Prediction error and myopic shift after intraocular lens implantation in paediatric cataract patients.

AIM: To determine the amount of myopic shift in children after cataract surgery with intraocular lens (IOL) implantation and to evaluate success in achieving the target refraction. METHODS: The children were assigned into three groups depending on age at time of surgery: Group A, 0-1 years old; Group B, 1-7 years old; Group C, 7-18 years old. Multiple regression analysis was used to create a formula for expected myopic shift and to find out which variables were associated with a higher absolute prediction error. RESULTS: Children less than 12 months of age experienced higher myopic shifts and a larger mean rate of refractive change per year compared with older children. We found higher myopic shifts in younger children at time of surgery and children with unilateral cataract. Absolute prediction error was significantly higher in Group A compared with Groups B and C (p=0.022 and p=0.037, respectively). Multiple regression analysis showed that corneal radius was the only variable significantly associated with absolute prediction error. CONCLUSION: Our data demonstrate the complexity in predicting the postoperative refraction in children under 1 year old and show that age at surgery and laterality are factors to consider when deciding which IOL power to implant in children.

The additional yield of a periodic screening programme for open-angle glaucoma: a population-based comparison of incident glaucoma cases detected in regular ophthalmic care with cases detected during screening.

AIM: To study the additional yield of a periodic screening programme for open-angle glaucoma (OAG) by comparing, in a population-based setting, incident OAG (iOAG) cases detected in regular ophthalmic care with those detected during screening. METHODS: Participants aged 55 and over from the population-based Rotterdam Study underwent the same ophthalmic examination at baseline (1991-3) and follow-up (1997-9), including visual field testing and simultaneous stereo optic disc photography. Of 3842 participants, 87 (2.3%) developed iOAG during a mean follow-up time of 6.5 years. Of these 87 iOAG cases, 78 (90%) were included in this study. RESULTS: Of the 78 iOAG cases detected at follow-up, 23 (29%) had already been detected before during regular ophthalmic care. The remaining 55 (71%) undetected iOAG cases more often showed glaucomatous optic neuropathy without glaucomatous visual field loss (29 of 55 (53%)) as compared with the detected cases (four of 23 (17%); p = 0.009). Of the undetected iOAG cases, only four had developed significant visual field loss in their better eye. CONCLUSION: The additional yield of a periodic OAG screening programme is lower than expected from published prevalence data. In the discussion, the authors estimate that-in a white population with a low prevalence of pseudoexfoliation-about one in 1000 screened persons could be saved from bilateral end-stage OAG.

Newborn with bilateral hazy corneas.

In this case report we present a preterm born baby with bilateral hazy corneas and initially normal intraocular pressures. After birth, the corneal opacification increased and a progressive buphthalmos became evident in the right eye. A trabeculectomy was performed in the right eye. Our final diagnosis was sclerocornea in combination with Peters' anomaly.

Prevalence and causes of visual field loss in the elderly and associations with impairment in daily functioning: the Rotterdam Study.

OBJECTIVES: To determine the prevalence and causes of visual field loss (VFL) and the association between VFL and indicators of impairment in daily functioning. DESIGN: Population-based cohort study. SETTING: Suburb of Rotterdam, the Netherlands. PARTICIPANTS: Community-dwelling elderly residents (n = 6250). MAIN OUTCOME MEASURE: Visual field loss on suprathreshold static, Goldmann kinetic perimetry, or both. METHODS: Suprathreshold testing of the central visual field was performed on both eyes and repeated if results were abnormal or unreliable. Goldmann perimetry was performed to confirm defects. Causes were determined using ophthalmologic and neurologic examination data and medical records. Impairment was assessed using data from interviews and medical records on disability in daily life, falling, and fractures. RESULTS: The overall prevalence of VFL was 5.6% (3.0% in those aged 55-64 years to 17.0% in those > or =85 years); glaucoma was the leading cause in all age groups. Before age 75 years, other optic nerve diseases and stroke ranked second and third, respectively, as did age-related macular degeneration and retinal vascular occlusive disease, respectively, after this age. Also, after adjustment for visual acuity, VFL was associated with disability, diminished enjoyment of reading and watching television, and a higher risk of incident falling. Risk of incident hip fracture was not increased. CONCLUSIONS: Visual field loss is present in 1 of every 20 community-dwelling elderly people and is associated with impaired daily functioning. Glaucoma is the leading cause in all age groups. Other high-ranking causes, some of which are partly preventable, vary by age.

