Showing papers by "Ronald Klein published in 2001"

The prevalence of glaucoma in a population-based study of Hispanic subjects: Proyecto VER.

Abstract: Objective To determine the prevalence of glaucoma in a population-based sample of Hispanic adults older than 40 years. Methods Using 1990 census data for Arizona, groups of persons living in sections of the city in Nogales and Tucson were randomly selected with a probability proportional to the Hispanic population older than 40 years. We tried to recruit all eligible adults in homes with 1 self-described Hispanic adult. Detailed ocular examinations at a local clinic included visual acuity testing, applanation tonometry, gonioscopy, an optic disc evaluation, and a threshold visual field test. Open-angle glaucoma (OAG) was defined using a proposed international system for prevalence surveys, including threshold visual field defect and optic disc damage. Angle-closure glaucoma was defined as bilateral appositional angle closure, combined with optic nerve damage (judged by field and disc as for OAG). Results Examinations were conducted in 72% (4774/6658) of eligible persons, with a 1.97% prevalence (95% confidence interval, 1.58%-2.36%) of OAG (94 persons). The age-specific OAG prevalence increased nonlinearly from 0.50% in those aged 41 to 49 years to 12.63% in those 80 years and older. Angle-closure glaucoma was detected in 5 persons (0.10%). Sex, blood pressure, and cigarette smoking were not significant OAG risk factors. Only 36 (38%) of the 94 persons with OAG were aware of their OAG before the study. Screening results with an intraocular pressure higher than 22 mm Hg (in the eye with a higher pressure) would miss 80% of the OAG cases. Conclusions The prevalence of OAG in Hispanic persons was intermediate between reported values for white and black persons. The prevalence increased more quickly with increasing age than in other ethnic groups. Glaucoma was the leading cause of bilateral blindness.

Lutein and zeaxanthin in the diet and serum and their relation to age-related maculopathy in the third national health and nutrition examination survey

Abstract: Relations of the carotenoids lutein and zeaxanthin in the diet and serum to photographic evidence of early and late age-related maculopathy (ARM) among persons over age 40 years (n = 8,222) were examined. Inverse relations of these carotenoids in the diet or serum to any form of ARM were not observed overall. There was a direct relation of dietary levels to one type of early ARM (soft drusen). However, relations differed by age and race. In the youngest age groups who were at risk for developing early (ages 40-59 years) or late (ages 60-79 years) ARM, higher levels of lutein and zeaxanthin in the diet were related to lower odds for pigmentary abnormalities, one sign of early ARM (odds ratio among persons in high vs. low quintiles = 0.1, 95 percent confidence interval: 0.1, 0.3) and of late ARM (odds ratio = 0.1, 95 percent confidence interval: 0.0, 0.9) after adjustment for age, gender, alcohol use, hypertension, smoking, and body mass index. Relations of these carotenoids to ARM may be influenced by age and race and require further evaluation in separate populations and in prospective studies.

The Prevalence of Age-Related Macular Degeneration and Associated Risk Factors

Abstract: Objectives To determine the prevalence of age-related macular degeneration (AMD) and to examine how retinal drusen, retinal pigmentary abnormalities, and early AMD are related to age, sex, and other risk factors. Participants A total of 2810 people aged 21 to 84 years participating in the Beaver Dam Offspring Study. Methods The presence and severity of various characteristics of drusen and other lesions typical of AMD were determined by grading digital color fundus images using the Wisconsin Age-Related Maculopathy Grading System. Results Early AMD was present in 3.4% of the cohort and varied from 2.4% in those aged 21 to 34 years to 9.8% in those aged 65 years or older. In a multivariable model (expressed as odds ratio; 95% confidence interval), age (per 5 years of age, 1.22; 1.09-1.36), being male (1.65; 1.01-2.69), more pack-years of cigarettes smoked (1-10 vs 0, 1.31; 0.75-2.29; ≥11 vs 0, 1.67; 1.03-2.73), higher serum high-density lipoprotein cholesterol level (per 5 mg/dL, 0.91; 0.83-0.998), and hearing impairment (2.28; 1.41-3.71) were associated with early AMD. There were no associations of blood pressure level, body mass index, physical activity level, history of heavy drinking, white blood cell count, hematocrit level, platelet count, serum total cholesterol level, or carotid intimal-medial thickness with early AMD. Conclusions These data indicate that early AMD is infrequent before age 55 years but increases with age thereafter. Early AMD is related to modifiable risk factors, eg, smoking and serum high-density lipoprotein cholesterol level.

