Mineral composition of serially slaughtered Holstein steers supplemented with zilpaterol hydrochloride.

Calf-fed Holstein steers (n = 115; 449 ± 20 kg) were utilized in a serial harvest experiment. A baseline group of five steers was harvested after 226 d on feed (DOF), which was designated day 0. The remaining cattle were assigned randomly to 11 harvest groups, with slaughter every 28 d. Cattle were either not (CON) or were fed zilpaterol hydrochloride for 20 d followed by a 3 d withdrawal (ZH). There were five steers per treatment in each slaughter group ranging from days 28 to 308. Whole carcasses were divided into lean, bone, internal cavity, hide, and fat trim components. Apparent mineral retention (Ca, P, Mg, K, and S) within the body was calculated as the difference between mineral concentration at slaughter and day 0. Mineral concentration at day 0 was determined from body composition of steers harvested at day 0 multiplied by individual live body weight (BW) at day 0. All data were analyzed as a 2 × 11 factorial arrangement with individual animal as the experimental unit. Orthogonal contrasts were used to analyze linear and quadratic contrasts over time (11 slaughter dates). There were no differences in concentration of Ca, P, and Mg in bone tissue as feeding duration increased (P ≥ 0.89); concentration of K, Mg, and S in lean tissue did fluctuate across DOF (P < 0.01). Averaged across treatment and DOF, 99% of Ca, 92% of P, 78% of Mg, and 23% of S present in the body were in bone tissue; 67% of K and 49% of S were in lean tissue. Expressed as gram per day, apparent retention of all minerals decreased linearly across DOF (P < 0.01). Expressed relative to empty body weight (EBW) gain, apparent Ca, P, and K retention decreased linearly as BW increased (P < 0.01) whereas Mg and S increased linearly (P < 0.01). Apparent retention of Ca was greater for CON cattle (greater bone fraction) and apparent retention of K was greater for ZH cattle (greater muscle fraction) when expressed relative to EBW gain (P ≤ 0.02), demonstrating the increase in lean gain by ZH cattle. There were no differences in apparent retention of Ca, P, Mg, K, or S due to treatment (P ≥ 0.14) or time (P ≥ 0.11) when expressed relative to protein gain. Apparent retention averaged 14.4 g Ca, 7.5 g P, 0.45 g Mg, 1.3 g K, and 1.0 g S/100 g protein gain. Expressing apparent mineral retention on a protein gain basis minimized effects of rate and type of gain, allowing for better comparison across treatments and time. Feeding zilpaterol hydrochloride did not affect apparent mineral retention when expressed relative to protein gain.

Mineral requirements for feedlot cattle are largely based on measured mineral concentration in the body at harvest. Fairly extensive research has been done quantifying Ca and P in the body of cattle, but data on Mg, K, and S are sparse. Serial harvest experiments are expensive and labor intensive and therefore not conducted frequently. A group of 115 Holstein steers was fed a finishing diet with serial harvest every 28 d. Two treatments were evaluated, control and cattle fed zilpaterol hydrochloride to increase lean tissue growth. Every 28 d, five steers from each treatment group were harvested with the whole carcass divided into lean, bone, internal cavity, hide, and fat trim components. Apparent mineral retention was calculated as the difference between mineral composition at day 0 (baseline harvest group) and each 28 d harvest group. Averaged across treatment and days on feed, 99% of Ca, 92% of P, 78% of Mg, and 23% of S present in the body were measured in bone tissue; 67% of K and 49% of S were in lean tissue. Apparent retention averaged 14.4 g Ca, 7.5 g P, 0.45 g Mg, 1.3 g K, and 1.0 g S/100 g protein gain.

A pooled analysis of six large-pen feedlot studies: effects of a noncoated initial and terminal implant compared with a single initial and delayed-release implant on arrival in feedlot heifers.

