Showing papers by "Robert G. Cumming published in 1997"
TL;DR: A population-based, cross-sectional study of vision and common eye diseases in an urban area of the Blue Mountains, near Sydney, Australia, found that there was a higher prevalence of nuclear cataracts in subjects using inhaled corticosteroids, after adjustment for age and sex.
Abstract: Background The use of systemic corticosteroids is a risk factor for the development of posterior subcapsular cataracts, but the association between inhaled corticosteroids and cataracts is uncertain. Methods We conducted a population-based, cross-sectional study of vision and common eye diseases in an urban area of the Blue Mountains, near Sydney, Australia. We recruited 3654 people 49 to 97 years of age; the participation rate was 82 percent. We collected information by questionnaire on potential risk factors for cataracts, including the current or prior use of inhaled corticosteroids (beclomethasone or budesonide). Photographs of the subjects' lenses were graded, without information on the subjects, to determine the presence and severity of cortical, nuclear, and posterior subcapsular cataracts. Results Three hundred seventy subjects reported using inhaled corticosteroids, 164 currently and 206 previously. Among these subjects, after adjustment for age and sex, there was a higher prevalence of nuclear c...
452 citations
TL;DR: The Wisconsin cataract grading system was used in an older Australian population with acceptable reproducibility and susceptibility of the lower nasal lens to cortical cataracts was confirmed, supporting a potential role of sunlight exposure in its development.
356 citations
TL;DR: Hip fractures are the most serious osteoporotic fracture at both an individual and population level and, of the survivors, many never regain their prefracture level of physical function.
Abstract: Hip fractures are the most serious osteoporotic fracture at both an individual and population level. In the United States alone there are over 250,000 hip fractures each year (1), costing at least 5.4 billion dollars annually (2). About 20 percent of persons who fracture their hip are dead within a year (3, 4) and, of the survivors, many never regain their prefracture level of physical function (5, 6).
306 citations
TL;DR: Assessment of the effectiveness of calcium supplements and/or dietary calcium for the prevention of osteoporotic fractures in postmenopausal women supports the current clinical and public health policy of recommending increased calcium intake among older women for fracture prevention.
Abstract: A systematic review of the literature was conducted to assess the effectiveness of calcium supplements and/or dietary calcium for the prevention of osteoporotic fractures in postmenopausal women. Studies were identified by conducting a Medline search using the text words “fracture” and “calcium” for the period 1966 to March 1997 and by reviewing articles known to the authors. Only studies with fracture outcomes were eligible. There were 14 studies of calcium supplements (including 4 randomized trials), 18 studies of dietary calcium and hip fracture (no randomized trials), and 5 studies of dietary calcium and other fracture sites (no randomized trials). The 4 randomized trials of calcium supplements (mean calcium dose: 1050 mg) found relative risk (RR) reductions between 25% and 70%. Meta-analytic techniques for dose-response data were used to investigate and pool the findings of 16 observational studies of dietary calcium and hip fracture. These hip fracture studies were not consistent and heterogeneity of study findings (p = 0.02) was not easily explained by subject characteristics or study design. Pooling study results gave an odds ratio (OR) of 0.96 (95% confidence interval, (CI) 0.93–0.99) per 300 mg/day increase in calcium intake (the equivalent of one glass of milk). This is likely to be an underestimate of calcium's true effect because of inaccurate measurement of dietary calcium in observational studies. This review supports the current clinical and public health policy of recommending increased calcium intake among older women for fracture prevention.
233 citations
TL;DR: The use of inhaled corticosteroids is associated with the development of posterior subcapsular and nuclear cataracts, and the associations were less marked when the analyses were restricted to subjects who had never used systemic cortiosteroids.
198 citations
TL;DR: Smoking was associated with a higher prevalence of nuclear and posterior subcapsular cataracts and the only adverse effect of alcohol was among smokers: people who smoked and drank heavily had an increased prevalence ofnuclear cataract.
