This proposal describes a population-based cohort study aimed at determining the long-term (10-year) incidence and progression of the most common vision-threatening conditions of adult Americans, age-related cataract and maculopthy, and their risk factors. The population was 43-86 years of age at the census prior to the first survey in 1987-88. Standardized protocols for interviews, examinations, ocular photography, and grading have been employed during the baseline (n=4,926) and the 5-year follow-up (n=3,816) examinations. Refusal rates have been low. Because this cohort initially included a substantial number of middle-aged adults, the study provides a unique opportunity to follow the course of these eye conditions and document their natural history as this population enters the age of marked increase in disease incidence. The study in its initial prevalence survey and at the 5-year follow-up obtained information about cardiovascular disease, hypertension, diabetes and other medical conditions, cigarette smoking, nutritional supplements, light exposure, drug use history, and blood factors (e.g. glycosylated hemoglobin, total and HDL cholesterol). The 10-year follow-up is essential because the cohort is maturing and the number of cases of disease will be great enough to test many of the hypotheses that could not be precisely tested when the population was younger. In addition, at the 5-year examination, additional questions were added regarding subjective assessment of visual ability and history of falls and fractures, while continuing to monitor other risk factors and ocular variables that were measured at baseline. We will examine the relationship of impaired vision from specific age-related eye conditions to self-reported visual function, falls, and fractures and nursing home placement. Frequencies of age-related maculopathy differ between whites and ethnic minority groups. We will determine the relation of risk factors (cardiovascular disease, hypertension, diabetes, other characteristics as described above) for age-related maculopathy in nonHispanic whites, nonHispanic blacks and Mexican Americans participating in the National Health and Nutrition Examination Survey III (NHANES III) and whites and blacks participating in the Atherosclerosis Risk in Communities (ARIC) study. Existing graded fundus photographs will be used. Findings regarding cataract and age-related maculopathy will be of great public health importance in helping to predict the requirement for visual care and rehabilitative services as the population ages, and in directing further efforts at preventing these conditions.
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