Randomized complete block design experiments (n = 6 experiments) evaluating steroidal implants (all from Merck Animal Health, Madison, NJ) were conducted in large-pen feedlot research facilities between 2015 and 2018 comparing an 80 mg trenbolone acetate (TBA) and 8 mg estradiol-17ß (E2) initial implant (Revalor-IH) and reimplanted with 200 mg TBA and 20 mg E2 (Revalor-200; REPEATED) to a single 80 mg TBA and 8 mg E2 uncoated; 120 mg TBA and 12 mg E2 coated implant (Revalor-XH) at arrival (SINGLE) on growth and carcass responses in finishing heifers. Experiments occurred in Nebraska, Oklahoma, Washington, and Texas. Similar arrival processing was used across experiments where 17,675 heifers [initial body weight = 333 kg SEM (4.1)] were enrolled into 180 pens (90 pens per treatment with 65-240 heifers per pen) and fed for 145-222 d. Only REPEATED heifers were removed from their pen at reimplant. Diets contained monensin and tylosin, consisted of ingredients common to each region, and contained greater than 90% concentrate. Ractopamine hydrochloride was fed for a minimum of 28 d prior to harvest. Linear mixed models were used for all analyses; model-adjusted means for each implant group and the corresponding SEM were generated. Distributions of U.S. Department of Agriculture (USDA) quality grade (QG) and yield grade (YG) were analyzed as ordinal outcomes. No differences (P ≥ 0.11) were detected for any performance parameters except dry matter intake (DMI), where SINGLE had greater (P = 0.02) DMI (9.48 vs. 9.38 ± 0.127 kg) compared with REPEATED. Heifers implanted with REPEATED had greater (P ≤ 0.02) hot carcass weight (HCW; 384 vs. 382 ± 2.8 kg), dressing percentage (64.54 vs. 64.22 ± 0.120%), and ribeye area (91.87 vs. 89.55 ± 0.839 cm2) but less (P ≤ 0.01) rib fat (1.78 vs. 1.83 ± 0.025 cm) and calculated YG (2.82 vs. 2.97 ± 0.040) and similar (P = 0.74) marbling scores (503 vs. 505 ± 5.2) compared with SINGLE heifers. Distributions of USDA YG and QG were impacted (P ≤ 0.03) by treatment such that REPEATED had fewer USDA Prime and YG 4 and 5 carcasses. Heifer growth performance did not differ between implant regimens, but HCW and muscling did, perhaps indicating that REPEATED may be suited for grid-based marketing, and SINGLE might be suited for heifers sold on a live basis depending upon market conditions and value-based grid premiums and discounts. However, these decisions are operational dependent and also may be influenced by factors including animal and employee safety, stress on animals, processing facilities, time of year, labor availability, and marketing strategies.

Carcass fabrication yields of beef steers supplemented zilpaterol hydrochloride and offered ad libitum or maintenance energy intake.

An experiment was conducted to evaluate the fabrication yields of carcasses from beef steers supplemented zilpaterol hydrochloride (ZH) and fed at maintenance (MA) or ad libitum (AB) intake levels. Beef steers (n = 56) from a common sire were blocked (n = 28 per block) by terminal growth implant and sorted into pairs by BW. Four pairs (n = 8) were harvested on day 0; the remaining 24 pairs (n = 48) were assigned to a dietary intake level (MA or AB) and days on feed (28 or 56 d). Within pairs of MA or AB intakes, steers harvested on day 56 were randomly assigned to supplementation of ZH (90 mg·d-1 per steer) for 20 d followed by a withdrawal period of 4 d or control (C). Steers (BW = 603.5 ± 48.1 kg) were harvested at a commercial processing facility. After a 24-h chill period, standard USDA grading procedures were used to derive a calculated yield grade and quality grade. Following grading, left carcass sides were transported to the West Texas A&M University Meat Laboratory for fabrication. Each side was fabricated into subprimals to determine individual red meat yield (RMY), trimmable fat yield (TFY), and bone yield (BY). A mixed model was used for analysis; fixed effects included treatment combinations and random effects included block and pairs. Single df contrasts tested day 0 vs. 28, day 0 vs. 56, day 28 vs. 56, MA vs. AB, and C vs. ZH. Yield of chuck eye roll differed (P = 0.05) by days on feed (0 d = 4.14, 28 d = 4.11, 56 d = 4.55%). Similarly, eye of round yield was impacted (P = 0.02) by days on feed (0 d = 1.51, 28 d = 1.37, 56 d = 1.36%). Additionally, brisket yield was altered (P < 0.01) by days on feed (0 d = 4.08, 28 d = 3.56, 56 d = 3.48%) and treatment (C = 3.34, ZH = 3.61%). For remaining subprimals, no differences (P ≥ 0.15) were detected. Furthermore, results indicated that RMY tended (P = 0.07) to differ by treatment (C = 61.35, ZH = 63.67%). Comparatively, TFY was impacted (P = 0.04) by intake (MA = 20.44, AB = 23.33%). Results from this study indicate that a MA intake level during the last 56 d of the finishing period concurrent with ZH supplementation impacts subprimal yields as well as carcass RMY and TFY of beef steers.

