Enlargement of Geographic Atrophy From First Diagnosis to End of Life.

IMPORTANCE: Treatments for geographic atrophy (GA), a late stage of age-related macular degeneration (AMD), are currently under development. Understanding the natural course is needed for optimal trial design. Although enlargement rates of GA and visual acuity (VA) in the short term are known from clinical studies, knowledge of enlargement in the long term, life expectancy, and visual course is lacking. OBJECTIVE: To determine long-term enlargement of GA. DESIGN, SETTING, AND PARTICIPANTS: In this study, participant data were collected from 4 population-based cohort studies, with up to 25 years of follow-up and eye examinations at 5-year intervals: the Rotterdam Study cohorts 1, 2, and 3 and the Blue Mountains Eye Study. Data were collected from 1990 to 2015, and data were analyzed from January 2019 to November 2020. MAIN OUTCOMES AND MEASURES: Area of GA was measured pixel by pixel using all available imaging. Area enlargement and enlargement of the square root-transformed area, time until GA reached the central fovea, and time until death were assessed, and best-corrected VA, smoking status, macular lesions according to the Three Continent AMD Consortium classification, a modified version of the Wisconsin age-related maculopathy grading system, and AMD genetic variants were covariates in Spearman, Pearson, or Mann-Whitney analyses. RESULTS: Of 171 included patients, 106 (62.0%) were female, and the mean (SD) age at inclusion was 82.6 (7.1) years. A total of 147 of 242 eyes with GA (60.7%) were newly diagnosed in our study. The mean area of GA at first presentation was 3.74 mm2 (95% CI, 3.11-4.67). Enlargement rate varied widely between persons (0.02 to 4.05 mm2 per year), with a mean of 1.09 mm2 per year (95% CI, 0.89-1.30). Stage of AMD in the other eye was correlated with GA enlargement (Spearman ρ = 0.34; P = .01). Foveal involvement was already present in incident GA in 55 of 147 eyes (37.4%); 23 of 42 eyes (55%) developed this after a mean (range) period of 5.6 (3-12) years, and foveal involvement did not develop before death in 11 of 42 eyes (26%). After first diagnosis, 121 of 171 patients with GA (70.8%) died after a mean (SD) period of 6.4 (5.4) years. Visual function was visually impaired (less than 20/63) in 47 of 107 patients (43.9%) at last visit before death. CONCLUSIONS AND RELEVANCE: In this study, enlargement of GA appeared to be highly variable in the general population. More than one-third of incident GA was foveal at first presentation; those with extrafoveal GA developed foveal GA after a mean of 5.6 years. Future intervention trials should focus on recruiting those patients who have a high chance of severe visual decline within their life expectancy.

Reduced estimated GFR and cancer mortality.

BACKGROUND: Chronic kidney disease is associated with an increased risk of cancer, but whether reduced kidney function also leads to increased cancer mortality is uncertain. The aim of our study was to assess the independent effects of reduced kidney function on the risk of cancer deaths. STUDY DESIGN: Prospective population-based cohort study. SETTING & PARTICIPANTS: Participants of the Blue Mountains Eye Study (n=4,077; aged 49-97 years). PREDICTOR: Estimated glomerular filtration rate (eGFR). OUTCOMES: Overall and site-specific cancer mortality. RESULTS: During a median follow-up of 12.8 (IQR, 8.6-15.8) years, 370 cancer deaths were observed in our study cohort. For every 10-mL/min/1.73 m(2) reduction in eGFR, there was an increase in cancer-specific mortality of 18% in the fully adjusted model (P<0.001). Compared with participants with eGFR ≥ 60 mL/min/1.73 m(2), the adjusted HR for cancer-specific mortality for those with eGFR<60 mL/min/1.73 m(2) was 1.27 (95% CI, 1.00-1.60; P=0.05). This excess cancer mortality varied with site, with the greatest risk for breast and urinary tract cancer deaths (adjusted HRs of 1.99 [95% CI, 1.05-3.85; P=0.01] and 2.54 [95% CI, 1.02-6.44; P=0.04], respectively). LIMITATIONS: Residual confounding, such as from unmeasured socioeconomic factors and the potential effects of erythropoiesis-stimulating agents on cancer deaths, may have occurred. CONCLUSIONS: eGFR<60 mL/min/1.73m(2) appears to be a significant risk factor for death from cancer. These effects appear to be site specific, with breast and urinary tract cancers incurring the greatest risk of death among those with reduced kidney function.

