Biomedical subjects

Beatriz Munoz

Publications and source records attributed to Beatriz Munoz.

At least 19 recordsLinked to original sources

PubMed2006

Intensive insecticide spraying for fly control after mass antibiotic treatment for trachoma in a hyperendemic setting: a randomised trial.

BACKGROUND: There are no data on the cumulative effect of fly control and antibiotic distribution on trachoma in hyperendemic communities. We sought to determine whether insecticide spray intervention after mass antibiotic treatment could reduce trachoma and ocular infection with Chlamydia trachomatis in hyperendemic neighbourhoods in Tanzania. METHODS: We did a single-blind, randomised clinical trial in 16 neighbourhoods (balozi) in Kongwa, Tanzania. All children aged 1-7 years were enrolled, with 119 children in the eight balozi of the intervention group and 183 in the eight control balozi. Children were examined at baseline, 6 months, and 1 year for clinical trachoma and ocular C trachomatis infection. One dose of azithromycin was offered to all residents of both intervention and control balozi after the baseline survey. Households (and surrounding areas) in the intervention group were then sprayed with insecticide throughout the ensuing year and monitored for reductions in fly counts. This study is registered at ClinicalTrials.gov, number NCT00347763. FINDINGS: The intervention balozi had significantly lower fly counts than controls at all monitored weeks (p<0.05), apart from weeks 7-9. The trachoma rate did not differ significantly in the intervention and control balozi at 6 months post-treatment (20%vs 33%, p=0.07), nor did it at 1 year (43%vs 44%, p=0.90). Infection with C trachomatis did not differ between groups at 6 months post-treatment (9%vs 7%, p=0.45). INTERPRETATION: Intensive insecticide spraying reduced flies in the environment, but our results suggest that fly reduction after mass antibiotic treatment has no added benefit on reduction of trachoma.

Anti-Bacterial Agents↗

PubMed2006

Single-dose azithromycin prevents trichiasis recurrence following surgery: randomized trial in Ethiopia.

BACKGROUND: Trichiasis recurrence following surgery is a serious problem for trachoma programs. OBJECTIVE: To determine if postoperative treatment with azithromycin compared with topical tetracycline reduces recurrence up to 1 year, and if azithromycin treatment of household members provides additional benefit compared with treating only the surgical patient. DESIGN: A randomized, single-masked, clinical trial was conducted in Ethiopia. A total of 1452 patients with trichiasis were randomized 1:1:1 to the following 3 arms: single-dose (1 g) oral azithromycin alone, single-dose azithromycin for household members (20 mg/kg up to 1 g) plus the patient, or topical tetracycline (twice per day for 6 weeks). MAIN OUTCOME MEASURES: Trichiasis recurrence within 1 year following surgery. RESULTS: The combined azithromycin groups had significantly fewer recurrences, 6.9 of 100 person-years overall, compared with topical tetracycline, 10.3 of 100 person-years (P = .047). There was no additional reduction in the arm that also treated household members, 8.1 of 100 person-years, compared with treating the surgical patients alone, 5.8 of 100 person-years (P = .19). CONCLUSIONS: In trachoma-endemic areas, a single dose of azithromycin reduced postoperative trichiasis recurrence rates by one third compared with topical tetracycline. Application to Clinical Practice In countries where azithromycin is part of the Trachoma Control Program, patients with trachomatous trichiasis should be treated postoperatively to prevent recurrence.

Administration, Oral↗

PubMed2006

Impact of presbyopia on quality of life in a rural African setting.