Sunlight and the 5-year incidence of early age-related maculopathy: the beaver dam eye study.

Abstract: Objective To investigate the relation of sunlight exposure and indicators of sun sensitivity with the 5-year incidence of early age-related maculopathy (ARM). Design Longitudinal, population-based study. Participants (aged 43-86 years at baseline) in the Beaver Dam Eye Study were reexamined from 1993 to 1995, 5 years after the baseline examination. Questionnaire data about sunlight exposure and sun sensitivity were obtained at baseline. Additional information about earlier life patterns of exposure was ascertained at follow-up. Stereoscopic color fundus photographs were graded to determine the presence of ARM at the 5-year follow-up in eyes free from signs of early ARM at the baseline examination. Results Leisure time spent outdoors while persons were teenagers (aged 13-19 years) and in their 30s (aged 30-39 years) was significantly associated with the risk of early ARM (odds ratio, 2.09; 95% confidence interval, 1.19-3.65). There was a slight, but nonsignificant, protective effect associated with use of hats and sunglasses while persons were teenagers and in their 30s (odds ratio, 0.72; 95% confidence interval, 0.50-1.03). People with red or blond hair were slightly more likely to develop early ARM than people with darker hair (odds ratio, 1.33; 95% confidence interval, 0.97-1.83). There were no associations between estimated ambient UV-B exposure or markers of sun sensitivity and the incidence of early ARM. Conclusion Exposure to sunlight may be associated with the development of early ARM.

Diabetes and Diabetic Retinopathy in a Mexican-American Population: Proyecto VER

Abstract: OBJECTIVES The prevalence rate of diabetes is probably higher in Hispanics than in Caucasians, although there is controversy about differences in the risk of diabetic retinopathy. The purpose of the study is to determine the prevalence rates of diabetes and diabetic retinopathy in a population-based study of Hispanics aged ≥40 years. RESEARCH DESIGN AND METHODS —Proyecto VER is a random sample of Hispanic populations aged ≥40 years in Arizona. A total of 4,774 individuals (71.6% of the eligible sample) completed the examinations. Diabetes was defined as self-report of a physician diagnosis or HbA 1c value of ≥7.0%. Diabetic retinopathy was assessed on stereo fundus photographs of fields 1, 2, and 4. RESULTS —The prevalence rate of diabetes in the Hispanic community (individuals ≥40 years of age) was 22%. The prevalence rate of diabetic retinopathy (DR) was 48%; 32% had moderate to severe nonproliferative and proliferative retinopathy. DR increased with increasing duration of diabetes and increasing level of HbA 1c . The prevalence rate of DR-like changes in the sample of individuals without diabetic retinopathy was 15% and was not associated with hypertension, systolic blood pressure, or diastolic blood pressure. CONCLUSIONS —The prevalence rate of diabetes in this population of Hispanics is high, almost twice that of Caucasians. The prevalence rate of DR is high but similar to reports in a Caucasian population. The prevalence rate of 9% moderate to severe retinopathy in the newly diagnosed group suggests that efforts to improve detection and treatment of diabetes in Hispanics may be warranted.

The NEI-VFQ-25 in People With Long-term Type 1 Diabetes Mellitus: The Wisconsin Epidemiologic Study of Diabetic Retinopathy

