Ophthalmology (Eye & Ear Hospital) - Research Publications

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End date: 2005 × Start date: 2005 × Subject: CERA ×

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    Cardiovascular risk factors for retinal vein occlusion and arteriolar emboli: the atherosclerosis risk in communities & cardiovascular health studies
    Wong, Tien Yin ; Larsen, Emily K. Marino ; Klein, Ronald ; MITCHELL, PAUL ; Couper, David J. ; Klein, Barbara E. K. ; Hubbard, Larry D. ; Siscovick, David S. ; Sharrett, A. Richey (Elsevier, 2005)
    Objective: To examine the associations of retinal vein occlusion and arteriolar emboli with cardiovascular disease. Design: Population-based cross-sectional study. Participants: Pooled from the Atherosclerosis Risk in Communities Study (n = 12 642; mean age, 60 years) and the Cardiovascular Health Study (n = 2824; mean age, 79 years). Methods: Retinal vein occlusion and arteriolar emboli were identified from a single nonmydriatic retinal photograph using a standardized protocol. Photographs were also graded for arteriovenous nicking and focal arteriolar narrowing. All participants had a comprehensive systemic evaluation, including standardized carotid ultrasonography. Main Outcome Measures: Retinal vein occlusion and arteriolar emboli. Results: Prevalences of retinal vein occlusion and arteriolar emboli were 0.3% (n = 39 cases) and 0.2% (n = 34 cases), respectively. After adjusting for age, retinal vein occlusion was associated with hypertension (odds ratio OR, 2.96; 95% confidence interval CI, 1.43­6.14), systolic blood pressure (BP) (OR, 4.12; 95% CI, 1.40­12.16; highest quartile vs. lowest), diastolic BP (OR, 2.64; 95% CI, 1.07­6.46; highest quartile vs. lowest), carotid artery plaque (OR, 5.62; 95% CI, 2.60­12.16), body mass index (OR, 3.88; 95% CI, 1.23­12.18; highest quartile vs. lowest), plasma fibrinogen (OR, 3.29; 95% CI, 1.08­10.02; highest quartile vs. lowest), arteriovenous nicking (OR, 4.09; 95% CI, 2.00­8.36), and focal arteriolar narrowing (OR, 5.17; 95% CI, 2.59­10.29). After adjusting for age, retinal arteriolar emboli were associated with hypertension (OR, 3.14; 95% CI, 1.44­6.84), systolic BP (OR, 3.46; 95% CI, 1.13­10.65; highest quartile vs. lowest), prevalent coronary heart disease (OR, 2.33! ; 95% CI, 1.01­5.42), carotid artery plaque (OR, 4.62; 95% CI, 1.85­11.57), plasma lipoprotein (a) (OR, 3.6 []
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    Estrogen replacement therapy and retinal vascular caliber
    Wong, Tien Yin ; Knudtson, Michael D. ; Klein, Barbara E. K. ; Klein, Ronald ; Hubbard, Larry D. (Elsevier, 2005)
    Objective: It is unclear if estrogen replacement therapy (ERT) has an effect on the retinal circulation. In the current study, we examine the association of ERT, female reproductive factors, and retinal vascular caliber. Design: Population-based cross-sectional study. Participants: Women participants aged 43 to 84 years living in Beaver Dam, Wisconsin. Methods: Retinal photographs of participants taken at the baseline examination were digitized, and the diameters of arterioles and venules were measured using a well-established technique. Estrogen replacement therapy and female reproductive factors were ascertained by interview. Main Outcome Measures: Retinal arteriolar and venular diameters. Results: Of the 2469 women participants with data for analysis, 10.5% were current users of ERT and 7.4% were past users. After adjusting for age, blood pressure (BP), body mass index, smoking, and other factors, women who were current users of ERT had narrower retinal arteriolar and venular diameters than those who were past users or never used, with mean arteriolar diameters of 167.6 µm for current users, 170.8 µm for past users, and 170.9 µm for those who never used (P = 0.009) and mean venular diameters of 239.9 µm for current users, 244.0 µm for past users, and 243.9 µm for those who never used (P = 0.02). There was a significant trend of increasing narrowing for both arterioles (P trend, 0.01) and venules (P trend, 0.007) with increasing duration of ERT. Associations were somewhat stronger in younger women and women without a history of hypertension and cigarette smoking. Female reproductive factors (e.g., age of menarche and pregnancy) were not associated with retinal vessel diameters. Conclusions: Estrogen replacement therapy is associated with narrower retinal vessel diameters, independent of BP and other vascular factors.