PURPOSE: To determine the impact of uncorrected presbyopia on quality of life in rural Tanzania. DESIGN: Cross-sectional study. PARTICIPANTS: Population-based sample of 1709 village and town-dwelling adults aged 40 and older in the Kongwa district in rural Tanzania. METHODS: Subjects underwent distance and near visual acuity testing to determine presbyopia. A near vision-related quality of life questionnaire was administered by trained interviewers to determine the degree of self-rated difficulty with tasks appropriate to life in a rural African setting, and how much near vision loss contributed to this difficulty. MAIN OUTCOME MEASURES: Near vision-related quality of life. RESULTS: Complete data were available for 1564 (92%) of the subjects. The prevalence rate of presbyopia was 62%. The majority of presbyopes (94%) did not have corrective near vision glasses. Compared with nonpresbyopes, being presbyopic increased the odds of reporting some difficulty with near vision tasks by 2-fold (odds ratio [OR], 2.04; 95% confidence interval [CI]: 1.57-2.66), odds of reporting moderate difficulty by 5-fold (OR 5.01; 95% CI: 3.19-7.89), and odds of reporting high difficulty by >8-fold (OR 8.52; 95% CI 3.13-23.10). The degree of presbyopia was associated with increasing difficulty with daily tasks (P<0.0001). CONCLUSIONS: This is the first study to demonstrate that uncorrected presbyopia has a significant impact on vision-related quality of life in a rural African setting. The high prevalence of presbyopia, and increased aging of the population in developing countries, suggests that the World Health Organization's Vision 2020 refraction agenda should place greater emphasis on presbyopia.

Activities of Daily Living↗

PubMed2006

Population-based study of presbyopia in rural Tanzania.

OBJECTIVE: To determine the prevalence of presbyopia in a rural African population. DESIGN: Cross-sectional prevalence study. PARTICIPANTS: One thousand seven hundred nine persons age 40 years and older who resided in 3 villages and randomly selected neighborhoods of Kongwa town, Tanzania. METHODS: Eligible persons were refracted and given best distance correction. Near vision was tested and corrected to the nearest 0.5 diopter. Presbyopia was defined as at least 1 line of improvement on a near visual acuity chart with an addition of a plus lens. RESULTS: A total of 61.7% of eligible participants were presbyopic. A higher prevalence of presbyopia was associated with increased age, female gender, higher educational level, and residence in town (odds ratio = 3.09; 95% confidence interval: 2.46-3.90). The odds of developing presbyopia increased 16% per year of age from age 40 to 50, but the increase was nonsignificant at 1% per year after age 50. More severe presbyopia was associated with female gender and less with education. CONCLUSIONS: This study provides the first population-based data on prevalence of presbyopia in a large, random sample of older Africans and suggests a high rate of presbyopia. Presbyopia plateaus after age 50, and it is more common in females. In addition, the 3-fold increased odds in town versus village dwellers was unexpected and suggests that research of other factors, including environmental factors, is warranted.

Adult↗

PubMed2006

Spatial clustering of ocular chlamydial infection over time following treatment, among households in a village in Tanzania.

PURPOSE: To observe the spatial distribution of households with high loads of ocular chlamydia infection in children, before and after mass treatment with azithromycin to determine whether there exists spatial clustering of households with high loads of infection and the spatial scale of the clustering. METHODS: All residents of a village in Tanzania were invited to participate in the study. A global positioning system unit recorded the location of each house. Mass treatment with azithromycin was offered, with participation above 80%. Active trachoma and swab samples of the conjunctiva were assessed at baseline and at 2, 6, 12, and 18 months after treatment. A k-function analysis was performed to detect clustering of households with high loads of ocular chlamydia in children younger than 8 years. RESULTS: A total of 1055 villagers were examined during the study; of these, 374 (35.4%) were children younger than 8 years. The total number of households was 215, with 182 (84.6%) households having at least one child. K-function analysis showed clustering of households with high loads of ocular chlamydia at distances up to 2 kilometers (km) at baseline; at 6 months, slight clustering existed within 0.5 km. At 12 and 18 months, high load households clustered at distances up to 1.3 km. CONCLUSIONS: This analysis suggests that infection spreads between households with children or that nearby households share the same risk factors for infection. Mass treatment has value in lowering infection prevalence within the community, and clustering of households with infection takes up to 1 year to reemerge at the same level as baseline. Re-treatment at yearly intervals may interrupt spread of infection.

Anti-Bacterial Agents↗

PubMed2006

Factors associated with spectacle-wear compliance in school-aged Mexican children.

