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Karen J Cruickshanks

Publications and source records attributed to Karen J Cruickshanks.

At least 19 recordsLinked to original sources
PubMed2006

Changes in visual acuity in a population over a 15-year period: the Beaver Dam Eye Study.

PURPOSE: To describe the change in visual acuity in a 15-year period. DESIGN: Population-based study. METHODS: setting: Beaver Dam, Wisconsin. participants: 4068 persons 43 to 86 years of age at the time of a baseline examination in 1988 to 1990, and with follow-up examinations every five years thereafter. observation procedures: Best-corrected visual acuity after refraction, assessed by a modification of the ETDRS protocol. main outcome measure: Doubling of the visual angle; incidence of visual impairment. RESULTS: Eight percent of the population developed impaired vision (20/40 or worse), 0.8% developed severe visual impairment (20/200 or worse), 7% had doubling of the visual angle, and 2% had improved vision. People 75 years of age or older at baseline were more likely to develop impaired vision (odds ratio [OR] 12.8, 95% confidence interval [CI] 9.6 to 17.1, P < .001), doubling of the visual angle (OR 7.8, 95% CI 5.6 to 10.7, P < .001), and severe visual impairment (OR 20.6, 95% CI 9.5 to 44.8, P<0.001) compared with people younger than 75 years of age. CONCLUSIONS: These data provide population-based estimates of the cumulative 15-year incidence of loss of vision over a wide spectrum of ages. In people 75 years of age or older the cumulative incidence of visual impairment accounting for the competing risk of death is 25%, of which 4% is severe, indicating a public health problem of considerable proportions as the US population in this age is expected to increase by 55% from 18 million in the year 2005 to 28 million by the year 2025.

Adult↗
PubMed2005

Age-related eye disease, quality of life, and functional activity.

OBJECTIVE: To examine the associations of measures of quality of life (Medical Outcomes Study Short Form Health Survey) and functional activities (activities of daily living, instrumental activities of daily living, and visual function) in persons with and without age-related eye diseases. METHODS: Two thousand, six hundred seventy persons participated in the 1998 through 2000 examinations of both the Beaver Dam Eye Study and the Epidemiology of Hearing Loss Study. Age-related eye disease (age-related maculopathy, cataract, diabetic retinopathy, glaucoma, macula edema, occlusions, amblyopia, and macular holes) were assessed by fundus, slitlamp, and retroilluminated photographs and self-reported ocular history. Also administered was a standard interview that included the Medical Outcomes Study Short Form Health Survey, activities of daily living, instrumental activities of daily living, and visual function questionnaires and information on other medical conditions. RESULTS: After controlling for age and sex, we found that persons with an age-related eye disease had decreased scores in almost all the domains of the Medical Outcomes Study Short Form Health Survey, and persons with eye disease in both eyes had poorer scores than persons with eye disease in only 1 eye. Stratifying by age-related maculopathy and central cataract yielded similar results. Further adjustment for current visual acuity and the number of comorbid conditions explained most associations. Several of the mental scales were still marginally significantly lower (P<.10) in persons with age-related maculopathy after adjustment. Persons with an age-related eye disease were not more likely to have impaired activities of daily living or instrumental activities of daily living. After adjustment for current visual acuity and number of comorbidities, persons who had trouble reading small print or recognizing people across the street were more likely to have an age-related eye disease. Otherwise, there were no significant associations with the visual function questions and any of the specific ocular conditions. CONCLUSIONS: Many measures of general quality of life and functional activities were related to age-related eye diseases, but few associations remained significant after adjustments for vision and other comorbidities. Our data are compatible with the notion that decreased visual function, irrespective of the pathologic reason for the decrease, is associated with diminished quality of life and functional activities of living.

Activities of Daily Living↗
PubMed2005

A questionnaire for assessing environmental tobacco smoke exposure.