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    The Q368STOP myocilin mutation in a population-based cohort: The Blue Mountains Eye Study
    Baird, PN ; Richardson, AJ ; Craig, JE ; Rochtchina, E ; Mackey, DA ; Mitchell, P (ELSEVIER SCIENCE INC, 2005-06)
    PURPOSE: To investigate the prevalence of the Q368STOP myocilin mutation in a population-based cohort: the Blue Mountains Eye Study (BMES). DESIGN: Population-based study. METHODS: DNA was extracted from 2,142 individuals collected through the BMES, including 31 individuals with glaucoma. All individuals were screened for the presence of the Q368STOP mutation of myocilin. Genotyping of the microsatellite markers My5, My3, D1S2815, and D1S1619 was also undertaken. RESULTS: None of the 31 open-angle glaucoma-positive individuals presented with the Q368STOP mutation. However, two individuals (aged 56 and 72) with no clinical signs of OAG, were identified with this mutation. Allele sharing at the four microsatellite markers defining the Q368STOP disease haplotype for OAG was found in these two individuals. CONCLUSIONS: The Q368STOP myocilin mutation occurs at a low prevalence (0.09%) in a general, older population.
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    Analysis of the EFEMP1 gene in individuals and families with early onset drusen
    Narendran, N. ; Guymer, R. H. ; Cain, M. ; Baird, P. N. (Nature Publishing Group, 2005-01)
    Aims Age-related macular degeneration (AMD) is considered a complex genetic disease, although the genetic influences are not yet fully understood. Genetic analysis is hampered by the late onset of disease and the difficulty in obtaining multigenerational families. To investigate this problem further we studied our population of early onset drusen cases. The Arg345Trp mutation on exon 10 of the EGF-containing fibulin-like extracellular matrix protein 1 (EFEMP1) gene causes two clinical phenotypes of early onset drusen (Doyne honeycomb retinal dystrophy and Malattia Leventinese), yet does not appear to be involved in other early onset drusen phenotypes or typical AMD. We wished to ascertain the involvement of the EFEMP1 gene in our population of sporadic and familial subjects presenting with early onset drusen! and t heir affected relatives.Methods Individuals presenting with drusen/end-stage maculopathy at 60 years or under were identified from retinal clinics in Melbourne. All available first- and second-degree relatives were also examined. In all, 116 ethnically matched controls were collected from the same community for comparison.Results Single stranded conformational polymorphism (SSCP) analysis and subsequent sequencing revealed four previously described and three novel sequence variations. Most occurred at similar frequencies in the case and control populations and were not thought to be disease associated.ConclusionThe term early onset drusen encompasses a wide range of phenotypes and our findings indicate that it is likely that more than one gene is involved in its causation. It is essential that these clinical phenotypes are well described and categorised to allow greater possibility! of su ccess in the search for other disease genes.
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    Detecting cataract causing visual impairment using a nonmydriatic fundus camera
    Ferraro, John G. ; Pollard, Tamara ; MULLER, ANDREAS ; Lamoureux, Ecosse L. ; Taylor, Hugh R. (Elsevier, 2005-04)
    To assess the validity of a digital nonmydriatic fundus camera in detecting cataract as a cause of visual impairment. DESIGN: Diagnostic test comparison. METHODS: Photos of the anterior segment of 72 eyes were taken with a nonmydriatic fundus camera and assessed for cataract by two graders. Dilated biomicroscopy examination of the anterior segment of the same 72 eyes was then performed and cataract graded using the Wilmer scale. RESULTS: Grader 1 and 2 reported 90% and 94% sensitivity and 82% and 77% specificity, respectively, when the digital photos were compared with slit-lamp biomicroscopy in determining visually significant cataract. In addition, both graders showed similar subs al photos and slit-lamp biomicroscopy when assessed for cataract (unweighted kappa 0.87 and 0.92, respectively, for graders 1 and 2). CONCLUSION: The nonmydriatic fundus camera may be an alternative method for screening for visually significant cataract in the community.
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    Prevalence of associations of epiretinal membranes in the Visual Impairment Project
    McCarty, Daniel J. ; Mukesh, Bickol N. ; Chikani, Vatsal ; Wang, Jie J. ; MITCHELL, PAUL ; Taylor, Hugh R. ; McCarty, Catherine A. (Elsevier, 2005)
    Epiretinal Membrane also referred as primary retinal folds, silent central vein obstruction, wrinkling of the internal retinal surface, preretinal gliosis, preretinal macular fibrosis, cellophane maculopathy, and macular pucker, is a condition characterised by proliferation of abnormal tissues on the surface of the macula or central retina of the eye.
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    Clinical examination and laboratory tests for estimation of trachoma prevalence in a remote setting: what are they really telling us?