The relationship of retinal vessel caliber with erectile dysfunction in patients with type 2 diabetes.

PURPOSE: To investigate the relationship of retinal vessel caliber with erectile dysfunction (ED) in males with type 2 diabetes. METHODS: A hospital-based cross-sectional study. Male patients with type 2 diabetes were recruited from the Diabetic Management Project. All underwent a complete eye examination, a comprehensive interview, and blood and urine tests. Retinal vessel diameter was measured from retinal photographs by trained graders using semiautomated software. ED was defined as problems achieving or maintaining an erection and was assessed using a self-reported questionnaire. RESULTS: A total of 289 male patients with a mean (±SD) age of 65.3 years (±11.2) were assessed. After adjusting for age, diastolic blood pressure, duration of diabetes, HbA1c, total cholesterol, presence of diabetic retinopathy, and any diabetic complication, narrower retinal arteriolar diameter (odds ratio [OR] 1.66; 95% confidence interval [CI] 1.09-2.54; P = 0.019) and wider venular diameter (OR 1.58; 95% CI 1.03-2.44; P = 0.038) were associated with ED. CONCLUSIONS: Narrower retinal arteriolar and wider venular diameter are independently associated with an increased risk of self-reported ED. These results suggest a microvascular component in the pathogenesis of this condition.

Automated quantification of retinal arteriovenous nicking from colour fundus images.

Retinal arteriovenous nicking (AV nicking) is the phenomenon where the venule is compressed or decreases in its caliber at both sides of an arteriovenous crossing. Recent research suggests that retinal AVN is associated with hypertension and cardiovascular diseases such as stroke. In this article, we propose a computer method for assessing the severity level of AV nicking of an artery-vein (AV) crossing in color retinal images. The vascular network is first extracted using a method based on multi-scale line detection. A trimming process is then performed to isolate the main vessels from unnecessary structures such as small branches or imaging artefact. Individual segments of each vessel are then identified and the vein is recognized through an artery-vein identification process. A vessel width measurement method is devised to measure the venular caliber along its two segments. The vessel width measurements of each venular segment is then analyzed and assessed separately and the final AVN index of a crossover is computed as the most severity of its two segments. The proposed technique was validated on 69 AV crossover points of varying AV nicking levels extracted from retinal images of the Singapore Malay Eye Study (SiMES). The results show that the computed AVN values are highly correlated with the manual grading with a Spearman correlation coefficient of 0.70. This has demonstrated the accuracy of the proposed method and the feasibility to develop a computer method for automatic AV nicking detection. The quantitative measurements provided by the system may help to establish a more reliable link between AV nicking and known systemic and eye diseases, which deserves further examination and exploration.

Reliability and reproducibility of retinal oxygen saturation measurements using a predefined peri-papillary annulus.

PURPOSE: To determine the reliability and reproducibility of the Vesselmap Oximetry Module for arteriolar and venular oxygen saturation (SO2 ) of the same retinal area, specified by a peripapillary annulus, in healthy subjects. METHODS: Fundus oximetry images were obtained, using a standardized protocol by a single observer, from the right eye of 20 healthy individuals. Age range was 19-45 years old, and images were analysed using the oximetry module of the Vesselmap System (Imedos, UG, Germany). Intra-observer reliability (assessment of two measurements of SO2 values performed 5 days apart); interobserver reliability (assessment of SO2 performed by two different trained observers); and intrasubject reproducibility (comparison of SO2 measurements of two different images of the same subject and retinal area, taken 10 min apart) were assessed. The standard deviations between the repeated measurements (SDr), together with the intraclass correlation coefficient (ICC), of these three parameters were calculated. RESULTS: The SDr for intra-observer reliability was 0.56% and 0.55% for arteriolar and venular SO2 , respectively. The results were similar for intrasubject reproducibility (0.69% and 0.79% for arteriolar and venular SO2, respectively); interobserver reliability, however, was higher (SDr 1.22% and 1.01% for arteriolar and venular SO2 , respectively). The ICC values for intra-observer reliability were 0.99 for both arteriolar and venular SO2 . The results were similar for both interobserver reliability (0.94 for arteriolar SO2 and 0.96 for venular SO2 ) and intrasubject reproducibility (0.98 for both arteriolar and venular SO2 ). CONCLUSION: Retinal oxygen saturation values taken using the oximetry module of the Vesselmap System are highly reliable and reproducible, provided the image quality is standardized, the same measurement area is analysed in each image, and the number of observers analysing the images is kept to a minimum.

