Blue Mountains Eye Study Research Articles

Incidence and Progression of Epiretinal Membranes in Eyes After Cataract Surgery

To assess eye-specific epiretinal membrane (ERM) incidence 3 years after phacoemulsification surgery, and ERM detection bias attributable to cataract. Cohort study. We recruited 1932 cataract surgical patients aged ≥64 years at Westmead Hospital (2004-2007). The surgical eye of each patient was assessed for presence of cellophane reflex or preretinal fibrosis at preoperative and 1-month-postoperative visits, and annually thereafter, using retinal image grading. Agreement on ERM detection between preoperative and 1-month-postoperative visits was assessed using kappa statistics. Cumulative incidence of ERM from 1 month to 3 years postoperatively was estimated using Kaplan-Meier methods and compared to the 5-year incidence of idiopathic ERM in right eyes of age-matched Blue Mountains Eye Study (BMES) participants. ERM prevalence was 13.9% among 1394 participants with retinal photographs taken 1 month postoperatively. Of 1040 participants with retinal photographs from both preoperative and 1-month-postoperative visits, ERM was detected in 3.1% and 14.8%, respectively, with low diagnostic agreement (kappa = 0.17). Of 1119 subjects without ERM 1 month post surgery, the 3-year cumulative incidence of ERM was 11.2% (95% confidence interval [CI], 9.4%-13.4%; cellophane reflex 6.6%; preretinal fibrosis 4.2%). The age-standardized 3-year incidence of ERM in the surgical cohort (12.1%, 95% CI 8.6%-16.9%) was higher than the 5-year incidence of the BMES subsample (4.4%, 95% CI 3.0%-6.0%). A substantial under-detection of ERM in eyes before cataract surgery could incorrectly contribute to ERM incidence after surgery. Over 3 years, ERM developed in >10%, including preretinal fibrosis in 4%, of surgical eyes free of ERM 1 month post surgery.

Relationship between thyroid dysfunction and chronic kidney disease in community-dwelling older adults

ObjectivesRenal function has been shown to be influenced by thyroid status in animal models and human studies. We aimed to assess the cross-sectional association between thyroid hormones and function with prevalence of chronic kidney diseases (CKD) in older adults. Study design1571 Blue Mountains Eye Study participants aged ≥60 years were analyzed in 2002–4. Thyroid dysfunction was defined using serum thyrotropin (TSH) screen, followed by serum free T4 (FT4) assessment. Baseline biochemistry including serum creatinine was measured. Moderate CKD was defined as estimated glomerular filtration rate (eGFR) <60ml/min/1.73m2. ResultsAfter adjusting for age, sex, receipt of pension payment, body mass index, smoking, hypertension and diabetes, persons with any thyroid dysfunction (hyperthyroidism or hypothyroidism) had 84% higher likelihood of having CKD, odds ratio, OR, 1.84 (95% confidence intervals, CI, 1.03–3.31). Participants in the highest versus lowest quartile (reference) of serum TSH and FT4 had a significantly greater odds of prevalent CKD, OR 1.82 (95% CI 1.22–2.71), and OR 1.64 (95% CI 1.10–2.45), respectively. Similarly, among participants not receiving treatment for their thyroid dysfunction (n=1329), those in the third and fourth quartiles of serum TSH had significantly greater odds of having prevalent CKD, OR 1.83 (95% CI 1.15–2.92) and OR 1.96 (95% CI 1.23–3.13), respectively, Ptrend=0.001. Significant associations were not observed between type of thyroid dysfunction (hyperthyroidism or hypothyroidism) and prevalent CKD. ConclusionsIncreasing serum TSH was associated with a greater likelihood of prevalent CKD among older adults, independent of the influence of age, diabetes and hypertension.

