To investigate cross-sectional associations among blood pressures (BPs), arterial stiffness, and openangle glaucoma (OAG). M e t h o d s : Study participants came from the population-based Rotterdam Study. The baseline examination phase took place after an extensive home inter-

The authors examined the association between age at menopause and open-angle glaucoma among women aged > or = 55 years in the population-based Rotterdam Study (1990--1993). Information on age and type of menopause was obtained by interview. Subjects (n = 3,078) were stratified into three categories according to age at menopause: <45 years, 45--49 years, and > or = 50 years, with the last group serving as the reference group. Diagnosis of open-angle glaucoma was based on the presence of a glaucomatous visual field defect and glaucomatous optic neuropathy. Open-angle glaucoma was diagnosed in 78 women with a natural menopause and 15 women with an artificial menopause. In the category of natural menopause, women who went through menopause before reaching the age of 45 years had a higher risk of open-angle glaucoma than the reference group (odds ratio = 2.6; 95% confidence interval: 1.5, 4.8), after adjustment for age and use of hormone replacement therapy. Among women who went through menopause between the ages of 45 and 49 years, the odds ratio was 1.1 (95% confidence interval: 0.7, 2.0). These findings suggest that early menopause is associated with a higher risk of open-angle glaucoma.

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Objective To evaluate the additional value of funduscopy in the routine management of patients with hypertension. Design Systematic review. Participants Adults aged 19 or more with hypertensive retinopathy. Data sources Medline, Embase, and the Cochrane Library from 1990. Review methods Studies were included that assessed hypertensive retinopathy with blinding for blood pressure and cardiovascular risk factors. Studies on observer agreement had to be assessed by two or more observers and expressed as a statistic. Studies on the association between hypertensive retinopathy and hypertensive organ damage were carried out in patients with hypertension. The association between hypertensive retinopathy and cardiovascular risk was carried out in unselected normotensive and hypertensive people without diabetes mellitus. Results The assessment of microvascular changes in the retina is limited by large variation between observers. The positive and negative predictive values for the association between hypertensive retinopathy and blood pressure were low (47% to 72% and 32% to 67%, respectively). Associations between retinal microvascular changes and cardiovascular risk were inconsistent, except for retinopathy and stroke. The increased risk of stroke, however, was also present in normotensive people with retinopathy. These studies did not adjust for other indicators of hypertensive organ damage. Conclusion Evidence is lacking that routine funduscopy is of additional value in the management of hypertensive patients.

ABSTRACT.Purpose: To assess the effect of media opacities on thickness measurements of the peripapillary retinal nerve fibre layer (pRNFL) and macular inner retinal layer (mIRL) performed with spectral-domain optical coherence tomography (SD-OCT) using a set of filters with known optical density. Methods: Spectral-domain optical coherence tomography volume scans of the optic disc and the macular area were performed in 18 healthy volunteers, using Topcon-3DOCT-1000 Mark II. A set of five filters with optical density ranging from 0.04 to 0.69 was used. The correlation was calculated between the percentage change in thickness measurements (%DpRNFL and %DmIRL) and the change in optical density. All scans and measurements were performed in duplicate by one operator. Results: Eighteen right eyes of 18 healthy volunteers were included in this study. Percentage decrease in pRNFL and mIRL thickness correlated with change in optical density (Spearman's rho r = 0.82; p < 0.001 and r = 0.89; p < 0.001, respectively). The measured decrease in pRNFL thickness differed from the decrease in mIRL thickness, not only between individuals, but also within the same individual. Conclusions: Optical coherence tomography thickness measurements of both pRNFL and mIRL are influenced by image degradation caused by optical density filters as a model for media opacities. An underestimation of the thickness of these layers was observed, caused by a shift of retinal layer boundary placement due to image quality loss. This underestimation is not the same for each individual and also differed between the pRNFL and mIRL thickness measurements. These individual and interindividual differences demonstrate that an individual approach will be necessary to correct for this underestimation per layer.