    Wright, Heathcote R. ; Taylor, Hugh R. (Elsevier, 2005-05)
    Worldwide, an estimated 84 million people have active trachoma and 7.6 million people have trachomatous trichiasis. WHO’s SAFE strategy is an effective tool in the worldwide effort to eliminate blinding trachoma, but its institution and monitoring requires a simple, reliable, and cost-effective method to detect disease. To date, clinical examination has provided the main method of diagnosis. Detection of Chlamydia trachomatis with nucleic acid amplification test does not always correlate well with clinical findings, which has prompted the suggestion that these methods should replace clinical examination. However, a review of the research carried out in animals and human beings suggests the relation between laboratory tests and clinical examination is due to the kinetics of trachoma and not to an inherent problem in either detection system. Given the increased difficulties of using laboratory tests in parts of the world where trachoma is endemic, we should not abandon clinical grading as a tool to asses the need for, and the effectiveness of, trachoma intervention programmes.
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    Impact of unilateral and bilateral vision loss on quality of life
    Vu, H. T. V. ; Keeffe, J. E. ; McCarty, C. A. ; Taylor, H. R. (BMJ Publishing Group, 2005-03)
    Aim: To investigate whether unilateral vision loss reduced any aspects of quality of life in comparison with normal vision and to compare its impact with that of bilateral vision loss. Methods: This study used cluster stratified random sample of 3271 urban participants recruited between 1992 and 1994 for the Melbourne Visual Impairment Project. All predictors and outcomes were from the 5 year follow up examinations conducted in 1997–9. Results: There were 2530 participants who attended the follow up survey and had measurement of presenting visual acuity. Both unilateral and bilateral vision loss were significantly associated with increased odds of having problems in visual functions including reading the telephone book, newspaper, watching television, and seeing faces. Non-correctable by refraction unilateral vision loss increased the odds of falling when away from home (OR = 2.86, 95% CI 1.16 to 7.08), getting help with chores (OR = 3.09, 95% CI 1.40 to 6.83), and becoming dependent (getting help with meals and chores) (OR = 7.50, 95% CI 1.97 to 28.6). Non-correctable bilateral visual loss was associated with many activities of daily living except falling. Conclusions: Non-correctable unilateral vision loss was associated with issues of safety and independent living while non-correctable bilateral vision loss was associated with nursing home placement, emotional wellbeing, use of community services, and activities of daily living. Correctable or treatable vision loss should be detected and attended to.
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    Assessment of optic disc cupping with digital fundus photographs
    Constantinou, M. ; Ferraro, J. G. ; Lamoureux, E. L. ; Taylor, H. R. (Elsevier, 2005)
    PURPOSE: To determine the agreement between the assessment of retinal digital images by using an overlay transparency sheet and the Heidelberg retinal tomograph (HRT) in determining cup-disk ratios greater than 0.6. DESIGN: Diagnostic test comparison. METHODS: Computerized topographic and monoscopic digital images of the optic disk of 628 people aged 70 to 79 years were assessed. A grader (M.C.) defined the disk margin on HRT images, and the operation software computed the area cup-disk ratio. The same grader also determined whether the vertical cup-disk ratio on retinal images was greater than 0.6 by superimposing a transparency overlay sheet over the images. Findings of a second grader (J.G.F.) were used to establish reliability measures. RESULTS:The intragrader reliability for the overlay method and HRT was almost perfect (intraclass correlation coefficient [ICC] = 0.96 and 0.99, respectively), whereas the intergrader reliability was good (ICC = 0.77 and 0.92, respectively). A perfect agreement was found on 28 (85%) of 33 eyes between the overlay and HRT methods in determining cup-disk ratios greater than 0.6. CONCLUSIONS: The overlay transparency method appears to be a reliable and promising alternative in determining cup-disk ratios greater than 0.6 in a community screening setting.
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    Retinopathy in persons with impaired glucose metabolism : The Australian Diabetes Obesity and Lifestyle (AusDiab) Study
    Wong, T. ; Barr, E. ; Tapp, R. ; Harper, C. A. ; Taylor, H. R. ; Zimmet, P. ; Shaw, J. (Elsevier, 2005)
    PURPOSE: To describe risk factors and vascular disease associations of retinopathy in people with impaired glucose metabolism. DESIGN: Population-based cross-sectional study. METHODS: Retinal photographs taken of participants with impaired glucose tolerance and impaired fasting glucose were graded for retinopathy. Risk factors and cardiovascular outcomes were ascertained. RESULTS: Retinopathy was present in 69 (6.7%) of 1027 participants with impaired glucose tolerance or impaired fasting glucose. After multivariate adjustment, retinopathy was associated with prevalent stroke (odds ratio 4.2, 95% confidence interval, 1.8 to 9.7). CONCLUSIONS: Retinopathy is common in persons with impaired glucose metabolism and may be associated with prevalent stroke.