Macular Degeneration: Munoz B

Friedman DS, West SK, Munoz B, Park W, Deremeik J, Massof R, Frick K, Broman A, McGill W, Gilbert D, German P. · Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA. · Arch Ophthalmol. · Pubmed #15249367 No free full text.

Abstract: 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.

Chang MA, Bressler SB, Munoz B, West SK. · Retina Division and Dana Center for Preventative Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA. · Invest Ophthalmol Vis Sci. · Pubmed #18263809 links to  free full text

Abstract: PURPOSE: To evaluate risk factors for the incidence and progression of age-related macular degeneration (AMD) in a racially heterogeneous, geriatric population. METHODS: Subjects (n = 2240) aged 65 to 84 years underwent 2 examinations separated by 2 years, of which 1937 subjects (85%) were included in this report. Fundus photographs were performed at each examination and were graded by trained readers. Multivariate logistic regression models adjusted for age, sex, race, and clustering between eyes were used to evaluate risk factors for AMD incidence and progression. RESULTS: Smoking was a strong, dose-dependent, risk factor for progression from medium size drusen to large drusen or pigmentary abnormalities within the central 1500-microm macular zone. Smoking was also a strong risk factor for development of incident focal pigmentation within 3000 microm of the foveal center. White participants were significantly more likely than blacks to develop large drusen and focal pigmentation and to progress from medium- to large-sized drusen or pigment abnormalities within the central 1500 microm macular zone. However, whites did not have an increased risk of progression from large drusen or pigment abnormalities within the central 1500-microm perimacular zone to foveal GA or CNV when compared with blacks. CONCLUSIONS: Smoking and race are important risk factors for progression from medium to large drusen or to pigment abnormalities within the central 1500-microm macular zone. Limitations in the power of this study preclude assessment of the roles of smoking and race on the ultimate progression to foveal GA or CNV once central large drusen or pigment abnormalities are present.

Freeman EE, Munoz B, West SK, Tielsch JM, Schein OD. · Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287-9019, USA. · Am J Ophthalmol. · Pubmed #12788126 No free full text.

Abstract: PURPOSE: To determine whether cataract surgery is associated with an increased prevalence of age-related macular degeneration (AMD) in three independent population-based data sets. DESIGN: Cross-sectional study. METHOD: Data were used from the Salisbury Eye Evaluation (2,520 subjects from Salisbury, Maryland, aged 65 to 84 years), the Proyecto VER (4,774 Hispanic subjects from Arizona aged 40 years and older), and the Baltimore Eye Survey (4,396 subjects from Baltimore, Maryland, aged 40 and older). The main outcome measure was AMD as determined by retinal photographs or clinical examination. RESULTS: A history of cataract surgery was associated with an increased prevalence of late AMD in all three data sets after adjusting for age, race, sex, and smoking, but odds ratios (OR) were not individually statistically significant. The OR for the combined analysis was 1.7 (95% confidence interval: 1.1-2.6). Having a severe cataract in the eye was also associated with a slightly higher prevalence of late AMD, although the combined OR was not statistically significant (OR = 1.4; 95% confidence interval, 0.8%-2.4). Overall, increasing time since cataract surgery was not associated with late AMD. CONCLUSIONS: A history of cataract surgery may be associated with an increased prevalence of late AMD. However, having a severe cataract in the eye may also be associated with a higher prevalence of late AMD. Additional research is needed to investigate whether a causal relationship exists between cataract surgery and AMD or whether this relationship is due to residual confounding or bias.

Rodriguez J, Sanchez R, Munoz B, West SK, Broman A, Snyder RW, Klein R, Quigley H. · Department of Ophthalmology, University of Arizona, Tucson, AZ, USA. · Ophthalmology. · Pubmed #11927431 No free full text.

Abstract: OBJECTIVE: To describe the causes of blindness and visual impairment in a population-based sample of Hispanics. DESIGN: A cross-sectional study. PARTICIPANTS: A random sample of 4774 Hispanic residents of Santa Cruz and Pima Counties in Southern Arizona aged 40 years and older who participated in Proyecto VER (Vision Evaluation and Research). TESTING: Subjects were interviewed and underwent a thorough ophthalmic examination. Presenting and best-corrected visual acuity was determined using the Early Treatment of Diabetic Retinopathy Study protocol, followed by a standardized ophthalmic examination to determine the causes of visual loss. Anterior and posterior segment specialists in ophthalmology confirmed the causes. MAIN OUTCOME MEASURES: Causes of visual loss (best-corrected acuity worse than 20/40). RESULTS: The response rate of eligible participants was more than 70%. Best-corrected acuity in the better seeing eye worse than 20/40 increased from 0.3% in those aged 40 to 49 to 5.6% in those aged 65 and older. The leading cause was cataract, accounting for 42% of all visual loss, followed by age-related macular degeneration (15%), and diabetic retinopathy (13%). Among 14 people who were bilaterally blind, open-angle glaucoma was the leading cause. Women had higher age-adjusted prevalence of severe cataract compared with men and were more likely to be visually impaired from cataract, diabetic retinopathy, and open-angle glaucoma, although gender differences were not statistically significant. CONCLUSIONS: Causes of visual impairment differ from those reported in Caucasian populations, with open-angle glaucoma being the leading cause of blindness. Further work on gender-based obstacles to eye care in the Hispanic community may be warranted.