PURPOSE: To study the prevalence and determinants of compliance with spectacle wear among school-age children in Oaxaca, Mexico, who were provided spectacles free of charge. METHODS: A cohort of 493 children aged 5 to 18 years chosen by random cluster sampling from primary and secondary schools in Oaxaca, Mexico, all of whom had received free spectacles through a local program, underwent unannounced, direct examination to determine compliance with spectacle wear within 18 months after initial provision of spectacles. Potential determinants of spectacle wear including age, gender, urban versus rural residence, presenting visual acuity, refractive error, and time since dispensing of the spectacles were examined in univariate and multivariate regression models. Children not currently wearing their spectacles were asked to select the reason from a list of possibilities, and reasons for noncompliance were analyzed within different demographic groups. RESULTS: Among this sample of children with a mean age of 10.4 +/- 2.6 years, the majority (74.5%) of whom were myopic (spherical equivalent [SE] < or = -0.50 D), 13.4% (66/493) were wearing their spectacles at the time of examination. An additional 34% (169/493) had the spectacles with them but were not wearing them. In regression models, the odds of spectacle wear were significantly higher among younger (OR = 1.19 per year of age; 95% CI, 1.05-1.33) rural (OR = 10.6; 95% CI, 5.3-21.0) children and those with myopia < or = -1.25 D (OR = 3.97; 95% CI, 1.98-7.94). The oldest children and children in urban-suburban areas were significantly more likely to list concerns about the appearance of the glasses or about being teased than were younger, rurally resident children. CONCLUSIONS: Compliance with spectacle wear may be very low, even when spectacles are provided free of charge, particularly among older, urban children, who have been shown in many populations to have the highest prevalence of myopia. As screening programs for refractive error become increasingly common throughout the world, new strategies are needed to improve compliance if program resources are to be maximized.

Adolescent↗

PubMed2005

Infection with Chlamydia trachomatis after mass treatment of a trachoma hyperendemic community in Tanzania: a longitudinal study.

BACKGROUND: Data from studies done in communities where trachoma is mesoendemic suggest that ocular infection with Chlamydia trachomatis can be eliminated after one mass treatment with antibiotics. However, there are no comparable long-term data from trachoma hyperendemic communities. Our aim, therefore, was two-fold: first, to ascertain the disease pattern of trachoma and ocular infection with C trachomatis in a trachoma hyperendemic community after mass treatment; and, second, to ascertain the risk factors for incident infection. METHODS: We did a longitudinal study of a trachoma hyperendemic community (n=1017) in Tanzania. We did surveys, including ocular swabs, at baseline, 2, 6, 12, and 18 months to identify the presence, and quantity, of C trachomatis after single mass treatment of all individuals aged 6 months or older with azithromycin 20 mg per kg; pregnant women without clinical disease received topical tetracycline. FINDINGS: Mass treatment (coverage 86%) significantly reduced the prevalence of infection from 57% (495 of 871) to 12% (85 of 705) at 2 months. Infection remained fairly constant to 12 months, with evidence of increasing numbers and load of infection by 18 months post-treatment. Incident infection at 6 months was 3.5-times more likely if another member of the household had more than 19 organisms per swab at 2 months. Travel outside the village, and visitors to the household, did not increase the risk of infection within households up to 12 months. INTERPRETATION: In this trachoma hyperendemic community, infection levels after high antibiotic coverage persisted at a low level to 18 months, with evidence for re-emergence after 1 year. Fairly light loads of infection were associated with household transmission. Yearly mass treatment over a few years could be sufficient to eliminate infection.

Administration, Oral↗

PubMed2005

Compensatory strategy use identifies risk of incident disability for the visually impaired.

