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AimTo assess the prevalence of retrodots and vacuoles and their associations with the prevalence and long-term incidence of age-related cataract in an older Australian cohort.MethodsOf 3654 baseline participants of the Blue Mountains Eye Study aged 49+ years (1992-1994), 2335 and 1952 were re-examined after 5 and 10 years, respectively. Lens photographs were graded for cataract, retrodots, and vacuoles. Eye-specific data were used to assess the associations between retrodots or vacuoles at baseline and the prevalence and 10-year incidence of nuclear, cortical, and posterior subcapsular (PSC) cataract and cataract surgery.ResultsAt baseline, retrodots were present in 142 persons (4%) and vacuoles in 1333 persons (40%). Prevalence of both lens features increased with increasing age (Pfor trend <0.0001). After adjusting for age and gender, vacuoles were associated with prevalent PSC cataract at baseline (odds ratio (OR), 1.60, 95% confidence interval (CI), 1.25-2.05). After adjusting for age, gender, smoking, hypertension, diabetes, education, and use of inhaled/oral steroids, baseline retrodots were associated with an increased incidence of cataract surgery (OR 2.90, 95% CI 1.71-4.91), while 3+ vacuoles at baseline were associated with an increased risk of PSC cataract (OR 3.56, 95% CI 2.13-5.95) and cataract surgery (OR 1.84, 95% CI 1.22-2.77).DiscussionLens retrodots and vacuoles were found to be positively associated with 10-year incidence of cataract surgery, and vacuoles associated with PSC cataract, a finding suggestive of shared risk factors or pathogenesis between these two lens features and the development of PSC cataract. [ABSTRACT FROM AUTHOR]

PurposeTo describe the relationship of retinal vascular calibre with diabetes and diabetic retinopathy in an Asian population.MethodsA total of 3280 (78.7% response) subjects, aged 40–80 years, of Malay ethnicity residing in Singapore participated in this population-based, cross-sectional study. Retinal vascular calibre was measured and summarized using a validated computer programme from digital retinal photographs. Diabetic retinopathy signs were graded from photographs using the modified Airlie House classification.ResultsOf the 3004 subjects with data for this analysis, 682 (22.7%) had diabetes, of whom 194 (28.4%) had retinopathy. After multivariable adjustment, retinal arteriolar calibre was significantly wider in persons with diabetes (141 vs139 μm, P<0.001); venular calibre was not associated with diabetes (P=0.93). Among participants with diabetes, venular calibre increased from 218.7 μm in those without retinopathy to 231.1 μm in those with moderate and 231.4 μm in those with severe retinopathy (Pfor trend=<0.001); arteriolar calibre was not associated with diabetic retinopathy.ConclusionsThis study shows wider retinal arterioles in diabetes and wider venules in those with diabetic retinopathy in an Asian population. These findings confirm earlier data on white population, supporting the concept that a quantitative assessment of retinal vasculature may provide further insights into early diabetic microvascular damage.Eye (2009) 23, 1719–1724; doi:10.1038/eye.2008.362; published online 12 December 2008 [ABSTRACT FROM AUTHOR]

PurposeTo determine the prevalence and risk factors of epiretinal membranes (ERM) in a Japanese population.Patients and MethodsThe Funagata Study examined 1758 Japanese aged 35 years or older (42% of eligible) from June 2000 to June 2002. A total of 1723 (98.0%) participants had non-mydriatic fundus photographs of the right eye to grade the presence of ERM, using the Blue Mountains Eye Study (BMES) protocol. After age standardization, the prevalence of ERM in the right eyes of the participants included in this study was compared with that reported from right eyes of participants in the BMES and the Beaver Dam Eye Study (BDES). ERM detected in eyes with diabetic retinopathy and other retinal lesions were excluded from the analysis of associations. Multiple logistic regression models were used to determine risk factors for the presence of ERM, adjusting for age and gender.ResultsThere were 84 right eyes with ERM, representing 5.44% of this sample. After age standardization, the prevalence rate (5.7%) was within the range reported in the BMES (3.5%) and the BDES (6.9%). Older age (gender-adjusted odds ratio (OR) per 10 years: 1.72, 95% confidence interval (CI): 1.40–2.11) and diabetes (age-gender-adjusted OR: 1.84, 95% CI: 1.01–3.37) were the only two factors associated with ERM.ConclusionsWe found a similar prevalence of ERM in the Japanese as in mainly white populations. Increasing age and diabetes were risk factors for ERM in this adult Japanese population.Eye (2009) 23, 1045–1051; doi:10.1038/eye.2008.238; published online 8 August 2008 [ABSTRACT FROM AUTHOR]

