眼压与全身血压的纵向前瞻性研究:BeaverDam眼科研究

Aim: To investigate the relation between change in systemic blood pressures an d change in intraocular pressure. Methods: This was a population based study of people 43-86 years old living in Beaver Dam, Wisconsin. Measurements at baselin e (1988-90) and 5 year follow up of systemic blood pressures, intraocular press ures, and history of use of blood pressure medications. Results: Intraocular pre ssures were significantly correlated with systolic and diastolic blood pressures at both baseline and follow up. There were significant direct correlations betw een changes in systemic blood pressures and changes in intraocular pressure. The re was a 0.21 (95%CI: 0.16 to 0.27) mm Hg increase in IOP for a 10 mm Hg increa se in systolic and 0.43 (0.35 to 0.52) mm Hg increase in IOP for a 10 mm Hg incr ease in diastolic blood pressure. Further adjustment for diabetes and medication use did not alter these associations. Decreased systolic or diastolic blood pre ssures of more than 10 mm Hg over 5 years were significantly associated with dec reased IOP. Conclusions: Reduced systemic blood pressure is associated with redu ced intraocular pressure. T5his finding should be evaluated in other studies, es pecially with respect to the possibility of resultant decreased risk of open ang le glaucoma.

视网膜微血管异常与MRI确诊的亚临床脑梗死:动脉粥样硬化风险的社区研究

Background and Purpose-Retinal microvascular abnormalities reflect cumulative small vessel damage from elevated blood pressure and may reflect subclinical cerebral microvascular changes.We examined their associations with MRI-defined cerebral infarcts.Methods-Population-based,cross-sectional study of 1684 persons 55 to 74 years of age without a history of clinical stroke,sampled from 2 US southeastern communities.Retinal photographs were obtained and graded for presence of retinal microvascular abnormalities,including arteriovenous nicking,focal arteriolar narrowing,retinal hemorrhages,soft exudates and microaneurysms.Photographs were also digitized,and retinal vessel diameters were measured and summarized as the arteriole-to-venule ratio(AVR).Cerebral MRI scans were graded for presence of cerebral infarct,defined as a lesion ≥ 3 mm diameter in a vascular distribution with typical imaging characteristics.Results-There were a total of 183 MRI cerebral infarcts.After adjustment for age,gender,race,6-year mean arterial blood pressure,diabetes,and other stroke risk factors,cerebral infarcts were associated with retinal microvascular abnormalities,with odds ratios 1.90(95% CI,1.25 to 2.88)for arteriovenous nicking,1.89(95% CI,1.22 to 2.92)for focal arteriolar narrowing,2.95(95% CI,1.30 to 6.71)for blot hemorrhages,2.08(95% CI,0.69,6.31)for soft exudates,3.17(95% CI,1.05 to 9.64)-for microaneurysms,and 1.74(95% CI,0.95 to 3.21)for smallest compared with largest AVR.In stratified analyses,these associations were only present in persons with hypertension.Conclusions-Retinal microvascular abnormalities are associated with MRI-defined subclinical cerebral infarcts independent of stroke risk factors.These data suggest that retinal photography may be useful for studying subclinical cerebrovascular disease in population-based studies.

Beaver Dam眼科研究视网膜血管直径的家族聚集性

PURPOSE. To describe familial correlations of retinal vessel measurements. METHODS. A standardized examination and interview was administered to a population- based cohort of adults aged 43- 86 years. Blood pressure was measured, and family relationships, current smoking status, and photographs of the retina were obtained. Computer- assisted grading was done to determine central retinal arteriole (CRAE) and venule equivalents (CRVE), and the arteriole- to- venule ratio (AVR)- was computed. Familial correlations were calculated using FCOR in the SAGE software package. Analysis was done on the right eye measures for 871 sibling, 341 parent- child, 1362 cousin, 554 avuncular, and 887 spousal pairs. RESULTS. After adjustment for age, gender, mean arterial blood pressure, and current smoking status, the correlations (and 95% confidence interval) between siblings for the CRVE, CRAE,and AVR were 0.23 (0.16, 0.31), 0.20 (0.12, 0.28) and 0.13 (0.05, 0.20), respectively. Parent- child correlations were very similar, and the avuncular correlations were about half as great. The cousin correlations were about half the avuncular correlations. Spousal correlations of 0.03, 0.04, and 0.01 for CRVE, CRAJE, and AVR, respectively, were not significantly different from 0. CONCLUSIONS. Retinal vessel equivalents were more highly correlated between relatives than between unrelated individuals. The relative magnitudes of these correlations were likely the result of shared genes. Because the vessel measurements have been shown to be predictive of cardiovascular and other systemic diseases, understanding the determinants of these familial relationships could have important health benefits.