Abstract: Objectives To examine the association of the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) overall and specific scale scores with visual acuity, diabetic retinopathy, and other characteristics, in a cohort of persons with type 1 diabetes. Design Population-based cohort study. Setting An 11-county area in southern Wisconsin. Participants Six hundred two persons with diabetes whose conditions were diagnosed when they were younger than 30 years and who were currently taking insulin participated in baseline, 4-year, 10-year, and 14-year follow-up examinations. Main Outcome Measures An interview that consisted of the 25-item NEI-VFQ was completed. Visual acuity was measured by the Early Treatment of Diabetic Retinopathy Study (ETDRS) protocol and the presence and severity of retinopathy and macular edema were detected by masked grading of stereoscopic color fundus photographs using the modified Airlie House classification and the ETDRS retinopathy severity scheme. Results Univariate analyses revealed that the total NEI-VFQ-25 score was lower in persons who were older, had a longer duration of diabetes, higher glycosylated hemoglobin, were in renal failure, had a history of cardiovascular disease, hypertension, or amputation of a lower limb, had poorer visual acuity, more severe diabetic retinopathy, macular edema, glaucoma, cataract, abnormalities in tactile sensation or temperature sensitivity, smoked more total pack-years, led a more sedentary lifestyle, and had poor peak expiratory flow. In multivariate analyses, while controlling for the physical and mental component scores from the Medical Outcomes Survey 36-Item Short-Form Health Survey as measures of comorbidity, lower total NEI-VFQ-25 scores were independently associated with poorer visual acuity, more severe retinopathy, older age, history of loss of tactile sensation, and more total pack-years of cigarettes smoked. Conclusions In this cross-sectional study, the 25-item NEI-VFQ seems to be strongly associated with vision, independent of severity of retinopathy and other complications associated with type 1 diabetes. It may be a useful measure of health-related quality of life as it relates to vision in epidemiological studies and clinical trials in persons with diabetes.

Refractive errors and incident cataracts: the Beaver Dam Eye Study.

Abstract: Purpose To describe the relation between refractive errors and incident age-related cataracts in a predominantly white US population Methods All persons aged 43 to 84 years of age in Beaver Dam, Wisconsin, were invited for a baseline examination from 1988 through 1990 and a follow-up examination 5 years later from 1993 through 1995 At both examinations, participants had refraction and photographic assessment of cataract, according to a standardized protocol Myopia was defined as a spherical equivalent of -10 diopters (D) or less, hyperopia as +10 D or more The relations between refractive errors at baseline and cataract at baseline (prevalent cataract), 5-year incident cataract, and incident cataract surgery were analyzed by using generalized estimating equations Results When age and gender were controlled for, myopia was related to prevalent nuclear cataract (odds ratio [OR], 167; 95% confidence interval [CI], 123-227), but not to cortical and posterior subcapsular cataracts Myopia was not related to 5-year incident nuclear, cortical, and posterior subcapsular cataracts, but was related to incident cataract surgery (OR 189; CI 118-304) Hyperopia was related to incident nuclear (OR 156; CI 125-195) and possibly cortical (OR 125; CI 096-163) cataracts, but not to posterior subcapsular cataract or cataract surgery After further adjustment for diabetes, smoking, and education, the association between myopia and incident cataract surgery was attenuated (OR 160; CI 096-264), but the associations between hyperopia and incident nuclear and cortical cataracts were unchanged Conclusions These data support the cross-sectional association between myopia and nuclear cataract seen in other population-based studies, but provide no evidence of a relationship between myopia and 5-year incident cataract Hyperopia may be related weakly to incident nuclear and cortical cataract

Medication use and the 5-year incidence of early age-related maculopathy: the Beaver Dam Eye Study.

Abstract: Objective To evaluate incident early age-related maculopathy (ARM) after a 5-year interval with respect to medication use. Design Population-based incidence study. Setting Participants were adults aged 43 to 86 years living in Beaver Dam, Wis, when first examined in 1988-1990 (n = 4926); they were reexamined in 1993-1995(n = 3684). Methods All participants were examined and interviewed and stereoscopic color fundus photographs were taken. All procedures were done by standard protocol at both examinations. Incidence of ARM was based on grading using the Wisconsin ARM Grading System. All prescribed and over-the-counter medications in current use were brought to the examination site and the names were recorded at that time. Results There were 678 drug preparations (active ingredients) being used at the baseline examination. No relations were found between most antihypertensive drugs, most central nervous system medications, aspirin and other nonsteroidal anti-inflammatory agents, estrogens, lipid-lowering agents, and incident early ARM over the 5-year period. Age- and sex-adjusted logistic regression analyses suggested possible associations ( P P = .06), desiccated thyroid hormones (OR, 2.32; 95% CI, 0.89-6.07; P = .09), and calcium channel blockers (OR, 1.70; 95% CI, 0.93-3.12; P = .08) with incident ARM. When additional information on past use was included in the regression model, the association remained for calcium channel blockers, but not for phenothiazines and desiccated thyroid hormones. A lower incidence of early ARM occurred in those who took antidepressants(OR, 0.34; 95% CI, 0.12-0.94; P = .04) at the baseline examination. Conclusion Although many different medications were being used at the baseline examination in the Beaver Dam Eye Study cohort, there were no striking associations with the 5-year incidence of early ARM.

