Showing papers by "Ronald Klein published in 2002"

Prevalence of olfactory impairment in older adults.

Abstract: Context Older adults represent the fastest-growing segment of the US population, and prevalences of vision and hearing impairment have been extensively evaluated. However, despite the importance of sense of smell for nutrition and safety, the prevalence of olfactory impairment in older US adults has not been studied. Objective To determine the prevalence of olfactory impairment in older adults. Design, setting, and participants A total of 2491 Beaver Dam, Wis, residents aged 53 to 97 years participating in the 5-year follow-up examination (1998-2000) for the Epidemiology of Hearing Loss Study, a population-based, cross-sectional study. Main outcome measures Olfactory impairment, assessed by the San Diego Odor Identification Test and self-report. Results The mean (SD) prevalence of impaired olfaction was 24.5% (1.7%). The prevalence increased with age; 62.5% (95% confidence interval [CI], 57.4%-67.7%) of 80- to 97-year-olds had olfactory impairment. Olfactory impairment was more prevalent among men (adjusted prevalence ratio, 1.92; 95% CI, 1.65-2.19). Current smoking, stroke, epilepsy, and nasal congestion or upper respiratory tract infection were also associated with increased prevalence of olfactory impairment. Self-reported olfactory impairment was low (9.5%) and this measure became less accurate with age. In the oldest group, aged 80 to 97 years, sensitivity of self-report was 12% for women and 18% for men. Conclusions This study demonstrates that prevalence of olfactory impairment among older adults is high and increases with age. Self-report significantly underestimated prevalence rates obtained by olfaction testing. Physicians and caregivers should be particularly alert to the potential for olfactory impairment in the elderly population.

Retinal arteriolar narrowing and risk of coronary heart disease in men and women. The Atherosclerosis Risk in Communities Study.

Abstract: ContextMicrovascular processes have been hypothesized to play a greater role in the development of coronary heart disease (CHD) in women than in men; however, prospective clinical data are limited.ObjectiveTo examine the association between retinal arteriolar narrowing, a marker of microvascular damage from hypertension and inflammation, and incident CHD in healthy middle-aged women and men.Design, Setting, and ParticipantsThe Atherosclerosis Risk in Communities Study, an ongoing prospective, population-based cohort study in 4 US communities initiated in 1987-1989. Retinal photographs were taken in 9648 women and men aged 51 to 72 years without CHD at the third examination (1993-1995). To quantify retinal arteriolar narrowing, the photographs were digitized, individual arteriolar and venular diameters were measured, and a summary arteriole-to-venule ratio (AVR) was calculated.Main Outcome MeasureRisk of CHD associated with retinal arteriolar narrowing.ResultsDuring an average 3.5 years of follow-up, 84 women and 187 men experienced incident CHD events. In women, after controlling for mean arterial blood pressure averaged over the previous 6 years, diabetes, cigarette smoking, plasma lipid levels, and other risk factors, each SD decrease in the AVR was associated with an increased risk of any incident CHD (relative risk [RR], 1.37; 95% confidence interval [CI], 1.08-1.72) and of acute myocardial infarction (RR, 1.50; 95% CI, 1.10-2.04). In contrast, AVR was unrelated to any incident CHD in men (RR, 1.00; 95% CI, 0.84-1.18) or to acute myocardial infarction (RR, 1.08; 95% CI, 0.85-1.38).ConclusionRetinal arteriolar narrowing is related to risk of CHD in women but not in men, supporting a more prominent microvascular role in the development of CHD in women than in men. Future work is needed to confirm these findings.

Cerebral white matter lesions, retinopathy, and incident clinical stroke.

