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A. G. Tan, P. Mitchell, E. Rochtchina, R. G. Cumming, J. J. Wang, Blue Mountains Eye Study; Discrete Cortical Opacities/Retrodots and Vacuoles, and the Long-Term Incidence of Age-Related Cataract. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2874. doi: https://doi.org/.
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To investigate the prevalence of discrete cortical opacities (retrodots) and vacuoles, and their association with the long-term incidence of age-related cataract.
The Blue Mountains Eye Study examined 3654 participants aged 49+ years at baseline (1992-94); 2335 persons (75.1% of survivors) and 1952 persons (75.6% of survivors) were re-examined after 5 and 10 years, respectively. At each visit, participants had lens photos taken to grade signs of cataract, using the Wisconsin Cataract Grading System. Seen in retroillumination photos, retrodots appear as bifringent, amorphous globular opacities with a high refractive index, while vacuoles are fluid-filled spherical cystoid spaces with a low refractive index. Nuclear cataract was defined as nuclear opacity >std photo #3, cortical cataract as opacity ≥5% of total lens area, and any posterior subcapsular (PSC) cataract as present. Eye-specific data were analysed adjusting for age, gender, smoking, hypertension, diabetes, education and use of inhaled steroids.
At baseline, retrodots were found in 142 persons (4%) or 178 eyes (3%) while vacuoles were found in 1333 persons (40%) or 1734 eyes (25%). There was a significant age-related trend for increasing prevalence of retrodots and vacuoles (P for trend, both <0.0001). Participants with retrodots had significantly lower visual acuity than those without, before adjustment for age and gender (mean letters read correctly, 46.3 vs 52.2, P=0.003) but not after adjustment (mean letters read correctly, 51.7 vs 52.1, P=0.64). Participants with vacuoles had significantly lower visual acuity than those without, even after adjusting for age and gender (mean letters read correctly, 50.6 vs 52.2, P=0.004). Retrodots at baseline were associated with a 2-fold greater risk of cataract surgery (adjusted odds ratio, OR, 2.26, 95% confidence interval, CI, 1.45-3.51). The presence of 3+ vacuoles at baseline was associated with a 3-fold higher risk of PSC cataract (OR 3.47, 95% CI 2.06-5.84) and nearly 2-fold higher risk of cataract surgery (OR 1.84, 95% CI 1.25-2.71). Retrodots or vacuoles were not associated with incident nuclear or cortical cataract.
Vacuoles predicted a 3-fold long-term risk of PSC cataract, and both retrodots and vacuoles predicted an overall 2-fold higher risk of subsequent cataract surgery in this older population.
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