Exposure to environmental tobacco smoke (ETS) has been associated with adverse health consequences. In this study, the association between self-reported ETS exposure and serum cotinine levels was examined. As part of the population-based Epidemiology of Hearing Loss Study in Beaver Dam, WI, self-reported data on ETS were obtained at the 5-year follow-up examination (1998-2000; n = 2800). Serum cotinine levels were obtained on 643 of these participants (53-75 years old). Serum cotinine levels increased with reported number of hours of recent ETS exposure. Most (95.3%) participants who reported being smokers had serum cotinine levels >15 ng/mL, compared with only 2.7% of nonsmokers. Usual ETS exposure among nonsmokers was assessed with a brief questionnaire quantifying exposure at work, at home, and in social settings, and then classified into three levels of exposure. Those reporting little or no exposure had a geometric mean cotinine level of 0.06 ng/mL (95% confidence interval (CI): 0.05, 0.07), compared with 0.14 (95% CI: 0.09, 0.22) and 0.63 (95% CI: 0.36, 1.10) for those reporting moderate and high ETS exposure, respectively (F-test for trend: P < 0.001). These results suggest that the questionnaire can be used to distinguish relative levels of exposure to ETS.

Adult↗
PubMed2005

The association between cardiovascular disease and cochlear function in older adults.

The purpose of this research was to evaluate the relation between self-reported cardiovascular disease (CVD) and cochlear function in older adults. The Epidemiology of Hearing Loss Study (EHLS) is an ongoing population-based study of hearing loss and its risk factors in Beaver Dam, Wisconsin. As part of the EHLS questionnaire, participants were asked about their cardiovascular medical history. CVD history was determined from questions regarding history of angina, myocardial infarction (MI), and stroke. Questions about the use of antihypertensive medication and blood pressure measurements determined the presence or absence of hypertension. Among the audiologic measures completed were distortion product otoacoustic emissions (DPOAEs). Cochlear function was measured using DPOAEs and participants were categorized as having (a) cochlear impairment, (b) possible cochlear impairment, or (c) no cochlear impairment. There were 1,501 participants with complete CVD and DPOAE data from the 1998-2000 examination phase. Women with a self-reported history of MI were twice as likely (age-adjusted odds ratio [OR] = 2.00, 95% confidence interval [CI] = 1.15-3.46) to have cochlear impairment than women without a history of MI. This association was not significant in men (age-adjusted OR = 0.98, 95% CI = 0.61-1.58). Additionally, no other CVD variables were associated with cochlear impairment. This study provides data on a possible sex-specific association between CVD and DPOAEs in older adults.

Adult↗
PubMed2005

Factors related to vision care in an older adult cohort.

PURPOSE: This study provides cross-sectional data on eye care utilization in a community-based adult population. METHODS: Data are from a questionnaire administered during the 7-year follow-up of the Epidemiology of Hearing Loss Study in 2000 to 2002. Participants in the population-based Beaver Dam Eye Study were eligible for the Epidemiology of Hearing Loss Study, which began in 1997. The primary outcome was self-reported vision testing within the past year. RESULTS: Subject ages ranged from 55 to 99 years (n = 2433), and 60.4% were female. Fifty-three percent of subjects reported they had their vision tested in the past year. Diabetes was self-reported by 11.5% of subjects, and 70.9% of diabetic participants had their vision tested in the past year. A current hospitalization or health insurance plan was reported by 98.6% of subjects. In multivariate analyses, self-reported factors significantly associated with having a vision test in the past year were female gender (odds ratio [OR] = 1.27; 95% confidence interval [CI] 1.06-1.52), current use of refractive correction for distance (OR = 1.98; 95% CI 1.56-2.52), glaucoma (OR = 3.52; 95% CI 2.37-5.24), cataract surgery (OR = 1.57; 95% CI 1.21-2.03), age-related macular degeneration (ARMD) (OR = 1.74; 95% CI 1.22-2.47), diabetes (OR = 2.46; 95% CI 1.83-3.31), visiting a primary care practitioner for any reason in the past year (OR = 1.72; 95% CI 1.32-2.25), having a hearing test in the past year (OR = 1.79; 95% CI 1.40-2.28), and the cessation of driving because of poor vision (OR = 1.64; 95% CI 1.16-2.52). In participants 65 years of age or older, having private insurance was associated with increased odds (OR = 3.39, 95% CI 1.82-6.31) of vision testing in the past year. CONCLUSION: This study suggests that chronic ocular conditions, diabetes, health insurance beyond government entitlements, and the use of other healthcare services are associated with increased eye care utilization.