Is quality of diet associated with the microvasculature? An analysis of diet quality and retinal vascular calibre in older adults

It is unknown whether diet quality is associated with microvascular structure. The present study aimed to investigate the relationship between diet quality, reflecting adherence to dietary guidelines, with retinal microvascular calibre in older adults. The dietary data of 2720 Blue Mountains Eye Study participants, aged 50+ years, were collected using a semi-quantitative FFQ. A modified version of the Healthy Eating Index for Australians was developed to determine total diet scores (TDS). Fundus photographs were taken and retinal vascular calibre measured using computer-assisted techniques and summarised. After adjusting for age, sex, BMI, mean arterial blood pressure, smoking, serum glucose, leucocyte count and history of diagnosed stroke or CHD, persons with higher TDS had healthier retinal vessels cross-sectionally, with wider retinal arteriolar calibre (by approximately 3 μm, comparing the highest with the lowest quartile of TDS, Ptrend = 0·0001) and narrower retinal venular calibre (by approximately 2·5 μm; Ptrend = 0·02). In younger subjects aged ≤65 years, increasing TDS (lowest to the highest quartile) was associated with healthier retinal vessels: approximately 4·4 μm wider retinal arteriolar (Ptrend < 0·0001) and approximately 2·3 μm narrower venular calibre (Ptrend = 0·03). After multivariable adjustment, however, baseline TDS were not associated with retinal arteriolar (Ptrend = 0·89) or venular calibre (Ptrend = 0·25), 5 years later. Also, baseline TDS were not associated with the 5-year change in retinal arteriolar (β = 0·14; P=0·29) or venular calibre (β = - 0·26; P=0·07). Greater compliance with published dietary guidelines (higher diet quality) was cross-sectionally associated with wider retinal arterioles and narrower venules, indicating better retinal microvascular health.

Dual Sensory Impairment in Older Adults Increases the Risk of Mortality: A Population-Based Study

Although concurrent vision and hearing loss are common in older adults, population-based data on their relationship with mortality is limited. This cohort study investigated the association between objectively measured dual sensory impairment (DSI) with mortality risk over 10 years. 2812 Blue Mountains Eye Study participants aged 55 years and older at baseline were included for analyses. Visual impairment was defined as visual acuity less than 20/40 (better eye), and hearing impairment as average pure-tone air conduction threshold greater than 25 dB HL (500–4000 Hz, better ear). Ten-year all-cause mortality was confirmed using the Australian National Death Index. After ten years, 64% and 11% of participants with DSI and no sensory loss, respectively, had died. After multivariable adjustment, participants with DSI (presenting visual impairment and hearing impairment) compared to those with no sensory impairment at baseline, had 62% increased risk of all-cause mortality, hazard ratio, HR, 1.62 (95% confidence intervals, CI, 1.16–2.26). This association was more marked in those with both moderate-severe hearing loss (>40 dB HL) and presenting visual impairment, HR 1.84 (95% CI 1.19–2.86). Participants with either presenting visual impairment only or hearing impairment only, did not have an increased risk of mortality, HR 1.05 (95% CI 0.61–1.80) and HR 1.24 (95% CI 0.99–1.54), respectively. Concurrent best-corrected visual impairment and moderate-severe hearing loss was more strongly associated with mortality 10 years later, HR 2.19 (95% CI 1.20–4.03). Objectively measured DSI was an independent predictor of total mortality in older adults. DSI was associated with a risk of death greater than that of either vision loss only or hearing loss alone.

Potential effects of systematic errors in intraocular pressure measurements on screening for ocular hypertension

Raised intraocular pressure (IOP) increases the risk of glaucoma. Eye-care professionals measure IOP to screen for ocular hypertension (OHT) (IOP>21 mm Hg) and to monitor glaucoma treatment. Tonometers commonly develop significant systematic measurement errors within months of calibration, and may not be verified often enough. There is no published evidence indicating how accurate tonometers should be. We analysed IOP measurements from a population study to estimate the sensitivity of detection of OHT to systematic errors in IOP measurements. We analysed IOP data from 3654 participants in the Blue Mountains Eye Study, Australia. An inverse cumulative distribution indicating the proportion of individuals with highest IOP>21 mm Hg was calculated. A second-order polynomial was fitted to the distribution and used to calculate over- and under-detection of OHT that would be caused by systematic measurement errors between -4 and +4 mm Hg. We calculated changes in the apparent prevalence of OHT caused by systematic errors in IOP. A tonometer that consistently under- or over-reads by 1 mm Hg will miss 34% of individuals with OHT, or yield 58% more positive screening tests, respectively. Tonometers with systematic errors of -4 and +4 mm Hg would miss 76% of individuals with OHT and would over-detect OHT by a factor of seven. Over- and under-detection of OHT are not strongly affected by cutoff IOP. We conclude that tonometers should be maintained and verified at intervals short enough to control systematic errors in IOP measurements to substantially less than 1 mm Hg.

