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Background Little is known about motor vehicle collision (MVC) risk in older drivers with age-related macular degeneration (AMD). The purpose of this study is to examine associations between MVC involvement and AMD presence and severity. Methods In a retrospective cohort study pooling the samples from four previous studies, we examined associations between MVC rate and older drivers with early, intermediate or advanced AMD as compared with those in normal eye health. MVC data were based on accident reports obtained from the state agency that compiles this information. Results MVC rate was highest among those in normal eye health and progressively declined among those with early and intermediate disease, and then increased for those with advanced AMD. However, only for drivers with intermediate AMD was the MVC rate significantly different (lower) as compared with those in normal eye health, regardless of whether the rate was defined in terms of person-years (RR 0.34, 95% CI 0.13 to 0.89) or person-miles (RR 0.35, 95% CI 0.13 to 0.91) of driving. Conclusions These results suggest that older drivers with intermediate AMD have a reduced risk of collision involvement. Further research should investigate whether self-regulatory driving practices by these drivers (avoiding challenging driving situations) underlies this reduced risk.

Aim To examine associations between retinal thickness and rod-mediated dark adaptation in older adults with non-exudative age-related maculopathy (ARM) or normal macular health. Methods A cross-sectional study was conducted with 74 adults ≥50 years old from the comprehensive ophthalmology and retina services of an academic eye centre. ARM presence and disease severity in the enrolment eye was defined by the masked grading of stereofundus photos using the Clinical Age-Related Maculopathy grading system. High-definition, spectral-domain optical coherence tomography was used to estimate retinal thickness in a grid of regions in the macula. Rod-mediated dark adaptation, recovery of light sensitivity after a photo-bleach, was measured over a 20-min period for a 500 nm target presented at 5° on the inferior vertical meridian. Main outcomes of interest were retinal thickness in the macula (μm) and parameters of rod-mediated dark adaptation (second slope, third slope, average sensitivity, final sensitivity). Results In non-exudative disease retinal thickness was decreased in greater disease severity; thinner retina was associated with reductions in average and final rod-mediated sensitivity even after adjustment for age and visual acuity. Conclusions Impairment in rod-mediated dark adaptation in non-exudative ARM is associated with macular thinning.

Aim:To examine whether the relationship between vision impairment and health-related quality of life (HRQoL) in nursing-home residents is impacted by coexisting cognitive impairment.Methods:This cross-sectional study involved a total of 382 English-speaking older adults (>55 years of age) with ⩾13 on the Mini Mental State Exam (MMSE) from seventeen nursing homes in Birmingham, Alabama. Assessments were taken of visual acuity (Lighthouse Near Visual Acuity Test), cognition (MMSE) and health-related quality of life (Nursing Home Vision-Targeted Health-Related Quality of Life Questionnaire, VF-14, and the SF-36).Results:A greater portion of participants had both vision and cognitive impairments (38.5%) as compared with those with neither impairment (21.5%), vision impairment alone (13.4%), and cognitive impairment alone (26.7%). Cognitive impairment did not modify the impact of vision impairment on HRQoL. The reduction in HRQoL associated with vision impairment was similar for those with and without cognitive impairment.Conclusion:The deleterious impact of vision impairment on HRQoL in nursing-home residents was not exacerbated by the co-occurrence of cognitive impairment. Ageing-related visual impairment in nursing-home residents is often reversible through treatment leading to improved HRQoL, and thus it is clinically important to know that cognitive impairment is unlikely to interfere with this benefit.

Background: Two recent studies reported over 70% of the patients with non-arteritic anterior ischaemic optic neuropathy (NAION) had sleep apnoea syndrome (SAS) diagnosed by overnight polysomnography. The current study used the Sleep Apnea scale of the Sleep Disorders Questionnaire (SA-SDQ) to evaluate this association. Methods: A matched case-control study was conducted among 73 cases of NAION matched on age and gender to 73 controls without a history of NAION. Information regarding demographics, medical conditions, health behaviours and SAS was obtained via a telephone questionnaire that included the SA-SDQ. Conditional logistic regression was used to calculate odds ratios (OR) and the 95% confidence intervals (CI) for the association between NAION and the SA-SDQ. Results: Cases were significantly more likely to report symptoms and characteristics consistent with SAS than controls (OR 2.62; 95% CI 1.03 to 6.60) when adjusted for medical and health behaviour characteristics. Conclusions: The results of this study suggest that patients with SAS are at increased risk of NAION. Additional research in a larger population is needed to confirm the observed results and validate the use of the SA-SDQ in patients with NAION.