Relationship of dietary fat to age-related maculopathy in the Third National Health and Nutrition Examination Survey.

Abstract: Objective To evaluate the associations between dietary fat and age-related maculopathy(ARM) in persons 40 years or older who participated in the Third National Health and Nutrition Examination Survey. Methods We used a single, nonmydriatic, fundus photograph of 1 eye to ascertain ARM status in 7883 of 11 448 survey participants. Intake of fat was estimated from 24-hour recall, and specific sources of dietary fat were estimated from responses to food frequency questionnaires. Logistic regression was used to compute odds ratios (ORs) and 95% confidence intervals (CIs) that accounted for complex survey design, nonresponse, and potential risk factors for ARM(age, smoking, race, sex, body mass index, history of cardiovascular disease or hypertension, eye color, and sedentary lifestyle). Persons aged 40 to 79 years (n = 7405) were included in analyses for early ARM (n = 644); those 60 years or older (n = 4294) were included in analyses for late ARM (n = 53). Results After adjustment for age, race, eye color, and sedentary lifestyle, OR for early ARM was 1.4 (95% CI, 0.9-2.2; P for trend, .10) among persons in high vs low quintiles of total fat intake (percentage of total energy). Associations for specific types of fatty acids (as percentages of caloric intake) were in the same direction and unrelated to ARM. The OR for late ARM was 0.7 (95% CI, 0.2-2.6; P for trend,.60) in persons 60 years or older. Further adjustments for other potential confounders did not significantly affect the ORs. Conclusion Age-related maculopathy was not significantly associated with dietary fat in this large cross-sectional survey.

Measures of obesity and age-related eye diseases.

Abstract: OBJECTIVE. To compare body mass index with waist-to-hip ratio as correlates of age-related eye disease. DESIGN. Population-based cross-sectional study. PARTICIPANTS. Participants of the Beaver Dam Eye Study at 5-year follow-up examinations. METHODS. Body mass index was computed from weight and height, and waist-to-hip ratio was computed from measurements all done at the 5-year examination. Presence of ocular lesions was based on gradings of standard photographs of the retina and lens. MAIN OUTCOME MEASURES. Presence of early and late age-related maculopathy and nuclear, cortical, and posterior subcapsular cataracts. RESULTS. In women, early age-related maculopathy was significantly associated with both body mass index and waist-to-hip ratio. The relationship between waist-to-hip ratio and late age-related maculopathy was of borderline significance. When analyzed as continuous measures, waist-to-hip ratio was more strongly associated with nearly every outcome compared to body mass index. In men, there was ...

Psychometric properties of the 25-item NEI-VFQ in a Hispanic population: Proyecto VER.

Abstract: PURPOSE To assess the psychometric properties of the NEI-VFQ-25 in a population-based study of older Hispanic persons living in the United States, explore other demographic factors that affect participant response, and observe the comparability of the Spanish and English versions of the instrument. METHODS A sample of randomly selected block groups in Tucson and Nogales, Arizona, were selected for study. Participants were interviewed at home; a majority of the interviews were conducted in Spanish. The home interview included questions from the NEI-VFQ-25 and HHANES: Presenting acuity was done using ETDRS methodology, followed by a standardized eye examination by an ophthalmologist. The authors analyzed the internal consistency of the NEI-VFQ-25 responses using Cronbach's alpha coefficient and the construct validity by assessing the relationship between presenting acuity and scale scores, adjusting for age and gender. A second model was also explored to determine whether other demographic variables affected scale scores; differences in reporting between the Spanish and English versions was observed in this model, used in a subset of the population that minimized interviewer effect. RESULTS Of the 4774 participants in the study, 99.7% had completed questionnaires, not completed by proxy. The highest nonresponse rate occurred in the Driving scale, with 25% of participants not driving for reasons other than problems with vision. Internal consistency was high, with Cronbach alpha ranging between 0.65 and 0.86 for scales with multiple items. Adjusting for age and gender, those with presenting acuity worse than 20/40 scored significantly lower than those with presenting acuity 20/40 or better, for all scales. The demographic variables with the most consistent association across the NEI-VFQ-25 scales were presenting acuity, income, and gender. No significant differences in reporting were found between the Spanish and English versions of the questionnaire in the subset of the population. CONCLUSIONS In this study of Hispanic people age 40 years or older, the NEI-VFQ-25 was sensitive to presenting acuity and other demographic variables, such as age, gender, and income. The findings from this psychometric analysis provide evidence of the reliability and validity of some of the scales in the 25-item NEI-VFQ when used among people with a range of visual acuity level, providing other explanatory variables are also considered.