Incidence and progression rates of age-related maculopathy: the Rotterdam Study.

PURPOSE: To describe the incidence rate of age-related macular degeneration (AMD) and the progression rates of early stages of age-related maculopathy (ARM), and to study the hierarchy of fundus features that determine progression. METHODS: A group of 4953 subjects aged 55 years and older living in Rotterdam, The Netherlands, was studied at baseline and at 2-year follow-up to determine the incidence of neovascular and atrophic AMD. A subgroup of 1244 subjects was studied for progression of early stages of ARM. Fundus transparencies were graded for features of ARM using the International Classification System. ARM was stratified in four exclusive stages, according to type of drusen and presence of pigmentary irregularities. RESULTS: The overall 2-year cumulative incidence of AMD was 0.2%, increasing to 1.8% in subjects of 85 years and older. Of those in the early stages, one fourth showed progression to a more severe stage. The most important predictors for progression were more than 10% of macular area covered by drusen (odds ratio [OR] 5.7, 95% confidence interval [CI] 2.9-11.3), presence of depigmentation (OR 4.0, 95% CI 2.5-6.4), and hyperpigmentation (OR 3.4, 95% CI 2.1-5.4). CONCLUSIONS: The incidence of AMD appears to be lower in The Netherlands than in the United States. Progression of early ARM stages occurs in a distinct pattern at a stable rate, with a large area of drusen and presence of pigmentary changes as the most important predictors.

Is open-angle glaucoma associated with early menopause? The Rotterdam Study.

The authors examined the association between age at menopause and open-angle glaucoma among women aged > or = 55 years in the population-based Rotterdam Study (1990--1993). Information on age and type of menopause was obtained by interview. Subjects (n = 3,078) were stratified into three categories according to age at menopause: <45 years, 45--49 years, and > or = 50 years, with the last group serving as the reference group. Diagnosis of open-angle glaucoma was based on the presence of a glaucomatous visual field defect and glaucomatous optic neuropathy. Open-angle glaucoma was diagnosed in 78 women with a natural menopause and 15 women with an artificial menopause. In the category of natural menopause, women who went through menopause before reaching the age of 45 years had a higher risk of open-angle glaucoma than the reference group (odds ratio = 2.6; 95% confidence interval: 1.5, 4.8), after adjustment for age and use of hormone replacement therapy. Among women who went through menopause between the ages of 45 and 49 years, the odds ratio was 1.1 (95% confidence interval: 0.7, 2.0). These findings suggest that early menopause is associated with a higher risk of open-angle glaucoma.

Changing views on open-angle glaucoma: definitions and prevalences--The Rotterdam Study.

PURPOSE: To create a quantitative basis for diagnostic criteria for open-angle glaucoma (OAG), to propose an epidemiologic definition for OAG based on these, and to determine the prevalence of OAG in a general white population. METHODS: Of the 7983 subjects 55 years of age or older participating in the population-based Rotterdam Study, 6756 subjects participated in the ophthalmic part of this study (6281 subjects living independently and 475 in nursing homes). The criteria for the diagnosis of OAG were based on ophthalmoscopic and semiautomated Imagenet estimations of the optic disc such as vertical cup-to-disc ratio (VCDR), minimal width of neural rim, or asymmetry in VCDR between both eyes, and visual field testing with kinetic Goldmann perimetry. All criteria for the diagnosis of OAG were assessed in a masked way independently of each other. RESULTS: Mean VCDR on ophthalmoscopy was 0.3 and with Imagenet 0.49, and the 97.5th percentile for both was 0.7. The prevalence of glaucomatous visual field defects was 1.5%. Overall prevalence of definite OAG in the independently living subjects was 0.8% (95% confidence interval [CI] 0.6, 1.0; 50 cases). Prevalence of OAG in men was double that in women (odds ratio 2.1; 95% CI 1.2, 3.6). Different commonly used criteria for diagnosis of OAG resulted in prevalence figures ranging from 0.1% to 1.2%. CONCLUSIONS: The overall prevalence of OAG in the present study was comparable to most population-based studies. However, prevalence figures differed by a factor of 12 when their criteria for OAG were applied to this population. A definition for definite OAG is proposed: a glaucomatous optic neuropathy in eyes with open angles in the absence of history or signs of secondary glaucoma characterized by glaucomatous changes based on the 97.5 percentile for this population together with glaucomatous visual field loss. In the absence of the latter or of a visual field test, it is proposed to speak of probable OAG based on the 99.5th or possible OAG based on the 97.5th percentiles of glaucomatous disc changes for a population under study.