PurposeTo examine the prevalence of refractive error and distribution of ocular biometric parameters among major ethnic groups in a population-based sample of 11–15-year-old Australian children.MethodsThe Sydney Myopia Study examined 2353 students (75.3% response) from a random cluster-sample of 21 secondary schools across Sydney. Examinations included cycloplegic autorefraction, and measures of corneal radius of curvature, anterior chamber depth, and axial length.ResultsParticipants mean age was 12.7 years (range 11.1–14.4); 49.4% were female. Overall, 60.0% of children had European Caucasian ethnicity, 15.0% East Asian, 7.1% Middle Eastern, and 5.5% South Asian. The most frequent refractive error was mild hyperopia (59.4%, 95% confidence interval (CI), 53.2–65.6), defined as spherical equivalent (SE) +0.50 to +1.99 D. Myopia (SE−0.50 D or less) was found in 11.9%, 95% (CI 6.6–17.2), and moderate hyperopia (SE+2.00 D) in 3.5%, 95% (CI 2.8–4.1). Myopia prevalence was lower among European Caucasian children (4.6%, 95% CI 3.1–6.1) and Middle Eastern children (6.1%, 95% CI 1.3–11.0) than among East Asian (39.5%, 95%, CI 25.6–53.5) and South Asian (31.5%, 95%, CI 21.6–41.4) children. European Caucasian children had the most hyperopic mean SE (+0.82 D) and shortest mean axial length (23.23 mm). East Asian children had the most myopic mean SE (−0.69 D) and greatest mean axial length (23.86 mm).ConclusionThe overall myopia prevalence in this sample was lower than in recent similar-aged European Caucasian population samples. East Asian children in our sample had both a higher prevalence of myopia and longer mean axial length.Eye (2008) 22, 649–656; doi:10.1038/sj.eye.6702701; published online 2 February 2007 [ABSTRACT FROM AUTHOR]

PurposeTo assess the long-term outcomes from cataract surgery on self-rated health, and health-related quality of life (HRQOL) in a population-based older sample.MethodsParticipants of the Blue Mountains Eye Study at the baseline (n=3654), 5 (n=2335), and 10-year follow-up (n=1952) were interviewed and examined. Questionnaires included an assessment of self-rated health and HRQOL using the 36-item Short-Form Health Survey (SF-36). Incident cataract surgery was defined if participants had cataract surgery since baseline, and confirmed via lens photographic grading.ResultsThere was no statistically significant difference in the proportions of participants who experienced a change in self-rated health between those who had incident cataract surgery (14.1% improvement; 29.1% deterioration) and non-surgical subjects (16.7% improvement; 27.0% deterioration). We found no association between incident cataract surgery and the odds for 10-year change in self-rated health, after multivariate adjustment. In contrast, participants who had incident cataract surgery had a significant improvement in the mean scores of ‘mental health’ domain of HRQOL (+1.60 vs−2.04, P=0.02) and in the mental component score (+1.43 vs−0.82, P=0.02) than participants who did not undergo surgery. Cataract surgery during follow-up had no significant influence on change in mean scores of other domains or in their physical component score of the SF-36 (−2.57 in participants who had incident surgery vs−2.29 in non-surgical participants, P=0.78).ConclusionsWe confirmed long-term improvement following cataract surgery in the mental but not in the physical domain of the SF-36 or in answers to a specific self-rated health question.Eye (2008) 22, 479–484; doi:10.1038/sj.eye.6702854; published online 4 May 2007 [ABSTRACT FROM AUTHOR]