Risk of Incident Age-related Eye Diseases in People with an Affected Sibling The Beaver Dam Eye Study

Abstract: The purpose of this investigation was to determine whether age-related cataract and maculopathy in older siblings predicts development of the same in younger siblings. A population-based study of age-related eye diseases was conducted in 1988-1990 in Beaver Dam, Wisconsin, and a follow-up examination was performed 5 years later. Diagnoses of age-related eye diseases were assigned on the basis of gradings of study photographs. There were 1,088 people from 488 sibships with at least two siblings who could contribute information for these analyses. The authors computed odds ratios and 95% confidence intervals for developing the specific lesion and identifying it 5 years later if an older sibling had it at baseline. The odds ratios were 1.65 (95% confidence interval (CI): 0.91, 2.99) for nuclear cataract, 1.62 (95% Cl: 0.92, 2.85) for cortical cataract, 1.95 (95% CI: 0.48, 7.95) for posterior subcapsular cataract, 1.82 (95% CI: 0.91, 3.66) for soft drusen, 8.18 (95% CI: 3.34, 20.08) for retinal pigment epithelium depigmentation, 3.59 (95% CI: 1.71, 7.57) for increased retinal pigment, and 10.32 (95% Cl: 0.83, 128.58) for exudative age-related maculopathy. These findings suggest that strong family determinants of lesions of age-related maculopathy are likely, less so for age-related cataract, which confer risk of the same lesion in a younger sibling. Am J Epidemiol 2001;154:207-11.

Association of Leisure-Time Noise Exposure and Hearing Loss:Asociación entre exposición a ruido durante el tiempo libre e hipoacusia

Abstract: The purpose of this study was to investigate the association of noisy leisure activities with hearing loss. Participants (n=3571) were examined in a population-based study of age-related hearing loss conducted in Beaver Dam, Wisconsin. Hearing thresholds were determined by audiometry. Hearing loss was defined as the pure-tone average of the frequencies 500,1,000, 2,000, and 4,000 Hz greater than 25 dB HL in either ear. Information regarding exposure to leisure-time noise was obtained by interview. After adjusting for potential confounders, individuals who engaged in leisure activities with average sound levels greater than 90 dBA were significantly more likely to have a hearing loss than participants who did not engage in noisy leisure activities (OR=1.11, 95 per cent 0=1.01-1.22). Individuals who engaged in woodworking were 30 per cent more likely to have a hearing loss than those who had never done woodworking. There was a 6 per cent increased risk of hearing loss for each 5-year period of participation...

Comparison of Diagnosis of Early Retinal Lesions of Diabetic Retinopathy Between a Computer System and Human Experts