BACKGROUND: Use of compensatory strategies may be a marker for preclinical disability. OBJECTIVE: To determine, among persons who did not report mobility disability, if the reported use of compensatory strategies was a predictor of subsequent disability at 2 years in those who did and did not have visual impairment at baseline. METHODS: Within a population-based sample of 2520 persons aged 65 to 84 years, those who reported no difficulty walking or stair-climbing at baseline (not disabled) were studied. Visual impairment was defined as a visual acuity worse than 20/40, log contrast sensitivity less than 1.5, or more than 30 points missing in the visual field. Use of compensatory strategies at baseline was reported as changing the frequency or method used to walk or climb stairs. Incident disability was defined as report of new difficulty in mobility at 2 years. RESULTS: Those using compensatory strategies at baseline were 3 times more likely to report incident disability in walking and stair-climbing, compared with persons who did not use compensatory strategies. Visual field impairment was the most significant predictor of incident mobility disability of all the vision measures studied. Among those with visual field impairment, users of compensatory strategies were 3 times more likely to report incident walking disability (95% confidence interval, 1.87-5.58) and incident stair-climbing disability (95% confidence interval, 1.86-4.83) compared with those who did not use compensatory strategies. CONCLUSION: Preclinical disability, characterized by use of compensatory strategies in those with no disability, is a predictor for subsequent disability and may help identify patients with visual impairment for whom mobility interventions are warranted.

Activities of Daily Living↗

PubMed2005

Cortical, but not posterior subcapsular, cataract shows significant familial aggregation in an older population after adjustment for possible shared environmental factors.

PURPOSE: To quantify the risk for age-related cortical cataract and posterior subcapsular cataract (PSC) associated with having an affected sibling after adjusting for known environmental and personal risk factors. DESIGN: Sibling cohort study. PARTICIPANTS: Participants in the ongoing Salisbury Eye Evaluation (SEE) study (n = 321; mean age, 78.1+/-4.2 years) and their locally resident siblings (n = 453; mean age, 72.6+/-7.4 years) were recruited at the time of Rounds 3 and 4 of the SEE study. INTERVENTION/TESTING METHODS: Retroillumination photographs of the lens were graded for the presence of cortical cataract and PSC with the Wilmer grading system. The residual correlation between siblings' cataract grades was estimated after adjustment for a number of factors (age; gender; race; lifetime exposure to ultraviolet-B light; cigarette, alcohol, estrogen, and steroid use; serum antioxidants; history of diabetes; blood pressure; and body mass index) suspected to be associated with the presence of cataract. RESULTS: The average sibship size was 2.7 per family. Multivariate analysis revealed the magnitude of heritability (h(2)) for cortical cataract to be 24% (95% CI, 6%-42%), whereas that for PSC was not statistically significant (h(2) 4%; 95% CI, 0%-11%) after adjustment for the covariates. The model revealed that increasing age, female gender, a history of diabetes, and black race increased the odds of cortical cataract, whereas higher levels of provitamin A were protective. A history of diabetes and steroid use increased the odds for PSC. CONCLUSIONS: This study is consistent with a significant genetic effect for age-related cortical cataract but not PSC.

Aged↗

PubMed2005

Familial aggregation of hyperopia in an elderly population of siblings in Salisbury, Maryland.

PURPOSE: To determine whether hyperopia aggregates in families in an older mixed-race population. DESIGN: Cross-sectional familial aggregation study using sibships. METHODS: We recruited 759 subjects (mean age, 73.4 years) in 241 families through the population-based Salisbury Eye Evaluation study. Subjects underwent noncycloplegic refraction if best-corrected visual acuity (BCVA) was 20/40 with spectacles, or were considered to be plano (refraction of zero) if the BCVA was >20/40 without spectacles. Preoperative refraction from medical records was used for bilaterally pseudophakic subjects. RESULTS: Utilizing hyperopia cutoffs from 1.00 to 2.50 diopters, age-, race-, and gender-adjusted odds ratios for hyperopia with an affected sibling ranged from 2.72 (95% confidence interval [CI], 1.84-4.01) to 4.87 (95% CI, 2.54-9.30). The odds of hyperopia increased with age until 75 years, after which they remained relatively constant. Black men were significantly less likely to be hyperopic than white men, white women, or black women. CONCLUSIONS: Hyperopia appears to be under strong genetic control in this older population.

Aged↗

PubMed2005

The association between myopia and various subtypes of lens opacity: SEE (Salisbury Eye Evaluation) project.

