Biomedical subjects

H Hirvelä

Publications and source records attributed to H Hirvelä.

8 recordsLinked to original sources

PubMed1997

Diabetic retinopathy in people aged 70 years or older. The Oulu Eye Study.

AIMS: To evaluate the presence and severity of diabetic retinopathy and the value of retinopathy screening in people aged 70 years or older. METHODS: In a population based study on 500 of 560 eligible (89%) people aged 70 years or older, signs of diabetic retinopathy were evaluated through dilated pupils by an ophthalmologist using photographic and/or ophthalmoscopic methods. RESULTS: 23% of the study population (113/500) had diabetes mellitus. Signs of diabetic retinopathy were found in 24 people (21% of the diabetic population). Retinopathy changes were graded as mild to moderate non-proliferative retinopathy (NPDR) in 40 eyes (18 people), severe NPDR (preproliferative) in five eyes (four people), and proliferative in three eyes (two people). Preproliferative or proliferative changes were present in four people (3.5% of the diabetic population) and diabetic maculopathy was diagnosed in nine (8% of the diabetic population). Laser treatment was considered to be indicated in seven people for maculopathy, and in two for proliferative changes. In four people the visual acuity was reduced to a low vision level as a result of diabetic retinopathy. CONCLUSION: In spite of the high prevalence of diabetes mellitus in the elderly population, the prevalence of vision threatening diabetic retinopathy, particularly proliferative retinopathy, is low. Ophthalmoscopically, reliable information on fundus changes could be obtained in 94%, but photographs were gradable in only 76% of the diabetic population. Therefore, the value of photographic screening for diabetic retinopathy in this age group is poor in comparison with younger age groups.

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PubMed1996

Risk factors of age-related maculopathy in a population 70 years of age or older.

PURPOSE: To evaluate possible risk factors for age-related maculopathy (ARM) in an epidemiologic cross-sectional population study of inhabitants 70 years of age or older in a rural area in Oulu County, Northern Finland. METHODS: Five hundred of the 560 (89 percent) eligible subjects were examined. The diagnosis of ARM was based on fundus photographs in 83 percent of the population or on ophthalmoscopic findings in 13 percent; in 4 percent, the fundi could not be seen. Both early and late forms of ARM were included. RESULTS: The prevalence of ARM increased steadily with age without overall significant difference between men and women. The condition was, however, related to high body mass index in men. The ARM appeared to be also associated with the presence of cataract, broad peripapillary atrophy, and severe sclerosis of the retinal arteries, but after controlling for age, these associations were nonsignificant. No association was found between ARM and systemic hypertension, diabetes, smoking, working outside, myopia, glaucoma, or the presence of exfoliation. In logistic regression analysis, age was the only statistically significant risk factor for ARM in both sexes. In men, a high body mass index also was found to be a predictor for ARM. CONCLUSIONS: The presence of ARM was associated with cataract and signs of age-related vascular changes in the eyes. Of the general factors, age in both sexes and high body mass index in men were found to be the only predictors of ARM.

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PubMed1995

Prevalence and risk factors of lens opacities in the elderly in Finland. A population-based study.

PURPOSE: The distribution and prevalence of lens opacities and visual impairment caused by cataract were studied in an epidemiologic cross-sectional population study of inhabitants 70 years of age or older in three communities in Oulu County, Finland. METHODS: Of the 560 eligible subjects, 500 (89.3%) were examined. The best-corrected visual acuity for distance in both eyes was determined. The diagnosis of lens opacities was based on clinical biomicroscopy. The findings were compared with standardized photographs of the Lens Opacities Classification System II. RESULTS: One hundred sixty-five (33.0%) persons in the study population had a clear lens in both eyes. Cataract, aphakia, or pseudophakia was recorded in one or both of the eyes in 64.4% (322 persons) of the participants. The prevalence increased with age from 44.6% of persons (n = 88) in the 70- to 74-year-old age group to 97.6% of persons (n = 41) in the 85- to 89-year-old age group. A total of 56.4% of persons had cataract, aphakia, or pseudophakia in both eyes. Nuclear, cortical, and posterior subcapsular opacities were detected in 38.5%, 37.6%, and 27.7% of the participants, respectively. Exfoliation was present in one or both eyes in 22.1% of the participants. There was no difference in the prevalence of cataract between the sexes when age was considered. Visual impairment to 20/50 or worse was at least partly due to cataract in 23.8% of the right eyes and 22.4% of the left eyes. Significant risk factors for cataract were age and the presence of exfoliation in men and age, occupational exposure to sunlight, and current cigarette smoking in women. CONCLUSIONS: Almost two thirds of the population 70 years of age or older had lens opacities, and in 23.1% of the eyes visual impairment to 20/50 or worse was at least partly due to cataract. Including the patients who had undergone surgery, 30.3% of all the eyes of persons 70 years of age or older can be considered for cataract surgery.

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PubMed1995

Visual acuity in a population aged 70 years or older; prevalence and causes of visual impairment.

Visual acuity and the prevalence and causes of impaired vision were studied in an epidemiological cross-sectional population study of inhabitants aged 70 years or older in three communities in the county of Oulu, Finland. 500 of the 560 eligible persons (89.3%) were examined. Information on visual acuity was obtained for 476 co-operative persons (85.0%). 59.0% had a visual acuity of 0.3-0.6 in the better eye. 10.1% (48 persons) had low vision and 1.9% (9 persons) were blind as categorized according to the classification of visual impairment by the World Health Organization. Experienced visual capacity did not, however, always correspond to objective tests. Age-related maculopathy and cataract were the leading causes of visual deterioration. Age-related maculopathy was the main cause of low vision and blindness in 4.6% of the population. In 1.3% the etiology was cataract, and in 2.1% both early age-related maculopathy and cataract were present without obvious dominance. Cataract was often associated with other conditions. Glaucoma was considered the main cause of visual deterioration in 1.5%, diabetic maculopathy in 0.6% and macula pucker in 0.4%. In 1.5% the visual deterioration was due to other causes.