The effect of zilpaterol hydrochloride on beef producer and processor revenue of calf-fed Holstein steers.

A serial harvest was conducted every 28 d from 254 to 534 days on feed (DOF) to quantify changes in growth and composition of calf-fed Holstein steers (n = 110, initial BW = 449.2 ± 19.9 kg). One-half were supplemented the ß-2 adrenergic agonist zilpaterol hydrochloride (ZH; 8.33 mg/kg 100% DM basis), and the remainder fed a control (CON) ration during the final 20 d followed by a 3 d withdrawal prior to harvest. Cattle were randomly allocated to dietary treatment and harvest endpoint (254, 282, 310, 338, 366, 394, 422, 450, 478, 506, and 534 DOF) using a 2 × 11 factorial treatment structure and a completely randomized experimental design structure. The objective of this ad-hoc investigation was to quantify changes in value across multiple harvest endpoints and marketing strategies for cattle supplemented with ZH. Cattle-fed ZH had increased (P < 0.01) value when sold on a dressed basis (+$82.64) or on a value-based formula (+$75.59) compared with CON cattle. No differences (P ≥ 0.14) were detected between ZH and CON carcasses for premiums and discounts related to HCW, yield grade, or quality grade. Moreover, no differences (P = 0.98) were detected for overall adjusted carcass value between ZH and CON carcasses. Fabrication values revealed that ZH carcasses had greater (P < 0.01) revenue than CON carcasses for primal round (+$36.23), loin (+$38.16), flank (+$8.95), rib (+$16.33), and chuck (+$27.49) regardless of DOF. Increased primal values ultimately led to greater (P < 0.01) processor revenue (+$138.94) and carcass value per 45.4 kg (+$6.45) for cattle-fed ZH compared with CON cattle. Overall, increased carcass weight and improved fabrication yield led to greater revenue at all harvest endpoints for cattle-fed ZH. Linear increases in live and dressed values indicated the daily change in live value was $3.48, which is less than an increase of $3.77 daily for dressed carcass value. Greater beef processor margin and profitability are expected when this growth technology is used.

Post-mortem mechanical injection of low quality beef loins with pork back fat improves palatability and sensory attributes.

Palatability attributes of beef striploin steaks mechanically enhanced with pork fat were evaluated. Striploins were collected from USDA Standard steer carcasses, longitudinally cut into halves (lateral or medial) and assigned randomly to pork fat injection (PFI) or non-injected control (CON). Loin halves assigned to PFI were enhanced with pork fat using a multi-needle injector. Steaks were analyzed via Warner-Bratzler shear force, trained and consumer sensory panels, and proximate analysis (cooked and uncooked). Shear force values for PFI steaks were lower (P<0.01) than CON steaks (24.5 vs. 43.5N, respectively). Trained panelists detected (P=0.02) an off-flavor for PFI steaks but were unable to discern other attribute differences. Consumer panelists denoted (P=0.05) improved juiciness and overall preference (P=0.02) for the PFI treatment. Cooked PFI steaks had less (P<0.01; -1.0%) moisture and more (P<0.01; +1.3%) fat than CON steaks; protein did not differ (P=0.14). This processing method deserves further investigation for new product development.

Abiotrophia defectiva bleb-associated endophthalmitis confirmed with 16s ribosomal RNA sequencing.

One recognized complication of trabeculectomy with visually devastating potential is blebitis. We present a case of a 74-year-old woman with a culture and polymerase chain reaction-positive Abiotrophia defectiva bleb-associated endophthalmitis. Abiotrophia defectiva is a rare but possible cause of endophthalmitis secondary to blebitis and should be considered in culture-negative cases. Prompt identification, hence directed eradication, of the causative organism in such visually threatening cases may be facilitated by requesting polymerase chain reaction and 16S ribosomal RNA sequencing.

Retinal vessel caliber is associated with the 10-year incidence of glaucoma: the Blue Mountains Eye Study.