Influence of TIMP3/SYN3 polymorphisms on the phenotypic presentation of age-related macular degeneration

Age-related macular degeneration (AMD) is a leading cause of irreversible central visual loss in the elderly. A recent genome-wide association studies (GWAS) reported that rs9621532 near the tissue inhibitor of metalloproteinase 3 (TIMP3)/synapsin III (SYN3) region of 22q12.3 is associated with AMD. In this study, we characterize its phenotypic influence on AMD using three independent study cohorts: case-control studies from the National Eye Institute Clinical Center (NEI, n=397) and the Age-Related Eye Disease Study (n=523) as well as a nested case-control study from Blue Mountains Eye Study (BMES, n=852). Comparisons between cases and controls show no association between rs9621532 and AMD in the three sample sets. However, stratifying NEI cases uncovers a moderate protective role of rs9621532 in neovascular AMD (nAMD) and the association adhered to a dominant model (odds ratios=0.32; 95% CI: 0.11-0.89; P=0.02). The BMES data followed the same pattern of association with nAMD as that seen in the NEI sample but did not reach statistical significance. Polychotomous logistic regression showed a trend that rs9621532 correlates with less severe disease, for example, with the majority of carriers having intermediate AMD rather than nAMD/geographic atrophy AMD. Functionally, rs9621532 influences TIMP3 mRNA expression in cultured primary human fetal retinal pigment epithelium (hfRPE) cells. In hfRPE donors carrying the protective rs9625132 allele, we measured a reduction in TIMP3 mRNA by quantitative RT-PCR. Our data suggest that rs9621532 carriers have a lower risk of developing nAMD, potentially because of decreased transcription of TIMP3.

Carbohydrate quality is not associated with liver enzyme activity and plasma TAG and HDL concentrations over 5 years in an older population

Non-alcoholic fatty liver disease (NAFLD) is closely associated with insulin resistance and obesity. Hence, carbohydrate quality could be of relevance to the risk of NAFLD, but prospective data are lacking. The aim of the present study was to investigate longitudinal associations between carbohydrate quality (including dietary glycaemic index (GI) and intakes of sugar, starch and fibre) and markers of liver function in an older Australian population. The analysis was based on 866 participants ( ≥ 49 years) of the Blue Mountains Eye Study with fasting blood specimens and dietary intake data at baseline and 5-year follow-up. Multi-level mixed regression analysis was used to relate dietary GI and sugar, starch and fibre intake to the liver enzymes alanine aminotransferase (ALT) and γ-glutamyltransferase (GGT), as well as fasting TAG and HDL-cholesterol (HDL-C). After adjustment for potential confounding factors, a lower fibre intake was cross-sectionally related to higher GGT (P= 0.02) and fasting TAG (P= 0.002) levels, with fruit fibre being the most relevant fibre source (P= 0.095 for GGT; P= 0.003 for TAG). A higher dietary GI was associated with lower HDL-C (P= 0.046). Changes in carbohydrate quality during 5 years were not related to changes in ALT, GGT, TAG or HDL-C (P≥ 0.08). In conclusion, the absence of longitudinal associations between carbohydrate quality and liver enzymes and serum lipids in this older population does not support a major role of carbohydrate nutrition in liver function among the elderly.

Use of Community Support Services and Activity Limitations Among Older Adults With Chronic Kidney Disease

There is a lack of population-based data on associations between chronic kidney disease (CKD) and the functional status/independence of older adults. We assessed prospective associations between CKD and (a) use of community support services and/or reliance on nonspouse family/friend support and (b) activities of daily living measures among older adults. A total of 1,952 participants from the Blue Mountains Eye Study aged 50 years or older at baseline were examined between 1992-1994 and 2002-2004. CKD was defined as Modification of Diet in Renal Disease Study estimated glomerular filtration rate of less than 60mL(.)min(-1)·1.73·m(-2). Use of services and nonspouse family/friend support was self-reported at baseline and follow-up. Functional status was determined by the Older Americans Resources and Services activities of daily living scale. After adjusting for age, sex, education level, receipt of pension, living status, poor self-rated health, hypertension, diabetes, number of hospital admissions, walking disability, and visual impairment, participants with CKD had increased odds of using community support services, odds ratio, 1.75 (95% confidence interval: 1.06-2.89). With increasing severity of CKD at baseline, the likelihood of using community support services 10 years later increased significantly, p trend = .02. After multivariable adjustment, participants with CKD had a greater likelihood of incident impaired instrumental activities of daily living after 10 years, odds ratio, 2.02 (95% confidence interval: 1.15-3.57). Increasing severity of CKD at baseline was associated with increased likelihood of incident impaired instrumental activities of daily living, p trend = .02. CKD could be a potential barrier to independent living for older adults, as shown by the increased need for formal home care services.