Abstract: ContextWhite matter lesions (WMLs) detected on cerebral imaging scans have been hypothesized to have a microvascular etiology and to precede the development of clinical stroke. However, few clinical data are available to support these hypotheses.ObjectiveTo examine the relationship of WMLs, retinal microvascular abnormalities, and incident clinical stroke in healthy, middle-aged men and women.Design and SettingThe Atherosclerosis Risk in Communities Study (ARIC), a prospective, population-based cohort study conducted in 4 US communities and initiated in 1987-1989.ParticipantsA total of 1684 persons aged 51 to 72 years who had cerebral magnetic resonance imaging (MRI) and retinal photography at the third examination (1993-1995).Main Outcome MeasuresOdds of WMLs, defined by standardized methods from MRI, by presence or absence of specific retinal microvascular abnormality (eg, microaneurysm, retinal hemorrhage) on retinal photograph; incident clinical stroke, ascertained after a median follow-up of 4.7 years, according to presence or absence of WMLs and retinopathy.ResultsPersons with retinopathy were more likely to have WMLs than those without retinopathy (22.9% vs 9.9%; odds ratio, 2.5; 95% confidence interval [CI], 1.5-4.0, adjusted for age, sex, race, and vascular risk factors). The 5-year cumulative incidence of clinical stroke was higher in persons with vs without WMLs (6.8% vs 1.4%; adjusted relative risk [RR], 3.4; 95% CI, 1.5-7.7) and in persons with vs without retinopathy (8.0% vs 1.4%; adjusted RR, 4.9; 95% CI, 2.0-11.9). Persons with both WMLs and retinopathy had a significantly higher 5-year cumulative incidence of stroke than those without either WMLs or retinopathy (20.0% vs 1.4%; adjusted RR, 18.1; 95% CI, 5.9-55.4).ConclusionsIn this cohort, middle-aged persons with cerebral WMLs detected on MRI were more likely to have retinal microvascular abnormalities and to have an increased risk of clinical stroke than people without WMLs. The risk of stroke was higher when retinopathy was simultaneously present in persons with WMLs.

Components of the Metabolic Syndrome and Risk of Cardiovascular Disease and Diabetes in Beaver Dam

Abstract: OBJECTIVE —To determine whether components of the metabolic syndrome precede the 5-year incidence of cardiovascular disease and diabetes. RESEARCH DESIGN AND METHODS —A population of individuals aged 43–84 years was evaluated from 1988 to 1990 and again 5 years later. Medical history, blood pressure, and laboratory measures were obtained at both examinations following the same protocols. Subjects without diabetes were classified according to level of glycemia, high blood pressure, high-risk lipid levels, high uric acid levels, and proteinuria at baseline. History of incident myocardial infarction, angina, stroke, and diabetes was obtained at follow-up. RESULTS —Of the 4,423 subjects without diabetes, 6.9% had elevated levels of glycemia, 18.4% had high blood pressure, 82.7% had high-risk lipid levels (either high serum total cholesterol or low HDL cholesterol or high ratio of these two levels), 27% had elevated uric acid levels, 33.2% had high BMI, and 3.3% had proteinuria (≥30 mg/dl). The risk of incident cardiovascular disease 5 years later increased with the number of the components present; 2.5% of those with one component developed cardiovascular disease, whereas 14.9% of those with four or more components developed cardiovascular disease. Of those with one component, diabetes developed in 1.1% 5 years later, whereas diabetes developed in 17.9% of those with four or more components. CONCLUSIONS —Components of the metabolic syndrome are common and are associated with incident cardiovascular disease and diabetes after 5 years. Interventions to alter BMI, lipid levels, and blood pressure may decrease incident diabetes and cardiovascular disease.

Retinal Arteriolar Narrowing and Risk of Diabetes Mellitus in Middle-aged Persons