年龄相关性眼部疾病、视力受损和生存率的Beaver Dam眼部研究

Objective: To investigate the relationship of age-related maculopathy,cataract,glaucoma,visual impairment,and diabetic retinopathy to survival during a 14-year period. Methods: Persons ranging in age from 43 to 84 years in the period from September 15,1987,to May 4,1988,participated in the baseline examination of the population-based Beaver Dam Eye Study (n=4926). Standardized protocols,including photography,were used to determine the presence of ocular disease. Survival was followed using standardized protocols. Results: As of December 31,2002,32% of the baseline population had died (median follow-up,13.2 years). After adjusting for age,sex,and systemic and lifestyle factors,poorer survival was associated with cortical cataract (hazard ratio HR,1.21; 95% confidence interval CI,1.06-1.37),any cataract (HR,1.16; 95% CI,1.03-1.32),diabetic retinopathy (HR per 1-step increase in 4-level severity,1.36; 95% CI,1.14-1.63),and visual impairment (HR,1.24; 95% CI,1.04-1.48) and marginally associated with increasing severity of nuclear sclerosis (HR,1.07;95% CI,0.99-1.16). Age-related maculopathy and glaucoma were not associated with poorer survival. Associations tended to be slightly stronger in men than women. Conclusions: Cataract,diabetic retinopathy,and visual impairment were associated with poorer survival and not explained by traditional risk factors for mortality. These ocular conditions may serve as markers for mortality in the general population.

多种族动脉粥样硬化研究中4个种族人群年龄相关性黄斑变性的患病率研究

Objective: To describe the prevalence of age-related macular degeneration (AMD) in 4 racial/ethnic groups (white, black, Hispanic, and Chinese) that participated in the second examination of the Multi-ethnic Study of Atherosclerosis (MESA). Design: Prospective cohort study. Participants: Six thousand one hundred seventy-six 45- to 85- year-old subjects selected from 6 United States communities. Methods: Fundus images were taken using a 45° digital camera through dark-adapted pupils and were graded for drusen size, type, area, increased retinal pigment, retinal pigment epithelial depigmentation, neovascular lesions, and geographic atrophy using the modified Wisconsin Age-Related Maculopathy Grading System. Main Outcome Measure: Age-related macular degeneration. Results: Prevalences of AMD were 2.4% (black), 4.2% (Hispanic), 4.6% (Chinese), to 5.4% (white) (P<0.001 for any differences among groups). The highest prevalence of any AMD occurred in those 75 to 84 years old, varying from 7.4% in blacks to 15.8% in whites and Chinese (P=0.03). Estimated prevalences of late AMD were 0.3% (black), 0.2% (Hispanic), 0.6% (white), and 1.0% (Chinese). These differences were marginally significant (age and gender adjusted, P=0.08). The frequency of exudative AMD was highest in Chinese (age-and gender-adjusted odds ratio, 4.30; 95% confidence interval, 1.30- 14.27) compared with whites. Differences in age, gender, pupil size, body mass index, smoking, alcohol drinking history, diabetes, and hypertension status did not explain the variability among the 4 racial/ethnic groups. Conclusions: Low prevalences of AMD were found in the MESA cohort in all groups. A lower prevalence of AMD was found in blacks compared with whites. The higher prevalence of exudative AMD in Chinese needs further study.