PURPOSE: To establish the relationship between myopia and lens opacity. DESIGN: Population-based cross-sectional study. PARTICIPANTS: Two thousand five hundred twenty participants from the Salisbury Eye Evaluation aged 65 to 84 years. METHODS: Participants filled out questionnaires regarding medical history, social habits, and a detailed history of distance spectacle wear. They underwent a full ocular examination. Lens photographs were taken for assessment of lens opacity using the Wilmer grading system. Multivariate logistic regression models using generalized estimating equations were used to analyze the relationship between lens opacity type and degree of myopia, while accounting for potential confounders. MAIN OUTCOME MEASURES: Presence of posterior subcapsular opacity, cortical opacity, or nuclear opacity. RESULTS: Significant associations were found between myopia and both nuclear and posterior subcapsular opacities. For nuclear opacity, the odds ratios (ORs) were 2.25 for myopia between -0.50 diopters (D) and -1.99 D (P<0.001), 3.65 for myopia between -2.00 D and -3.99 D (P<0.001), 4.54 for myopia between -4.00 D and -5.99 D (P<0.001), and 3.61 for myopia -6.00 D or more (P = 0.002). For posterior subcapsular cataracts, ORs were 1.59 for myopia between -0.50 D and -1.99 D (P = 0.11), 3.22 for myopia between -2.00 D and -3.99 D (P = 0.002), 5.36 for myopia between -4.00 D and -5.99 D (P<0.001), and 12.34 for myopia -6.00 D or more (P<0.001). No association was found between myopia and cortical opacity. The association between posterior subcapsular opacity and myopia was equally strong for those wearing glasses by age 21 years and for those without glasses; for nuclear opacity, significantly higher ORs were found for myopes who started wearing glasses after age 21. CONCLUSIONS: These results confirm the previously reported association between myopia, posterior subcapsular opacity, and nuclear opacity. Furthermore, the strong association between early spectacle wear and posterior subcapsular opacity among myopes, absent for nuclear opacity, suggests that myopia may precede opacity in the case of posterior subcapsular opacity, but not nuclear opacity. Measures of association between posterior subcapsular opacity and myopia were stronger in the current study than have previously been found. Longitudinal studies to confirm the association are warranted.

Aged↗

PubMed2005

Surgery for Trichiasis, Antibiotics to prevent Recurrence (STAR) Clinical Trial methodology.

Trachoma is the leading infectious cause of blindness worldwide. Surgery is available to correct trichiasis, which results from repeated episodes of infection with C. trachomatis. However, trichiasis recurrence rates post-surgery are very high. Methods for reducing post-surgical trichiasis recurrence need to be explored. This paper outlines the design of the Surgery for Trichiasis, Antibiotics to prevent Recurrence (STAR) Clinical Trial currently underway in Ethiopia. The STAR trial, funded by The National Eye Institute, is a randomized, controlled clinical trial of antibiotic use at time of trichiasis surgery, comparing topical tetracycline to single-dose azithromycin for the surgical patient and single-dose azithromycin for the surgical patient and all household members. The primary outcome is trichiasis recurrence at one-year. Data from this trial will be critical in helping to determine future policy on antibiotic treatment for C. trachomatis following surgery.

Adolescent↗

PubMed2005

Mass treatment and the effect on the load of Chlamydia trachomatis infection in a trachoma-hyperendemic community.

PURPOSE: Trachoma remains a leading cause of blindness. Determining the most effective antibiotic treatment strategy is essential for the success of country-based trachoma control programs. METHODS: Baseline and 2-month follow-up examinations were performed in a trachoma-hyperendemic village. All residents were offered azithromycin for trachoma after baseline was determined. Infection with Chlamydia trachomatis and chlamydial load were determined by PCR. Clinical trachoma status was evaluated. A high chlamydial load was defined as a higher than median chlamydial load among those with infection. Risk factors were examined in multiple logistic regression models. Associations are presented as odds ratios and 95% confidence intervals. RESULTS: At baseline, 57% of participants were infected with C. trachomatis. Although clinical trachoma correlated with infection, 23% of participants with high chlamydial loads showed no clinical signs. Adults represented only 10% of the population with high loads. Treatment significantly decreased the proportion positive in the community and the load in the community. However, 27% of individuals with high loads at baseline who received treatment also were infected at 2 months. Of those, 93% with high loads at 2 months were aged < or =10 years. CONCLUSIONS: Although most of the chlamydial load in this community resided in children, 10% of the high load resided in adults, most of whom did not have follicular trachoma and in whom the infection would be missed under treatment strategies that focus on clinical disease or children. These data support a mass treatment strategy for hyperendemic communities, at least as a first approach. In addition, treatment of children age < or =2 years should be reexamined, as >30% with high loads at baseline remained infected at 2 months, despite monitored treatment according to weight.