Abstract: ContextMicrovascular processes have been hypothesized to play a role in the pathogenesis of type 2 diabetes mellitus, but prospective clinical data regarding this hypothesis are unavailable.ObjectiveTo examine the relation of retinal arteriolar narrowing, a marker of microvascular damage from aging, hypertension, and inflammation, to incident diabetes in healthy middle-aged persons.Design, Setting, and ParticipantsThe Atherosclerosis Risk in Communities Study, an ongoing population-based, prospective cohort study in 4 US communities that began in 1987-1989. Included in this analysis were 7993 persons aged 49 to 73 years without diabetes, of whom retinal photographs were taken during the third examination (1993-1995).Main Outcome MeasuresIncident diabetes (defined as fasting glucose levels of ≥126 mg/dL [7.0 mmol/L], casual levels of ≥200 mg/dL [11.1 mmol/L], diabetic medications use, or physician diagnosis of diabetes at the fourth examination) by quartile of retinal arteriole-to-venule ratio (AVR).ResultsAfter a median follow-up of 3.5 years, 291 persons (3.6%) had incident diabetes. The incidence of diabetes was higher in persons with lower AVR at baseline (2.4%, 3.1%, 4.0%, and 5.2%, from highest to lowest AVR quartile; P for trend<.001). After controlling for fasting glucose and insulin levels, family history of diabetes, adiposity, physical activity, blood pressure, and other factors, persons in the lowest quartile of AVR were 71% more likely to develop diabetes than those in the highest quartile (odds ratio [OR], 1.71; 95% confidence interval [CI], 1.13-2.57; P for trend = .002). This association persisted with different diagnostic criteria (OR, 1.92; 95% CI, 1.10-3.36; P for trend = .01, using a fasting glucose level of ≥141 mg/dL [7.8 mmol/L] as a cutoff), and was seen even in people at lower risk of diabetes, including those without a family history of diabetes, without impaired fasting glucose, and with lower measures of adiposity.ConclusionsRetinal arteriolar narrowing is independently associated with risk of diabetes, supporting a microvascular role in the development of clinical diabetes.

Retinal microvascular abnormalities and blood pressure in older people: the Cardiovascular Health Study

Abstract: Aim: To examine the relation between blood pressure and retinal microvascular abnormalities in older people. Methods: The Cardiovascular Health Study is a prospective cohort study conducted in four US communities initiated in 1989 to 1990. Blood pressure was measured according to standardised protocols at each examination. During the 1997–8 examination, retinal photographs were taken of 2405 people aged 69–97 years (2056 without diabetes and 349 with diabetes). Signs of focal microvascular abnormalities (focal arteriolar narrowing, arteriovenous nicking, and retinopathy) were evaluated from photographs according to standardised methods. To quantify generalised arteriolar narrowing, the photographs were digitised and diameters of individual arterioles were measured and summarised. Results: In non-diabetic people, elevated concurrent blood pressure taken at the time of retinal photography was strongly associated with presence of all retinal microvascular lesions. The multivariable adjusted odds ratios, comparing the highest to lowest quintile of concurrent systolic blood pressure, were 4.0 (95% confidence intervals (CI): 2.4 to 6.9, p test of trend<0.001) for focal arteriolar narrowing, 2.9 (95% CI: 1.6 to 5.3, p<0.001) for arteriovenous nicking, 2.8 (95% CI: 1.5 to 5.2, p<0.001) for retinopathy, and 2.1 (95% CI: 1.4 to 3.1, p<0.001) for generalised arteriolar narrowing. Generalised arteriolar narrowing and possibly arteriovenous nicking were also significantly associated with past blood pressure measured up to 8 years before retinal photography, even after adjustment for concurrent blood pressure. These associations were somewhat weaker in people with diabetes. Conclusions: Retinal microvascular abnormalities are related to elevated concurrent blood pressure in older people. Additionally, generalised retinal arteriolar narrowing and possibly arteriovenous nicking are related to previously elevated blood pressure, independent of concurrent blood pressure. These data suggest that retinal microvascular changes reflect severity and duration of hypertension.

Prevalence and 5-Year Incidence of Tinnitus among Older Adults : The Epidemiology of Hearing Loss Study

Abstract: Tinnitus (ringing or buzzing in the ear or head) can range from barely noticeable to debilitating . Although a few studies have estimated the prevalence of this condition in adult populations, we know of no population-based estimates of incidence. As part of a population-based study of hearing loss in adults aged 48 to 92 years at baseline in Beaver Dam, Wisconsin, self-reported data on tinnitus were obtained at the baseline examination (1993-1995 ; N = 3753) and again 5 years later (1998-2000 ; N = 2800) . A person was classified as having tinnitus if their tinnitus was at least moderate in severity or caused difficulty in falling asleep. The prevalence of tinnitus at baseline was 8 .2 percent. The 5-year incidence of tinnitus among the 2513 participants at risk was 5.7 percent. Risk factors for prevalent and incident tinnitus were evaluated. The results suggest that tinnitus is a common problem for older adults and is associated with some modifiable risk factors.