Symmetry of Optic Nerve Head Parameters Measured by the Heidelberg Retina Tomograph 3 in Healthy Eyes: The Blue Mountains Eye Study

To assess the symmetry of optic nerve head parameters measured by the Heidelberg Retina Tomograph 3 (HRT 3) between fellow eyes in a normal elderly population. Cross-sectional population-based study. Participants of the Blue Mountains Eye Study 10-year follow-up who did not have optic disc disease, including glaucoma, were included. Optic nerve head parameters measured by HRT 3 were compared between fellow eyes. The normal range of interocular asymmetry (larger disc minus smaller disc) was determined by the 2.5th and 97.5th percentiles. A total of 1276 eligible participants had HRT scans of both eyes. HRT measurements in right eyes differed slightly in rim steepness and rim volume from those in left eyes (P < .05). The 2.5th and 97.5th percentile of interocular asymmetry limits were -0.41 and 0.45 for cup-to-disc ratio and -0.19 and 0.22 for cup-to-disc area ratio, respectively. The highest interocular correlation was found in disc area and cup area (r ranged from 0.74-0.76), whereas mean cup depth, cup volume, and retinal nerve fiber layer thickness had the poorest correlation (r ≤ 0.07). Greater optic disc area asymmetry was associated with a larger interocular difference in the other optic nerve head parameters. There was minimal interocular difference and substantial interocular correlation in optic nerve head parameters measured by HRT 3. Interocular asymmetry greater than 0.2 for cup-to-disc area ratio was considered outside the normal range.

The Glaucoma Guidelines of the Swedish Ophthalmological Society

The Glaucoma Guidelines of the Swedish Ophthalmological Society

Metabolic syndrome and mortality in the elderly: A time-dependent association

AimsTo evaluate the association between metabolic syndrome (MetS) components and mortality over time. Methods3086 residents aged ≥49 years were followed in the Blue Mountains Eye Study, Australia. MetS components as defined by the International Diabetes Federation criteria were measured at baseline (1992–1994), 5-year (1997–1999) and 10-year (2002–2004). Using Cox proportional hazards and competing risks models with MetS as a time-dependent covariate, we estimated the effects of MetS on all-cause and cause-specific mortality. Time-dependent receiver-operating-characteristic curve, integrated-discrimination-improvement and net-reclassification-improvement tests assessed predicting abilities of individual and combined MetS components. ResultsEffect of MetS on mortality increased with time: all cause: 2-year: adjusted hazard ratio 0.96 [95% confidence interval 0.69–1.34]; 5-year: 1.06 [0.84–1.32]; 10-year: 1.23 [1.01–1.51]; and CHD: 2-year: 0.46 [0.20–1.03]; 5-year: 0.70 [0.41–1.21]; 10-year: 1.62 [1.02–2.59]. Conversely, MetS was associated with an increased risk of cancer death at 2-year only: 1.62 [1.01–2.62]; but not 5-year: 1.30 [0.94–1.81] or 10-year: 0.90 [0.57–1.44]. The discrimination analyses showed that different MetS components were associated with different causes of death. ConclusionsThe long-term effect of MetS on all-cause and CHD mortality in an older population was detected using time-dependent models while simulating the real scenarios of MetS changes over time.

Genetic Association of Refractive Error and Axial Length with 15q14 but Not 15q25 in the Blue Mountains Eye Study Cohort

