摘要:

Published in this second issue of Ophthalmic Epidemiology is a review article by Dr. David H. Sliney entitled‘Epidemiological studies of sunlight and cataract: the critical factor of ultraviolet exposure geometry'. Ultraviolet radiation as a risk factor for cataract development is a hot and hotly debated controversy with conflicting results presented in a number of superb research studies by experienced ophthalmic epidemiologists. This review article by Dr. Sliney offers some insight as to why the results of these epidemiologic studies are not uniformly consistent; he points out some of the pitfalls associated with instruments we use to measure ultraviolet radiation in population-based studies, and the importance of considering the circumstances under which ultraviolet exposure to the human eye is measured, whether it be by direct measurement of ultraviolet light impinging upon the eye, questionnaire of ultraviolet light exposure history, tables of resident area of sunlight or ultraviolet A, B, or C exposure or by other modalities of ultraviolet determinations. Using the information provided by Dr. Sliney in this review article may help future investigators improve the precision of instruments used in epidemiologic studies to quantify ultraviolet light impinging upon the human eye. Improvement of the precision of collected data can only reduce the variance of findings among studies on the association of ultraviolet radiation as a cause of age-related cataract. A similar issue is raised by Christen and associates in the article published in this same issue of Ophthalmic Epidemiology,‘Confirmation of self-reported cataract in the Physicians’Health Study', a well-conducted and well-respected study, that points out the need for independent confirmation of self-reported cataracts as recorded by questionnaire, to improve the accuracy of diagnosis of a disease whose risk factors are under investigation. A dictum taught me by my mentors at Johns Hopkins University, Drs. Philip Sartwell and George Comstock, that because of the imprecision and variance of epidemiologic measurement instruments, it takes many studies‘like swallows to make a spring’to confirm risk-factor relationships to a given disease. The often cited, numerous controversial studies on the association of cigarette smoking and lung cancer which were published long before it became clear that cigarette smoking was the major risk factor in that disease, emphasize the role of multiple studies in confirming an association between risk factor and disease, even when it is readily obvious in hind sight. I personally feel that review articles, published in ophthalmic journals, serve an essential function in the advancement of ophthalmic research. Periodic review articles on a particular ocular disease, by summarizing the known infomation about that particular disease up to that point in time, help current investigators plan future research based upon the balanced review of past knowledge. No current ophthalmic or epidemiologic journal is committed to consistently publishing those review articles necessary to provide a readily available repository of critical information, presented in a balanced perspective by experts in the field, for citation by researchers to further future research advances in particular fields of ophthalmic epidemiologic investigation.The stimulus for Dr. Sliney's article came from the recent World Health Organization Report of an Informal Consultation on‘The Effects of Solar UV Radiation on the Eye', convened by the WHO Prevention of Blindness Programme and the w HO Division of Environmental Health. This consultative study was stimulated in part by substantiated observations of ozone depletion at both polar regions of the earth and the logical question of what the potential effect of increased ultraviolet radiation on the eye in these areas may be, based upon the known ultraviolet exposure data currently available. Dr. Thylefors, Head of the WHO Prevention of Blindness Programme, has allowed Ophthalmic Epidemiology to publish portions of this consultative report in order to disseminate, to the general ophthalmic community, this‘state-of-the-art’information on the relationship of ultraviolet radiation and potential ocular damage. The article by Dr. Sliney, who contributed to the WHO report, is just the first of several review articles to be published on this subject by Ophthalmic Epidemiology; the putative relationship of ultraviolet exposure to cataract development has importent environmental, social, economic and health-related importance. Dr. Paul Dolin, a member of the w HO consultative team, has written an article, accepted in the next issue of Ophthalmic Epidemiology, which provides suggested epidemiologic studies that might help us in further investigation of the relationship of ultraviolet radiation and cataract development. Professor Gordon Johnson, also a contributor to the WHO consultation, has submitted a review paper on ultraviolet light exposure and its overall effect on the eye and adnexa, except for cataract and macular degeneration, which will be published in a future issue of Ophthalmic Epidemiolgy.One of the reasons I accepted the major undertaking necessary to bring‘Yet another Journal’into the field of ophthalmic information overload, comes from my exasperation from attending many meetings over my 25 years as an ophthalmic epidemiologist where I felt that important papers and posters were presented and I wished that I were able to review in detail the methodology, results and discussion of the research presented; papers that were stimulating, provocative, controversial, methodologic, with negative results, positive results, or otherwise, which I thought worthy of publication to advance the field of ophthalmic epidemiologic research. I have seen research on specific areas repeated by subsequent investigators because no such repository of knowledge, where past research, be it positive or negative, could be found, had been published. Most ophthalmic and epidemiologic journals cannot, with their wide obligations to broad areas of readership, publish all the‘nuts-and-bolts’articles essential to provide the repository of information necessary to ophthalmic epidemiologists. These are the articles that need to be published, review and original articles, that form the basic building blocks which current researchers in ophthalmic epidemiology can use as foundations for future investigations. Ophthalmic Epidemiology is committed to providing the repository of information upon which new ideas can evolve based upon the building blocks of the past. Part of this foundation is the depository provided by review articles, special topics, methodologic studies, and negative results which I will encourage, so that others in our footsteps do not repeat our repetitious failures and successes out of ignorance, but can use our past footsteps to lead the march to future advances in the conquest of world blindness.

