We propose to investigate the relationships of dietary factors to cataract extraction and age-related maculopathy (ARM) among two prospectively followed cohorts of men and women. The Nurses' Health Study (NHS) began in 1976 among 121,700 women ages 30-55 at that time. Over 85,000 participants completed an extensively validated semiquantitative food frequency questionnaire (SFFQ) in 1980 and again in 1984,1986 and 1990. The Health Professional Follow-up Study (HPFS) began in 1986 among 52,000 men ages 45-75, all of whom completed a SFFQ. Both groups have been sent a questionnaire biennially to update both exposure information and reports of major illnesses and surgeries, including cataract extraction and ARM. Information has been collected on specific vitamin supplement use (both dose and duration of use), smoking, diagnosis of hypertension, diabetes, and cardiovascular disease (CVD) among other factors. In the proposed study we will confirm reports of cataract extraction and ARM by contacting the participant's ophthalmologist, and will obtain fundus photographs from the ophthalmologist for those with ARM. A case will be considered to have ARM if it is judged to be sufficient to result in a visual acuity loss of at least 20130 and is also confirmed by a standardized review of the fundus photograph by two readers. Based on data collected thus far, we anticipate 3570 cases of cataract extraction (1998 in the NHS and 1572 in the HPFS) and 513 cases of ARM (364 in NHS and 149 in HPFS) through the 1996 follow-up period. Specific hypotheses to be addressed include the associations between dietary intake of vitamin G, E, and carotenoids in relation to both cataract ARM. Additionally, the relationship between specific carotenoids and tocopherols, and cataract risk will be determined using archived plasma samples. Over 32,000 blood samples were collected in the NHS in 1989. Secondary hypotheses to be examined include the association between alcohol, cigarette smoking, diabetes and cataract extraction and smoking and history of CVD and ARM. Stratified and multivariate techniques will be used to quantify the risk of cataract extraction and ARM according to the level of dietary factors and other variables after controlling for potentially important confounding variables; analyses will be conducted among participants who reported having a recent eye exam.
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