Myopia is a common complex condition influenced by genetic and environmental factors. Two recent genome-wide association studies have identified loci on chromosomes 15q25 and 15q14 associated with refractive error in Caucasian populations. Our study aimed to assess the association of these 2 loci with refractive error and ocular biometric measures in an independent ethnically matched Caucasian cohort. Genetic association study using unrelated individuals. Blue Mountains Eye Study (BMES) cohort. A total of 1571 individuals were included in this study. Single nucleotide polymorphism (SNP) genotype data were collected from the BMES cohort as part of the Wellcome Trust Case Control Consortium 2. Imputation was performed using MACH version 1.1.16, and statistical analysis was conducted using PLINK. Association tests were performed at both loci using refractive error (spherical equivalent), axial length, corneal curvature, and anterior chamber depth as the phenotypes. Refractive error, axial length, corneal curvature, and anterior chamber depth. A total of 1571 individuals were available from the BMES for analysis. A statistically significant association for refractive error was evident for SNPs at the 15q14 locus, with P values ranging from 1.5 × 10(-2) at rs685352 to 6.4 × 10(-4) at rs560764, whereas association could not be confirmed for SNPs at the 15q25 locus, with P values ranging from 8.0 × 10(-1) to 6.4 × 10(-1). Ocular biometric analysis revealed that axial length was the most likely trait underlying the refractive error association at the 15q14 locus for SNPs rs560766 (P=0.0054), rs634990 (P=0.0086), and rs8032019 (P=0.0081). Our results confirm the association with refractive error at the 15q14 locus but do not support the association observed at the 15q25 locus. Axial length seemed to be a major parameter at the 15q14 locus, underscoring the importance of this locus in myopia and future clinical treatment.

Retinal Vessel Caliber Is Associated with the 10-year Incidence of Glaucoma: The Blue Mountains Eye Study

To examine associations between quantitatively measured retinal vessel caliber and the 10-year incidence of primary open-angle glaucoma (OAG).Population-based cohort study.The Blue Mountains Eye Study examined 3654 persons at baseline and 2461 persons at either 5 years, 10 years, or both times. After excluding 44 subjects with OAG at baseline, 2417 participants at risk of OAG at the 5- or 10-year examinations were included.Retinal vessel calibers of baseline retinal photographs were measured using a computer-based program and summarized as central retinal artery and vein equivalents (CRAE, CRVE). Incident OAG was defined as the development of typical glaucomatous visual field loss combined with matching optic disc rim thinning and an enlarged cup-to-disc (C:D) ratio of >0.7 or C:D asymmetry between the 2 eyes (≥0.3) at either the 5- or 10-year examination. Generalized estimating equation models were used to account for correlation between eyes while adjusting for glaucoma risk characteristics including intraocular pressure (IOP) or ocular perfusion pressure (OPP).We assessed the 10-year incidence of OAG.There were 82 persons (104 eyes) who developed incident OAG over the 10-year follow-up. After adjusting for age, sex, family history of glaucoma, smoking, diabetes, hypertension, hypercholesterolemia, body mass index, spherical equivalent refraction, and C:D ratio, narrower CRAE was associated with higher risk of incident OAG (adjusted odds ratio [OR], 1.77; 95% confidence interval [CI], 1.12-2.79, per standard deviation decrease in CRAE). This association persisted after further adjustment for IOP (adjusted OR, 1.87; 95% CI, 1.14-3.05) or OPP (adjusted OR, 1.76; 95% CI, 1.11-2.78), and remained significant when analyses were confined to eyes with IOP<20 mmHg and C:D ratio<0.6 at baseline. There were no independent associations between CRVE and incident OAG.Retinal arteriolar narrowing, quantitatively measured from retinal photographs, was associated with long-term risk of OAG. These data support the concept that early vascular changes are involved in the pathogenesis of OAG and suggest that computer-based measurements of retinal vessel caliber may be useful to identify people with an increased risk of developing the clinical stage of glaucoma.The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Pseudoexfoliation Syndrome and the Long-Term Incidence of Cataract and Cataract Surgery: The Blue Mountains Eye Study

To assess whether the pseudoexfoliation syndrome (PXS) is associated with the long-term incidence of cataract or cataract surgery. Population-based cohort study. The Blue Mountains Eye Study examined 3654 persons 49 years of age and older at baseline; 2564 were re-examined after 5 or 10 years, or both. PXS was recorded at the baseline eye examination by an ophthalmologist. Masked graders assessed lens photographs using the Wisconsin Cataract Grading System. Generalized estimating equation regression models were used to examine the association between PXS and cataract by eye. Eyes with PXS had a significantly greater prevalence of cortical cataract (P=.02) and nuclear cataract (P < .0001) than eyes without PXS. The association between PXS and cortical cataract, however, did not persist after further adjustment for age, gender, smoking, diabetes, steroid use, myopia, socioeconomic status, and open-angle glaucoma (odds ratio [OR], 0.89; 95% confidence interval [CI], 0.53 to 1.46), whereas the association between PXS and nuclear cataract persisted after adjustment for the above confounders (OR, 1.90; 95% CI, 1.04 to 3.48). In addition, significant associations were found between the presence of PXS at baseline and the 10-year incidence of either nuclear cataract (P< .0001) or cataract surgery (P < .0001). These associations persisted after adjustment for the potential confounders listed above (OR, 3.25; 95% CI, 1.38 to 7.65; and OR, 4.09; 95% CI, 2.25 to 7.44; respectively). No significant cross-sectional or longitudinal associations were found between PXS and posterior subcapsular cataract. Long-term follow-up data from this population-based older cohort suggest that the presence of PXS is associated with an increased risk of nuclear cataract and cataract surgery.

