Aim: To determine the level of correct knowledge about common eye disease and attitudes towards blindness prevention and treatment, and how these factors influence self care practices in a population based sample.Methods: A cluster random sample of the Victorian population was interviewed. The study population comprised residents aged 40 years of age or older living in five randomly selected Melbourne metropolitan suburbs and four randomly selected rural areas of Victoria. Questions were asked to ascertain each person's knowledge of common age related eye disease - that is, cataract, age related macular degeneration (AMD), and glaucoma. A subsample of the population was also asked questions to determine their attitudes to blindness prevention and treatment. All respondents were asked the year of their last visit to an eye practitioner.Results: A total of 3184 (89%) eligible residents were assessed. Sex (females), age (younger people), higher levels of education (secondary, trade, or tertiary education), recent visit to an eye practitioner (within the past 2 years) and English spoken at home appeared to be significant predictors of knowledge of common age related eye conditions. Younger people believed blindness prevention and blindness treatment were the highest priorities compared with other diseases; people who spoke English at home and people with knowledge of common age related eye disease also considered blindness treatment to be the highest priority compared with other diseases. People with a previous diagnosis of age related eye disease, older people, females, people with correct knowledge of common eye diseases, and those who spoke English at home were significantly more likely to be under eye care. No interaction was found between knowledge and positive attitudes to self care practices.Conclusion: These data show that here is a large gap in the public's knowledge and understanding of eye disease that will need to be understood for e

Purpose: To describe predictors of mortality in the 5-year follow-up of the Melbourne Visual Impairment Project (VIP) cohort. Methods: The Melbourne VIP was a population-based study of the distribution and determinants of age-related eye disease in a cluster random sample of Melbourne residents aged 40 years and older. Baseline examinations were conducted between 1992 and 1994. In 1997, 5-year follow-up examinations of the original cohort commenced. Causes of death were obtained from the National Death Index for all reported deaths. Results: Of the original 3,271 participants, 231 (7.1%) were reported to have died in the intervening 5 years. Of the remaining 3,040 participants eligible to return for follow-up examinations, 2,594 (85% of eligible) did participate, 51 (2%) had moved interstate or overseas, 83 (3%) could not be traced, and 312 (10%) refused to participate. Best corrected visual acuity <6/12 and cortical cataract were associated with a significantly increased risk of mortality, as were increasing age, male sex, increased duration of cigarette smoking, increased duration of hypertension, and arthritis. Conclusions: Even mild visual impairment increases the risk of death more than twofold.

As part of the Visual Impairment Project, a population-based study of eye disease, we have studied the self-reported prevalence of diabetes mellitus in a random sample of Victorians aged 40 years and older, and examined the distribution of haemoglobin A1c (HbA1c) in participants from rural areas.

Cataract is the most important eye disease associated with increased ocular exposure to UV-B. Biochemical and experimental evidence clearly links the development of cataract to UV-B exposure. Because of the difficulties in ascertaining individual ocular UV-B exposure over a lifetime, epidemiologic data have been much more limited. However; a number of epidemiologic studies have shown a consistent association between excess UV-B exposure and cortical cataracts, one of the major types of age-related cataract. These data provide the basis to recommend avoidance of unnecessary exposure of the eye to UV-B radiation, whether by avoiding outdoor activities in the middle of the day, or by protecting the eye by wearing a hat and/or UV-B absorbing eye glasses.

Background - Information about socio-economic factors associated with visual impairment can assist in the design of intervention programmes. Such information was collected by the Melbourne Visual Impairment Project (Melbourne VIP). Methods - The Melbourne VIP was a population based study of non-institutionalised permanent residents in nine suburbs of the Melbourne metropolitan area aged 40 years of age or older. A standardised eye examination was provided to eligible residents which included a structured interview. Variables of interest for this analysis were age, sex, country of birth, language spoken at home, education level, use of private health insurance, employment status, and living arrangements. Visual impairment was defined as a best corrected visual acuity < 6/18 and/or visual field constriction to within 20o of fixation. Results - A total of 3271 (83%) residents participated. Participants ranged in age from 40 to 98 years; 54% were female. Forty-four (1.34%) were classified as visually impaired due to visual acuity and/or visual field loss. To evaluate the independent association of the significant socio-demographic variables with visual impairment, a regression model was constructed that included age, retirement status, use of private health insurance, and household arrangement. The results showed that age was the significant predictor of visual impairment (OR: 3.19; CI: 2.29-4.43), with the mean age of people with visual impairment significantly older (75.0 years) compared with people without visual impairment (58.2 years) (t test=9.71; p=0.0001). Of the 44 visually impaired people, 39 (87%) were aged 60 years of age and older. Conclusion - The results indicate that age is the most significant factor associated with visual impairment. Of some importance was the finding that people with visual impairment were less likely to have private health insurance. With the aging of the population, the number of people affected by visual impairment will increase significantly. Intervention programmes need to be established before the onset of middle age to offset the escalation of visual impairment in the older population.

