Five-year refractive changes in an older population: the Blue Mountains Eye Study

doi:10.1016/S0161-6420(03)00465-2

Ophthalmology

Volume 110, Issue 7, July 2003, Pages 1364-1370

https://doi.org/10.1016/S0161-6420(03)00465-2 Get rights and content

Abstract

Purpose

To examine 5-year changes in refractive error and astigmatism in an older population.

Design

Population-based cohort study.

Participants

The Blue Mountains Eye Study examined 3654 residents aged 49 years or older from 1992 to 1994. After excluding 543 persons who died since baseline, 2335 (75.1%) attended 5-year examinations from 1997 to 1999.

Methods

Both examinations included a detailed eye assessment, with subjective refraction performed according to a modified Early Treatment of Diabetic Retinopathy Study protocol.

Main outcome measures

Spherical equivalent (sum of sphere + $12$ cylinder) was used as the measure of refractive error. Only phakic eyes with best-corrected visual acuity >20/40 were included (n = 3701).

Results

Similar changes in refractive error were observed for the two eyes. Symmetric changes were found in 72% of participants when the difference between eyes was within 0.5 diopters (D) and in 91% when the difference was within 1.0 D. The 5-year change in spherical power was in a hyperopic direction for younger age groups and in a myopic direction for older subjects, P < 0.0001. The gender-adjusted mean change in refractive error in right eyes of persons aged 49 to 54, 55 to 64, 65 to 74, and 75 years or older at baseline was +0.41 D, +0.30 D, +0.05 D, and −0.22D, respectively. Refractive change was strongly related to baseline nuclear cataract severity; grades 4 to 5 were associated with a myopic shift (−0.33 D, P < 0.0001). Education level and age of onset of myopia, but not gender or diabetes, also predicted refractive change. The mean age-adjusted change in refraction was +0.14 D for hyperopic eyes, +0.32 D for emmetropic eyes, and +0.15 D for myopic eyes. The mean change in cylinder power over the 5-year period was small, irrespective of baseline refraction. The axis of astigmatism remained stable in most cases (64%), whereas 12% changed to “against the rule” and 11% to “with the rule.”

Conclusions

This report has documented refractive error changes in an older population and confirmed reported trends of a hyperopic shift before age 65 years and a myopic shift thereafter associated with the development of nuclear cataract.

Section snippets

Population studied

The BMES is a population-based survey of vision and common eye diseases in an urban population aged 49 years or older in an area west of Sydney, Australia, the details of which have previously been reported.2, 10 The study included two adjoining urban postcode areas with a relatively stable and homogenous population representative of the state of New South Wales for income and socioeconomic status.

After a door-to-door census, all noninstitutionalized permanent residents with birth dates before

Results

Of the 2335 BMES I participants re-examined in BMES II, 485 were excluded from the refractive change analyses because they had previous history of cataract surgery (n = 301), best-corrected visual acuity ≤20/40 (n = 182), or missing data (n = 2). This left 1850 subjects, including 1036 women and 814 men. There were 3701 phakic eyes available for analysis, including 1850 right and 1851 left eyes. The correlation coefficient for refractive changes between right and left eyes was 0.52, P < 0.0001.

Discussion

Information regarding the nature and cause of trends in refractive changes over time might be useful in predicting the future eye care needs in our aging population. This report is the second7 to describe the pattern of refractive changes over a 5-year interval in a large population-based cohort of older persons. Most longitudinal studies have examined spherical equivalent refraction changes in young adults.17, 18, 19, 20 Strengths of our study include its relatively high baseline participation

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Regression after corneal refractive surgery is a complex phenomenon which seems inevitable. The choice of surgical technique has very little influence on regression for low myopia or myopic astigmatism. However, LASIK and SMILE are the two techniques of choice in the correction of high myopia. LASIK is also better for the correction of hyperopia, hyperopic astigmatism and mixed astigmatism. Intraoperatively, the choice of a wide optical zone and adherence to a thick residual stromal bed provide stability. Regression may also be reduced by modulating anti-inflammatory therapy, treating dry eye, and using mitomycin C in PKR. In all cases, obtaining keratometry during patient follow-up helps to identify the cause of the regression. The objective of this review is to synthesize recent data from the literature on regression in refractive surgery as a function of the ablation profiles used.
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^☆

Manuscript no. 220190.

Supported by the Australian National Health and Medical Research Council, Canberra Australia (Grant no. 974159).

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Five-year refractive changes in an older population: the Blue Mountains Eye Study☆

Abstract

Purpose

Design

Participants

Methods

Main outcome measures

Results

Conclusions

Section snippets

Population studied

Results

Discussion

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Am J Ophthalmol

Refractive status in the Beaver Dam Eye Study

Invest Ophthalmol Vis Sci

Prevalence and risk factors for refractive errors in an adult inner city population

Invest Ophthalmol Vis Sci

Refractive errors in a black adult populationthe Barbados Eye Study

Invest Ophthalmol Vis Sci

Prevalence and risk factors for refractive errors in adult Chinese in Singapore

Invest Ophthalmol Vis Sci

Refractive errors in an urban population in Southern Indiathe Andhra Pradesh Eye Disease Study

Invest Ophthalmol Vis Sci

Changes in refractive error over a 5-year interval in the Beaver Dam Eye Study

Invest Ophthalmol Vis Sci

Changes in refraction and corneal curvature during growth and adult life. A cross-sectional study

Acta Ophthalmol (Copenh)

“With the rule” astigmatism is not the rule in the elderly. Reykjavik Eye Studya population based study of refraction and visual acuity in citizens of Reykjavik 50 years and older. Iceland-Japan Co-Working Study Groups

Acta Ophthalmol Scand

Refractive changes following cataract surgerythe Blue Mountains Eye Study

Clin Exp Ophthalmol