Aged↗
PubMed2005

Five-year changes in middle ear function for older adults.

Longitudinal changes in tympanometric measures of middle ear function over five years were reported for a large population of older adults. Findings were similar for men and women, for right and left ears, and across age groups from 48 to 92 years. Although some of the mean changes reached statistical significance, the vast majority of observed changes were small in magnitude relative to the observed variability and the tolerances of the measuring instrument. Observed mean changes in Peak Ytm for older adults were quite small and were in the positive direction. This is counter to changes that would be predicted on the basis of increases in the stiffness of the middle ear transmission system with advancing age suggested in earlier reports. Overall, the findings suggest little in the way of functional change in middle ear mechanics over a span of five years in older adults.

Acoustic Impedance Tests↗
PubMed2004

Cardiovascular disease, mortality, and retinal microvascular characteristics in type 1 diabetes: Wisconsin epidemiologic study of diabetic retinopathy.

BACKGROUND: Diabetic retinopathy and proteinuria, manifestations of microvascular abnormalities, occur early in the course of diabetes mellitus; in contrast, macrovascular cardiovascular complications usually occur later. Retinal vessel characteristics may be informative about risk of cardiovascular disease in persons with diabetes. We evaluated this in a longitudinal cohort study of persons with type 1 diabetes. METHODS: The population consisted of persons with type 1 diabetes who were receiving care in 11 counties in Wisconsin. Subjects (n = 996) were examined at baseline (1980-1982), and 4, 10, 14, and 20 years later. Evaluations included medical history and measurements of height, weight, blood pressure, and glycosylated hemoglobin. Fundus photographs were graded for diabetic retinopathy at baseline, and the same photographs were graded later for the diameters of retinal blood vessels. At each examination, a history of cardiovascular disease events since the last examination (and prior to baseline) was obtained. Mortality was monitored yearly. RESULTS: The 20-year age-adjusted cumulative incidences were 18.1% for angina, 14.8% for myocardial infarction, and 5.9% for stroke. Severity of diabetic retinopathy was associated with angina and stroke. Arteriovenous ratio was associated with myocardial infarction. Of 273 deaths, 176 involved heart disease. The severity of retinopathy and arteriovenous ratio was associated with heart disease mortality. Nephropathy was more informative about the cardiovascular end points than were the blood vessel characteristics. CONCLUSIONS: Incidences of cardiovascular disease, including mortality, were common in people with type 1 diabetes during a 20-year interval. Retinal vascular characteristics were associated with these end points, but this association was confounded by nephropathy.

Adolescent↗
PubMed2004

The relation of retinal vessel caliber to the incidence and progression of diabetic retinopathy: XIX: the Wisconsin Epidemiologic Study of Diabetic Retinopathy.

OBJECTIVE: To describe the relation of retinal arteriolar and venular caliber to the incidence and progression of diabetic retinopathy in people with type 1 diabetes mellitus. DESIGN: Incidence findings in a population-based study of diabetic retinopathy in Wisconsin. Participants included 996 persons diagnosed as having diabetes mellitus before 30 years of age who took insulin and underwent the baseline examination, 891 in the 4-year follow-up, 765 in the 10-year follow-up, and 634 in the 14-year follow-up. Retinal photographs of 7 standard fields were taken at all examinations. Computer-assisted grading was performed from a digitized image of field 1 to determine the average diameter of retinal arterioles and venules and their ratio. Main outcome measures included incidence and progression of retinopathy, incidence of proliferative retinopathy, and macular edema. RESULTS: While adjusting for other factors, larger arteriolar (relative risk [RR] for the fourth vs first quartile range, 2.04; 95% confidence interval [CI], 1.20-3.47; test of trend, P =.008) and venular diameters (RR, 2.33; 95% CI, 1.37-3.95; test of trend, P =.005) were associated with greater 4-year progression of retinopathy. Larger venular diameters (RR, 4.28; 95% CI, 1.50-12.19; test of trend, P =.006) but not arteriolar diameters were associated with greater 4-year incidence of proliferative retinopathy. In multivariable analyses, arteriolar and venular calibers were not associated with the 4-year incidence of retinopathy. While adjusting for other factors, arteriolar and venular calibers were not associated with incidence of macular edema at 4 years. There were few associations of arteriolar or venular caliber with the 10- or 14-year incidence or the progression of retinopathy. CONCLUSIONS: Larger arteriolar and venular caliber, independent of retinopathy severity level, is related to the progression of retinopathy, and larger venular caliber is associated with the 4-year incidence of proliferative retinopathy. Caliber of retinal vessels is not associated with incident retinopathy. These data suggest a quantitative measure of retinal vascular caliber provides additional information regarding risk for progression of retinopathy.