Adolescent↗

PubMed2005

Risk factors for postsurgical trichiasis recurrence in a trachoma-endemic area.

PURPOSE: The World Health Organization recommends trichiasis surgery to prevent blindness caused by trachoma; however, recurrence is common. Risk factors for recurrence have not been widely studied, particularly in trachoma hyperendemic areas. METHODS: Three hundred ninety-four persons with trichiasis in Tanzania were examined. Participants had undergone surgery >18 months before the study. Trichiasis recurrence and active trachoma at study visit were assessed. Ocular swabs were collected and tested for Chlamydia trachomatis. Household members were examined for active trachoma. RESULTS: Of the surgical eyes, 28% had recurrence; 40% of patients had recurrence in one or both eyes. Rates did not vary by time since surgery. Eye-level recurrence rates varied significantly across districts, ranging from 16% to 38%. Current chlamydial infection among surgical cases was low (6%) and was not associated with recurrence. Recurrence was associated with tarsal conjunctival inflammation (OR: 2.4; 95% confidence interval [CI]: 1.6-3.8) and residence in the Kongwa district (OR: 2.3; 95% CI: 1.2-4.6). CONCLUSIONS: Recurrence after trichiasis surgery is high, suggesting that vigilant follow-up in surgical cases is needed to reduce blindness. Recurrence is associated with evidence of inflammation in the tarsal conjunctiva, although it is not clear whether the inflammation contributes to recurrence, or is a result of the recurrence. Longitudinal studies of trichiasis patients after surgery are needed.

Aged↗

PubMed2005

Heritability of refractive error and familial aggregation of myopia in an elderly American population.

PURPOSE: To determine the heritability of refractive error and the familial aggregation of myopia in an older population. METHODS: Seven hundred fifty-nine siblings (mean age, 73.4 years) in 241 families were recruited from the Salisbury Eye Evaluation (SEE) Study in eastern Maryland. Refractive error was determined by noncycloplegic subjective refraction (if presenting distance visual acuity was < or =20/40) or lensometry (if best corrected visual acuity was >20/40 with spectacles). Participants were considered plano (refractive error of zero) if uncorrected visual acuity was >20/40. Preoperative refraction from medical records was used for pseudophakic subjects. Heritability of refractive error was calculated with multivariate linear regression and was estimated as twice the residual between-sibling correlation after adjusting for age, gender, and race. Logistic regression models were used to estimate the odds ratio (OR) of myopia, given a myopic sibling relative to having a nonmyopic sibling. RESULTS: The estimated heritability of refractive error was 61% (95% confidence interval [CI]: 34%-88%) in this population. The age-, race-, and sex-adjusted ORs of myopia were 2.65 (95% CI: 1.67-4.19), 2.25 (95% CI: 1.31-3.87), 3.00 (95% CI: 1.56-5.79), and 2.98 (95% CI: 1.51-5.87) for myopia thresholds of -0.50, -1.00, -1.50, and -2.00 D, respectively. Neither race nor gender was significantly associated with an increased risk of myopia. CONCLUSIONS: Refractive error and myopia are highly heritable in this elderly population.

Aged↗

PubMed2004

Racial variations in causes of vision loss in nursing homes: The Salisbury Eye Evaluation in Nursing Home Groups (SEEING) Study.