Retinal Microvascular Abnormalities and Cognitive Impairment in Middle-Aged Persons The Atherosclerosis Risk in Communities Study

Abstract: Background and Purpose— Cerebral microvascular disease has been hypothesized to contribute to cognitive impairment, but few clinical data are available. Here, we examine the relation of retinal mic...

Prevalence of sleep problems and quality of life in an older population.

Abstract: Study Objectives: To determine the prevalence of insomnia traits in a population and the effect of these traits on health-related quality of life. Design: The Epidemiology of Hearing Loss Study is a population-based study in Beaver Dam, Wisconsin. Setting: Participants were interviewed as part of the 5-year follow-up examination (1998-2000) of the Epidemiology of Hearing Loss Study. Participants were interviewed at the study office in Beaver Dam, WI, by telephone, or at their residence. Participants: 2800 adults aged 53-97 years. Interventions: N/A Measurements and Results: Participants were asked to what extent they experienced difficulty getting to sleep, waking up at night and having a hard time getting back to sleep, and waking up repeatedly during the night for any reason. A response of often or almost always was coded as positive for an insomnia trait. The SF-36 was administered to assess mental and physical function. Twenty-six percent of the population reported one insomnia trait, 13% reported two, and 10% reported three. All eight domains and the Mental and Physical Component Summary scores of the SF-36 decreased significantly (F-test for linear trend statistically significant at p<0.0001) as the number of reported insomnia traits increased. Conclusions: These results indicate that symptoms of insomnia are common among older adults and are associated with a decrease in health related quality of life.

The impact of visual impairment and eye disease on vision-related quality of life in a Mexican-American population: proyecto VER.

Abstract: PURPOSE. To describe the relationship of visual acuity impairment and eye disease on vision-related quality of life, as measured by the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25), in a cross-sectional, population-based study of older Hispanic persons living in Arizona. METHODS. A random sample of block groups with Hispanic residents in Nogales and Tucson, Arizona, were selected for study. Participants were interviewed at home with a questionnaire that included the NEI-VFQ-25, an instrument measuring vision-related quality of life. Acuity was obtained with Early Treatment Diabetic Retinopathy Study (ETDRS) charts and standard protocol. Cataract was determined by clinical examination, diabetic retinopathy was diagnosed on stereo fundus photographs, and glaucoma was diagnosed on the basis of clinical examination and visual field results. Analyses were done to determine the degree of association between subscale scores and acuity in the better-seeing eye, monocular visual impairment, and specific eye diseases, with adjustment for acuity. RESULTS. Of the 4774 participants in the study, 99.7% had completed questionnaires that were not completed by proxy. Participants with visual impairment had associated decrements in scores on all subscales, with a decrease in presenting acuity associated with a worse score (P < 0.05), after adjustment for demographic variables. Monocular impairment was also associated with lower scores in several subscales. In those with cataract, low acuity explained most of the low scores, but those with glaucoma or diabetic retinopathy had low scores independent of acuity. CONCLUSIONS. In this study of Mexican-American persons aged 40 or more, monocular impairment and better-eye acuity was associated with a decrease in most domains representing quality of life. Subjects with uncorrected refractive error, cataract, diabetic retinopathy, and glaucoma had associated decrements in quality of life, many not explained by loss of acuity. Further work on the specific measures of vision associated with reported decreases in quality of life, such as visual field or contrast sensitivity, is warranted.