Correlation and Reproducibility of Retinal Vascular Geometric Measurements for Stereoscopic Retinal Images of the Same Eyes

Purpose: To assess the correlation and reproducibility of retinal vascular geometric measurements obtained from two stereo-paired fundus images.Methods: Thirty stereoscopic pairs of color optic disc-centered photographs from the Blue Mountains Eye Study were analyzed. Side-by-side grading was performed by a single grader, using semi-automated computer software to quantify the following retinal geometric parameters: (1) retinal arteriolar/venular caliber (CRAE/CRVE); (2) arteriole-to-venule ratio (AVR); (3) branching angle; and (4) tortuosity. We used Pearson correlation (r), intra-class correlation coefficient (ICC), and Bland-Altman plots to assess within-pair correlation and reproducibility for each parameter measured.Results: Inter- and intra-grader r and ICC were high (all r > 0.90 and ICC > 0.90), except for branching angle (ICCs between 0.69–0.83). There was no significant difference between within-pair means of all retinal vascular geometric parameters, before and after excluding poor quality images. CRAE, CRVE, AVR, and arteriolar and venular tortuosity showed very high within-pair correlation and agreement (all r > 0.80 and all ICC > 0.90 respectively). Arteriolar and venular branching angles demonstrated moderate within-pair correlation (r = 0.65 and r = 0.62, respectively) and within-pair agreement (ICC = 0.76 and ICC = 0.77, respectively).Conclusions: Use of computer-assisted software to measure retinal vascular geometric parameters from paired fundus images was highly repeatable and is robust to differences in photographic angles of paired stereo images. Such measurements can be applied to evaluate temporal changes in longitudinal studies.

Prevalence and Risk Factors of Epiretinal Membrane in Asian Indians

To describe the prevalence of epiretinal membrane (ERM) and its risk factors in an Indian population and compare the findings with other populations. The Singapore Indian Eye Study is a population-based survey of 3400 Asian Indians aged between 40 and 80 years. A comprehensive ophthalmic examination, standardized interviews, and laboratory blood tests were performed. Digital retinal fundus photographs were assessed for the presence of ERM following the definitions used in the Blue Mountains Eye Study (BMES). ERM was classified into a less severe form termed "cellophane macular reflex" (CMR) and a more severe form termed "preretinal macular fibrosis" (PMF) and also as primary and secondary (if it was associated with retinal pathology or cataract surgery). A total of 3328 persons (mean age 57.8 ± [SD] 10.1 years, and 50.2% male) provided data in this study. The age-standardized prevalence of ERM was 7.6% (95% confidence interval [CI], 6.8-8.6), CMR 4.1% (95% CI, 3.5-4.9), and PMF 3.5% (95% CI, 2.9-4.2). Older age (odds ratio [OR], 1.09; 95% CI, 1.07-1.11, per year increase), increasing myopic refraction (OR, 1.14; 95% CI, 1.07-1.22, per diopter decrease), and narrower retinal arteriolar diameter (OR, 1.02; 95% CI, 1.00-1.03, per μm decrease) were significantly associated with primary ERM. The age-standardized prevalence of ERM in the Indian population in Singapore was 7.6%. This is similar to Malays in Singapore (8.0%) and higher than the prevalence in whites in Australia (4.7%). Significant factors associated with primary ERM were older age, myopia, and narrower retinal arteriolar diameter.