Aim of purposeTo observe the different expression of matrix metalloproteinases (MMPs) between pre- and postoperation of sham cataract surgery in vitrohuman lens capsule bag model from the same donor eye in order to investigate a possible role of MMPs in posterior capsule opacification (PCO).MethodsSham cataract surgeries were performed in six human donor eyes. Immunohistochemical staining was used to detect the expression of MMP-2 and -9 of human lens epithelial cells (LECs) on the anterior capsulorhexis. LEC migration on posterior capsule of human lens from the same donor eye was observed in a modified capsule bag model without pin. Total MMP-2 and -9 protein production were determined by enzyme-linked immunosorbent assay at days 2, 10, 20, and 30 postoperation, respectively.ResultsMMP-2 and -9 could not be detected immunohistochemically on the anterior capsulorhexis preoperation of cataract. Lens epithelia cells at the equator began to migrate by day 4. A confluent monolayer of lens epithelia cells was present on the posterior capsule at day 20. Total MMP-2 and -9 protein production increased with time with maximum levels reached on day 30.ConclusionMMP-2 and -9 were showed to be upregulated following sham cataract surgery. MMP expression could play an important role in PCO.Eye (2008) 22, 439–444; doi:10.1038/sj.eye.6702735; published online 16 February 2007 [ABSTRACT FROM AUTHOR]

PurposeTo assess age-related maculopathy (ARM) in eyes of patients who had undergone cataract surgery for at least a year.MethodsConsecutive patients aged 60+ years who had undergone cataract surgery at Westmead Hospital, Sydney, Australia, during 2001–2003 were examined in 2004. Interview using standardized questionnaires and stereo retinal photography was performed. Retinal photographs were graded using the Wisconsin ARM grading system. The proportions with ARM were compared between surgical and nonsurgical eyes, and between this surgical cohort and the Blue Mountains Eye Study (BMES) population.ResultsOf the 622 eligible patients, 454 (73%) were re-examined, with a mean follow-period of 2.8 years. Surgical eyes had a higher proportion of early ARM compared to nonsurgical eyes (15.2 vs10.3%, P=0.07) and to the early ARM prevalence found in BMES participants of similar age (14.5 vs6.9%, P<0.01), which persisted after age standardization to the BMES population (9.7 vs6.9%, P<0.05).ConclusionsWe found an increased prevalence of early ARM in surgical eyes of patients 1–3 years after cataract surgery. Whether this increased early ARM prevalence leads to an increased prevalence of late ARM in the long-term warrants further investigation.Eye (2007) 21, 512–517. doi:10.1038/sj.eye.6702254; published online 27 January 2006 [ABSTRACT FROM AUTHOR]

PurposeTo assess visual acuity (VA) and health-related quality of life (HRQoL) outcomes in patients with and without age-related maculopathy (ARM) after cataract surgery.MethodsPatients aged 60+ years who had undergone cataract surgery at the Westmead Hospital during 2001–2003 were re-examined 1–3 years after surgery. Tests included VA and assessment of visual- and HRQoL using standardised questionnaires (VF-14, SF-12). Preoperative comorbidity data were collected from medical records. Poor surgical outcomes (VA<6/12; no VA improvement; lowest quintile of VF-14, SF-12 scores) were compared in patients with and without ARM, adjusting for age, sex, preoperative systemic comorbidities, ocular comorbidities and surgical or postoperative complications.ResultsOf 622 surviving patients, 454 (73%) were followed up for a mean period of 2.8 years. Similar proportions with VA≥6/12 were observed in patients with (80.2%) and without (88.8%) pre-existing ARM. Preoperative early ARM was only associated with slightly lower mean VF-14 scores (87.64 with vs92.58 without ARM, P=0.01). Increasing age and preoperative ocular comorbidities were associated with all poor outcomes measured. Low SF-12 scores were associated with preoperative systemic comorbidities.ConclusionOur study documents favourable cataract surgical outcomes 1–3 years after cataract surgery in patients with preoperative ARM.Eye (2007) 21, 324–330. doi:10.1038/sj.eye.6702171; published online 11 November 2005 [ABSTRACT FROM AUTHOR]

