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M C Leske

Publications and source records attributed to M C Leske.

16 recordsLinked to original sources
PubMed1991

The Lens Opacities Case-Control Study. Risk factors for cataract.

The Lens Opacities Case-Control Study evaluated risk factors for age-related nuclear, cortical, posterior subcapsular, and mixed cataracts. The 1380 participants were ophthalmology outpatients, aged 40 to 79 years, classified into the following groups: posterior subcapsular only, 72 patients; nuclear only, 137 patients; cortical only, 290 patients; mixed cataract, 446 patients; and controls, 435 patients. In polychotomous logistic regression analyses, low education increased risk (odds ratio [OR] = 1.46) and regular use of multivitamin supplements decreased risk (OR = 0.63) for all cataract types. Dietary intake of riboflavin, vitamins C, E, and carotene, which have antioxidant potential, was protective for cortical, nuclear, and mixed cataract; intake of niacin, thiamine, and iron also decreased risk. Similar results were found in analyses that combined the antioxidant vitamins (OR = 0.40) or considered the individual nutrients (OR = 0.48 to 0.56). Diabetes increased risk of posterior subcapsular, cortical, and mixed cataracts (OR = 1.56). Oral steroid therapy increased posterior subcapsular cataract risk (OR = 5.83). Females (OR = 1.51) and nonwhites (OR = 2.03) were at increased risk only for cortical cataract. Risk factors for nuclear cataract were a nonprofessional occupation (OR = 1.96), current smoking (OR = 1.68), body mass index (OR = 0.76), and occupational exposure to sunlight (OR = 0.61). Gout medications (OR = 2.48), family history (OR = 1.52), and use of eyeglasses by age 20 years, which is an indicator of myopia (OR = 1.44), increased risk of mixed cataract. The results support a role for the nutritional, medical, personal, and other factors in cataractogenesis. The potentially modifiable factors suggested by this study merit further evaluation.

Adult↗
PubMed1991

Breast cancer risk and oral contraceptive use: results from a large case-control study.

The association between oral contraceptive use and breast cancer risk was examined using data from a case-control study of breast cancer in Long Island, New York. Cases were defined as female residents of Nassau and Suffolk Counties between the ages of 20 and 79, diagnosed with breast cancer between January 1, 1984 and December 31, 1986. Age- and county-matched controls were selected from driver's license files. Among all women under age 70 at diagnosis, there was no association between oral contraceptive use and breast cancer; there was, however, a positive association in the subgroup ages 20-49 (adjusted odds ratio = 1.68, 95% CI: 1.16-2.42). Risk increased with increasing duration of use, but did not differ between women who first used oral contraceptives before the first pregnancy and those who first used them later, or between women who first used oral contraceptives before age 25 and those who first used them at a later age. Risk also appeared to increase with number of years of use before the first pregnancy or before age 25, although numbers were small. History of benign breast disease did not influence risk. The association of breast cancer risk with oral contraceptive use appeared stronger in women from Suffolk County than Nassau County.

Adult↗
PubMed1989

Lens opacities classification system II (LOCS II)

The Lens Opacities Classification System, version II (LOCS II), uses a set of colored slit-lamp and retroillumination transparencies to grade different degrees of nuclear, cortical, and subcapsular cataract. The system uses four nuclear standards for grading nuclear opalescence and color, five cortical standards, and four subcapsular standards. The LOCS II can be used to grade patients' cataracts at the slit lamp or to grade slit-lamp and retroillumination photographs; it is easy to learn and can be applied consistently by different observers. We obtained very good interobserver reproducibility of the clinical gradings at the slit lamp, excellent intraobserver reproducibility, very good to excellent interobserver reproducibility of photographic gradings, and good agreement between clinical and photographic gradings. The LOCS II is potentially useful for both cross-sectional and longitudinal studies of cataract.

Cataract↗
PubMed1989

A pilot project of glaucoma in Barbados.