Determinants of optic disc characteristics in a general population: The Rotterdam Study.

OBJECTIVE: To determine whether age, gender, height, and refractive error are associated with optic disc morphology in a general elderly population. DESIGN: Population-based, cross-sectional study. PARTICIPANTS: A total of 5114 subjects 55 years of age or older participated in this study, representing 76% of a population-based sample of 6777 ophthalmologically examined white patients from a geographically well-defined suburb in Rotterdam, The Netherlands. MAIN OUTCOME MEASURES: Disc area, neural rim area, cup area, vertical and horizontal cup-to-disc ratios, and parapapillary atrophy. METHODS: Disc characteristics were measured on stereoscopic simultaneous optic disc transparencies using an image analyzer. The presence and location of parapapillary atrophy, differentiated into zones alpha and beta, were assessed from disc transparencies of both eyes in a random sample of 894 persons. Subjects with open-angle glaucoma were excluded. RESULTS: The mean disc area was 2.42 mm2 (standard deviation [SD], 0.47), mean neural rim area was 1.85 mm2 (SD, 0.39), mean cup area was 0.57 mm2 (SD, 0.34), mean vertical cup-to-disc ratio was 0.49 (SD, 0.14), and mean horizontal cup-to-disc ratio was 0.40 (SD, 0.14). Age was not a determinant of any disc characteristic. Disc and rim areas were 3.2% (P < 0.0005; 95% confidence interval [CI], 2.7%-3.7%) and 4.3% (P < 0.0005; 95% CI, 3.5%-4.6%) larger in men than in women. For each diopter increase toward myopia, the disc area increased by 0.033 mm2 (P < 0.0005; 95% CI, 0.027-0.038) and neural rim area by 0.029 mm2 (P < 0.0005; 95% CI, 0.025-0.034). The disc area increased by 0.02 mm2 (P = 0.02; 95% CI, 0.005,0.05) for each 10-cm increase in height. The prevalence of zone alpha slightly decreased by 0.4% per 10 years of age (P = 0.035; 95% CI, 0.03%-0.8%), whereas the prevalence of zone beta increased by 1.3% (P = 0.0003; 95% CI, 0.57%-1.9%) for each diopter increase toward myopia. CONCLUSIONS: In a general population, statistically normal discs may vary twofold in disc area and threefold in rim area. Age is not associated with any disc characteristic, whereas disc area and neural rim area are slightly larger in men than in women. Refractive error is weakly related to disc area and neural rim area. Height is weakly related to disc area in persons of medium height. The prevalence of zone beta is higher in myopic eyes.

Cup-to-disc ratio: ophthalmoscopy versus automated measurement in a general population: The Rotterdam Study.

OBJECTIVE: To determine the correlations between ophthalmoscopic estimations and the measurements with a semiautomated image-analysis device of the vertical cup-to-disc ratio (VCDR) in the human optic disc. DESIGN: Population-based, cross-sectional study. PARTICIPANTS: All subjects 55 years of age and older from the population-based sample of 6777 ophthalmologically examined subjects from The Rotterdam Study of whom gradable optic disc transparencies of at least 1 eye and ophthalmoscopic data of the same eye were available. MAIN OUTCOME MEASURES: Ophthalmoscopic assessment of the VCDR and semiautomated measurement of the VCDR. METHODS: Indirect and direct ophthalmoscopy were performed in mydriasis to assess the VCDR. Optic disc transparencies made with a simultaneous stereoscopic telecentric fundus camera were analyzed with a semiautomated measurement system (Topcon Imagenet). RESULTS: In 5143 subjects, the mean ophthalmoscopic VCDR was 0.30 (standard error [SE], 0.0021; range, 0.00, 1.00) compared with a semiautomatically measured VCDR of 0.49 (SE, 0.0019; range, 0.04, 0.86; difference, 0.19; P < 0.0001). The overall correlation between both methods was moderate (correlation coefficient, 0.61; SE, 0.11) and lower in small optic discs. Semiautomated optic disc measurements correctly identified 76% of the glaucoma cases (as defined using visual field data and ophthalmoscopic data about the optic disc). CONCLUSION: Semiautomated measurements of the VCDR are larger than the ophthalmoscopic VCDR estimate with a moderate correlation. The interobserver variability using Imagenet was smaller compared with the ophthalmoscopic assessments, and Imagenet was better standardized, which is important for epidemiologic surveys and follow-up studies.