PURPOSE: To examine associations between quantitatively measured retinal vessel caliber and the 10-year incidence of primary open-angle glaucoma (OAG). DESIGN: Population-based cohort study. PARTICIPANTS: The Blue Mountains Eye Study examined 3654 persons at baseline and 2461 persons at either 5 years, 10 years, or both times. After excluding 44 subjects with OAG at baseline, 2417 participants at risk of OAG at the 5- or 10-year examinations were included. METHODS: Retinal vessel calibers of baseline retinal photographs were measured using a computer-based program and summarized as central retinal artery and vein equivalents (CRAE, CRVE). Incident OAG was defined as the development of typical glaucomatous visual field loss combined with matching optic disc rim thinning and an enlarged cup-to-disc (C:D) ratio of >0.7 or C:D asymmetry between the 2 eyes (≥0.3) at either the 5- or 10-year examination. Generalized estimating equation models were used to account for correlation between eyes while adjusting for glaucoma risk characteristics including intraocular pressure (IOP) or ocular perfusion pressure (OPP). MAIN OUTCOME MEASURES: We assessed the 10-year incidence of OAG. RESULTS: There were 82 persons (104 eyes) who developed incident OAG over the 10-year follow-up. After adjusting for age, sex, family history of glaucoma, smoking, diabetes, hypertension, hypercholesterolemia, body mass index, spherical equivalent refraction, and C:D ratio, narrower CRAE was associated with higher risk of incident OAG (adjusted odds ratio [OR], 1.77; 95% confidence interval [CI], 1.12-2.79, per standard deviation decrease in CRAE). This association persisted after further adjustment for IOP (adjusted OR, 1.87; 95% CI, 1.14-3.05) or OPP (adjusted OR, 1.76; 95% CI, 1.11-2.78), and remained significant when analyses were confined to eyes with IOP<20 mmHg and C:D ratio<0.6 at baseline. There were no independent associations between CRVE and incident OAG. CONCLUSIONS: Retinal arteriolar narrowing, quantitatively measured from retinal photographs, was associated with long-term risk of OAG. These data support the concept that early vascular changes are involved in the pathogenesis of OAG and suggest that computer-based measurements of retinal vessel caliber may be useful to identify people with an increased risk of developing the clinical stage of glaucoma. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Emerging drugs for ocular hypertension.

INTRODUCTION: Glaucoma is a prevalent ocular disease with characteristic optic disc and visual field changes. Globally, it is the second most common cause of visual disability, and the most common cause of irreversible and preventable blindness. Ocular hypertension (OH) occurs where intraocular pressure elevation occurs in the absence of glaucomatous disc and visual field changes. OH is a strong risk factor for glaucoma. Ocular hypotensive medications are the mainstay of glaucoma and OH treatment, and their use modifies the course of the disease by preventing onset and progression of damage. AREAS COVERED: Prostaglandin analogs, ß-blockers, α-agonists, carbonic anhydrase inhibitors and parasympathomimetics are available in our glaucoma armamentarium and are reviewed. Novel agents have evolved as our understanding of the complex mechanisms involved in aqueous humor production and obstacles to aqueous outflow increases. Potential future candidates appear to act on enhancing trabecular meshwork outflow: the Rho-kinase inhibitors, ion-channel modulators and chelating agents. Further work is needed on other promising agents: serotonergics, melatonins, cannabinoids, adenosine agonists, components of the actomyosin system, nucleotide analogs and gene silencing. Methods to improve side effect profiles or efficacy of currently available therapies are also being developed. As glaucoma treatment adherence is poor, novel drug delivery methods might address this challenge. EXPERT OPINION: Although there are good intraocular pressure-lowering medications available, novel mechanisms and drug delivery modes may provide more effective glaucoma control in future.

Implementing mental health peer support: a South Australian experience.

Mental illness is among the greatest causes of disability, diminished quality of life and reduced productivity. Mental health policy aims to reform services to meet consumers' needs and one of the strategies is to increase the number of consumers working in the mental health service system. In South Australia, the Peer Work Project was established to provide a program for the training of consumers to work alongside mental health services. The project developed a flexible training pathway that consisted of an information session, the Introduction to Peer Work (IPW) course and further training pathways for peer workers. External evaluation indicated that the IPW course was a good preparation for peer workers, but a crucial factor in the implementation process of employing peer workers was commitment and leadership within the organisation in both preparing the organisation and supporting peer workers in their role. To assist organisations wanting to employ peer workers, a three step model was developed: prepare, train and support. The project has been successful in establishing employment outcomes for IPW graduates. The outcomes increased with time after graduation and there was a shift from voluntary to paid employment.

Diagnostic accuracy of the Heidelberg Retina Tomograph for glaucoma a population-based assessment.