The prevalence of open-angle glaucoma is believed to be very high among West Indian blacks. To begin investigating the prevalence and risk factors for glaucoma and other eye diseases in Barbados, WI, a pilot study was conducted. The pilot project identified a stratified, random national sample of 300 persons over 35 years of age who were invited to participate in an ophthalmic examination and an interview. Of those contacted 89% were eligible and 95% of these agreed to participate. The overall glaucoma prevalence in the participants was 6%; it was 13% among black and mixed persons over 54 years. Age related cataract, hypertension, and diabetes were frequent findings. Although the sample size of the pilot project is small, the results suggest a high prevalence of glaucoma in Barbados, a finding that merits further study.

Adult↗
PubMed1989

Strategies for measuring the rate of age-related cataract formation in vivo.

The Lens Opacities Classification System (LOCS II) has been tested as a method for detecting and grading longitudinal changes in cataract severity. The LOCS I and II systems have already been tested and validated for cross-sectional classification of human cataracts in vivo. 130 eyes (of 68 patients) were photographed at baseline and follow-up visits with Neitz CTR and Zeiss slit photography. The mean length of follow-up was 14.7 +/- 4.4 months. The severity of nuclear opalescence (NO), cortical (C) and posterior subcapular cataract (P) was graded in a masked fashion using the LOCS II standards. Side-by-side comparisons of baseline and follow-up photos were also done in a masked fashion to detect more subtle changes than might be evident in the LOCS II gradings. The annual percent progression in cataracts graded by LOCS II standards are: (NO): 12.4%, (C): 17.9%, and (P): 6.5%. The LOCS II standards are offered as a promising subjective method for longitudinal grading of human cataractous change in vivo.

Aged↗
PubMed1988

Evaluation of a Lens Opacities Classification System.

A simple system, based on standard photographs, has been developed to classify lens opacities. The system allows the definition of cataract cases and noncases according to the location of lens opacification (nuclear, cortical, posterior subcapsular) and its extent (early or more advanced). Evaluation of the system has shown good to excellent reproducibility for clinical and photographic classifications. Comparisons of clinical and photograph-derived gradings has shown generally good agreement in classifying the presence and type of cataract; this agreement is highest for nuclear cataract. Photographic gradings of posterior subcapsular and, to a lesser degree, cortical opacities tend to underestimate the extent of opacification found by clinical gradings. The Lens Opacities Case-Control Study system is simple, reproducible, and easy to implement; it is offered for use in case-control and other cross-sectional studies of cataract with compatible classification goals.

Aged↗
PubMed1988

Lens Opacities Classification System.

The Lens Opacities Classification System (LOCS) is a simple system for classifying age-related human lens opacities at the slit lamp or in retroilluminated and slit-lamp photographs. The system employs a set of standard Neitz CTR retroilluminated black-and-white photographs for classification of cortical and posterior subcapsular cataracts and a single color slit-lamp photograph for classification of nuclear color and opalescence. We present a detailed description of the system.

Cataract↗
PubMed1988

Design of a pilot study of glaucoma in Barbados.

In Barbados, West Indies, open-angle glaucoma is a major cause of blindness, presenting early and with advanced visual loss. This report describes the design of a pilot project that evaluated the feasibility of an epidemiologic study to measure glaucoma prevalence and ascertain risk factors in this population. A major goal of the pilot project was to test the proposed sampling and recruitment methods for the larger study. The pilot project identified a random national sample of 300 persons ≥ 35 years, 100 from each of three geographic strata, who were invited to participate in a comprehensive interview and ophthalmologic examination. Because the pilot study was still ongoing at the time of this report, data are available only on the first 172 persons in the sample; 88 percent of those contacted were eligible for the study and 97 percent agreed to participate without any differential participation by geographic area. Preliminary data on the first 170 persons examined show that 20 to 25 percent of participants had best corrected visual acuity of 20/40 or worse; about 10 percent had intraocular pressure >21 mmHg; over 20 percent had cup-disc ratios of ≥0.5; and ten persons had open-angle glaucoma.

Adult↗
PubMed1987

Progress toward developing a cataract classification system.