Quantitative and qualitative retinal microvascular characteristics and blood pressure.

OBJECTIVE: The present study examined the effects of blood pressure on a spectrum of quantitative and qualitative retinal microvascular signs. METHODS: Retinal photographs from the Singapore Malay Eye Study, a population-based cross-sectional study of 3280 (78.7% response) persons aged 40-80 years, were analyzed. Quantitative changes in the retinal vasculature (branching angle, vascular tortuosity, fractal dimension, and vascular caliber) were measured using a semi-automated computer-based program. Qualitative signs, including focal arteriolar narrowing (FAN), arteriovenous nicking (AVN), opacification of the arteriolar wall (OAW), and retinopathy (e.g., microaneurysms, retinal hemorrhages), were assessed from photographs by trained technicians. After excluding persons with diabetes and ungradable photographs, 1913 persons provided data for this analysis. RESULTS: In multivariable linear regression models controlling for age, sex, BMI, use of antihypertensive medication, and other factors, retinal arteriolar branching asymmetry ratio, arteriolar tortuosity, venular tortuosity, fractal dimension, arteriolar caliber, venular caliber, FAN, AVN, and retinopathy were independently associated with mean arterial blood pressure. In contrast, arteriolar/venular branching angle, venular branching asymmetry ratio and OAW were not related to blood pressure. Retinal arteriolar caliber (sß = -0.277) and FAN (sß = 0.170) had the strongest associations with mean arterial blood pressure, and higher blood pressure levels were associated with increasing number of both quantitative and qualitative retinal vascular signs (P trend <0.001). CONCLUSION: Elevated blood pressure is associated with a spectrum of quantitative and qualitative retinal vascular signs, with the number of signs increasing with higher blood pressure levels.

Heritability of optic disc diameters: a twin study.

PURPOSE: To assess the relative influence of genetic and environmental factors on optic disc size and cup/disc ratio in healthy eyes. METHODS: A sample of 55 monozygotic and 50 dizygotic healthy twin pairs aged 20-46, all having the same sex within pairs (47 pairs were male) had optic discs measured from colour fundus photographs according to the Wisconsin Protocol. Structural equation modelling was used to estimate the relative contribution of genetic and environmental factors to the phenotype. RESULTS: Disc dimensions did not vary significantly by age or sex. After adjusting for age and sex, additive genetic factors (i.e. heritability) explained 77% (95% CI: 65-85%) of variation of vertical disc diameters, whereas estimated unshared environmental effect was 23% (95% CI: 15-35%). For vertical cup diameters, heritability accounted for 70% (95% CI: 55-80%) and environmental factors 30% (95% CI: 20-45%). For cup/disc ratio, additive genetic and unshared environmental factors explained 66% (95% CI: 48-77%) and 34% (95% CI: 23-52%) of the variations, respectively. DISCUSSION: In this healthy twin sample, we found that three quarters of the variations in vertical optic disc and optic cup diameters were attributable to genetic influence.

Lens opacity and refractive influences on the measurement of retinal vascular fractal dimension.

PURPOSE: To examine the influence of lens opacity and refraction on the measurement of retinal vascular fractal dimension (Df). METHODS: Optic disc photographs (right eyes) of 3654 baseline Blue Mountains Eye Study participants (aged 49-97) were digitized. Retinal vascular Df was quantified using a computer-based program. Summated severity scores for nuclear, cortical and posterior subcapsular (PSC) cataract were assessed from lens photographs. Refraction data were converted to spherical equivalent refraction (SER), as sum spherical plus 0.5 cylinder power. Axial length was measured at 10-year follow-up examinations using an IOL master. RESULTS: Mean Df of the retinal vasculature was 1.444±0.023 for 2859 eligible participants. Increasing lens opacity scores were associated with significant reduction in Df (ß=-0.0030, p<0.0001). Both cortical and PSC cataract involving central lens area were associated with reduced Df, after controlling for confounding factors (p(trend) ≤0.0105). Increasing myopia severity was associated with reduced Df after adjusting for lens opacity scores and other confounders (p(trend) <0.0001). The slope of Df decrease per SER reduction was 0.0040 in eyes with SER≤-4D, compared to -0.0016 in eyes with SER>-4D. For axial length quintiles, there were no significant differences in mean Df in all groups except a reduction in the fifth quintile (axial length ≥24.15mm) (all p<0.05). CONCLUSION: Ocular media opacity independently influenced retinal vascular Df measurement, but we found no evidence supporting any refractive axial magnification effect on this measure. Myopic refraction ≤-4D was associated with a reduction in Df, suggesting rarefaction of retinal vasculature associated with high myopia.