ISSN:0928-6586    

DOI:10.3109/09286589409052362

出版商:Taylor&Francis    

年代:1994

数据来源: Taylor

摘要:

The knowledge of sunlight effects on the eyes and protective behaviors was assessed in the general community of Brisbane, Australia. Five hundred people were systematically sampled and surveyed via a telephone questionnaire. Of the participants, 279 (56%) were female and 258 (52%) were aged 40 years or less. Levels of knowledge were found to be lower in the older subjects, those with dark complexions and outdoor workers. Most were unaware of specific ultraviolet light related eye diseases such as cataract, pterygium and eye cancer. Three hundred and ninety (78%) wore sunglasses>10% of the time while outdoors during the day; the most common reasons for wearing included protection from glare in 254 (65%) and driving in 60 (15%). Ninety-six (19%) never wore sunglasses, the most common reasons being inconvenience in 16 (17%), thought unnecessary in 16 (17%) and uncomfortable in 13 (14%). Promotion of sun protection to prevent ultraviolet light related diseases should include information on the eye. This information is important for establishing preventative behaviors and the selection of optimal eye protective measures.

ISSN:0928-6586    

DOI:10.3109/09286589409052363

出版商:Taylor&Francis    

年代:1994

数据来源: Taylor

摘要:

Large-scale prospective studies of disease development often rely on self-reported data. To assess the accuracy of self-reports of cataract, we compared the self-reports with medical record data obtained from diagnosing ophthalmologists and optometrists for participants in the Physicians’Health Study, a randomized trial of aspirin and beta-carotene among 22,071 male U.S. physicians aged 40–84 years. A report of cataract, defined as a positive response to a question about whether cataract had ever been diagnosed in either eye and the date of diagnosis, was found to be a very good indicator of lens opacification but was not a good indicator of an incident, age-related opacity that reduced visual acuity. These results indicate that in large prospective studies of clinically significant cataract, where examination of all study participants is not feasible and self-reported data are used, additional documentation to supplement the self-reports should be obtained and strict diagnostic criteria applied to minimize the likely effects of misclassification.

ISSN:0928-6586    

DOI:10.3109/09286589409052364

出版商:Taylor&Francis    

年代:1994

数据来源: Taylor

摘要:

A case-control study was conducted to evaluate risk factors for cortical, nuclear, posterior subcapsular and mixed cataract. The 385 cases and 215 controls (age range 40–75 yrs) included in the study underwent a complete ophthalmological examination and laboratory blood tests, and were interviewed about behavioral variables, environmental exposure and their medical history. Lens opacity was classified using the‘Lens Opacity Classification System 11’(locs 11). On multivariate analysis, the risk factors for cortical cataract were the presence of diabetes for more than five years (or = 3.7) and increased serum K+ and Na+ levels. A history of surgery under general anesthesia and the use of sedative drugs were associated with reduced risk (or = 0.4). Posterior subcapsular cataract was associated with the use of steroids (or = 18.2) and diabetes (or = 8.1), and nuclear cataract with calcitonin (or = 5.7) and milk intake (or = 0.25). Mixed cataract was associated with a history of surgery under general anesthesia (or = 0.5). Some of these results are consistent with the findings of similar studies performed in different geographical areas, others are not. The results suggest a possible role of electrolyte imbalance in the development of senile cataract.

ISSN:0928-6586    

DOI:10.3109/09286589409052365

出版商:Taylor&Francis    

年代:1994

数据来源: Taylor

摘要:

Despite the large body of laboratory evidence that ultraviolet radiation (uvr) is cataractogenic, epidemiological studies of the relationship between age-related cataract and chronic uvr exposure have provided apparently conflicting results. An explanation for these conflicting results could be related to errors in dosimetry. Failure to account for the biophysical, physiological and behavioral factors, as well as ground reflectance, which determine the level of uvr exposure of the lens can lead to completely wrong assignments of lifetime exposure. It is argued that by overlooking these factors, past epidemiological studies of uvr and cataract could readily be expected to produce conflicting results.

ISSN:0928-6586    

DOI:10.3109/09286589409052366

出版商:Taylor&Francis    

年代:1994

数据来源: Taylor