OBJECTIVE: To determine the prevalence and causes of low vision in a large sample of nursing home residents. METHODS: Twenty-eight nursing homes on the Eastern Shore of Maryland and Delaware were enrolled in a clinical trial to assess the impact of vision restoration/rehabilitation on nursing home residents. Visual acuity was measured using both recognition charts and preferential looking techniques. An ophthalmologist examined all residents with visual acuity worse than 20/40 in the better-seeing eye and determined the primary cause for decreased vision. Results are reported for the better-seeing eye. RESULTS: Of 2544 eligible residents, 1591 (63%) participated, but 286 residents were unable to respond to visual acuity testing. Of the remaining 1307 residents, 496 (37%) had best-corrected visual acuity worse than 20/40 in the better-seeing eye. Causes were ascribed for 412 subjects. Rates of low vision were similar between African American subjects and white subjects (39% and 38%, respectively; age-adjusted P =.18). Cataract was the leading cause of low vision, responsible for 37% of low vision among white subjects and 54% of low vision among African American subjects. Macular degeneration was responsible for 29% of low vision among white subjects but only 7% among African American subjects. Glaucoma caused low vision in 4% of white subjects and 10% of African American subjects. Refractive error was not a frequent cause of low vision in nursing home residents. CONCLUSIONS: Low vision is highly prevalent among nursing home residents, with 37% having visual acuity worse than 20/40 in the better-seeing eye. Differences in causes of low vision between African American subjects and white subjects were noted, with African American subjects more likely to have vision loss on the basis of cataract, a readily treated condition. Appropriate interventions for nursing home residents, who face significant obstacles in accessing eye care services, have the potential to improve the quality of life of this at-risk older population.

Aged↗

PubMed2004

Incidence and progression of lens opacities: effect of hormone replacement therapy and reproductive factors.

BACKGROUND: Hormone replacement therapy (HRT) is associated in cross-sectional studies with a decreased prevalence of lens opacities. We explored the associations of HRT and reproductive factors with the incidence and progression of lens opacities over a 2-year period. METHODS: Data were derived from 1458 women ages 65 years and older from the Salisbury Eye Evaluation population-based prospective cohort study in Salisbury, MD, 1993-1997. RESULTS: HRT was not associated with incident nuclear, cortical, or posterior subcapsular opacities, or with progression of nuclear or cortical opacification. Women who had an early menopause had a higher risk of nuclear progression, whereas those who had a later menopause had a lower risk (linear trend P = 0.013). Other variables related to reproduction, such as oral contraceptive use, age at menarche, number of births, and history of hysterectomy, were not associated with any of the outcomes. CONCLUSIONS: These data suggest no evidence of protection against the incidence or progression of lens opacities with HRT.

Age Factors↗

PubMed2004

Association of visual field loss and mobility performance in older adults: Salisbury Eye Evaluation Study.

PURPOSE: To determine the association between visual field loss and orientation and mobility (O&M) performance in a population-based sample of older adults and to identify the specific regions of the visual field that are most strongly associated with O&M performance. METHODS: A population-based sample of 1504 persons between the ages of 72 to 92 was enrolled in the third round of Salisbury Eye Evaluation. Monocular visual fields (60 degrees radius) were tested with the 81-point, single intensity (24 dB) screening test strategy on the Humphrey Field Analyzer. Binocular visual fields were estimated from a combination of the monocular fields. The number of points missed was calculated for the overall visual field and for 3 non-overlapping regions: central (< or = 20 degrees radius), upper- and lower-peripheral visual fields. Orientation and mobility performance was evaluated by walking speed, number of bumps, and number of orientation errors on a circuitous, 32.8-m course seeded with obstacles. Log-linear regressions and linear regressions, adjusting for age, gender, body mass, height, cognitive and general health status, were performed. RESULTS: Loss in the overall visual field was associated with an increase in the number of bumps and decrease in walking speed. Visual field loss was not associated with the number of orientation errors. Out of the three visual field sub-regions that we tested, in terms of percentage of loss, the central and lower peripheral regions showed comparable decrements in walking speed and the central region was most strongly associated with number of bumps. CONCLUSIONS: The loss in visual field, which occurs with aging, is associated with a decline in mobility performance. Walking speed decreases, and the number of bumps into obstacles increases, with decreases in the visual field. The number of orientation errors is not associated with the loss in visual field that occurs with aging.

Aged↗