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Five-year refractive changes in an older population: the Blue Mountains Eye Study.
Ophthalmology. 2003 Jul; 110(7):1364-70.O

Abstract

PURPOSE

To examine 5-year changes in refractive error and astigmatism in an older population.

DESIGN

Population-based cohort study.

PARTICIPANTS

The Blue Mountains Eye Study examined 3654 residents aged 49 years or older from 1992 to 1994. After excluding 543 persons who died since baseline, 2335 (75.1%) attended 5-year examinations from 1997 to 1999.

METHODS

Both examinations included a detailed eye assessment, with subjective refraction performed according to a modified Early Treatment of Diabetic Retinopathy Study protocol.

MAIN OUTCOME MEASURES

Spherical equivalent (sum of sphere + cylinder) was used as the measure of refractive error. Only phakic eyes with best-corrected visual acuity >20/40 were included (n = 3701).

RESULTS

Similar changes in refractive error were observed for the two eyes. Symmetric changes were found in 72% of participants when the difference between eyes was within 0.5 diopters (D) and in 91% when the difference was within 1.0 D. The 5-year change in spherical power was in a hyperopic direction for younger age groups and in a myopic direction for older subjects, P < 0.0001. The gender-adjusted mean change in refractive error in right eyes of persons aged 49 to 54, 55 to 64, 65 to 74, and 75 years or older at baseline was +0.41 D, +0.30 D, +0.05 D, and -0.22D, respectively. Refractive change was strongly related to baseline nuclear cataract severity; grades 4 to 5 were associated with a myopic shift (-0.33 D, P < 0.0001). Education level and age of onset of myopia, but not gender or diabetes, also predicted refractive change. The mean age-adjusted change in refraction was +0.14 D for hyperopic eyes, +0.32 D for emmetropic eyes, and +0.15 D for myopic eyes. The mean change in cylinder power over the 5-year period was small, irrespective of baseline refraction. The axis of astigmatism remained stable in most cases (64%), whereas 12% changed to "against the rule" and 11% to "with the rule."

CONCLUSIONS

This report has documented refractive error changes in an older population and confirmed reported trends of a hyperopic shift before age 65 years and a myopic shift thereafter associated with the development of nuclear cataract.

Authors+Show Affiliations

Guzowski M
Department of Ophthalmology, University of Sydney Centre for Vision Research, Westmead Hospital, Hawkesbury Road, Westmead NSW 2145, Sydney, Australia.
Wang JJ
No affiliation info available
Rochtchina E
No affiliation info available
Rose KA
No affiliation info available
Mitchell P
No affiliation info available

MeSH

Age DistributionAgedAged, 80 and overAstigmatismCataractCohort StudiesFemaleHumansHyperopiaMaleMiddle AgedMyopiaNew South WalesSex DistributionTime FactorsVision Tests

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12867393

Citation

Guzowski, Magdalena, et al. "Five-year Refractive Changes in an Older Population: the Blue Mountains Eye Study." Ophthalmology, vol. 110, no. 7, 2003, pp. 1364-70.
Guzowski M, Wang JJ, Rochtchina E, et al. Five-year refractive changes in an older population: the Blue Mountains Eye Study. Ophthalmology. 2003;110(7):1364-70.
Guzowski, M., Wang, J. J., Rochtchina, E., Rose, K. A., & Mitchell, P. (2003). Five-year refractive changes in an older population: the Blue Mountains Eye Study. Ophthalmology, 110(7), 1364-70.
Guzowski M, et al. Five-year Refractive Changes in an Older Population: the Blue Mountains Eye Study. Ophthalmology. 2003;110(7):1364-70. PubMed PMID: 12867393.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Five-year refractive changes in an older population: the Blue Mountains Eye Study. AU - Guzowski,Magdalena, AU - Wang,Jie Jin, AU - Rochtchina,Elena, AU - Rose,Kathryn A, AU - Mitchell,Paul, PY - 2003/7/18/pubmed PY - 2003/7/29/medline PY - 2003/7/18/entrez SP - 1364 EP - 70 JF - Ophthalmology JO - Ophthalmology VL - 110 IS - 7 N2 - PURPOSE: To examine 5-year changes in refractive error and astigmatism in an older population. DESIGN: Population-based cohort study. PARTICIPANTS: The Blue Mountains Eye Study examined 3654 residents aged 49 years or older from 1992 to 1994. After excluding 543 persons who died since baseline, 2335 (75.1%) attended 5-year examinations from 1997 to 1999. METHODS: Both examinations included a detailed eye assessment, with subjective refraction performed according to a modified Early Treatment of Diabetic Retinopathy Study protocol. MAIN OUTCOME MEASURES: Spherical equivalent (sum of sphere + cylinder) was used as the measure of refractive error. Only phakic eyes with best-corrected visual acuity >20/40 were included (n = 3701). RESULTS: Similar changes in refractive error were observed for the two eyes. Symmetric changes were found in 72% of participants when the difference between eyes was within 0.5 diopters (D) and in 91% when the difference was within 1.0 D. The 5-year change in spherical power was in a hyperopic direction for younger age groups and in a myopic direction for older subjects, P < 0.0001. The gender-adjusted mean change in refractive error in right eyes of persons aged 49 to 54, 55 to 64, 65 to 74, and 75 years or older at baseline was +0.41 D, +0.30 D, +0.05 D, and -0.22D, respectively. Refractive change was strongly related to baseline nuclear cataract severity; grades 4 to 5 were associated with a myopic shift (-0.33 D, P < 0.0001). Education level and age of onset of myopia, but not gender or diabetes, also predicted refractive change. The mean age-adjusted change in refraction was +0.14 D for hyperopic eyes, +0.32 D for emmetropic eyes, and +0.15 D for myopic eyes. The mean change in cylinder power over the 5-year period was small, irrespective of baseline refraction. The axis of astigmatism remained stable in most cases (64%), whereas 12% changed to "against the rule" and 11% to "with the rule." CONCLUSIONS: This report has documented refractive error changes in an older population and confirmed reported trends of a hyperopic shift before age 65 years and a myopic shift thereafter associated with the development of nuclear cataract. SN - 0161-6420 UR - https://www.unboundmedicine.com/medline/citation/12867393/Five_year_refractive_changes_in_an_older_population:_the_Blue_Mountains_Eye_Study_ DB - PRIME DP - Unbound Medicine ER -