PurposeTo assess the 5-year incidence of vascular retinopathy and its associations in an older nondiabetic population.MethodsThe Blue Mountains Eye Study examined 3654 residents aged 49+ years (82.4% response rate) during 1992–1994, and re-examined 2335 (75.1% of survivors) during 1997–1999. Retinopathy lesions (microaneurysms, haemorrhages, hard or soft exudates) were assessed from 6-field retinal photographs in persons without diabetes. Incident retinopathy was assessed in those at risk. Hypertensive status was defined following the WHO/International Society of Hypertension guidelines.ResultsOf the 2335 re-examined, 195 had retinopathy lesions at baseline and 1725 were at risk of retinopathy after excluding subjects with diabetes (n=261), retinal vein occlusion (n=52) or missing/un-gradable photographs (n=102). The cumulative 5-year incidence was 9.7% (95% confidence intervals (CI) 8.3–11.1%). Age was the only factor significantly associated with incident retinopathy (Pfor trend=0.012). Neither fasting blood glucose (age–sex-adjusted P=0.147) nor hypertension (adjusted Pfor trend=0.43) was associated with incident retinopathy. Of the 195 with retinopathy lesions at baseline, 3.5% developed diabetes, 13.3% progressed, and 72.3% regressed/disappeared over 5 years. Progression was positively associated with elevated blood pressure (BP) (adjusted odds ratio (OR) 1.3, 95% CI 1.1–1.6 per 10 mmHg systolic BP) and inversely associated with fasting glucose level (OR 0.36, CI 0.14–0.92 per mmol/l increase). Aspirin use was weakly associated with regression (OR 2.4, CI 1.0–6.0).ConclusionsOver 5 years, retinopathy developed in 10% of older people without diabetes, while 72% of baseline lesions regressed. Age was significantly associated with the development of these lesions.Eye (2006) 20, 1239–1245. doi:10.1038/sj.eye.6702085; published online 16 September 2005 [ABSTRACT FROM AUTHOR]

PurposeThere are few data on the effect of serum lipids on microvascular disease. This study assessed the relationships between serum lipid levels and microvascular disease, as seen in the retina, among participants who attended a population-based study in Australia (n=3654, aged 49+years).MethodsDiameters of retinal arterioles and venules were measured from digitised photographs of each participant to obtain an estimate of generalised arteriolar narrowing. Focal arteriolar narrowing, arteriovenous nicking, and retinopathy lesions (microaneurysms, haemorrhages, hard/soft exudates) were graded using a standard protocol. Fasting blood tests were performed in 89% of subjects. Adjusted means were calculated using general linear models. Logistic regression models were used to determine the odds ratios for retinal microvascular signs.ResultsAfter controlling for age, sex, body mass index, smoking, and mean arterial blood pressure, elevated high-density lipoprotein cholesterol was associated with narrower retinal arterioles (Ptrend=0.002) and venules (Ptrend=0.03) and with increased odds of generalised arteriolar narrowing (odds ratio 1.6, 95% confidence interval 1.1–2.2 for the highest vs the lowest quintile of high-density lipoprotein cholesterol). Serum triglyceride had a U-shaped relationship with venular diameter (Ptrend=0.003). We found no consistent pattern of association between serum total cholesterol or low-density lipoprotein cholesterol and any retinal microvascular signs.ConclusionsThese findings suggest that microvascular disease in the retina may result from processes distinct from dyslipidaemia.Eye (2005) 19, 861–868. doi:10.1038/sj.eye.6701668; published online 3 September 2004 [ABSTRACT FROM AUTHOR]