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M.C. Leske, S. Wu, B. Nemesure, L. Yang, A. Hennis, Barbados Eye Studies Group; 9-Year Incidence of Lens Opacities in the Barbados Eye Studies . Invest. Ophthalmol. Vis. Sci. 2003;44(13):4239.
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Purpose: To provide 9-year cumulative incidence and progression rates of age-related lens opacities in the predominantly black participants of the Barbados Incidence Study of Eye Diseases II (BISED II). Methods: BISED II was a population-based cohort study that re-examined surviving members of the Barbados Eye Study nine years after baseline (n=2793, 81% participation). Slit-lamp examination was based on the Lens Opacities Classification System II (LOCS II). Cumulative incidence was estimated with the product-limit approach and was defined as the development of any nuclear, cortical or posterior subcapsular (PSC) opacities (LOCS II scores≥ 2) among persons without that opacity type at baseline. Cumulative progression was determined by a 2-step increase in LOCS II scores among persons with pre-existing lens opacities. Results. The 9-year incidence of overall lens changes was nearly doubled in black vs. white participants (age-gender adjusted relative risk=1.8; 95% confidence interval: 1.2-2.8). In the black population, the incidence was 33.8% (31.7-35.8%) for any cortical, 42.0% (40.0-44.0%) for any nuclear, and 6.3% (5.4-7.2%) for any PSC opacities. Incidence increased with age for all three types and women had higher risk of cortical and nuclear opacities (P<0.05). Incidence was approximately 2 to 3 times higher with co-existing PSC opacities at baseline. In persons without opacities at baseline, the most frequent type to develop was cortical-only opacities (23.2%), followed by nuclear only (17.1%) and mixed opacities (15.3%). Progression rates were 22.5% for cortical, 17.8% for nuclear, and 25.8% for PSC opacities. Overall, the frequency of cataract surgery increased over time; it was highest among persons 80 years or older, increasing from 12.9% at baseline to 15.2% at 4-years and 21.8% at 9-years. Conclusions: This long-term follow-up of an African-origin population demonstrated a high incidence and progression of both cortical and nuclear opacities; the latter appeared to have a relatively higher increase than previously observed at the 4-year follow-up, particularly among older ages. Although cataract surgery was infrequent at baseline, the frequency increased during the 9 years thereafter, mostly among the very old. The natural history of lens opacities provided by the study highlights the magnitude and public health importance of cataract in black populations.
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