美国多种族人群的糖尿病性视网膜病变调查

PURPOSE: To describe the prevalence and risk factors of diabetic retinopathy in a multi-ethnic US population of whites,blacks,hispanics,and chinese. DESIGN: Cross-sectional study of 778 individuals from ages 45 to 85 years with diabetes,participating in the Multi-Ethnic Study of Atherosclerosis (MESA). METHODS: Retinal photographs were obtained with a 45° nonmydriatic digital fundus camera. Presence and severity of diabetic retinopathy were graded at a central reading center on the basis of a modification of the Airlie House classification system. All participants underwent a standardized interview,examination,and laboratory investigations. RESULTS: In this population with diabetes,the prevalence of any retinopathy was 33.2% and macular edema 9.0% . The prevalence of any diabetic retinopathy and macular edema was significantly higher in blacks (36.7% and 11.1% ) and hispanics (37.4% and 10.7% ) than in whites (24.8% and 2.7% ) and chinese (25.7% and 8.9% ) (P=.01 and P=.007,comparing racial/ethnic differences for retinopathy and macular edema,respectively). Significant independent predictors of any retinopathy were longer duration of diabetes,higher fasting serum glucose,use of diabetic oral medication or insulin,and greater waist-hip ratio. Race was not an independent predictor of any retinopathy. CONCLUSIONS: This study provides contemporary data on the prevalence of and risk factors for diabetic retinopathy among whites,blacks,hispanics,and chinese participating in the MESA.

非糖尿病患者的视网膜病表现是否可作为糖尿病发病的预测因子

Background/aims: Isolated retinopathy signs are common in non-diabetic individuals and have been shown to be associated with impaired glucose metabolism. In a cohort of people without diabetes,the association of these retinopathy signs and subsequent development of diabetes were examined. Methods: A population based cohort study of 7992 people aged 49-73 years without diabetes was conducted. Retinal photographs of these participants were evaluated for the presence of retinopathy signs according to a standardised protocol. Incident cases of diabetes were identified prospectively. Results: After a follow up of 3 years,291 (3.6% ) people developed incident diabetes. In the total cohort,retinopathy was not significantly associated with incident diabetes (4.7% v 3.6% ,multivariable adjusted odds ratio (OR) 1.1,95% confidence intervals (CI),0.7 to 1.9). However,among participants with a positive family history of diabetes,retinopathy was associated with incident diabetes (10.4% v 4.8% ,multivariable adjusted OR 2.3,95% CI,1.0 to 5.3). Among participants without a family history of diabetes,retinopathy was not associated with incident diabetes Conclusions: In individuals with a family history of diabetes,retinopathy signs predict subsequent risk of clinical diabetes.

人群研究载脂蛋白E基因与早期年龄相关性黄斑变性的相关性:动脉粥样硬化的发病风险

Objective: To examine the association between the apolipo-protein E (APOE) gene and early age-related maculopathy (ARM) in middle-aged persons. Design: Population-based cross-sectional study. Participants: Participants from the Atherosclerosis Risk in Communities Study (n=10 139; age range,49-73 years). Methods: Retinal photographywas performed on 1 randomly selected eye,and grading for presence of ARMwas carried out using a modification of the Wisconsin ARM Grading System. Early ARM was defined as the presence of either soft drusen alone,retinal pigment epithelial depigmentation alone,or a combination of soft drusen with increased retinal pigment and/or depigmentation. DNA extracted from blood samples of participants were analyzed for common allelic variants of the APOE gene ( 2, 3,and  4). Main Outcome Measures: Presence of early ARM on retinal photographs. Results: The prevalence of early ARM was similar in participants with differentAPOE genotypes:  2/ 2 (5.9% ), 2/ 3 (5.2% ), 2/ 4 (3.2% ), 3/ 3 (5.2% ), 3/ 4 (4.9% ),and  4/ 4 (4.1% ). After controlling for age,gender,race,cigarette smoking,and other factors,early ARM was not associated with APOE genotypes,with an odds ratio (OR) of 1.35 (95% confidence interval CI,0.54-3.38) for  2/ 2 genotype,an OR of 1.06 (95% CI,0.80-1.40) for  2/ 3 genotype,an OR of 0.63 (95% CI,0.32-1.24) for  2/ 4 genotype,an OR of 0.99 (95% CI,0.80-1.24) for  3/ 4 genotype,and an OR of 0.88 (95% CI,0.47-1.63) for  4/ 4 genotype,as compared with 3/3 genotype (reference). No associations were found for specific early ARM signs or in analyses stratified by age,gender,race,or cigarette smoking status. Conclusions: These data provide no evidence of a strong association between the APOE gene and early ARM in middle-aged persons. This suggests that APOE is not likely a major determinant of the early stages of ARM in younger people. However,our study does not exclude the possibility of a weaker association or that APOE may influence only the development of late ARM in older populations,as reported in other studies.