A cataract classification system is being developed based on a set of standard photographs. The system uses an ordinal scale ranging from 0 (no opacities) to 2 (definite opacities) to classify cataractous changes in the nuclear, cortical, and posterior subcapsular lens zones. The reproducibility of slitlamp-derived and photo-derived classifications using the system was evaluated. The reproducibility between 2 observers for slitlamp-derived classifications was very high (n = 60). The reproducibility within and among 4 photography readers was also good for photo-derived classifications (n = 100). Discrepancies were found between ratings derived from slitlamp examinations and from photographs; such discrepancies were most frequent for gradings of cortical opacities.

Cataract↗
PubMed1985

Validity and reproducibility of the Cooperative Cataract Research Group (CCRG) cataract classification system.

The validity and reproducibility with which six classifiers [one experienced (L.T.C.), and five novices (W.G., F.G., W.W., J.W. and O.W.)] used the CCRG cataract classification system was assessed. The validity of index classifications was assessed by computing sensitivities and pairwise interclass correlations between experienced and novice classifiers using the former's classification as the standard. The number of unordered combinations of terms in the CCRG's classification was reduced by combining cortical terms according to the CCRG's accepted system of staged simplification. The number of combinations of terms at each stage is as follows: Stage I (greater than 1000); II (127); III (63); IV (15); V (7); VI and VII (3) and VIII (2). Excellent agreement was obtained between the experienced and novice classifiers for Stages VII and VIII of the classification, good agreement for Stages V and VI and poor agreement for Stages IV, III and II (sensitivities of 97, 96, 72, 59, 40, 24 and 20% respectively). Good agreement was also achieved for the classifications of single lenticular regions, except for subcapsular regions. The intra- and interobserver reproducibility was assessed by computing the Kappa statistic to (1) compare classifications between novice observers and (2) compare repeat classifications made by the same observer by viewing the same cataract once on each of three different days. The novice classifiers had excellent intraobserver reproducibility for Stages VII and VIII (Kappas of 0.87 and 0.97 respectively), good reproducibility for Stages IV, V and VI (Kappas of 0.53, 0.62 and 0.62, respectively) and marginal reproducibility for stages II and III (Kappas of 0.39 and 0.40, respectively). The intraobserver reproducibility of the experienced classifier was superior to the others for virtually all characteristics with excellent reproducibility for Stages IV, V, VI, VII and VIII with Kappas of 0.79, 0.90, 1.0, 1.0 and 1.0, respectively and good reproducibility for Stages II and III (Kappas of 0.55 and 0.64, respectively). These results indicate that the simplified CCRG cataract classification system (Stages IV-VIII) passes the minimum standards for reproducibility. The performance of the experienced classifier far exceeds the minimum standards and indicates the feasibility of improving classifier performance with training and practice.

Cataract↗
PubMed1978

Discrepancies between admission and discharge diagnoses in a university hospital.

Admission screening and certification systems for utilization review are based on acceptance of attending physicians' admitting diagnosis. This study was conducted to: 1) determine the consistency of admission diagnosis as compared to discharge diagnosis: i) identify the characteristics of patients and diagnoses subject to higher rates of diagnostic discrepancy; and 3) analyze the apparent reasons for such discrepancies. The following methods were used: direct comparison of admission and discharge diagnosis on a sample (n = 955) of university hospital patients using a rating scale to measure the degree of change in specificity and category of diagnosis; analysis of diagnostic change by hospital service, demographic characteristics of patients, length of stay, and source of payment; review of charts with the greatest diagnostic discrepancy. Diagnostic changes were found in 26.8 per cent of all admissions (n = 230) and were most frequent in neurological, medical and pediatric patients. The rate of change varied with patient age and length of stay and was lowest in Medicaid patients. Changes were usually from general to more specific diagnosis in related categories, with 4.3 per cent being discharged undiagnosed and 2.9 per cent with unrelated diagnosis. Major causes for discrepancies were related to clinical and laboratory findings. No evidence was found for deliberate diagnostic manipulation to gain admission or to improve financial coverage.

Adolescent↗
PubMedDate not supplied

Estimating incidence from age-specific prevalence for irreversible diseases with differential mortality.

We present a method for estimating incidence from age-specific prevalence data for an irreversible disease where the mortality risks may differ for persons with and without the disease. This method is an extension of previously presented methodology for estimating incidence from prevalence for a disease that does not entail differential mortality. An application to senile cataract illustrates the method.

Age Factors↗