Abstract: Objective To investigate whether a computer vision system is comparable with humans in detecting early retinal lesions of diabetic retinopathy using color fundus photographs. Methods A computer system has been developed using image processing and pattern recognition techniques to detect early lesions of diabetic retinopathy (hemorrhages and microaneurysms, hard exudates, and cotton-wool spots). Color fundus photographs obtained from American Indians in Oklahoma were used in developing and testing the system. A set of 369 color fundus slides were used to train the computer system using 3 diagnostic categories: lesions present, questionable, or absent(Y/Q/N). A different set of 428 slides were used to test and evaluate the system, and its diagnostic results were compared with those of 2 human experts—the grader at the University of Wisconsin Fundus Photograph Reading Center (Madison) and a general ophthalmologist. The experiments included comparisons using 3 (Y/Q/N) and 2 diagnostic categories (Y/N) (questionable cases excluded in the latter). Results In the training phase, the agreement rates, sensitivity, and specificity in detecting the 3 lesions between the retinal specialist and the computer system were all above 90%. The κ statistics were high (0.75-0.97), indicating excellent agreement between the specialist and the computer system. In the testing phase, the results obtained between the computer system and human experts were consistent with those of the training phase, and they were comparable with those between the human experts. Conclusions The performance of the computer vision system in diagnosing early retinal lesions was comparable with that of human experts. Therefore, this mobile, electronically easily accessible, and noninvasive computer system, could become a mass screening tool and a clinical aid in diagnosing early lesions of diabetic retinopathy.

How many steps of progression of diabetic retinopathy are meaningful? The Wisconsin epidemiologic study of diabetic retinopathy.

Abstract: Objective To determine whether a 1-step or more or 2-step or more progression on the Early Treatment Diabetic Retinopathy Study retinopathy severity scale over a 4-year period is meaningful in predicting the subsequent incidence of proliferative diabetic retinopathy (PDR) and clinically significant macular edema (CSME) over the following 6 years. Design Population-based study of diabetic persons with 10 years of follow-up. Setting and Patients Eleven-county area in southern Wisconsin. There were 1025 persons with diabetes who had fundus photographs at baseline and at 4- and 10-year follow-up examinations. Main Outcome Measures Incidence of PDR or CSME between the 4- and 10-year follow-up examinations as determined by masked grading of color stereoscopic fundus photographs of 7 standard fields. Results In a univariate analysis, those with 1 or more steps of progression(n = 551) over the first 4 years of the study were significantly ( P P Conclusions It seems that 1 or more or 2 or more steps of progression of retinopathy over a 4-year period strongly predict the development of PDR over the next 6 years. Therefore, using these end points of progression would result in the need for fewer subjects or shorter follow-up in some clinical trials.

Aggregation of Refractive Error and 5-Year Changes in Refractive Error Among Families in the Beaver Dam Eye Study

Abstract: Objective To examine aggregation of refraction, myopia, hyperopia, and astigmatism, as well as the 5-year change in each of these measures, among adult family members. Design Geographically defined, population-based cohort study in Beaver Dam, Wis. Participants were all 43 to 84 years of age in 1988. Family relationships among participants of the study were identified through interviews. The main outcome measures were noncycloplegic refractions. Aggregation was assessed by Pearson correlations and odds ratios (ORs) that both members of a pair were affected. Results Age-adjusted sibling correlation of refraction was 0.37 and the OR for a sibling to be myopic was 4.18, whereas the OR for being hyperopic was 2.87(all statistically significant, P Conclusions The strong aggregation of refractive error, including myopia and hyperopia, among siblings along with weaker associations among parent-child and cousin pairs and no associations among spouses suggest a potential genetic influence on refractive error. There is no such suggestion for a genetic influence on the changes in refraction or in cylinder power and astigmatism.

Association of leisure-time noise exposure and hearing loss.

Abstract: The purpose of this study was to investigate the association of noisy leisure activities with hearing loss. Participants (n=3571) were examined in a population-based study of age-related hearing loss conducted in Beaver Dam, Wisconsin. Hearing thresholds were determined by audiometry. Hearing loss was defined as the pure-tone average of the frequencies 500, 1,000, 2,000, and 4,000 Hz greater than 25 dB HL in either ear. Information regarding exposure to leisure-time noise was obtained by interview. After adjusting for potential confounders, individuals who engaged in leisure activities with average sound levels greater than 90 dBA were significantly more likely to have a hearing loss than participants who did not engage in noisy leisure activities (OR=1.11, 95 per cent CI=1.01-1.22). Individuals who engaged in woodworking were 30 per cent more likely to have a hearing loss than those who had never done woodworking. There was a 6 per cent increased risk of hearing loss for each 5-year period of participation. Health care professionals should consider counseling their patients who engage in noisy leisure activities about the risk of noise-induced hearing loss.