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PubMed1995

Prevalence and visual consequences of macular changes in a population aged 70 years and older.

In a population based study on 500 persons aged 70 years and older, photographic and/or ophthalmoscopic evaluation of the macula at least in one eye was possible for 478 persons (96%). No macular pathology in either eye was observed in 46%, signs of age-related maculopathy in one eye or both eyes occurred in 41% and other pathology in 16%. Early age-related maculopathy was diagnosed in 32%, geographic atrophy in 4.4% and disciform degeneration in 3.8%. Geographic atrophy was most common in persons aged 90 years and older (36%), and the highest prevalence of disciform degeneration was found in the age group of 85-89 years (17%). Of the 155 eyes with low vision or blindness and visible fundus, early age-related maculopathy was found in 35%, geographic atrophy occurred in 14% and disciform degeneration in 14%. Age-related maculopathy was considered the main cause for low vision and blindness in 4.7% of the 468 persons in whom visual acuity and information on fundus could be obtained, and in 3.6% it was one of the causes, usually together with cataract. The other macular disorders caused 1.5% of low vision and blindness.

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PubMed1995

Visual acuity and contrast sensitivity in the elderly.

The visual acuity of the better eye in the elderly inhabitants of three communities (476 persons, aged 70 years or more) ranged from 0 to 1.4 (mean 0.7), and 12% saw less than 0.3. The logarithm of binocular contrast sensitivity ranged from 1.0 to 2.75 (n = 412, mean 2.19) in the Cambridge test and from 0.15 to 1.95 (n = 468, mean 1.48) in the Pelli-Robson test. The 72 subjects with healthy eyes had a mean visual acuity of 1.03 (range 0.5-1.4) in the better eye, and the two contrast sensitivity tests gave mean values of 2.45 and 1.69, respectively. Cortical, nuclear and mixed cataracts and macular pathology impaired both contrast sensitivity and visual acuity. The correlation between the three tests was good in the whole sample and in the different subgroups of cataract and macular changes. Individually, however, a few contradictory results were obtained. According to these results measurement of contrast sensitivity does not add much to the general information obtained in the elderly by visual acuity measurement alone, but in selected cases it may give valuable information.

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PubMedDate not supplied

Metabolic characteristics and urine albumin excretion rate in relation to pubertal maturation in Type 1 diabetes.

BACKGROUND: The objective of this study was to assess the impact of pubertal maturation on urinary albumin excretion rate (AER) and persistent microalbuminuria, and to identify possible factors affecting urinary AER in adolescents with Type 1 diabetes. METHODS: One hundred patients aged 9.1-19.0 years with a duration of diabetes of >2 years out of 138 eligible adolescents with Type 1 diabetes from an outpatient diabetes clinic participated in the study, together with 100 healthy controls. A timed overnight urine sample was collected in the hospital, where all the adolescents stayed for 22-24 h, and microalbuminuria was confirmed with at least one consecutive positive sample (AER 20-200 microg/min). RESULTS: The prevalence of persistent microalbuminuria was 6%. All the patients affected were girls: one prepubertal (T I), one in late puberty (T IV) and three postpubertal (T V). These patients had significantly higher HbA(1c) levels than did the normoalbuminuric girls with Type 1 diabetes. Neither duration of diabetes nor age differed significantly between the two groups. AER increased more conspicuously with pubertal maturation in the boys with Type 1 diabetes than in the control boys, while the girls with diabetes had significantly higher body mass index (BMI) and serum total and LDL cholesterol than did the control girls. HbA(1c) was independently associated with AER in a multiple regression model. Diastolic blood pressure (BP) was elevated in both girls and boys with Type 1 diabetes as compared with healthy adolescents, while no difference was observed between the patients with microalbuminuria and normoalbuminuria. CONCLUSIONS: Persistent microalbuminuria was mainly observed in late puberty and after puberty among adolescents with Type 1 diabetes. Female sex and poor metabolic control predispose such adolescents to this condition during pubertal maturation.

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PubMedDate not supplied

Intraocular pressure and prevalence of glaucoma in elderly people in Finland: a population-based study.

The distribution of intraocular pressure (IOP) and the prevalence of glaucoma and their correlates were studied in a population-based study of inhabitants aged 70 years or older of three communities in the county of Oulu, Finland. 500 of the 560 eligible subjects (89%) were examined. IOP was measured using applanation tonometry. The diagnosis of glaucoma (or suspected glaucoma) was based on previous history and/or characteristic optic disc changes assessed first by ophthalmoscopy and later by photographic evaluation. No correlation existed between IOP level and age, but IOP was higher in women than in men. Glaucoma occurred in 12% of the participants (60 of 500 persons). In 42 of the 60 persons (8% of the participants) glaucoma had been diagnosed before this survey: non-exfoliative open-angle glaucoma in 15 persons (3.0%), bilateral or unilateral exfoliative open-angle glaucoma in 19 persons (3.8%), and congestive glaucoma in 8 persons (1.6%). In another 18 persons (4% of the participants) new open-angle glaucoma was detected, one third of these were exfoliative. In addition, 6% of the study population had suspected glaucomatous disc changes. In all new glaucoma cases and in all suspected cases the IOP was lower than 25 mmHg. Ocular hypertension (> or = 25 mmHg) without disc changes was found in 2%.

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