Aim - The use of eye care services by people with and without diabetes was investigated in the Melbourne Visual Impairment Project (VIP), a population based study of eye disease in a representative sample of Melbourne residents over 40 years of age and older.Methods - A comprehensive interview was employed to elicit information on history of diabetes, medication use, most recent visit to an ophthalmologist and optometrist, and basic demographic details. Presence and extent of diabetic retinopathy was determined by dilated fundus examination.Results - The Melbourne VIP comprised 3271 people who ranged in age from 40 to 98 years; 46.2% of them were male. Of 3189 people who had the fundus examination and knew their diabetes status, 162 (5.1%) reported having been previously diagnosed with diabetes and, of these, 37 (22.2%) were found to have diabetic retinopathy. Seven people (4.3%) had developed diabetes before age 30. The mean duration of diabetes was 9.2 years. People with diabetes were significantly more likely to have visited an ophthalmologist over or in the past 2 years than people without diabetes. However, 31.8% of people with diabetes had never visited an ophthalmologist. The proportion of people who had never seen an ophthalmologist was 47.1% for people without diabetes, 34.2% for people with diabetes but without diabetic retinopathy, and 25% for people with diabetic retinopathy. Sixty one per cent of people with diabetic retinopathy had seen an ophthalmologist in the past year and a further 3% within the past 2 years. People with diabetes were not significantly more likely to have visited an optometrist than people without diabetes (p=0.51). Overall, 37.7% of people with diabetes and 32.9% of people without diabetes had visited an optometrist within the past year (%2=2.25, 1 df, p=0.13). Information concerning retinal examinations was available for 135 individuals (83.3% of people with diabetes). Only 74 (54.8%) could recall ever having a dil

Aim - To assess the projected needs for cataract surgery by lens opacity, visual acuity, and patient concern. Methods - Data were collected as part of the Melbourne Visual Impairment Project, a population based study of age related eye disease in a representative sample of Melbourne residents aged 40 and over. Participants were recruited by a household census and invited to attend a local screening centre. At the study sites, the following data were collected: presenting and best corrected visual acuity, visual fields, intraocular pressure, satisfaction with current vision, personal health history and habits, and a standardised eye examination and photography of the lens and fundus. Lens photographs were graded twice and adjudicated to document lens opacities. Cataract was defined as nuclear greater than or equal to standard 2, 4/16 or greater cortical opacity, or any posterior subscapsular opacities. Results: 3271 (83% response) people living in their own homes were examined. The participants ranged in age from 40 to 98 years and 1511 (46.2%) were men. Previous cataract surgery had been performed in 107 (3.4%) of the participants. The overall prevalence of any type of cataract that had not been surgically corrected was 18%. If the presence of cataract as defined was considered the sole criterion for cataract surgery with no reference to visual acuity, There would be 309 cataract operations per 1000 people aged 40 and over (96 eyes of people who were not satisfied with their vision, 210 eyes of people who were satisfied with their vision, and three previous cataract operations). At a visual acuity criterion of less than 6/12 (the vision required to legally drive a car), 48 cataract operations per 1000 would occur and people would be twice as likely to report dissatisfaction with their vision. Conclusions - Estimates of the need for cataract surgery vary dramatically by level of lens opacity, visual acuity, and patient concern. These data should be useful for the planning of health services.

