The importance of epidemiology in understanding eye disease

Most leading causes of visual impairment are age related, so the health care implications of an increasing prevalence of eye disease in the elderly are significant. Epidemiological research provides the foundation to address immediate and long-term needs associated with visual impairment and eye disease. It contributes to a community's knowledge of the presence, diagnosis, characteristics, and distribution of eye conditions affecting the elderly. Obtaining accurate epidemiological information on the extent of visual impairment and eye disease in the community is essential to determine and estimate the cost of primary and secondary eye health care needs.

Association between apolipoprotein E polymorphisms and age-related macular degeneration: a HuGE review and meta-analysis

A possible association between apolipoprotein E polymorphisms and age-related macular degeneration has been investigated numerous times, with conflicting results. A previous analysis pooling results from four studies (Schmidt et al., Ophthalmic Genet 2002;23:209-23) suggested an association, but those investigators did not document allele frequencies, the magnitude of the association, or the possible genetic mode of action. Thus, the authors searched MEDLINE from 1966 to December 2005 for any English-language studies reporting genetic associations. Data and study quality were assessed in duplicate. Pooling was performed while checking for heterogeneity and publication bias. Frequencies of the E2 and E4 alleles in Caucasians were approximately 8% and 15%, respectively. Allele- and genotype-based tests of association indicated a risk effect of up to 20% for E2 and a protective effect of up to 40% for E4. E2 appeared to act in a recessive mode and E4 in a dominant mode. There appears to be a differential effect of the E2 and E4 alleles on the risk of age-related macular degeneration, although the possibility of survivor bias needs to be ruled out more definitively.

The prevalence of glaucoma in the Melbourne Visual Impairment Project

PURPOSE: The purpose of the study was to determine the prevalence of glaucoma in Melbourne, Australia. METHODS: All subjects were participants in the Melbourne Visual Impairment Project (Melbourne VIP), a population-based prevalence study of eye disease that included residential and nursing home populations. Each participant underwent a standardized eye examination, which included a Humphrey Visual Field test, applanation tonometry, fundus examination including fundal photographs, and a medical history interview. Glaucoma status was determined by a masked assessment and consensus adjudication of visual fields, optic disc photographs, intraocular pressure, and glaucoma history. RESULTS: A total of 3271 persons (83% response rate) participated in the residential Melbourne VIP. The overall prevalence rate of definite primary open-angle glaucoma in the residential population was 1.7% (95% confidence limits = 1.21, 2.21). Of these, 50% had not been diagnosed previously. Only two persons (0.1%) had primary angle-closure glaucoma and six persons (0.2%) had secondary glaucoma. The prevalence of glaucoma increased steadily with age from 0.1% at ages 40 to 49 years to 9.7% in persons aged 80 to 89 years. There was no relationship with gender. The authors examined 403 (90.2% response rate) nursing home residents. The age standardized rate for this component was 2.36% (95% confidence limits = 0, 4.88). CONCLUSION: The rate of glaucoma in Melbourne rises significantly with age. With only half of patients being diagnosed, glaucoma is a major eye health problem and will become increasingly important as the population ages.

Visual impairment and socioeconomic factors

BACKGROUND: Information about socioeconomic 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 and 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 20 degrees 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 sociodemographic 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.

Changes in abdominal obesity and age-related macular degeneration: the atherosclerosis risk in communities study

OBJECTIVE: To examine the association between changes in waist-hip ratio (WHR), a measure of abdominal obesity, and age-related macular degeneration (AMD). METHODS: A total of 12 515 persons from a population-based cohort study, aged 45 to 64 years in 1987 to 1989, were followed up over 6 years. The percentage change in WHR during follow-up was ranked into sex-specific deciles; an increase in WHR was defined as the top 10% of change and a decrease in WHR as the bottom 10%. The association of increased or decreased WHR and presence of AMD at follow-up was determined using logistic regression adjusting for potential confounders. RESULTS: The average change in WHR was an increase of 2%, ranging from a decrease of 44% to an increase of 102%. A decrease in WHR of 3% or more was associated with 29% lower odds of any AMD (odds ratio = 0.71; 95% confidence interval, 0.52-0.97). This effect was most pronounced among obese participants at baseline, where a decrease in WHR was associated with 59% lower odds of AMD (odds ratio = 0.41; 95% confidence interval, 0.20-0.82). CONCLUSIONS: Middle-aged persons who had a 3% or greater reduction in WHR over time were less likely to have AMD, particularly among those who were initially obese.

Emotional responses to filmed violence and the eye blink startle response

The study assessed gender differences in emotional responses to violent film. Both subjective emotional response and eye blink startle magnitude were assessed while 20 men and 20 women viewed a series of five violent film segments and five nature scenes. Participants exhibited higher levels of curiosity, anxiety, disgust, and anger, and lower levels of positive emotion and boredom in response to the violent film segments in comparison with the nature material. Startle response was magnified during the violent film segments, indicating an aversive response. Evidence that men and women responded to the violence differently was demonstrated by men' experiencing greater positive feelings, entertainment, and curiosity in relation to the violent film, whereas women reported more disgust, boredom, anger, and experienced greater startle in relation to the violent scenes portrayed in the film. Future directions for investigating filmed violence are outlined.

The influence of age on reproductive success and diet in Australasian gannets (Morus Serrator) breeding at Pope's Eye, Port Phillip Bay, Victoria

The influence of age on reproductive success and diet was examined in ‘old’ (experienced; 12 years and older) and ‘young’ (5–8 years of age) Australasian gannets (Morus serrator) breeding at Pope’s Eye, Port Phillip Bay, Victoria during the 2002–2003 breeding period. Although food availability, as indicated by commercial fish catches, throughout this breeding period was low, there were no significant differences in breeding success or chick growth between groups. Nevertheless, old birds tended to have higher reproductive success, replacing more lost eggs and fledging chicks of a greater mass. However, old birds also laid more eggs that failed to hatch. Five fish species, including jack mackerel (Trachurus declivis), barracouta (Thyrsites atun), redbait (Emmelichthys nitidus), anchovy (Engraulis australis) and red mullet (Upeneichthys vlamingii), were important in the gannet diet during this breeding period. There were no significant differences in dietary parameters, including range of species and size of prey, between old and young gannets, nor were there any differences between those of the chicks and their parents, suggesting that adults do not forage selectively for their chicks. This study showed that even during a period of presumed low food availability, when experienced (older) birds might be expected to have enhanced success, the differences between these and less experienced (younger) birds may not be apparent.

Mimicry and the eye of the beholder

Recent experiments (Dittrich et al. (Proc. R. Soc. Lond. B 251, 195 (1993))) suggest that pigeon perception of wasp mimicry by hoverflies is similar to that of humans and of computer-based image matching. However, the relations are nonlinear and may explain why some species are abundant despite their being poor mimics to the human eye. We suggest that these discrepancies between pigeon and human categorization may lie in the differences between avian and primate colour vision. As pigeon categorization and computer image analysis were both assessed by using colour slides designed for human vision, they lacked the natural colour information available to wild birds, in particular that from ultraviolet (uv) wavelengths.