OBJECTIVE: To evaluate the Heidelberg Retina Tomograph II (HRTII; Heidelberg Engineering, Heidelberg, Germany) as a screening tool for open-angle glaucoma (OAG) in an older population. DESIGN: Population-based, cross-sectional study. PARTICIPANTS: Participants from the 10-year follow-up Blue Mountains Eye Study (n = 1952; 75.6% of survivors). METHODS: Participants underwent optic nerve head imaging performed using the HRTII; OAG was diagnosed independently from optic disc photographs and Humphrey 24-2 visual fields. MAIN OUTCOME MEASURES: The Moorfields Regression Analysis (MRA) was applied to scans using the default results of "normal," borderline," and "outside normal limits." Outcome classification was at the person level and used data from both eyes. RESULTS: Mean age was 73.7 years. The HRT scans could be acquired in 1644 participants, 95.9% of those fully examined; 87.4% of scans having a topography standard deviation (TSD) < or =40 microm. Larger TSD was associated with older age and OAG. The MRA sensitivity was 64.1%, specificity 85.7%, positive predictive value 21%, and negative predictive value 97.6% for detecting OAG. Including borderline results improved sensitivity (87.0%) but specificity dropped to 70.6%. Significant predictors of abnormal MRA included OAG (odds ratio [OR], 7.70; 95% confidence interval [CI] 4.79-12.35), age (OR, 1.05; 95% CI, 1.03-1.07), TSD (OR, 1.01; 95% CI, 1.003-1.020) and disc size (OR, 3.2; 95% CI, 2.31-4.49). Diagnostic accuracy was improved by restricting TSD <40 microm. Further TSD restriction improved specificity at the expense of sensitivity. As disc size increased, specificity fell whereas sensitivity, OAG prevalence, and the proportion testing positive rose. Glaucoma prevalence, positive predictive value, and the proportion testing positive increased, but specificity fell with increasing age. Sensitivity also fell between youngest and oldest groups. Diagnostic performance improved for visual field mean deviation < -4.0 dB. Single eye analyses overestimated specificity and underestimated sensitivity compared with using data from both eyes. CONCLUSIONS: Diagnostic test evaluation studies of HRTII using single eye analyses or restrictive selection overestimate test accuracy compared with this population-based study. Although the specificity of the MRA was inadequate for use as a glaucoma screening test, the HRTII performed relatively well in an unselected older population with acceptable quality scans in most eyes.

Clinical utility and differential effects of prostaglandin analogs in the management of raised intraocular pressure and ocular hypertension.

Prostaglandin analogs (PGA) are powerful topical ocular hypotensive agents available for the treatment of elevated intraocular pressure (IOP). Latanoprost 0.005% and travoprost 0.004% are prodrugs and analogs of prostaglandin F2alpha. Bimatoprost 0.03% is regarded as a prostamide, and debate continues as to whether it is a prodrug. The free acids of all 3 PGAs reduce IOP by enhancing uveoscleral and trabecular outflow via direct effects on ciliary muscle relaxation and remodeling of extracellular matrix. The vast majority of clinical trials demonstrate IOP-lowering superiority of latanoprost, bimatoprost and travoprost compared with timolol 0.5%, brimonidine 0.2%, or dorzolamide 2% monotherapy. Bimatoprost appears to be more efficacious in IOP-lowering compared with latanoprost, with weighted mean difference in IOP reduction documented in one meta-analysis of 2.59% to 5.60% from 1- to 6-months study duration. PGAs reduce IOP further when used as adjunctive therapy. Fixed combinations of latanoprost, bimatoprost or travoprost formulated with timolol 0.5% and administered once daily are superior to monotherapy of its constituent parts. PGA have near absence of systemic side effects, although do have other commonly encountered ocular adverse effects. The adverse effects of PGA, and also those found more frequently with bimatoprost use include ocular hyperemia, eyelash growth, and peri-ocular pigmentary changes. Iris pigmentary change is unique to PGA treatment. Once daily administration and near absence of systemic side effects enhances tolerance and compliance. PGAs are often prescribed as first-line treatment for ocular hypertension and open-angle glaucoma.

Fixed combination of topical brimonidine 0.2% and timolol 0.5% for glaucoma and uncontrolled intraocular pressure.

