Elusive drusen and changing terminology of AMD

Ophthalmic researc

Het oog spiegelt de oogarts

REDE uitgesproken bij de aanvaarding van het ambt van gewoon hoogleraar in de oogheelkunde aan de faculteit der geneeskunde, Brasmus Universiteit Rotterdam, op 18 april 198

Atherosclerosis, C-reactive protein, and risk for open-angle glaucoma: The Rotterdam Study

PURPOSE. To test the hypotheses that atherosclerosis and elevated serum C-reactive protein (CRP) levels are risk factors for open-angle glaucoma (OAG). METHODS. In a prospective, population-based cohort study, all participants 55 years and older and at risk for incident OAG underwent, at baseline (1990-1993) and at follow-up (1997-1999), the same ophthalmic examination, including visual field testing and optic disc photography. Baseline atherosclerosis was assessed by means of echography of the carotid arteries, abdominal x-ray examination, and ankle-arm index; baseline serum CRP levels were used in the analyses. The diagnosis of OAG was based on an algorithm using optic disc measures and visual field loss. Odds ratios of OAG were computed with logistic regression analyses. Risk factors were categorized in tenues and according to standard deviation. RESULTS. After a mean follow-up of 6.5 years, incident OAG was diagnosed in 87 of 3842 (2.3%) participants at risk for OAG. Carotid artery plaques, carotid intima-media thickness, aortic calcifications, ankle-arm index, and CRP levels were not significant risk factors for OAG. The odds ratio, given for the highest and lowest tertiles, for carotid plaques was 1.43 (95% confidence interval [CI], 0.68-2.99), for carotid intima-media thickness 0.86 (95% CI, 0.47-1.57), for aortic calcifications 1.02 (95% CI, 0.60-1.75), for ankle-arm index 0.69 (95% CI, 0.38-1.25), and for CRP 1.19 (95% CI, 0.68-2.07). CONCLUSIONS. In this prospective, population-based study, neither atherosclerosis nor serum CRP level was an important risk factor for OAG.

Blood pressure, atherosclerosis, and the incidence of age-related maculopathy: the Rotterdam Study

PURPOSE: To determine whether blood pressure and subclinical atherosclerosis are associated with incident age-related maculopathy (ARM). METHODS: The study was performed within the Rotterdam Study, a population-based, prospective cohort study in Rotterdam, The Netherlands. A total of 4822 subjects who at baseline were aged 55 years more, were free of ARM, and participated in at least one of two follow-up examinations after a mean of 2 and 6.5 years, were included in the study. At baseline, blood pressure and the presence of atherosclerosis were determined. ARM was assessed according to the International Classification and Grading System and defined as large, soft drusen with pigmentary changes; indistinct drusen; or atrophic or neovascular age-related macular degeneration. RESULTS: After a mean follow-up of 5.2 years, incident ARM was diagnosed in 417 subjects. Increased systolic blood pressure or pulse pressure was associated with a higher risk of ARM. Adjusted for age, gender, smoking, total and high-density lipoprotein cholesterol, body mass index, and diabetes mellitus, odds ratios (OR) per 10-mm Hg increase were 1.08 (95% confidence interval [CI]: 1.03-1.14) and 1.11 (95% CI: 1.04-1.18), respectively. Moreover, different measures of atherosclerosis were associated with the risk of ARM. An increase in carotid wall thickness (OR per 1 SD, 1.15; 95% CI: 1.03-1.28) increased the risk of ARM. The lowest compared with the highest tertile of ankle-arm index had an OR of 1.32 (95% CI: 1.00-1.75). A weak association was found between aortic calcifications and the risk of ARM. CONCLUSIONS: Elevated systolic blood or pulse pressure or the presence of atherosclerosis may increase the risk of development of ARM

Dietary assessment in the elderly: Application of a two-step semiquantitative food frequency questionnaire for epidemiological studies

Objective: Description and application of an adapted semiquantitative food frequency questionnaire (SFFQ) for dietary assessment in the elderly population of the Rotterdam Study. Design: Dietary assessment consisting of a two-step approach was performed in 5434 participants (2225 men, 3029 women) of the Rotterdam Study from 1990 to 1993, a population-based prospective cohort of 7983 subjects aged 55-95 years (participation rate 78%). Statistical analysis: Nutrient intake was calculated for men and women in four age groups (55-64 years, 65-74 years, 75-84 years, 85-95 years) and linear trend analysis for differences in mean nutrient intake across age groups (55-64 gears 65-74 years, 75-95 years) by regression analysis was conducted. The influence of baseline characteristics on energy and nutrient intakes adjusted by age and sex was investigated by one-way-analysis of variance. Results: The adapted SFFQ made it possible to measure nutrient intake in the elderly within a limited time frame (2 x 20 min) across a wide age range (55-95 years). For nutrient intake we observed a general decline in mean intake of energy and most nutrients with age in men. In women the relation with age was not consistent: for most nutrients mean intake showed a decrease with age (e.g. water, magnesium, potassium), for some an incre

Retinal vessel diameters and risk of impaired fasting glucose or diabetes: the Rotterdam study

The association between a smaller retinal arteriolar-to-venular ratio (AVR) and incident diabetes may be due to arteriolar narrowing, venular dilatation, or both. We investigated associations between baseline vessel diameters and incident impaired fasting glucose or diabetes in a population-based cohort (aged > or =55 years). Baseline retinal vessel diameters (1990-1993) were measured on digitized images of 2,309 subjects with a normal glucose tolerance test (postload glucose or =7.0 mmol/l and/or antidiabetic medication use. Odds ratios (ORs) per SD increase in venular diameters were 1.13 (95% CI 1.00-1.29) for impaired fasting glucose and 1.09 (0.90-1.33) for diabetes. ORs per SD decrease in arteriolar diameters were 1.12 (0.98-1.27) and 1.08 (0.89-1.31) and per SD decrease in AVR were 1.29 (1.13-1.46) and 1.19 (0.98-1.45). After adjustment for cardiovascular risk factors, the associations were unaltered for venules and disappeared for arterioles. After stratification on age, associations between venular dilatation and impaired fasting glucose (1.23 [1.02-1.47]) or diabetes (1.18 [0.89-1.56]) were mainly present in participants aged <70 years. In conclusion, in our study, the risk of impaired fasting glucose and diabetes with AVR was explained by venular dilatation rather than arteriolar narrowing, warranting more focus on the causes of this dilatation