1% versus 48.3%, P < .0001) than those without diabetes. In those who were hypercholesterolemic, subjects with diabetes were slightly more likely to use lipid-lowering agents than those without diabetes (14.6% versus 9.8%, P = .05). In those who were hypertensive, subjects with diabetes were more likely to be on antihypertensive medications than those without diabetes (77.4% versus 57.0%, P < .0001). After adjusting for sociodemographic and cardiovascular disease risk factors, the odds of a participant with hypercholesterolemia receiving treatment with lipid-lowering agents was 1.61 (95% confidence intervals [CI] = 0.98, 2.65) and the odds of a participant with hypertension receiving treatment with antihypertensive medications was 2.32 (95% CI = 1.68, 3.20) for those with diabetes versus those without.(ABSTRACT TRUNCATED AT 250 WORDS)

Alcohol use and age-related maculopathy in the Beaver Dam Eye Study.

PURPOSE: Because there are few epidemiologic data examining the relationship between alcohol use and age-related maculopathy, we investigated this relationship via the population-based Beaver Dam Eye Study. METHODS: Alcohol consumption in the year before examination was determined by a standardized questionnaire. Age-related maculopathy status was determined by grading stereoscopic color fundus photographs. RESULTS: While controlling for other factors, consumption of beer in the past year was related to greater odds of increased retinal pigment degeneration (odds ratio, 1.13; 95% confidence interval, 1.02, 1.25) and exudative macular degeneration (odds ratio, 1.41; 95% confidence interval, 1.05, 1.88). Current consumption of neither wine nor liquor was related to early or late age-related maculopathy. CONCLUSIONS: These data suggest a relationship between beer consumption and greater odds of having exudative macular degeneration. Whether this is from a toxic effect specific to beer or from other unknown confounders cannot be determined.

Hypertension and lens opacities from the Beaver Dam Eye Study.

PURPOSE: To examine the relationship between hypertension and lens opacities, and the use of antihypertensive agents. METHODS: A total of 4,926 adults, 43 to 84 years of age, living in Beaver Dam, Wisconsin, at the time of a private census, were invited to participate in a study that included a medical interview and an examination that included ocular photography. All study procedures and photographic grading were done according to standard protocols. RESULTS: According to analysis with the Liang-Zeger multiple logistic regression model, people with hypertension were more likely to have posterior subcapsular opacities than people without hypertension (odds ratio, 1.39; 95% confidence interval, 1.05, 1.84). Specific medications for hypertension did not meaningfully affect the risk. Hypertension was associated with increased risk in both those with and without diabetes. CONCLUSIONS: Hypertension is associated with increased risk of posterior subcapsular opacities. The pathophysiologic mechanisms that may explain the relationship are unknown. Incidence data will give a better indication of temporal relationship between hypertension, medications to lower blood pressure, and lens opacities.

The relation of socioeconomic factors to age-related cataract, maculopathy, and impaired vision. The Beaver Dam Eye Study.

PURPOSE: To investigate the relations between socioeconomic factors and the prevalence of age-related cataract, maculopathy, and visual impairment. METHODS: A population-based sample of 4926 people 43 to 86 years of age was examined from 1988 to 1990. Education, income, employment status, marital status, nuclear sclerosis, cortical, and posterior subcapsular cataract, age-related maculopathy, and impaired vision were all ascertained using standard protocols. RESULTS: While controlling for age, sex, diabetes status, multivitamin use, alcohol consumption, and cigarette smoking, less education was significantly associated with nuclear and cortical cataract, and lower income was significantly associated with cortical and posterior subcapsular cataract and impaired vision. There was a "U-shaped" relation between income and cataract surgery. Neither income nor education was related to age-related maculopathy. There was no relation of marital status to cataract status or age-related maculopathy. CONCLUSION: These data suggest that education and income are associated with cataract, cataract surgery, and impaired vision. These relations were not explained by other risk factors measured in the study.

Open-angle glaucoma and older-onset diabetes. The Beaver Dam Eye Study.

PURPOSE: To evaluate the relation of older-onset diabetes to open-angle glaucoma. METHODS: During a population-based study of age-related eye disease (n = 4926), participants were evaluated for the presence of glaucoma. Glycosylated hemoglobin levels were measured, and a medical history was obtained. RESULTS: Rates of persons meeting optic disc, visual field, and intraocular pressure criteria for definite glaucoma were more common in those with older-onset diabetes than in those without (4.2% versus 2.0%; P = 0.004). When persons with a history of treated glaucoma, despite whether they met the other criteria for glaucoma, were included, rates were 7.8% in those with diabetes compared with 3.9% in those without diabetes (P = 0.0005). CONCLUSIONS: The presence of open-angle glaucoma is increased in people with older-onset diabetes.