Lowering IOP is the most readily modifiable risk factor to delay the development and progression of glaucoma (POAG). The fixed combination of brimonidine tartrate 0.2% and timolol maleate 0.5% (FCBT) combines a highly selective alpha2-adrenergic agonist (brimonidine) with a non-selective beta-blocker (timolol). FCBT reduces aqueous production and enhances uveoscleral outflow. Concomitant brimonidine and timolol have additive effects on reducing intraocular pressure (IOP). Multi-center randomized control trials have documented superiority of FCBT twice daily on IOP control compared with monotherapy with the individual components, and equal efficacy compared with concomitant therapy. IOP reduction with FCBT versus fixed combination dorzolamide 2% and timolol 0.5% (FCDT) was similar in a small study. Other studies (n > 293) evaluating concomitant brimonidine and timolol have shown that it is not inferior to FCDT. However, concomitant brimonidine and timolol administered twice daily was significantly less efficacious in IOP reduction than fixed combination latanoprost 0.005% and timolol 0.5% (FCLT). There are no published studies comparing FCBT with FCLT. The side effect profile for FCBT reflects that of its individual components. FCBT was generally well tolerated, with less ocular side effects than brimondine alone, but more than timolol alone. Documented systemic effects were few, although this could be confounded by selection bias. FCBT is a safe and effective IOP lowering agent for POAG and ocular hypertension.

The inheritance of peripapillary atrophy.

PURPOSE: To estimate the relative importance of genes and environment in peripapillary atrophy type beta (beta-PPA) in a classic twin study. METHODS: Female twin pairs (n = 506) aged 49 to 79 years were recruited from the St. Thomas' UK Adult Twin Registry. Peripapillary atrophy was identified from masked grading of stereoscopic optic disc photographs. Structural equation modeling was performed using Mx with polychoric correlations of beta-PPA and refractive error (divided into deciles). RESULTS: Beta-PPA prevalence was 25.1% and did not vary with zygosity. Case-wise concordance for right eyes was 0.76 (95% CI, 0.57-0.88) for monozygotic (MZ) and 0.37 (95% CI, 0.15-0.56) for dizygotic (DZ) pairs. Multivariate modeling suggested additive genetic effects and individual environment, with no shared environment or dominant genetic effect. Beta-PPA heritability was 0.70 (95% CI, 0.54-0.83), and spherical equivalent 0.88 (95% CI, 0.85-0.91); age had no significant effect on variance. The genetic correlation between beta-PPA and spherical equivalent was -0.21. However, only 3% of the genetic variance of beta-PPA was explained by genetic factors in common with refractive error, with 67% explained by specific genetic factors for beta-PPA. Of the 30% of variance explained by unique environmental factors, only 3% was explained by these factors in common with environmental factors involved in refractive error. CONCLUSIONS: The presence of beta-PPA, a frequent ocular finding known to be associated with open-angle glaucoma, appears to be under strong genetic control, with only a small amount of this genetic effect shared with genes involved in myopia.

Ten-year incidence and progression of age-related maculopathy: the blue Mountains Eye Study.

PURPOSE: To assess the 10-year incidence of age-related maculopathy (ARM) in an older Australian cohort. DESIGN: Population-based cohort study. PARTICIPANTS: Three thousand six hundred fifty-four Blue Mountains Eye Study participants > or =49 years old were examined during 1992 through 1994; 2335 (75% of survivors) were reexamined after 5 years (1997-1999) and 1952 (76% of survivors) after 10 years (2002-2004). METHODS: The same graders performed retinal photographic grading in all examinations, using the Wisconsin Age-Related Maculopathy Grading System. Photographs of participants with ARM lesions at any of the examinations were subsequently regraded using a side-by-side comparison method. MAIN OUTCOME MEASURES: The diagnosis of incident late ARM was given if neovascular ARM or geographic atrophy was detected at either follow-up examination in persons free of these lesions at baseline. Incident early ARM was diagnosed if early ARM (soft indistinct or reticular drusen or combined soft distinct drusen and retinal pigment abnormality) was present in persons free of early and late ARM at baseline. Age-related maculopathy incidence was calculated using Kaplan-Meier methods to incorporate information from both 5- and 10-year examinations. Discrete logistic models were used to assess the risk of incident late ARM according to various baseline factors, including early ARM lesion characteristics. RESULTS: After excluding 72 late ARM cases present at baseline, 2395 of 3582 subjects at risk of late ARM (67%) were reexamined at either follow-up time point or both follow-up time points. Over the 10-year period, 72 of 2395 subjects (3.7%) developed late ARM and 266 of 2255 subjects (14.1%) developed early ARM. After age standardization to the Beaver Dam Eye Study population, our 10-year incidences of late and early ARM were 2.8% and 10.8%, respectively. Baseline age and early ARM lesion characteristics and severity were strong predictors of late ARM incidence. CONCLUSIONS: Long-term follow-up of this older population confirms that the risk of ARM progression is related strongly to the severity of early-stage lesions. The study provides evidence-based criteria for identifying persons at high risk of developing late ARM.