与视网膜静脉阻塞及小动脉栓子有关的心血管危险因素:社区研究及心血管健康研究中的动脉粥样硬化危险性

Objective: To examine the associations of retinal vein occlusion and arteriola r 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 iden tified from a single nonmydriatic retinal photograph using a standardized protoc ol. Photographs were also graded for arteriovenous nicking and focal arteriolar narrowing. All participants had a comprehensive systemic evaluation, including s tandardized carotid ultrasonography. Main Outcome Measures: Retinal vein occlusi on and arteriolar emboli. Results: Prevalences of retinal vein occlusion and art eriolar 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 (odd s ratio [OR], 2.96; 95%confidence interval [CI], 1.43-6.14), systolic bloo d pr essure (BP) (OR, 4.12; 95%CI, 1.40-12.16; highest quartile vs. lowest), diasto lic BP (OR, 2.64; 95%CI, 1.07-6.46; highest quartile vs. lowest), carotid arte ry plaque (OR, 5.62; 95%CI, 2.60-12.16), body mass index (OR, 3.88; 95%CI, 1. 23-12.18; highest quartile vs. lowest), plasma fibrinogen (OR, 3.29; 95%CI, 1. 08-10.02; highest quartile vs. lowest), arteriovenous nicking (OR, 4.09; 95%CI , 2.00-8.36), and focal arteriolar narrowing (OR, 5.17; 95%CI, 2.59-10.29). A fter adjusting for age, retinal arteriolar emboli were associated with hypertens ion (OR, 3.14; 95%CI, 1.44-6.84), systolic BP (OR, 3.46; 95%CI, 1.13-10.65; highest quartile vs. lowest), prevalent coronary heart disease (OR, 2.33; 95%CI , 1.01-5.42), carotid artery plaque (OR, 4.62; 95%CI, 1.85-11.57), plasma lip oprotein (a) (OR, 3.69; 95%CI, 1.20-11.41; highest quartile vs. lowest), plasm a fibrinogen (OR, 3.09; 95%CI, 0.98-9.76; highest quartile vs. lowest), and cu rrent cigarette smoking (OR, 3.08; 95%CI, 1.47-6.47). Approximately a quarter of participants with retinal vein occlusion and arteriolar emboli had evidence o f carotid artery plaque as defined from ultrasound. Conclusions: Retinal vein oc clusion and retinal arteriolar emboli are associated with carotid artery disease , hypertension, and other cardiovascular risk factors.

视网膜血管直径与高血压风险的前瞻性队列研究

Objective: To examine the relation between diameters of the re tinal arterioles and 10 year incidence of hypertension.Design: Population based prospective coho rt study. Setting: Beaver Dam eye study. Participants: 2451 normotensive people aged 43 to 84 years. Main outcome measures: Diameters of retinal arterioles and venules measured from digitised photographs of the retina taken at baseline. Mea surements summarised as the arteriole: venule ratio, with a lower ratio indicati ng smaller arteriolar diameters. Incident hypertension, defined as systolic bloo d pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or use of antihyper tensive drugs during follow up. Results: 721 participants developed hypertension over a 10 year period. Those with lower arteriole: venule ratios had a higher c umulative incidence of hypertension (incidences of 17.4%, 24.1%, 31.0%, and 4 5.1%, respectively, for decreasing quarters of distribution of arteriole:venule ratio). After adjustment for age and sex, participants with arteriole:venule ra tios in the lowest quarter had a threefold higher risk of hypertension (odds rat io 2.95, 95%confidence interval 2.77 to 3.88) than those with ratios in the hig hest quarter. This association remained significant after further adjustment for baseline systolic and diastolic blood pressure and other risk factors (1.82, 1. 39 to 2.40, for lowest versus highest ratio quarters). Conclusions: Narrowed ret inal arterioles are associated with long term risk of hypertension, suggesting t hat structural alterations of the microvasculature may be linked to the developm ent of hypertension.