Smoothing Spline ANOVA for Multivariate Bernoulli Observations With Application to Ophthalmology Data

Abstract: We combine a smoothing spline analysis of variance (SS-ANOVA) model and a log-linear model to build a partly flexible model for multivariate Bernoulli data. The joint distribution conditioning on the predictor variables is estimated. The log odds ratio is used to measure the association between outcome variables. A numerical scheme based on the block one-step successive over relaxation SOR–Newton-Ralphson algorithm is proposed to obtain an approximate solution for the variational problem. We extend the generalized approximate cross validation (GACV) and the randomized GACV for choosing smoothing parameters to the case of multivariate Bernoulli responses. The randomized version is fast and stable to compute and is used to adaptively select smoothing parameters in each block onestep SOR iteration. Approximate Bayesian confidence intervals are obtained for the flexible estimates of the conditional logit functions. Simulation studies are conducted to check the performance of the proposed method, using the com...

Macular edema and retinal hard exudates in African Americans with type 1 diabetes: the New Jersey 725.

Abstract: Objective To determine frequency and associated risk factors for macular edema and retinal hard exudates in hospitalized African Americans with type 1 diabetes. Subjects and Methods Included were 725 African Americans with type 1 diabetes who participated in the New Jersey 725. Clinical evaluations consisted of a structured clinical interview, ocular examination, stereoscopic fundus photographs, and blood pressure measurements. Presence of macular edema and hard exudates was determined via masked grading of fundus photographs. Biological evaluations included blood and urine assays. Results Of the 725 patients, 89 (12.3%) had macular edema and 149 (20.6%) had retinal hard exudates in at least 1 eye. The presence of macular edema and hard exudates was significantly associated with older age at examination, longer duration of diabetes, and severity of diabetic retinopathy. Presence of proteinuria, missing insulin injections at least once a week, and longer duration of diabetes were significantly and independently associated with macular edema. Presence of proteinuria, male sex, higher low-density lipoprotein cholesterol levels, and longer duration of diabetes were significantly and independently associated with severity of retinal hard exudates. Conclusion Macular edema and hard exudates are common in African Americans with type 1 diabetes, particularly in patients with evidence of renal disease.

Understanding the value of diabetic retinopathy screening.

Abstract: Regular dilated eye examinations are an effective approach to detecting and treating visionthreatening diabetic retinopathy. 1 They can help prevent blindness, and they are costeffective. 2,3 Guidelines for systematic screening have been developed because patients with retinopathy are often asymptomatic, and photocoagulation treatment is more effective at reducing visual loss when applied at specific, frequently asymptomatic, stages of retinopathy. 4,5 However, despite the recommendations for regular screening and the availability of effective treatment, many patients at risk of visual loss due to severe retinopathy are not receiving dilated eye examinations and needed photocoagulation treatments. 6,7 .

Peak expiratory flow rate: relationship to risk variables and mortality: the Wisconsin Epidemiologic Study of diabetic retinopathy.

Abstract: OBJECTIVE —To examine correlates of peak expiratory flow rate in people with type 1 diabetes and to evaluate the relationship of peak expiratory flow rate to mortality. RESEARCH DESIGN AND METHODS —A cohort study that was originally designed to determine the prevalence, incidence, and severity of diabetic retinopathy also provided the opportunity to measure peak expiratory flow rate. This was first measured at a 10-year follow-up and was evaluated in regard to risk factors for microvascular complications of diabetes. Mortality during 6 years of follow-up after the measurement was also ascertained. RESULTS —In multivariable analysis, peak expiratory flow rate was associated with sex, age, height, BMI, history of cardiovascular disease, pulse rate, duration of diabetes, glycosylated hemoglobin, and end-stage renal disease. Peak expiratory flow rate was significantly associated with survival in categorical analyses. Even after considering age, sex, renal disease, history of cardiovascular disease, respiratory symptoms, duration of diabetes, cigarette smoking, and hypertension, peak expiratory flow rate was still significantly related to survival (hazard ratio 0.61 [95% CI 0.46–0.82]). CONCLUSIONS —These data indicate that peak expiratory flow rate is associated with risk factors for other complications of diabetes. In addition, peak expiratory flow rate is a significant predictor of survival over even a relatively short period of time (6 years) in patients with younger-onset diabetes.