Blood pressure is associated with retinal vessel signs in preadolescent children.

OBJECTIVE: Few studies have examined the effect of blood pressure (BP) on the retinal microvasculature in children. We examined the relationship between BP and retinal vessel caliber in a sample of preadolescent schoolchildren. METHODS: Eligible high school students [2353/3144 (response 75.3%); mean age, 12.7 years] from 21 randomly selected schools in Sydney, Australia, were examined during 2004-2005. Retinal vessel caliber was quantified from digital retinal images using well known computer-based programs. BP was measured using a standard protocol and high BP was defined according to published guidelines for this age group. RESULTS: After adjusting for age, sex, ethnicity, BMI, iris color, axial length, birth weight and the fellow retinal vascular caliber, children in the highest quartiles of SBP, DBP or mean arterial BP had approximately 5 mum narrower mean retinal arteriolar caliber than those in the lowest quartiles of all three BP measures (all P for trend <0.0001). Children classified as having high BP had approximately 2.0 mum narrower mean retinal arteriolar caliber than normotensive children (P = 0.002). In boys, each 10-mmHg increase in SBP was associated with a 2.19-mum increase in the mean retinal venular caliber (P = 0.0003), but no similar significant association was evident in girls. CONCLUSION: Elevated BP is associated with narrower retinal arterioles in preadolescent boys and girls, and also with wider retinal venules in boys. These data provide further evidence of early microvascular changes associated with high BP in older children.

Retinal vascular fractal dimension and risk of early diabetic retinopathy: A prospective study of children and adolescents with type 1 diabetes.

OBJECTIVE: To examine the prospective association of retinal vascular fractal dimension with diabetic retinopathy risk in young people with type 1 diabetes. RESEARCH DESIGN AND METHODS: This was a hospital-based prospective study of 590 patients aged 12-20 years with type 1 diabetes free of retinopathy at baseline. All patients had seven-field retinal photographs taken of both eyes. Incident retinopathy was ascertained from retinal photographs taken at follow-up visits. Fractal dimension was measured from baseline photographs using a computer-based program following a standardized protocol. RESULTS: Over a mean +/- SD follow-up period of 2.9 +/- 2.0 years, 262 participants developed mild nonproliferative diabetic retinopathy (15.0 per 100 person-years). After adjusting for age, sex, diabetes duration, A1C, and other risk factors, we found no association between retinal vascular fractal dimension and incident retinopathy. CONCLUSIONS: Retinal vascular fractal dimension was not associated with incident early diabetic retinopathy in this sample of children and adolescents with type 1 diabetes.

Prevalence and risk factors of ocular trauma in an urban south-east Asian population: the Singapore Malay Eye Study.

PURPOSE: To describe the prevalence and risk factors of ocular trauma in an urban Asian population. METHODS: A population-based survey of 3280 (78.7% response rate) Malay people aged 40-80 years residing in Singapore was conducted in 2004-2006. Interviewer-administered questionnaire was used to ascertain a history of ocular trauma, defined as any eye injury requiring medical attention from a doctor. RESULTS: Of the 3264 participants, 149 (5.0%, 95% confidence intervals [CI] 4.1-6.0%) reported a history of ocular trauma. Of those, 30.2% had trauma from a blunt object, 33.6% from a sharp object, and 22.1% from chemical burns. After adjusting for age and sex, men had a higher prevalence of ocular trauma than women (8.3% vs. 2.1%, age-adjusted odds ratio [OR] 4.7, CI 3.1-7.1), and younger persons had a higher risk of ocular trauma (per year increase in age, OR 0.98, CI 0.96-0.99). Consumption of alcohol was associated with higher likelihood of having ocular injury (OR 4.3, CI 2.2-8.4). CONCLUSIONS: One in 20 persons in this urban south-east Asian population had a history of ocular trauma. Younger persons, men and consumption of alcohol were risk factors for ocular trauma.