Adult↗
PubMed2004

Sunlight and the 10-year incidence of age-related maculopathy: the Beaver Dam Eye Study.

OBJECTIVE: To examine the association of sunlight exposure and indicators of sun sensitivity with the 10-year incidence of age-related maculopathy (ARM). DESIGN: Population-based cohort study. PARTICIPANTS: We included persons aged 43 to 86 years at the baseline examination from 1988 to 1990, living in Beaver Dam, Wis, of whom 3684 persons underwent 5-year follow-up and 2764 underwent 10-year follow-up. METHODS: Data on sun exposure and indicators of sun sensitivity were obtained from a standardized questionnaire administered at baseline and/or follow-up. We determined ARM status by grading stereoscopic color fundus photographs using the Wisconsin Age-Related Maculopathy Grading System. MAIN OUTCOME MEASURES: Incidence and progression of ARM. RESULTS: While controlling for age and sex, we found that participants exposed to the summer sun for more than 5 hours a day during their teens, in their 30s, and at the baseline examination were at a higher risk of developing increased retinal pigment (risk ratio [RR], 2.99; 95% confidence interval [CI], 1.18-7.60; P =.02) and early ARM (RR, 2.20; 95% CI, 1.02-4.73; P =.04) [corrected] by 10 years than those exposed less than 2 hours per day during the same periods. In participants reporting the highest summer sun exposure levels in their teens and 30s, the use of hats and sunglasses at least half the time during the same periods was associated with a decreased risk of developing soft indistinct drusen (RR, 0.55; 95% CI, 0.33-0.90; P =.02) and retinal pigment epithelial depigmentation (RR, 0.51; 95% CI, 0.29-0.91; P =.02). Participants who experienced more than 10 severe sunburns during their youth were more likely than those who experienced 1 or no burn to develop drusen with a 250-microm diameter or larger (RR, 2.52; 95% CI, 1.29-4.94 [corrected] P =.01) by the 10-year examination. No relationships were found between UV-B exposure, winter leisure time spent outdoors, skin sun sensitivity, or number of bad sunburns experienced by the time of the baseline examination and the 10-year incidence and progression of ARM or its associated lesions. CONCLUSIONS: Few significant relationships between environmental exposure to light and the 10-year incidence and progression of ARM were found in the Beaver Dam Eye Study. Consistent with results from the baseline and 5-year follow-up examinations, significant associations were found between extended exposure to the summer sun and the 10-year incidence of early ARM and increased retinal pigment. A protective effect of hat and sunglasses use by participants while in their teens and 30s against the 10-year incidence of soft indistinct drusen and retinal pigment epithelial depigmentation was also found, but only in those who reported the highest amount of sun exposure during the same periods.

Adult↗
PubMed2004

Serum cotinine level and incident hearing loss: a case-control study.