Abstract: Objective: To investigate the associations between alcohol consumption, tobacco smoking, and cataract. Design: A population-based, cross-sectional study. Setting: An urban community in the Blue Mountains, close to Sydney, Australia. Participants: Three thousand six hundred fifty-four people aged 49 to 97 years. The participation rate was 82%. Main Outcome Measures: Smoking history and details of current alcohol consumption were assessed by questionnaire. Lens photographs were taken and graded for presence and severity of cortical, nuclear, and posterior subcapsular cataracts. Results: After adjusting for multiple potential confounders, people who had ever smoked cigarettes had a higher prevalence than nonsmokers of more severe nuclear (adjusted odds ratio [OR], 1.3; 95% confidence interval [CI], 1.1-1.6) and posterior subcapsular (adjusted OR, 1.5; 95% CI, 1.1-2.1) cataracts. The association between pipe smoking and nuclear cataract (adjusted OR, 3.1; 95% CI, 1.5-8.2) was stronger than the association with cigarette smoking. Alcohol consumption was associated with a reduced prevalence of cortical cataract: compared with people who did not drink, the adjusted OR for cortical cataract among people who drank at least 1 drink a day was 0.7 (95% CI, 0.6-0.9). Heavy alcohol consumption (≥4 drinks a day) was associated with nuclear cataract in current smokers (adjusted OR compared with nondrinkers, 3.9; 95% CI, 0.9-16.6) but not in never smokers. Conclusions: Consistent with other studies, smoking was associated with a higher prevalence of nuclear and posterior subcapsular cataracts. The only adverse effect of alcohol was among smokers: people who smoked and drank heavily had an increased prevalence of nuclear cataract.
167 citations
TL;DR: This study did not find a substantial beneficial effect of calcium on fracture risk, and it is more likely that the findings are due to inadequately controlled confounding by indications for use of supplements.
Abstract: The relation between dietary calcium, calcium, and vitamin D supplements and the risk of fractures of the hip (n = 332), ankle (n = 210), proximal humerus (n = 241), wrist (n = 467), and vertebrae (n = 389) was investigated in a cohort study involving 9,704 US white women aged 65 years or older. Baseline assessments took place in 1986-1988 in four US metropolitan areas. Dietary calcium intake was assessed at baseline with a validated food frequency questionnaire. Data on new nonvertebral fractures were collected every 4 months during a mean of 6.6 years of follow-up; identification of new vertebral fractures was based on comparison of baseline and follow-up radiographs of the spine done a mean of 3.7 years apart. Results were adjusted for numerous potential confounders, including weight, physical activity, estrogen use, protein intake, and history of falls, osteoporosis, and fractures. There were no important associations between dietary calcium intake and the risk of any of the fractures studied. Current use of calcium supplements was associated with increased risk of hip (relative risk = 1.5, 95% confidence interval 1.1-2.0) and vertebral (relative risk = 1.4, 95% confidence interval 1.1-1.9) fractures; current use of Tums antacid tablets was associated with increased risk of fractures of the proximal humerus (relative risk = 1.7, 95% confidence interval 1.3-2.4). There was no evidence of a protective effect of vitamin D supplements. Although a true adverse effect of calcium supplements on fracture risk cannot be ruled out, it is more likely that our findings are due to inadequately controlled confounding by indications for use of supplements. In conclusion, this study did not find a substantial beneficial effect of calcium on fracture risk.
156 citations
TL;DR: The hypothesis that estrogen and/or progestin may be involved in cataract development is supported and the effect of hormone replacement therapy on the lens needs to be evaluated in the laboratory and in further observational epidemiologic studies.
Abstract: The relation between estrogen (endogenous and exogenous) and cataract is unclear, with one large population-based study recently suggesting a protective effect of estrogen replacement therapy. The study reported in this paper, the Blue Mountains Eye Study, was conducted in Australia in 1992-1993 and involved 2,072 women aged 49-97 years. Subjects were recruited from a defined geographic area; the participation rate was 83 percent. Eye examination included photographs of the lens, which were graded for presence and severity of cortical, nuclear, and posterior subcapsular cataracts. Later age at menarche was associated with increased prevalence of all three types of cataract, but there were no associations with age at menopause, number of children, or use of the oral contraceptive pill. Among all women, there was no association between hormone replacement therapy and cataract. However, current users of hormone replacement therapy aged 65 years and over, among whom the duration of use was likely to have been longer than in younger current users, had lower prevalence of cortical cataract than did never users; the odds ratio adjusted for numerous potential confounders was 0.4 (95 percent confidence interval 0.2-0.8). The prevalence of posterior subcapsular cataract was increased in current users of hormone replacement therapy who had had a nonsurgical menopause; the adjusted odds ratio was 2.1 (95 percent confidence interval 1.1-4.1). The results of this study support the hypothesis that estrogen and/or progestin may be involved in cataract development. The effect of hormone replacement therapy on the lens needs to be evaluated in the laboratory and in further observational epidemiologic studies.
122 citations
TL;DR: Community awareness of this disease and the need for screening of people at risk may allow timely diagnosis and more effective therapy before advanced visual field loss has occurred and is more likely to comply better with recommended therapy.