Risk prediction of coronary heart disease based on retinal vascular caliber (from the Atherosclerosis Risk In Communities [ARIC] Study).

Recent studies showed that such retinal vascular signs as quantitative retinal vascular caliber were associated with increased risk of incident coronary heart disease (CHD), but whether these retinal vascular signs add to the prediction of CHD over and above traditional CHD risk factors was not addressed. Whether these signs add to the prediction of CHD over and above the Framingham risk score in people (n = 9,155) without diabetes selected from the ARIC Study was investigated. Incident CHD was ascertained using standardized methods, and retinal vascular caliber and other retinal signs were measured from retinal photographs. After a mean of 8.8 years of follow-up, there were 700 incident CHD events. Women with wider retinal venular caliber (hazard ratio 1.27/1-SD increase, 95% confidence interval 1.08 to 1.50) and narrower retinal arteriolar caliber (hazard ratio 1.31/1-SD decrease, 95% confidence interval 1.10 to 1.56) had a higher risk of incident CHD after adjusting for Framingham risk score variables. Area under the receiver operator characteristic curve increased from 0.695 to 0.706 (1.7% increase) with the addition of retinal vascular caliber to the Framingham risk model. Risk prediction models with and without retinal vascular caliber both fitted the data and were well calibrated for women. In men, retinal vascular caliber was not associated with CHD risk after adjustment. Other retinal vascular signs were not associated with 10-year incident CHD in men or women. In conclusion, although retinal vascular caliber independently predicted CHD risk in women, the incremental predictive ability over that of the Framingham model was modest and unlikely to translate meaningfully into clinical practice.

Diabetic retinopathy and risk of heart failure.

OBJECTIVES: The purpose of this study was to examine the association of diabetic retinopathy with incident heart failure (HF). BACKGROUND: Microvascular disease might play a more prominent role in the pathogenesis of diabetic cardiomyopathy, a major cause of HF in diabetes. Whether diabetic retinopathy, a microvascular complication of diabetes, predicts HF is unclear. METHODS: A population-based study included 1,021 middle-aged type 2 diabetic persons with normal renal function and free of clinical coronary heart disease or HF at baseline. Diabetic retinopathy signs were graded from retinal photographs. Incident HF events were prospectively identified from hospital stay and death records. RESULTS: There were 125 (12.8%) participants with diabetic retinopathy. After 9-year follow-up, 106 (10.1%) participants developed incident HF events. Persons with retinopathy were more likely to develop HF (cumulative incidence of 21.6%) than those without retinopathy (cumulative incidence of 8.5%). After controlling for age, gender, race, smoking, diabetes duration, insulin use, blood pressure, lipid profile, and other risk factors, participants with retinopathy had more than 2.5-fold higher risk of developing HF than those without retinopathy (hazard ratio [HR] 2.71; 95% confidence interval [CI] 1.46 to 5.05). This association remained significant after further adjustments for glycemic control, carotid atherosclerosis, and serum markers of endothelial dysfunction (HR 2.20, 95% CI 1.08 to 4.47). CONCLUSIONS: The presence of diabetic retinopathy signifies an excess risk of HF, independent of known risk factors. This further supports a contribution of microvascular disease to the development of HF in people with diabetes.

Relationships of retinal vessel diameters with optic disc, macular and retinal nerve fiber layer parameters in 6-year-old children.

PURPOSE: To describe the normal anatomic relationships of retinal vessel diameters with optic disc, macula, and retinal nerve fiber layer parameters in young children. METHODS: This was a population-based, cross-sectional study of 1204 healthy children 6 years of age who were participating in the Sydney Childhood Eye Study. Retinal arteriolar and venular diameters were measured from fundus photographs using standardized computer-based methods. Optical coherence tomography was performed to obtain measurements of the optic disc, macula, and retinal nerve fiber layer parameters. RESULTS: In multivariate analyses, each standard deviation (SD) decrease in optic disc area was associated with a 0.14-pixel decrease (P = 0.05) in arteriolar diameter and a 0.31-pixel decrease (P < 0.01) in venular diameter. Each SD decrease in optic cup area was associated with a 0.15-pixel decrease (P = 0.05) in arteriolar diameter and a 0.43-pixel decrease (P < 0.01) in venular diameter. Each SD decrease in macular (inner/outer) thickness or volume was associated with a 0.25- to 0.39-pixel decrease (P < 0.01) in arteriolar diameter and a 0.36- to 0.71-pixel decrease (P < 0.01) in venular diameter, and each SD decrease in retinal nerve fiber layer thickness was associated with a 0.62-pixel decrease (P < 0.01) in arteriolar diameter and a 0.99-pixel decrease (P < 0.01) in venular diameter. CONCLUSIONS: Children's eyes with a smaller optic disc, thinner macula, and thinner retinal nerve fiber layer have narrower retinal vessels. These anatomic relationships may provide new insights into the vascular etiology of various ocular diseases.