Aim: To determine if elevated plasma levels of atherogenic and/or anti-atherogenic lipoproteins are risk factors for developing age related maculopathy (ARM). Methods: In a cross sectional study in a university clinic setting, 129 patients (72 women and 57 men) underwent colour fundus photography, acuity and contrast sensitivity assessment, and electroimmunoassays of plasma apolipoproteins B (apoB) and A-I (apoA-I), the principal proteins of low density and high density lipoproteins, respectively. Maculopathy stage was assigned using the AREDS grading system. Results: Levels of apoB in no ARM, mild, intermediate, and advanced ARM groups were 93.3, 91.8, 95.2, and 98.2 mg/dl, respectively. Levels of apoA-I were 147.4, 148.6, 141.0, and 144.9 mg/dl in the same groups. There was no significant association between these measures, typical for age, and maculopathy stage. Conclusion: Although drusen associated with ARM and ageing contain cholesterol and apoB, like the lipid rich core of an atherosclerotic plaque, the results of this study and our previous work in toto make the prospects of a plasma origin for these lesion constituents increasingly untenable. This conclusion is consistent with an emerging hypothesis that a large lipoprotein of intraocular origin is an important pathway for constituent retinal lipid processing and the biogenesis of drusen.

Aim To determine the association between Viagra (sildenafil) and Cialis (tadalafil) and non-arteritic anterior ischaemic optic neuropathy (NAION). Methods A retrospective matched case-control study was conducted. 38 cases of NAION in males were identified from an academic ophthalmology practice in Birmingham, Alabama, and matched (on age) to 38 controls without a history of NAION. Self reported information regarding past and current use of Viagra and/or Cialis was obtained via a telephone questionnaire from interviewers who were not blind to case status. Results Overall, males with NAION were no more likely to report a history of Viagra or Cialis use compared to similarly aged controls (odd ratio (OR) 1.75, 95% confidence interval (CI) 0.48 to 6.30 and OR 1.82, 95% CI 0.21 to 15.39). However, for those with a history of myocardial infarction, a statistically significant association was observed (OR 10.7, 95% CI 1.3 to 95.8). A similar association was observed for those with a history of hypertension though it lacked statistical significance (OR 6.9, 95% CI 0.8 to 63.6). Conclusions For men with a history of myocardial infarction or hypertension the use of Viagra or Cialis may increase the risk of NAION. Physicians prescribing these medications to patients with these conditions should warn them about the potential risk of NAION.

Aim: To test the hypothesis that individuals with age related macular degeneration (AMD) have increased C reactive protein (CRP) levels. Methods: A cross sectional study design using data from the Cardiovascular Health Study (CHS), a longitudinal study that enrolled older adults from four communities in the United States from 1989 to 1990, was employed to investigate the existence of an association between AMD and CRP levels in this population. Fundus photographs from 1997 and 1998 were used to identify individuals with (n = 390) and without AMD (n = 2365). The association between AMD and CRP levels (measured at baseline) was compared, adjusting for the potentially confounding effect of demographic, lifestyle, and health related characteristics. Results: Among the 2755 CHS participants with gradable fundus photographs, 390 were identified as having AMD. Overall, median CRP levels among those with AMD (1.76 mg/l) were similar to those without AMD (1.77 mg/l). CRP levels were categorised into quartiles and compared between those with and without AMD. Relative to those in the lowest quartile (0.07–0.93 mg/l), the odds ratios (OR) in the higher quartiles, adjusted for demographic, lifestyle, and health related characteristics were increased but not statistically significant (0.94–1.77 mg/l: OR = 1.14, 95% CI 0.82 to 1.60; 1.78–3.04 mg/l: OR = 1.24, 95% CI 0.88 to 1.75; >3.04 mg/l: OR = 1.24, 95% CI 0.87 to 1.78). Conclusions: In the CHS, there is no evidence that CRP levels are associated with AMD. These data do not support the theory alleging non-specific systemic inflammation in the aetiology and natural history of this disease.

Aims: To evaluate the association between thyroid problems and glaucoma. Methods: A population-based cross-sectional sample with 12,376 participants from the 2002 National Health Interview Survey. Odds ratios (OR) and 95% confidence intervals (CIs) were used to quantify the association between a self-reported diagnosis of glaucoma and a self-reported history of thyroid problems, controlling for demographic characteristics and smoking status. Results: The overall prevalence of glaucoma was 4.6%; 11.9% reported a history of thyroid problems. The prevalence of glaucoma among those who did and did not report thyroid problems was 6.5% and 4.4%, respectively (p = 0.0003). Following adjustment for differences in age, gender, race and smoking status, the association between glaucoma and thyroid problems remained (OR 1.38, 95% CI 1.08 to 1.76). Conclusions: The results of this study lend support to the hypothesis that thyroid disorders may increase the risk of glaucoma. Research should continue evaluating potential mechanisms underlying this relationship and whether the treatment of thyroid problems reduces subsequent glaucoma risk.