Abstract: Purpose: To ascertain the level of knowledge of common causes of blindness in an adult Australian population and to relate this to use of eye care services.
Methods: A population-based study of common eye diseases in an urban population aged 49 years or older was conducted. The questions were concerned with the awareness and knowledge of and the ability to describe three common eye diseases, namely cataract, glaucoma and agerelated macular degeneration (AMD).
Results: Awareness of cataract (98%) and glaucoma (93%) were high in this population, but awareness of AMD was low (20%). Among people who were aware of the target eye disease, only 29% showed some knowledge of glaucoma, 26% showed some knowledge of AMD and 20% showed some knowledge of cataract; this was also low in people who had previous eye treatment, such as cataract surgery. Knowledge was related to education level, occupational prestige and knowledge of other eye diseases. After excluding people with a previous eye disease diagnosis, those people who were aware and had some knowledge of eye disease accessed eyecare services more frequently.
Conclusions: Knowledge of common eye diseases is generally lacking. Age-related macular degeneration is the leading cause of blindness in Australia, yet only 20% of the present study population had heard of it. As there are often no early symptoms for glaucoma, community awareness of this disease and the need for screening of people at risk may allow timely diagnosis and more effective therapy before advanced visual field loss has occurred. An informed public is more likely to present earlier with visual symptoms before irreversible visual loss has occurred and is more likely to comply better with recommended therapy.
96 citations
TL;DR: In the Blue Mountains eye Study, the Wisconsin cataract grading system provided good reproducibility, comparable to that reported from the Beaver Dam Eye Study, endorsing its usefulness inCataract epidemiology.
Abstract: Problem To measure the inter- and intra-grader reliability of the Wisconsin cataract grading system for grading of nuclear, cortical, and posterior subcapsular cataract (PSC) in the Blue Mountains Eye Study.Methods Random samples of lens photographs from study subjects were regraded by each grader according to the Wisconsin cataract grading system. The results were compared using quadratic weighted kappa statistics to derive measures of inter- and intra-grader reliability for the grading of nuclear (5 grades), PSC (3 grades), and cortical cataract (3 grades).Results Inter-grader reliability (quadratic weighted kappa) for grading of nuclear cataract varied between 0.82 and 0.79; kappa was 0.78 for cortical cataract and 0.57 for PSC. Intra-grader reliability was slightly higher than inter-grader reliability for all three cataract types.Conclusion In the Blue Mountains Eye Study, the Wisconsin cataract grading system provided good reproducibility, comparable to that reported from the Beaver Dam Eye Study, en...
41 citations
TL;DR: The type and range of hazards found in the homes of elderly persons referred to the occupational therapy department of a city teaching hospital are described and Mildly cognitively impaired persons and women were found to have more bed light hazards and people living with others were more likely to have a pet that may pose a risk of the elderly person falling.
Abstract: This study describes the type and range of hazards found in the homes of elderly persons (n=257) referred to the occupational therapy department of a city teaching hospital. Homes were assessed usi...
TL;DR: The present study provides a clinical alert that localized field loss is unlikely to be related to cataract, and neither cortical, nuclear nor PSC cataracts increase the total points missing on the 76-point suprathreshold field test.
Abstract: Purpose: To examine whether localized cataract is related to localized field defects on suprathreshold visual field testing.
Methods: Suprathreshold screening visual fields (Humphrey 76-point test) and lens photographs, graded using the Wisconsin System, were performed on participants attending the Blue Mountains Eye Study, which examined 3654 subjects residing in an area west of Sydney, NSW, Australia. The results for 2276 subjects were analysed in the present study.
Results: There were no significant relationships between total points missing in the visual field and the degree of cortical, posterior subcapsular (PSC) or nuclear cataract after adjusting for confounders (test for trend P=0.9, 0.7 and 0.9, respectively). Adjusted prevalence ratios and 95% confidence limits for the association between 10 or more points missing and the presence of cataract were 0.94 (0.77–1.25) for cortical, 1.26 (0.82–1.93) for PSC and 1.06 (0.86–1.30) for nuclear cataract. Similarly, there was no relationship between the presence of cortical or PSC cataract and sectoral visual field loss in any quadrant or hemifield.
Conclusions: Neither cortical, nuclear nor PSC cataracts increase the total points missing on the 76-point suprathreshold field test. Similarly, neither cortical nor PSC cataracts cause sectoral visual field loss on this screening field test. In the presence of cataract, sectoral visual field loss on non-thresholding visual field screeners must be attributed to other causes, such as glaucoma. The present study provides a clinical alert that localized field loss is unlikely to be related to cataract.