Olfactory impairment is associated with functional disability and reduced independence among older adults

ObjectivesDespite its relatively high prevalence, population-based data are lacking on whether olfactory impairment influences the functional status and independence of older adults. We assessed associations between olfactory impairment with activities of daily living (ADL) measures and the likelihood of using community support services and/or reliance on non-spouse family/friend support among older adults. Study designOlfaction was measured using the San Diego Odor Identification Test (SDOIT) among 1636 participants of the Blue Mountains Eye Study (2002–4). Functional status was determined by the Older Americans Resources and Services ADL scale. Use of services and non-spouse family/friend support was self-reported. ResultsUse of community support services was reported by 15.2% and 5.2% of persons with and without olfactory impairment, respectively. After multivariable adjustment including for cognitive function, participants with compared to those without olfactory impairment were more likely to use community support services and non-spouse family/friend support, odds ratio, OR, 1.82 (95% confidence intervals, CI 1.16–2.86) and OR 1.62 (95% CI 1.14–2.32), respectively. ADL difficulty was reported by 16.9% (n=57) and 4.4% (n=45) of participants with and without olfactory loss, respectively. Olfactory impairment was associated with increased likelihood of experiencing ADL difficulty, multivariable-adjusted OR 1.98 (95% CI 1.10–3.57). Olfactory loss was significantly associated with impaired basic ADL, OR 1.57 (95% CI 1.12–2.20). ConclusionsThe functional ability and independence of older adults is significantly impaired in the presence of olfactory impairment. Early diagnosis of olfactory loss by primary physicians and geriatricians could facilitate timely interventions assisting the maintenance of functional independence in later life.

Prevalence of paraproteinaemia in older Australians

Estimates of the prevalence of paraproteinaemia vary, from 1% in persons aged over 25 years to 10% in those aged over 80 years, although there are limited data from well-defined populations. We sought to determine the prevalence of paraproteinaemia in Australians aged 50 years and over, and to determine risks factors for its presence. We performed a population-based, cross-sectional study using data and serum collected in the Blue Mountains Eye Study. Serum samples from 2933 patients were analysed by capillary zone electrophoresis and, where indicated, immunosubtraction, which allowed for both quantitation and isotype detection. A paraprotein was detected in 134 of the 2933 samples, giving an overall prevalence of 4.6% (95% confidence interval, 3.8-5.3%). The presence of a paraprotein was strongly age-related (P(trend) = 0.001), with a prevalence of 2.8% in persons aged 50-59 years, rising steadily to 9.1% in those aged 80 years and over. The prevalence was significantly higher in men (5.9%) compared with women (4.0%) (P= 0.03). We conclude that approximately one in 20 Australians aged 50 years or over harbours a paraprotein, a prevalence that appears higher than from similar cohorts in other countries.

Lens retrodots and vacuoles and their associations with the prevalence and incidence of age-related cataract

To 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. Of 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. At baseline, retrodots were present in 142 persons (4%) and vacuoles in 1333 persons (40%). Prevalence of both lens features increased with increasing age (P for 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). Lens 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.

The Association Between Olfactory Impairment and Total Mortality in Older Adults

Population-based data on the relationship between impaired olfaction and risk of mortality among older adults are lacking. We used a representative cohort of adults aged 60 years or older to assess whether olfactory loss is a predictor of mortality, independent of potential confounders. Olfaction was measured by the San Diego Odor Identification Test (SDOIT) among 1,636 participants enrolled in the Blue Mountains Eye Study (2002-2004). Five-year all-cause mortality was confirmed using the Australian National Death Index. More than one in five participants (21.8%) with olfactory impairment had died over the 5 years compared with less than 10% of participants without olfactory loss. Moderate olfactory loss (SDOIT score ≤3) was associated with a 68% increased risk of all-cause mortality (multivariable-adjusted hazard ratio, 1.68; 95% confidence interval, 1.10-2.56). This association did not persist after further adjustment for cognitive impairment. The association between olfactory loss and all-cause mortality was more marked among older participants (≥70 years) than younger participants (<70 years) with olfactory impairment (multivariable-adjusted hazard ratio, 1.48; 95% confidence interval, 1.02-2.15). However, adjusting for cognitive impairment diminished this association. Older adults with moderately impaired olfaction compared with those with normal olfaction had a higher risk of dying 5 years later. The relationship between olfaction and mortality, however, may be largely mediated by cognitive impairment in these older adults. Our findings highlight the value of identifying olfactory loss in the preclinical stage in the older patient before the development of related comorbidities.