Open-angle glaucoma and cardiovascular mortality: the Blue Mountains Eye Study.

PURPOSE: To evaluate the association between open-angle glaucoma (termed glaucoma) and 9-year mortality in an older population-based cohort. DESIGN: Population-based cohort. PARTICIPANTS: Three thousand six hundred fifty-four persons aged 49 to 97 years (82.4% of the eligible population), residents of the Blue Mountains, west of Sydney, Australia. METHODS: At baseline (1992-1994), glaucoma was diagnosed from congruous typical glaucomatous visual field changes (full-threshold fields) and optic disc cupping (stereo-optic disc photography). Demographic information from baseline participants was matched with the Australian National Death Index data (December 2001) to obtain the number and causes of deaths. Cox proportional hazards regression analysis, controlling for age, male gender, diabetes, hypertension, heart disease, stroke, use of oral beta-blockers, current smoking history, alcohol use, myopia, and nuclear cataract were performed to assess hazard ratios for cardiovascular mortality. Adjustments for all-cause mortality also included history of cancer. MAIN OUTCOME MEASURES: Cardiovascular and all-cause mortality. RESULTS: At baseline, glaucoma was diagnosed in 108 participants (3.0%). Of 873 deaths (23.9%) before January, 2002, 312 people (8.5%) died of cardiovascular events. The age-standardized all-cause mortality was 24.3% in persons with and 23.8% in those without glaucoma, whereas cardiovascular mortality was 14.6% in persons with and 8.4% in those without glaucoma. After multivariate adjustment, those with glaucoma had a nonsignificant increased risk of cardiovascular death (relative risk [RR], 1.46; 95% confidence interval [CI], 0.95-2.23). Increased cardiovascular mortality was observed mainly in glaucoma patients aged <75 years (RR, 2.78; 95% CI, 1.20-6.47). Further stratified analyses showed that cardiovascular mortality was higher among those with previously diagnosed glaucoma (RR, 1.85; 95% CI, 1.12-3.04), particularly in those also treated with topical timolol (RR, 2.14; 95% CI, 1.18-3.89). CONCLUSIONS: Findings from the Blue Mountains Eye Study demonstrate an increased cardiovascular mortality in persons with previously diagnosed glaucoma. There was a suggestion of higher cardiovascular mortality in glaucoma patients using topical timolol that merits further study.

Intraocular pressure over the clinical range of blood pressure: blue mountains eye study findings.

PURPOSE: To quantify the relation of blood pressure (BP) and intraocular pressure (IOP) across the clinical range of BP in an older phakic population not using glaucoma medications. DESIGN: Cross-sectional population-based study METHODS: Seated BP and applanation IOP were measured, and their relation was assessed in regression models. RESULTS: Mean IOP of the two eyes increased linearly from 14.3 mm Hg for systolic BP <110 mm Hg to 17.7 mm Hg for systolic BP > or =200 mm Hg, a 3.4-mm Hg excursion over this range. Mean IOP also increased from 15.2 mm Hg for diastolic BP <70 to 18.4 mm Hg for diastolic BP > or =120, a similar variance. There were no changes after age and multivariate adjustments for IOP or after excluding undiagnosed glaucoma cases. CONCLUSION: A 3-mm linear IOP increase over the clinical spectrum of BP levels was evident; this variance is greater than with most other systemic and ocular parameters.

Retinal vessel diameter and open-angle glaucoma: the Blue Mountains Eye Study.