BACKGROUND: A growing body of literature suggests an association between cigarette smoking and hearing loss. OBJECTIVE: To assess the relation between levels of serum cotinine, a biomarker of exposure to tobacco smoke, and incident hearing loss. DESIGN: A cross-sectional, incident, case-control study of participants selected from a population-based cohort. SETTING: Testing was conducted at the Beaver Dam Community Hospital, Beaver Dam, Wis. PARTICIPANTS: A total of 197 participants with incident hearing loss and 394 control participants, aged 53 to 75 years, selected from the 2800 participants of the 5-year follow-up examination of the population-based Epidemiology of Hearing Loss Study, 1998-2000. MAIN OUTCOME MEASURE: Incident hearing loss. The incidence of hearing loss was defined as a pure-tone average of thresholds at 500, 1000, 2000, and 4000 Hz greater than 25-dB hearing level in either ear at follow-up among those without hearing loss at baseline. RESULTS: No significant associations were found between serum cotinine levels and incident hearing loss. CONCLUSIONS: These results were not consistent with a previous report, which found cross-sectional associations between prevalent hearing loss and current smoking and environmental tobacco smoke exposure in the home. Longer-term longitudinal studies of smoking and/or serum cotinine levels and the subsequent development of hearing loss may help clarify these associations.

Aged↗
PubMed2004

Characteristics of corneal ectasia after LASIK for myopia.

PURPOSE: There are numerous reports of corneal ectasia after laser in situ keratomileusis (LASIK) for myopia without a consistent definition of this condition or a definitive etiology. We conducted a retrospective analysis of published case reports to describe common characteristics of this postoperative event and compared them with findings from a group of successful LASIK patients. METHODS: A MEDLINE search for "LASIK" and "ectasia" yielded 21 relevant articles published before May 2003 (n = 86 eyes, 59 patients). A comparison group (n = 103 eyes, 63 patients) was selected from a clinic-based sample of successful LASIK patients with 12 months of follow-up after treatment. Descriptive statistics are reported as median and interquartile range. Comparisons were performed using the Wilcoxon rank sum, Wilcoxon signed rank, and chi-square tests. RESULTS: Time to diagnosis of ectasia after LASIK was 13 months (6 to 20 months). Residual myopia in the ectasia group was -3.69 D (-6.00 to -2.13 D) and was significantly greater than the comparison group, -0.38 D (-0.75 to 0.00 D), P < 0.001. After surgery, eyes with ectasia had increased corneal toricity 2.87 D (2.00 to 4.9 D) with increased oblique astigmatism 1.3 D (0.23 to 2.89 D) relative to eyes in the comparison group 0.00 D (0.00 to 0.08 D), and a loss of 2 lines (-0.5 to -6 lines) of best spectacle-corrected visual acuity (all P < 0.001). Thirty-five percent of reported cases resulted in subsequent corneal transplantation. CONCLUSIONS: Preoperative characteristics of corneal ectasia include worse visual acuity, less corneal thickness, greater residual myopia, and greater corneal toricity than nonectatic eyes. Treatment factors associated with corneal ectasia after LASIK are greater stromal ablation and less residual stromal bed thickness. Postoperative characteristics of corneal ectasia are myopic refractive error with increased astigmatism, worse spectacle-corrected visual acuity, increased corneal toricity with topographic abnormality, and progressive corneal thinning.

Adult↗
PubMed2003

Postmenopausal hormone therapy and its association with cognitive impairment.

BACKGROUND: Cognitive impairment is a common and potentially debilitating medical problem in older women. Postmenopausal hormone therapy (HT) has been associated with better cognitive function, but the literature is conflicting. Results of recent trials suggest that HT is inappropriate for prevention of heart disease, and we sought to determine the role of HT in the risk of cognitive impairment. METHODS: We measured HT use and cognitive function in a population-based cohort of 1462 postmenopausal women participating in the 5-year follow-up examination for the Epidemiology of Hearing Loss Study in 1998-2000. The cohort was defined in 1987-1988 by residency in Beaver Dam, Wis, and an age of 43 to 84 years. Women had also participated in the Beaver Dam Eye Study baseline examination in 1988-1990. Use of HT was assessed at the Beaver Dam Eye Study baseline (1988-1990), 5-year follow-up (1993-1995), and 10-year follow-up (1998-2000) visits. Cognitive impairment was defined as a low Mini-Mental State Examination score or a reported diagnosis of Alzheimer disease. RESULTS: Six percent of participants (n = 94) were impaired; these women were significantly older and less educated than those who were unimpaired. In age- and education-adjusted analysis, current HT use was not significantly associated with cognitive impairment (odds ratio, 0.6; 95% confidence interval, 0.2-1.3). Similarly, cognitive impairment was not associated with past HT use or duration of HT use. CONCLUSION: In this large population-based study, postmenopausal hormone therapy was not significantly associated with better cognitive function.