Genetic risk of primary open-angle glaucoma. Population-based familial aggregation study.

OBJECTIVES: To study familial aggregation of primary open-angle glaucoma in a general population and to determine the absolute and relative risks for first-degree relatives. METHODS: First-degree relatives of patients with glaucoma (n = 48) and control subjects (n = 155) from the population-based Rotterdam Study underwent a standardized examination, including perimetry. MAIN OUTCOME MEASURES: Intraocular pressure, vertical cup-disc ratio; and the presence of glaucoma, defined as a visual field defect with a cup-disc ratio of 0.7 or higher or asymmetry of 0.3 or higher between both eyes. RESULTS: The prevalence of glaucoma was 10.4% in siblings of patients, 1.1% in offspring of patients, 0.7% in siblings of controls, and 0% in offspring of controls. Life-time risk of elevated intraocular pressure in relatives of patients vs relatives of controls was 42.5% vs 6.7%, of enlarged cup-disc ratio was 62.2% vs 16.6%, and of glaucoma was 22.0% vs 2.3%, yielding a risk ratio for glaucoma of 9.2 (95% confidence interval = 1.2-73.9). The population-attributable risk of glaucoma was 16.4%. CONCLUSIONS: In a general population, relatives of patients with glaucoma have a strongly increased risk of glaucoma. Enlarged cup-disc ratio, not intraocular pressure, was the earliest and most prominent feature of familial aggregation. Further studies are needed to disentangle the genetic components of the increased familial risk.

Genetic risk of age-related maculopathy. Population-based familial aggregation study.

OBJECTIVE: To investigate to what extent age-related maculopathy (ARM) is genetically determined. DESIGN AND SETTING: Familial aggregation study based on probands derived from the population-based Rotterdam Study. PARTICIPANTS: First-degree relatives of 87 patients with late ARM, i.e., atrophic or neovascular macular degeneration, were compared with first-degree relatives of 135 control subjects without ARM. MAIN OUTCOME MEASURES: Presence and stage of ARM as diagnosed on fundus transparencies, odds ratio, lifetime risk, risk ratio, and population-attributable risk. RESULTS: Independent of other risk factors, the prevalence of early (odds ratio = 4.8, 95% confidence interval [CI] = 1.8-12.2) and late (odds ratio = 19.8, 95% CI = 3.1-126.0) ARM was significantly higher in relatives of patients with late ARM. The lifetime risk estimate of late ARM was 50% (95% CI = 26%-73%) for relatives of patients vs 12% (95% CI = 2%-16%) for relatives of controls (P < .001), yielding a risk ratio of 4.2 (95% CI = 2.6-6.8). Relatives of patients expressed the various features of ARM at a younger age. The population-attributable risk related to genetic factors was 23%. CONCLUSIONS: First-degree relatives of patients with late ARM developed ARM at an increased rate at a relatively young age. Our findings indicate that approximately one fourth of all late ARM is genetically determined and suggest that genetic susceptibility may play an important role in determining the onset of disease.

Age-specific prevalence and causes of blindness and visual impairment in an older population: the Rotterdam Study.

OBJECTIVE: To study the prevalence and causes of blindness and visual impairment in various age categories of a large population-based study. METHODS: For the study, 6775 subjects aged 55 years or older underwent an extensive ophthalmologic screening examination, including measurements of visual acuity and the visual field and fundus photography. The causes of blindness or visual impairment were determined using all screening information and medical records. RESULTS: The prevalence of blindness, according to World Health Organization criteria, ranged from 0.1% in subjects aged 55 to 64 years to 3.9% in subjects aged 85 years or older; the prevalence of visual impairment ranged from 0.1% to 11.8%. For persons younger than 75 years, myopic degeneration and optic neuropathy were the most important causes of impaired vision. For persons aged 75 years or older, age-related macular degeneration was the major cause of the increased prevalence of blindness, whereas age-related cataract predominantly caused the increased prevalence of visual impairment. CONCLUSIONS: The hierarchy of causes of blindness and visual impairment is highly determined by age. As yet, little can be done to reduce the exponential increase of blindness; however, adequate implementation of surgery to treat cataract could reduce visual impairment by one third. Underuse of ophthalmologic care is a prominent cause of the high frequency of untreated cataracts among the elderly.

Risk of acute angle-closure glaucoma after diagnostic mydriasis in nonselected subjects: the Rotterdam Study.

