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T.E. Clemons, T.R. Friberg, N. Kurinij, R.D. Sperduto, AREDS Research Group; Mortality in the Age-Related Eye Disease Study: Associations With Lens Opacity and Cataract Surgery . Invest. Ophthalmol. Vis. Sci. 2003;44(13):4242.
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Purpose: To assess retrospectively the association of lens opacities or cataract surgery with mortality among participants in the Age-Related Eye Disease Study (AREDS), a randomized clinical trial of AMD and lens opacity. Methods: Slit-lamp and retroillumination lens photographs were taken at baseline and graded by a reading center to diagnose nuclear, cortical and posterior subcapsular (PSC) opacities using the AREDS System for Classifying Cataracts. Median followup was 6.5 years. The primary outcome for this report was all cause mortality. Analyses of cause-specific mortality, based on ICD-9 codes, were also performed. Covariate-adjusted (i.e., age, gender, race, education, smoking, BMI, diabetes, angina, cancer and hypertension) Cox proportional hazards models were created using the various opacity types and history of cataract surgery at baseline as independent variables. Results: Between 1993 and 2001, 507 (11%) of the 4,753 participants (age 55 to 81 years [mean 69 years]) with follow-up data died. Nuclear opacity (RR 1.43, 95% CI: 1.14-1.79) and cataract surgery (RR 1.51, 95% CI: 1.13 - 2.01) were associated with a statistically significant increased risk in all-cause mortality. They remained significant predictors of mortality in models accounting for advanced AMD status. All-cause mortality was higher, but not significantly so, in persons with cortical (RR 1.18) and PSC (RR 1.43) opacities. Nuclear opacity (RR 1.54) and cataract surgery (RR 2.43) were significantly associated with cancer deaths. Nuclear opacity (RR 1.58) was also significantly associated with deaths from causes other than cardiovascular or cancer. Results from analyses considering potential AREDS treatment effect remain consistent. Conclusion: All-cause mortality was increased among AREDS participants who had nuclear lens opacities or a history of cataract surgery. In cause-specific analyses, persons with nuclear opacities or a history of cataract surgery had an apparent increased mortality from neoplasms. The relation of these statistical associations to cause and effect is unknown.
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