Dopaminergic Cell Loss Induced by Human A30P α-Synuclein Gene Transfer to the Rat Substantia Nigra

Abstract: Somatic cell gene transfer was used to express a mutant form of α-synuclein (α-syn) that is associated with Parkinson's disease (PD) in the rat substantia nigra (SN), a brain region that, in humans, degenerates during PD. DNA encoding the A30P mutant of human α-syn linked to familial PD was incorporated into an adeno-associated virus vector, which was injected into the adult rat midbrain. The cytomegalovirus/chicken β-actin promoter was used to drive transgene expression. Over a 1-year time course, this treatment produced three significant features relevant to PD: (1) accumulation of α-syn in SN neuron perikarya, (2) Lewy-like dystrophic neurites in the SN and the striatum, and (3) a 53% loss of SN dopamine neurons. However, motor dysfunction was not found in either rotational or rotating rod testing. The lack of behavioral deficits, despite the significant cell loss, may reflect pathogenesis similar to that of PD, where greater than 50% losses occur before motor behavior is affected.

The Association of Cataract and Cataract Surgery With the Long-Term Incidence of Age-Related Maculopathy: The Beaver Dam Eye Study

Abstract: Objective To examine the association between cataract and cataract surgery and the 10-year incidence of age-related maculopathy (ARM). Methods A population-based cohort study of persons aged 43 to 86 years at baseline, living in Beaver Dam, Wis, of whom 3684 participated in a 5-year and 2764 in a 10-year follow-up. We used standardized protocols for physical examination, blood collection, health history, slitlamp and retroillumination photography of the lenses to determine the presence of cataract, and stereoscopic color fundus photography to determine the presence of ARM. We used the Kaplan-Meier(product-limit) survival approach and discrete linear logistic regression in analyses. Main Outcome Measures The risk ratios (RRs) of persons with cataract or cataract surgery at baseline. Results While controlling for age, sex, systolic blood pressure, history of heavy drinking and smoking, and vitamin use, cataract at baseline was associated with incidence of early ARM (RR, 1.30; 95% confidence interval [CI], 1.04-1.63), soft indistinct drusen (RR, 1.38; 95% CI, 1.08-1.75), increased retinal pigment(RR, 1.38; 95% CI, 1.07-1.79), and progression of ARM (RR, 1.37; 95% CI, 1.06-1.77). We found no association with the incidence of late ARM. In contrast, cataract surgery before baseline was associated with incidence of late ARM (RR, 3.81; 95% CI, 1.89-7.69), increased retinal pigment (RR, 1.89; 95% CI, 1.18-3.03), retinal pigment epithelial depigmentation (RR, 1.95; 95% CI, 1.17-3.25), pure geographic atrophy (RR, 3.18; 95% CI, 1.33-7.60), exudative macular degeneration(RR, 4.31; 95% CI, 1.71-10.9), and progression of ARM (RR, 1.97; 95% CI, 1.29-3.02), but not with the incidence of early ARM. Conclusions These findings indicate an association of cataract with subsequent risk for early ARM. Cataract surgery increased the risk for late ARM.

Ten-Year Incidence of Age-related Maculopathy and Smoking and Drinking The Beaver Dam Eye Study

Abstract: The authors examined associations between smoking and alcohol consumption and the long-term incidence of age-related maculopathy (ARM) in people in the Beaver Dam Eye Study who were aged 43-86 years (n = 3,684) in 1988-1990 and examined over a 10-year period. ARM status was determined by grading stereoscopic color fundus photographs. After controlling for age, sex, and other factors, the authors found that people who had smoked more were more likely to develop large (> or =250 micro m in diameter) soft drusen (risk ratio (RR) per 10 pack-years smoked = 1.08, 95% confidence interval (CI): 1.02, 1.14) and pigmentary abnormalities (RR = 1.09, 95% CI: 1.04, 1.14) and to have progression of early ARM (RR = 1.05, 95% CI: 1.00, 1.10) than people who had smoked less. Smoking was not associated with the incidence of late ARM. People who reported being heavy drinkers at baseline were more likely to develop late ARM (RR = 6.94, 95% CI: 1.85, 26.1) than people who reported never having been heavy drinkers. Smoking appears to have a modest, positive association with early but not late signs of ARM, and heavy drinking appears to be related to an increased risk of late ARM, although the exposure and outcome were infrequent, and the effect is based on few exposed cases.