Adult↗
PubMed2003

Association of emphysema, gout, and inflammatory markers with long-term incidence of age-related maculopathy.

OBJECTIVE: To examine the relationship of 2 diseases associated with systemic inflammatory response, emphysema and gout, and selected markers of systemic inflammation with the 10-year incidence of age-related maculopathy. DESIGN: Population-based cohort study. PARTICIPANTS: We included persons aged 43 to 86 years at baseline examination from 1988 to 1990 living in Beaver Dam, Wis, of whom 3684 subjects participated in a 5-year follow-up examination and 2764 participated in a 10-year follow-up. METHODS: Standardized protocols for physical examination, blood collection, administration of a questionnaire, and stereoscopic color fundus photography to determine the presence of age-related maculopathy. Standard univariate and multivariate analyses were performed. MAIN OUTCOME MEASURES: Incidence and progression of age-related maculopathy. RESULTS: While controlling for age, sex, and other factors (history of heavy drinking or smoking, systolic blood pressure, and vitamin use), a higher white blood cell count at baseline was associated with the 10-year incidence of drusen 125 microm or greater in diameter (risk ratio [RR] per 10(6)/ microL = 1.10; 95% confidence interval [CI], 1.03-1.17), retinal pigment epithelial depigmentation (RR = 2.08; 95% CI, 1.01-1.16), and progression of age-related maculopathy (RR = 1.09; 95% CI, 1.03-1.15). A lower serum albumin level was associated with the incidence of exudative macular degeneration (RR per grams per deciliter = 0.31; 95% CI, 0.13-0.76). A history of emphysema at baseline was associated with the incidence of retinal pigment epithelial depigmentation (RR = 2.84; 95% CI, 1.40-5.78), increased retinal pigment (RR = 2.20; 95% CI, 1.11-4.35), and exudative macular degeneration (RR = 5.12; 95% CI, 1.63-16.06); a history of gout was associated with the incidence of pure geographic atrophy (RR = 3.48; 95% CI, 1.27-9.53). CONCLUSIONS: These findings indicate modest relationships between both increased white blood cell count and emphysema and the increased 10-year incidence of lesions defining early and late age-related maculopathy. Further investigation of these relationships in other studies is needed.

Adult↗
PubMed2003

Relation of statin use to the 5-year incidence and progression of age-related maculopathy.

OBJECTIVE: To examine the association of hydroxymethyl glutaryl coenzyme A reductase inhibitors (statins) with the 5-year incidence of age-related maculopathy (ARM). DESIGN: Population-based cohort study. Participants included persons 48 to 91 years old examined March 1, 1993, through June 14, 1995, living in Beaver Dam, Wis (N = 3684), of whom 2780 participated in a follow-up 5 years later. METHODS: Standardized procedures were used for physical examinations, blood sample collection, and questionnaire administration. Age-related maculopathy was determined by grading images of the posterior pole using a standard protocol. Standard univariate and multivariate analyses were performed. MAIN OUTCOME MEASURES: Incidence and progression of ARM was measured over the 5-year interval. RESULTS: While controlling for age and sex, statin use was not found to be associated with the 5-year incidence of early ARM (odds ratio [OR], 1.12; 95% confidence interval [CI], 0.47-2.67), progression of ARM (OR, 1.22; 95% CI, 0.54-2.76), or incidence of late ARM (OR, 0.41; 95% CI, 0.12-1.45). CONCLUSIONS: These findings do not suggest an association between statin use and incident ARM over a 5-year period. Further investigation of these relationships in larger studies over a longer period is needed.

Adult↗
PubMed2003

The 5-year incidence and progression of hearing loss: the epidemiology of hearing loss study.