PURPOSE: To report the prevalence of narrow anterior chamber angles on slit-lamp examination and the incidence of acute angle-closure glaucoma (AACG) after diagnostic mydriasis in nonselected white subjects aged 55 years and over. METHODS: Of all subjects in the population-based Rotterdam Study (n = 7983), 6760 participated in the ophthalmologic examination and received both tropicamide 0.5% and phenylephrine 5% eye drops for diagnostic mydriasis. No exclusion criteria (e.g., level of intraocular pressure, presence of narrow anterior chamber angles, history of or treatment for glaucoma) were used. After the ophthalmologic examination, all participants received thymoxamine 0.5% drops in both eyes and were warned about the symptoms of AACG. RESULTS: The prevalence of narrow angles was 2.2% and was twice as high in women. In two subjects (0.03%), an attack of AACG developed in one eye after diagnostic mydriasis. After medical therapy, peripheral iridotomies were made with a Nd:YAG laser, and both eyes healed without loss of visual acuity or visual field. CONCLUSIONS: In nonselected white subjects of 55 years of age or older, the 2% prevalence of narrow anterior chamber angles is similar to that in a mixed black and white population in the United States. According to our protocol, 3 in 10,000 subjects are likely to develop AACG after diagnostic mydriasis followed by miotic drops.

Distribution of central corneal thickness and its association with intraocular pressure: The Rotterdam Study.

PURPOSE: To perform a cross-sectional study on the distribution of central corneal thickness and its association with intraocular pressure in an elderly population. METHODS: We measured central corneal thickness and intraocular pressure in 395 subjects (352 control subjects, 13 patients with ocular hypertension, and 30 patients with primary open-angle glaucoma) aged 55 years or more. RESULTS: Mean central corneal thickness in the 352 control subjects was 537.4 microm (95% confidence interval [CI], 533.8 to 540.9 microm; range, 427 to 620 microm), with a maximal difference between eyes of 42 microm. There were no differences between sexes and no significant association with age. Linear regression analysis showed an increase of 0.19 mm Hg in intraocular pressure with each 10-microm increase in central corneal thickness (95% CI, 0.09 to 0.28 mm Hg). This association was similar in both eyes and in both sexes. The 13 patients with ocular hypertension had corneas a mean of 16.0 microm thicker (95% CI, -2.6 to +34.6 microm) compared with control subjects (P = .093); the 30 patients with primary open-angle glaucoma had corneas a mean of 21.5 microm thinner (95% CI, 8.8 to 34.1 microm) compared with control subjects (P = .001). CONCLUSION: Mean central corneal thickness was similar to that found in clinical studies, was slightly higher in patients with ocular hypertension, and was significantly lower in patients with primary open-angle glaucoma. Intraocular pressure was positively related with central corneal thickness. Central corneal thickness may influence the division between normal and increased intraocular pressure at a simple cutoff point of 21 mm Hg.

The prevalence of primary open-angle glaucoma in a population-based study in The Netherlands. The Rotterdam Study.

PURPOSE: The objective of this study is to assess the prevalence of primary open-angle glaucoma (POAG) in a defined population in Rotterdam, The Netherlands. METHODS: The Rotterdam Study is a single-center prospective cohort study of a total population of more than 10,000 people, 55 years of age or older. For the current analysis, the first 3062 consecutive, unselected, noninstitutionalized participants were examined according to standard protocols, including perimetry. The diagnosis of POAG was based on the presence of a glaucomatous visual field defect combined with either a vertical cup: disc ratio of 0.5 or more or a cup:disc ratio asymmetry of 0.2 or more, or an intraocular pressure (IOP) more than 21 mmHg, with open and normal anterior chamber angles. RESULTS: The overall prevalence of POAG in the current study was 1.10% (95% confidence interval [CI]: 1.09, 1.11). Age-specific prevalence figures increased from 0.2% (95% CI: 0.16, 0.24) in the age group of 55 to 59 years to 3.3% (95% CI: 2.57, 4.04) in the age group of 85 to 89 years. Men had a more than three times higher risk of having POAG than women (odds ratio, 3.6). In 52.9% of the patients, POAG had not been diagnosed previously. Of these patients, 38.9% had IOPs of 21 mmHg or lower. In 8.8% of the eyes (2.9% of patients), visual acuity was 20/200 or less due to POAG. CONCLUSION: The overall prevalence of POAG in the current study was 1.1%. The prevalence of POAG was higher in men than in women. Of the untreated patients, 38.9% had IOPs of 21 mmHg or lower.