Changes in Refraction over 10 Years in an Adult Population: The Beaver Dam Eye Study

Abstract: Purpose To quantify the 10-year change in refraction in persons more than 40 years of age Methods All people 43 to 84 years of age and living in Beaver Dam, Wisconsin, in 1988 were invited for a baseline examination (1988-1990), a 5-year follow-up examination (1993-1995), and a 10-year follow-up examination (1998-2000) Refractions were determined according to the same protocol at all examinations Aphakic and pseudophakic eyes and eyes with best corrected visual acuity of 20/200 or worse were excluded After exclusions, refraction data were available on 2362 right eyes of the 2937 people examined at baseline and 10-year follow-up Results Age was related to the direction and amount of change in refraction Spherical equivalent became more positive in the youngest subjects and more negative in the oldest After adjustment for the severity of nuclear sclerosis and other factors, the 10-year change in refraction was +048, +003, and -019 D for persons 43 to 59, 60 to 69 and 70+ years of age at the baseline examination, respectively Severity of nuclear sclerosis was also strongly related to amount of change Those with mild nuclear sclerosis at baseline had a change of +035 D, whereas those with severe nuclear sclerosis had a change of -053 D The amount of change was also related to diabetes and weakly related to baseline refractive error, but was unrelated to gender and education In addition to the longitudinal changes observed, there was a birth cohort effect In comparing people of the same age across examinations, those born in more recent years had more myopia than those born in earlier years Conclusions Significant changes in spherical equivalent in adults occur over a 10-year period Younger people became more hyperopic, whereas older people became more myopic These data provide evidence of a longitudinal change in refraction in adults, which may explain the refractive patterns observed in cross-sectional studies

Blindness, visual impairment and the problem of uncorrected refractive error in a Mexican-American population: Proyecto VER.

Abstract: PURPOSE. To report the prevalence of blindness and visual impairment and the contribution of uncorrected refractive error to visual loss in a population-based sample of Mexican Americans aged 40 and older. METHODS. Proyecto VER is a population-based study of blindness and visual impairment in Mexican Americans in Arizona. Block groups in Tucson and Nogales were randomly selected with probability proportional to the size of the Mexican-American population aged 40 and older. Participants had a complete ophthalmic evaluation, including assessment of presenting and best corrected visual acuity using standardized procedures. Those with presenting visual acuity worse than 20/30 had refraction to determine best corrected vision. A home questionnaire and a clinic examination provided data on education, perception of visual impairment, income, and acculturation. RESULTS. The prevalence of presenting visual acuity worse than 20/40 was 8.2%, with uncorrected refractive error accounting for 73% of the impaired acuity. In multivariate models comparing those who improved two or more lines on the acuity chart with proper refraction with those who had adequate optical correction, uncorrected refractive error showed a strong association with age, less than 13 years of education (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.5-2.0), low acculturation index (OR 1.3, CI 1.1-1.3), lack of insurance coverage (OR 1.4, CI 1.1-1.7), and not having seen an eye-care provider in the past 2 years (OR 2.5, CI 2.1-3.0). Prevalence of best corrected acuity worse than 20/40 increased from 0.3% in those aged 40 to 49 years to 18% in those aged 80 years or more. CONCLUSIONS. Visual loss in this Mexican-American population is higher than has been reported in whites and is comparable to that in African Americans. Almost three quarters of those with visual acuity impairment would improve with optical correction. Socioeconomic factors that are probable markers of limited access to health care services were associated with uncorrected refractive error. These data suggest that education programs and interventions to improve access to eye care could significantly decrease the burden of visual loss among Mexican Americans.

Reliability of computer-assisted retinal vessel measurementin a population.