CONTEXT: Hearing impairment affects many older adults, but the incidence is unknown. OBJECTIVE: To determine the 5-year incidence and progression of hearing impairment. DESIGN: A longitudinal, population-based study of adults aged 48 to 92 years at baseline examination. Hearing sensitivity was measured twice, 5 years apart. SETTING: Testing was conducted at the Beaver Dam Community Hospital, Beaver Dam, Wis. PARTICIPANTS: A total of 1636 participants without hearing loss and 1085 participants with hearing loss at the baseline examination in 1993-1995 were reexamined in 1998-2000. MAIN OUTCOME MEASURES: The examinations included otoscopy, screening tympanometry, and tone air- and bone-conduction audiometry. Incidence of hearing impairment was defined as a pure-tone average (PTA) of thresholds at 500, 1000, 2000, and 4000 Hz (PTA 0.5, 1, 2, and 4 kHz) greater than 25 dB HL (hearing level) in either ear at follow-up among those without hearing loss at baseline. Progression was defined as a change of more than 5 dB in the PTA 0.5, 1, 2, and 4 kHz among those with hearing loss at baseline. RESULTS: The 5-year incidence of hearing impairment was 21%. More than half of those with hearing loss at baseline experienced a decline in hearing. Age was an important risk factor for both incidence and progression. Male sex, occupation, and education were associated with the incidence of hearing loss after adjusting for age. CONCLUSIONS: Older adults have a high risk of developing hearing loss. Among those with hearing loss, most experience further declines in hearing sensitivity over time. These data indicate that hearing impairment is an important public health problem and underscore the need for appropriate hearing screening and treatment.

Acoustic Impedance Tests↗
PubMed2003

The association of cardiovascular disease with the long-term incidence of age-related maculopathy: the Beaver Dam eye study.

PURPOSE: To examine the association between cardiovascular disease and its risk factors and the 10-year incidence of age-related maculopathy. DESIGN: Population-based cohort study. PARTICIPANTS: Persons 43 to 86 years of age at baseline examination from 1988 to 1990, living in Beaver Dam, Wisconsin, of whom 3684 persons participated in a 5-year follow-up examination and 2764 participated in a 10-year follow-up examination. METHODS: Standardized protocols for physical examination, blood collection, administration of a questionnaire, and stereoscopic color fundus photography to determine age-related maculopathy. The Kaplan-Meier (product-limit) survival approach and discrete linear logistic regression were used in the data analysis. MAIN OUTCOME MEASURES: Incidence and progression of age-related maculopathy. RESULTS: When age, gender, and history of heavy drinking, smoking, and vitamin use were controlled for, higher systolic blood pressure at baseline was associated with the 10-year incidence of retinal pigment epithelial depigmentation (risk ratio [RR] per 10 mmHg systolic blood pressure, 1.10; 95% confidence interval [CI], 1.01-1.18; P = 0.02) and exudative macular degeneration (RR, 1.22; 95% CI, 1.06-1.41; P = 0.006). Higher pulse pressure at baseline was associated with the incidence of retinal pigment epithelial depigmentation (RR per 10 mmHg, 1.17; 95% CI, 1.07-1.28; P < 0.001), increased retinal pigment (RR, 1.10; 95% CI, 1.01-1.19; P = 0.03), exudative macular degeneration (RR, 1.34; 95% CI, 1.14-1.60; P < 0.001), and progression of age-related maculopathy (RR, 1.08; 95% CI, 1.01-1.17; P = 0.03). Higher serum high-density lipoprotein cholesterol at baseline was associated with pure geographic atrophy (RR per 10 mg/dl high-density lipoprotein cholesterol, 1.29; 95% CI, 1.05-1.58; P = 0.01). Physical activity at baseline was associated with the incidence of geographic atrophy (RR in those who worked up a sweat 5 times a week compared with those who did not, 0.12; 95% CI, 0.02-0.91; P = 0.04) exudative macular degeneration (RR, 0.27; 95% CI, 0.08-0.87; P = 0.05), and progression of age-related maculopathy (RR, 0.69; 95% CI, 0.47-1.00; P = 0.05). Neither a history of stroke nor heart attack was associated with the incidence or progression of age-related maculopathy. CONCLUSIONS: These findings indicate relationships between higher pulse pressure (a presumed indicator of age-related elastin and collagen changes in Bruch's membrane) and systolic blood pressure with an increased 10-year incidence of some lesions defining early age-related maculopathy and exudative macular degeneration.

Adult↗