视网膜动脉直径和高血压发生危险相关性的前瞻性队列研究

Obsjective: To examine the relation between diameters of the retinal arterioles and 10 year incidence of hypertension. Design: Population based prospective cohort study. Setting: Beaver Dam eye study. Participants: 2451 normotensive people aged 43 to 84 years. Main outcome measures: Diameters of retinal arterioles and venules measured from digitised photographs of the retina taken at baseline. Measurements summarised as the arteriole: venule ratio, with a lower ratio indicating smaller arteriolar diameters. Incident hypertension, defined as systolic blood pressure≥ 140 mm Hg, diastolic blood pressure≥ 90 mm Hg, or use of antihypertensive drugs during follow up. Results: 721 participants developed hypertension over a 10 year period. Those with lower arteriole: venule ratios had a higher cumulative incidence of hypertension (incidences of 17.4% , 24.1% , 31.0% , and 45.1% , respectively, for decreasing quarters of distribution of arteriole:venule ratio). After adjustment for age and sex, participants with arteriole:venule ratios in the lowest quarter had a threefold higher risk of hypertension (odds ratio 2.95, 95% confidence interval 2.77 to 3.88) than those with ratios in the highest quarter. This association remained significant after further adjustment for baseline systolic and diastolic blood pressure and other risk factors (1.82, 1.39 to 2.40, for lowest versus highest ratio quarters). Conclusions: Narrowed retinal arterioles are associated with long term risk of hypertension, suggesting that structural alterations of the microvasculature may be linked to the development of hypertension.

用非散瞳状态下的数码相机和标准眼底胶片相机检查老年性黄斑变性

Objective: To compare gradings of lesions associated with age- related macular degeneration (AMD) from digital and stereoscopic film images. Design: Instrument validation study. Participants: Sixty- two subjects (124 eyes) with varying degrees of AMD, including no AMD. Methods: Images of the optic disc and macula were taken using a 45° digital camera (6.3 megapixels) through dark- adapted pupils and pharmacologically dilated pupils. In addition, 30° stereoscopic retinal film images were taken through pharmacologically dilated pupils of the same eyes. All images were graded for drusen size, type, and area; pigmentary abnormalities; geographic atrophy; and neovascular lesions using the modified Wisconsin Age- Related Maculopathy Grading System. Exact agreement and unweighted κ .scores were calculated for paired gradings resulting from digital and film images. Main Outcome Measure: Agreement between gradings obtained from stereoscopic slide transparencies and digital nonstereoscopic images. Results: Exact agreement between gradings of digital and stereoscopic film images taken through pharmacologically dilated pupils was 91% (κ .=0.85) for the categories of none, early AMD, and late AMD. Exact agreement for gradings of digital images taken through dark- adapted pupils compared with gradings of film images was 80% (κ .=0.69). Exact agreement for gradings of digital images captured through dark- adapted and pharmacologically dilated pupils was 86% (κ =0.78). In addition, κ scores for agreement between different approaches for individual lesions were moderate to almost perfect. Conclusions: Gradings resulting from high- resolution digital images, especially when the pupil is pharmacologically dilated, are comparable with those resulting from film- based images. We conclude that digital imaging of the retina is useful for epidemiological studies of AMD.

他汀类药物应用与核性白内障

Context:Statins are widely prescribed for their lipid-lower-ing effects but also have putative antioxidant properties.Oxidative stress is believed to play a role in the development of nuclear cataract,but little is known regarding the relationship of statin use and cataract incidence.Objective:To evaluate the relationship of use of statins and incident cataract in adults in a midwestern community in the United States.Design,Setting,and Participants:The Beaver Dam Eye Study,an observational,longitudinal,population-based study of age-related eye disease in Beaver Dam,Wis.There were 1299 persons who were seen at the third examination in 1998-2000,had gradable photographs in both eyes,and were deemed to be at risk of developing nuclear cataract within 5 years.Main Outcome Measure:Five-year incidence of cataract with respect to statin use.Cataracts were graded from photographs taken through the participant’ s dilated pupil.Results:A total of 210 persons developed incident nuclear cataract in the interval from 1998-2000 to 2003-2005.Five-year incidence of nuclear cataract was 12.2% in statin users compared with 17.2% in nonusers(odds ratio OR,0.55;95% confidence interval CI,0.36-0.84),controlling for age.When only never smokers without diabetes were assessed,the age-,lipid level-,and sexadjusted OR was 0.40(95% CI,0.18-0.90).Five-year incidence of cortical cataract was 9.9% in statin users and 7.5% in nonusers(OR,1.28;95% CI,0.79-2.08);posterior subcapsular cataract occurred in 3.0% of statin users and 3.4% of nonusers(OR,0.82;95% CI,0.39-1.71).Conclusion:Statin use in a general population appears to be associated with lower risk of nuclear cataract,the most common type of age-related cataract.