Retinal vessel diameters and obesity: a population-based study in older persons.

OBJECTIVE: Obesity is linked with large vessel atherosclerosis and diabetes. Its association with microvascular changes is less clear. We investigated the associations among retinal vessel diameters, vessel wall signs, and BMI in an older population. RESEARCH METHODS AND PROCEDURES: Retinal photographs were taken on 3654 persons aged 49+ years at baseline of the Blue Mountains Eye Study in Australia. Arteriolar and venular diameters were measured from digitized retinal photographs of the right eyes. BMI was calculated as weight (kilograms)/height (meters2). Incident obesity was defined in persons with BMI < or = 30 at baseline but > 30 after 5 years. A significant weight gain was defined as an increase in BMI of 2+ SDs (4 or more units) over the 5-year period. RESULTS: At baseline, mean BMI was 26.1 (+/-4.6) in this population. At 5-year examinations, 177 (10.0% of 1773 at risk) developed incident obesity, and 136 (6.4% of 2143 at risk) had significant weight gain. After adjusting for age, sex, smoking, triglyceride levels, and mean arterial blood pressure, persons with wider retinal venular diameters had a higher risk of incident obesity (odds ratio, 1.8; 95% confidence interval, 1.0 to 3.1, comparing the highest with lowest venular diameter quintiles) and significant weight gain (odds ratio, 1.7; 95% confidence interval, 0.9 to 3.2). These associations were attenuated with further adjustment for baseline BMI. Arteriolar diameter was unrelated with baseline or change in BMI. DISCUSSION: Wider retinal venular diameter is associated with risk of obesity, independent of hypertension, diabetes, lipids, and cigarette smoking. These data may support a role for impaired microvascular function in the course of weight gain.

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. METHODS: Medical records of surgical patients in a large public hospital, west of Sydney, were reviewed retrospectively. Detection of ARM lesions was compared before and after surgery to determine sensitivity and specificity of preoperative diagnoses. Postoperative VA was assessed 4 weeks after surgery. RESULTS: Data were available for 721/784 eyes (92.0%) of 656 patients aged 60 years or older. ARM lesions were detected in 98 eyes (13.6%) before and 92 eyes (12.8%) after surgery. Sensitivities for detecting late ARM lesions, soft drusen and retinal pigment epithelium abnormalities preoperatively were 100%, 94% and 69%, respectively. Corresponding specificities were 100%, 100% and 77%, respectively. Postoperative VA achieved or remained 6/12 or better in 81.6% of eyes. CONCLUSION: A high sensitivity and specificity in detecting late ARM lesions and soft drusen preoperatively, and a good postoperative VA outcome is achievable in patients with preoperative early ARM lesions.

Prevalence and associations of epiretinal membranes in the visual impairment project.

PURPOSE: To determine the prevalence and factors associated with epiretinal membranes in a random sample of the population aged 40 years and older in Victoria, Australia. DESIGN: Population-based cross-sectional study. METHODS: Detailed eye examinations, including retinal photographs, were conducted in 1992 and 1997 in 3271 people (83% of the eligible) in Melbourne and 1473 (92% of the eligible) in rural Victoria. Eyes present with either cellophane macular reflex (CMR) or preretinal macular fibrosis (PMF) were classified as having epiretinal membranes. Eyes with both CMR and PMF present were classified as having PMF. Age-standardized prevalence rates and 95% confidence limits were calculated by the direct methods using Segi's world population. RESULTS: Epiretinal membranes were observed in 253 of 4313 participants (6.0%; 95% confidence interval [CI] 5.2 to 6.7), bilaterally in 19%. Prevalence increased significantly by age group (0.5% for 40 to 49 years, 2.6% for 50 to 59 years, 9.4% for 60 to 69 years, 15.1% for 70 to 79 years, and 11.3% for 80 years and older). Prevalence was similar in males and females after adjusting for age. The overall age- and gender-standardized prevalence of CMR was 4.8% (95% CI 4.0 to 5.6) and PMF was 1.7% (95% CI 1.2 to 2.3). A decrease in visual acuity (<6/6) was significantly associated with idiopathic PMF (odds ratio [OR] 1.9; 95% CI 1.0 to 3.6) and CMR (OR 1.5; 95% CI 1.1 to 2.0) after adjusting for age. CONCLUSIONS: The prevalence of epiretinal membranes was similar to that reported in other population-based studies. Population shifts in the age distribution to older ages could lead to an increase in mild visual impairment caused by epiretinal membranes.