Abstract: The purpose of the study was to assess the intergrader and intragrader reliability of computer-assisted retinal vessel dia-meter measurement in a defined, community-based population. Retinal photographs from participants in the Blue Mountains Eye Study were digitized using standard techniques. A grader identified all retinal vessels located 0.5-1.0 disc diameter from the optic disc margin,and a computer program measured the width of these vessels. Intergrader and intragrader reliability was assessed on a random sub-sample of 184 and 97 images, respectively, using quadratic weighted kappa(kappa) and correlation analysis (R2). Intergrader reliability was high for summary indices of retinal arteriolar (kappa = 0.85, R2 = 0.88)and venular (kappa = 0.90, R2 = 0.90)diameters, and their ratio, the arteriole-to-venule ratio (kappa = 0.75, R2 = 0.79).Intragrader reliability was also high, with kappa values ranging from 0.80 to 0.93 and from 0.80 to 0.92 for graders 1 and 2, respectively. It is concluded that the retinal vessel diameters could be reliably measured using computer-assisted software and may be used for population-based research.

The relation of atherosclerotic cardiovascular disease to retinopathy in people with diabetes in the Cardiovascular Health Study

Abstract: Aims: To describe the association of retinopathy with atherosclerosis and atherosclerotic risk factors in people with diabetes. Methods: 296 of the 558 people classified as having diabetes by the American Diabetes Association criteria, from a population based cohort of adults (ranging in age from 69 to 102 years) living in four United States communities (Allegheny County, Pennsylvania; Forsyth County, North Carolina; Sacramento County, California; and Washington County, Maryland) were studied from 1997 to 1998. Lesions typical of diabetic retinopathy were determined by grading a 45° colour fundus photograph of one eye of each participant, using a modification of the Airlie House classification system. Results: Retinopathy was present in 20% of the diabetic cohort, with the lowest prevalence (16%), in those 80 years of age or older. Retinopathy was detected in 20.3% of the 296 people with diabetes; 2.7% of the 296 had signs of proliferative retinopathy and 2.1% had signs of macular oedema. The prevalence of diabetic retinopathy was higher in black people (35.4%) than white (16.0%). Controlling for age, sex, and blood glucose, retinopathy was more frequent in black people than white (odds ratio (OR) 2.26, 95% confidence interval (CI) 1.01, 5.05), in those with longer duration of diabetes (OR (per 5 years of diabetes) 1.42, 95% CI 1.18, 1.70), in those with subclinical cardiovascular disease (OR 1.49, 95% CI 0.51, 4.31), or coronary heart disease or stroke (OR 3.23, 95% CI 1.09, 9.56) than those without those diseases, in those with higher plasma low density lipoprotein (LDL) cholesterol (OR (per 10 mg/dl of LDL cholesterol) 1.12, 95% CI 1.02, 1.23), and in those with gross proteinuria (OR 4.76, 95% CI 1.53, 14.86). Conclusion: Data from this population based study suggest a higher prevalence of retinopathy in black people than white people with diabetes and the association of cardiovascular disease, elevated plasma LDL cholesterol, and gross proteinuria with diabetic retinopathy. However, any conclusions or explanations regarding associations described here must be made with caution because only about one half of those with diabetes mellitus were evaluated.

Retinal arteriolar emboli: epidemiology and risk of stroke.

Abstract: Retinal arteriolar emboli can be found in approximately 1% of adults more than 40 years of age. The frequency of retinal emboli increases with age and are more common in men than in women. Bilateral retinal emboli are rare, although multiple emboli in a single eye may be seen in up to one third of cases. Retinal emboli are associated with the presence of carotid artery plaque and stenosis, hypertension, cigarette smoking, and, possibly, diabetes. There are few prospective studies regarding the risk of stroke associated with retinal emboli. Available data suggest that retinal emboli in otherwise asymptomatic people are associated with a higher risk of stroke and stroke mortality, independent of conventional risk factors. Therefore, these patients are likely to benefit from a careful cardiovascular evaluation for risk stratification. Whether carotid ultrasound and other vascular imaging studies should be performed routinely for all patients with asymptomatic retinal emboli remains uncertain.