PURPOSE: To examine the relationship between open-angle glaucoma (OAG) and retinal vessel diameter among baseline participants in the Blue Mountains Eye Study. DESIGN: Population-based cross-sectional study. PARTICIPANTS: The study included 3654 persons older than 49 years, representing 82.4% of permanent residents living in an area west of Sydney. METHODS: Participants had a detailed eye examination, including automated perimetry and stereo optic disc photography. A computer-assisted program measured retinal vessel diameters from digitized photographs of right eyes. MAIN OUTCOME MEASURES: Open-angle glaucoma was diagnosed from matching visual field defects and optic disc cupping, without reference to intraocular pressure (IOP) level. Ocular hypertension was defined as IOP of >21 mmHg in either eye, without matching glaucomatous optic disc and field changes. Average retinal vessel diameters, measured from right eyes, were summarized as arteriolar and venular equivalents. The lowest quintile of the arteriolar equivalent or arteriole-to-venule ratio was used to define generalized retinal arteriolar narrowing. RESULTS: The study included 3314 participants, after excluding those with incomplete data or nonglaucomatous optic nerve disease. Of persons included, 59 (1.8%) had evidence of glaucomatous damage affecting the right eye, 3065 (92.5%) had no damage to either eye, and 163 (4.9%) had ocular hypertension. Right eyes with glaucomatous damage had significantly narrower retinal arteriolar diameters (183+/-2.6 microm) than eyes without glaucoma (194+/-0.4 microm, P = 0.0001) or eyes with ocular hypertension (195+/-1.6 microm, P = 0.0002), after adjusting for age, mean arterial blood pressure, and other confounding variables, including refraction. Right eyes with glaucomatous damage were at least 2 times more likely to have generalized retinal arteriolar narrowing than eyes without glaucoma (odds ratio, 2.7; 95% confidence interval, 1.5-4.8). CONCLUSIONS: These population-based data suggest that generalized retinal arteriolar narrowing, an indicator of localized vascular change, is significantly associated with optic nerve damage caused by OAG. It is not clear whether such a retinal arteriolar change reflects an ischemic process leading to optic nerve damage or results from loss of retinal neurons secondary to glaucoma.

Open-angle glaucoma and systemic hypertension: the blue mountains eye study.

PURPOSE: To assess whether systemic hypertension is associated with open-angle glaucoma (OAG) in an older population. PATIENTS AND METHODS: The Blue Mountains Eye Study examined 3654 subjects aged 49 to 97 years. Hypertension was diagnosed from history in treated subjects or from systolic blood pressure (BP) > or=160 mm Hg or diastolic BP > or=95 mm Hg. OAG was diagnosed from congruous glaucomatous optic disc rim thinning and visual field loss, without reference to intraocular pressure (IOP) level. Ocular hypertension (OH) was defined when IOP was > 21 mm Hg in either eye, among persons without OAG. RESULTS: Hypertension was present in 45.7% of subjects, OAG in 3.0%, and OH in 5.2%. Hypertension was significantly associated with OAG, after adjustment for OAG risk factors including IOP, odds ratio (OR) 1.56, 95% confidence interval (CI) 1.01-2.40. This relation was strongest in subjects with poorly controlled treated hypertension (OAG prevalence 5.4%), compared with normotensive subjects (OAG prevalence 1.9%), independent of IOP (OR 1.88, CI 1.09-3.25). The population attributable risk for hypertension (20.4%) was higher than for other identified OAG risk factors. The prevalence of OH was 8.1% in subjects with poorly controlled treated hypertension (OR 1.81, CI 1.20-2.73) and 8.2% in untreated hypertension (OR 1.96, CI 1.31-2.95), compared with 4.2% in normotensive subjects. CONCLUSIONS: Hypertension, particularly if poorly controlled, appears related to a modest, increased risk of OAG, independent of the effect of BP on IOP and other glaucoma risk factors. However, we could not exclude nocturnal hypotensive episodes among treated subjects. Hypertension was also associated with OH, a relationship that could in part reflect the influence of BP on IOP.

Intraocular pressure asymmetry and undiagnosed open-angle glaucoma in an older population.

PURPOSE: To quantify prevalence of asymmetric intraocular pressure (IOP) and assess associations with undiagnosed open-angle glaucoma. DESIGN: Population-based cross-sectional study. METHODS: Participants underwent applanation tonometry. Intraocular pressure asymmetry was defined for differences > or = 3 mm Hg; open-angle glaucoma was diagnosed if glaucomatous optic disk and field changes were congruous. Analyses excluded subjects using glaucoma medication, known glaucoma, pseudoexfoliation, and cataract surgery. RESULTS: Intraocular pressure asymmetry was present in 5.1% of subjects and was greater for patients older than 70 years (6.2%). Of subjects with maximum IOP > 21 mm Hg, IOP asymmetry was present in 41.1%. Undiagnosed open-angle glaucoma was more frequent among subjects with (4.8%) than without (1.2%) IOP asymmetry. This relationship remained significant for maximum IOP < or = 21 mm Hg. CONCLUSIONS: Intraocular pressure asymmetry may be a useful sign of undiagnosed glaucoma in subjects without elevated IOP.