Five-year incidence of age-related maculopathy: the Visual Impairment Project.

PURPOSE: To describe the 5-year incidence of age-related maculopathy (ARM) and the progression of the early stages of ARM lesions in Melbourne, Australia. DESIGN: Population-based cohort study. PARTICIPANTS: A total of 3271 participants aged 40 years and older from Melbourne, Victoria, Australia. MAIN OUTCOME MEASURES: The 5-year incidence and progression of ARM lesions. METHODS: Participants were recruited through a cluster random sampling from 9 urban clusters. Baseline examinations were conducted from 1992 through 1994, and the follow-up data were collected from 1997 through 1999. Presence of ARM lesions was graded from color stereo fundus photographs according to the International Classification and Grading System. RESULTS: The overall cumulative 5-year incidence of age-related macular degeneration (AMD) was 0.49% (95% confidence interval [CI], 0.2-0.8) and that of early ARM was 17.3% (95% CI, 8.7-26.0). The incidence of all ARM lesions increased with age (all P<0.001). The 5-year incidence of AMD was 0%, 0.69%, 1.7%, and 6.3% and that of early ARM was 13%, 22.7%, 29.8%, and 20% for participants aged 60 years and younger, aged 60 to 69 years, aged 70 to 79 years, and aged 80 years and older at baseline, respectively. People with soft indistinct drusen with pigmentary abnormalities had a 9.5 times (95% CI, 1.9-45.6) higher risk of developing AMD compared with people with soft drusen or pigmentary abnormalities. After adjusting for age, people with unilateral early ARM at baseline were 3 times (95% CI, 0.98-8.0) as likely to have early ARM in their second eye when compared with people with no ARM in both eyes. CONCLUSIONS: These data suggest that 1 in 3 persons aged 70 years or older will have ARM lesions over a 5-year period and that the disease will progress to a more severe form after the age of 80 years. The presence of soft indistinct drusen with pigmentary abnormalities significantly increased the risk for development of AMD.

Use of vitamin and zinc supplements and age-related maculopathy: the Blue Mountains Eye Study.

PURPOSE: To investigate relationships between vitamin and zinc supplement use and age-related maculopathy in a population-based sample. METHODS: We studied 2873 (79%) of the 3654 participants aged 49- 97 years who attended the cross-sectional Blue Mountains Eye Study and completed a detailed food frequency questionnaire, including type, dose and duration of supplement use. ARM was assessed during a masked grading of macular photographs. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using logistic regression. RESULTS: After adjusting for multiple confounders, we found that no vitamin or zinc supplements were significantly associated with reduced prevalence of any ARM lesions in either eye. The OR for use of any vitamin supplement was 1.3 (CI 0.9-1.7, p = 0.11) for individuals with any retinal pigment changes. It was 1.1 (CI 0.8-1.5, p = 0.59) for those with any soft (large) drusen and 1.5 (CI 0.7-3.0, p = 0.31) for those with late ARM lesions. The lack of association between supplement intake and ARM persisted regardless of their duration of use, dose or the smoking status of participants. The Breslow-Day test for heterogeneity was 0.24 with an OR for early ARM lesions among smokers of 0.7 (CI 0.4-1.3, p = 0.27), and 1.2 (CI 0.9-1.5, p = 0.24) among non-smokers. CONCLUSION: This cross-sectional population-based study investigated associations between vitamin and zinc supplement use and the prevalence of ARM lesions. Our findings provide no support for a protective association between vitamin and zinc supplement use and lesions indicating early ARM. The small numbers of subjects with late ARM lesions precluded any detailed investigation of benefits from supplement use on the prevalence of these lesions.