Quantification of ocular exposure to ultraviolet-B radiation (UV-B) has become an important public health issue, with reports that the ozone layer is being depleted worldwide. Ocular exposure to UV-B is determined by ambient UV-B levels, the duration of outdoor exposure, the proportion of ambient UV-B that reaches the eye, and the use of ocular protection. We have developed a simplified model for quantifying lifetime ocular UV-B exposure that can be used in large epidemiological surveys. Exposure to UV-B is assessed and quanified using a model based on personal exposure over the six summer months. Data available for a population-based sample of 1150 people in the age range 40-98 years revealed a distribution in average annual lifetime ocular VU-B exposure similar to that reported in a previous study on which this model is based, and also demonstrate that people can recall lifetime personal behaviour related to ocular protection. It takes 12 minutes on average to collect these data. This model can be employed by researchers worldwide for uniform assessment of ocular UV-B exposure.

Age-related macular degeneration (AMD) is the leading cause of blindness in elderly Australians. Currently, there are limited treatment options, and current research efforts are focused on determining the risk factors for AMD and developing effective treatment strategies. Some risk factors for cardiovascular disease have been shown to be associated with AMD, and one study has suggested that Alzheimer's disease is associated with age-related maculopathy. It has also been suggested that alleles of the apolipoprotein E (ApoE) gene may be associated with AMD, cardiovascular disease and Alzheimer's disease. Given this, it is interesting that statins - cholesterol-lowering medications - have been shown to decrease the risk of dementia and diabetes mellitus.

How much cataract surgery do we have to do? When is enough enough? Around the world, this is a common question asked by governments, regional health authorities, health trusts, hospital managers, operating theatre staff, and ophthalmologists themselves. These are fair questions. The volume of cataract surgery already has increased dramatically around the world over the past 20 years. It increased approximately fourfold in just 10 years in both the United States and Sweden through the 1980s; and increased threefold in the United Kingdom over this time. In many areas cataract surgery now forms over half of all ophthalmic surgery, and in a number of countries cataract surgery has become the most common elective surgical procedure.

Recent reviews of the published literature revealed conflicting evidence for an association between solar ultraviolet radiation and ocular diseases such as cataract, climatic droplet keratopathy, uveal melanoma and macular degeneration. Differences between study conclusions could be due to methodology, and in some cases, the 'ecological fallacy'. The ecological fallacy occurs when conclusions regarding individual risk (i.e. of cataract) are inferred based on data collected regarding group risk. To avoid the ecological fallacy, it is necessary to collect individual exposure data.Individual ocular UV-B exposure is dependent on four factors which must all be assessed to avoid the ecological fallacy: (1) the ambient level of UV-B in the environment; (2) the amount of time the individual spends outdoors and is exposed to UV-B radiation; (3) the ocular ambient exposure ratio (the proportion of ambient UV-B that actually reaches the eye), and (4) the use of ocular protection such as hats and sunglasses. The aim of this study was to develop a questionnaire and model for use in epidemiologic studies to quantify lifetime personal ocular UV-B exposure.

Aim: To describe the prevalence of and risk factors for pterygium in a population based sample of residents of the Australian state of Victoria who were aged 40 years and older.Methods:The strata comprised nine randomly selected clusters from the Melbourne statistical division, 14 nursing homes randomly selected from the nursing homes within a 5 kilometre radius of the nine Melbourne clusters, and four randomly selected clusters from rural Victoria. Pterygium was measured in millimetres from the tip to the middle of the base. During an interview, people were queried about previous ocular surgery, including surgical removal of pterygium, and their lifetime exposure to sunlight. Results: 5147 people participated. They ranged in age from 40 to 101 years and 2850 (55.4%) were female. Only one person in the Melbourne cohort reported previous pterygium surgery, and seven rural residents reported previous surgery; this information was unavailable for the nursing home residents. Pterygium was present upon clinical examination in 39 (1.2%) of the 3229 Melbourne residents who had the clinical examination, six (1.7%) of the nursing home residents, and 96 (6.7%) of the rural residents. The overall weighted population rate in the population was 2.83% (95% CL 2.35, 3.31). The independent risk factors for pterygium were found to be age (OR=1.23, 95% CL=1.06, 1.44), male sex (OR=2.02, 95% CL=1.35, 3.03), rural residence (OR=5.28, 95% CL=3.56, 7.84), and lifetime ocular sun exposure (OR=1.63, 95% CL=1.18, 2.25). The attributable risk of sunlight and pterygium was 43.6% (95% CL=42. 7,44.6). The result was the same when ocular UV-B exposure was substituted in the model for broad band sun exposure. Conclusion: Pterygium is a significant public health problem in rural areas, primarily as a result of ocular sun exposure.