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Cataract is a major cause of blindness, accounting for nearly half of all blindness worldwide. Epidemiological research provides the principles and methods to assess the extent of cataract, and supplies the necessary information for policy planning. Obtaining accurate epidemiological data on cataract is essential to ascertain and estimate the cost of primary and secondary eye health care needs. Determining risk factors is also necessary to reduce the economic and social repercussions associated with the disease. The following paper presents a review of the epidemiology of cataract in the middle to elderly age group.

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The relation of the consumption of caffeine from coffee, tea, and all caffeine-containing soft drinks (hereafter referred to as "cola") to blood lipid levels was studied in 1,035 white women ranging in age from 65 to 90 years (mean, 71.2 years) from October 1986 through October 1988. All study subjects were participants in the Pittsburgh, Pennsylvania, clinic of the Study of Osteoporotic Fractures. Fasting blood samples were tested for total cholesterol, triglycerides, apolipoproteins A-I and B-100, total high-density lipoprotein (HDL) cholesterol, and the HDL2 and HDL3 subfractions. Low-density lipoprotein (LDL) cholesterol was calculated using the Friedewald equation. Current consumption of coffee, tea, and cola was assessed by means of a self-administered personal habits questionnaire. Potential confounders, such as body mass index (weight (kg)/height (m)2), waist/hip ratio, smoking status, and alcohol intake were also measured for each woman. Analyses of variance and tests for mean differences revealed an inverse relation between the consumption of tea and apolipoprotein B-100 and a positive association between the consumption of cola and apolipoprotein B-100. Apolipoprotein A-I levels were found to be positively related to coffee consumption and negatively related to tea consumption. There was no consistent relation between caffeine consumption and total cholesterol, LDL cholesterol, total HDL cholesterol and its subfractions, or apolipoprotein B-100. Adjustment for potential confounders yielded no remaining significant associations between caffeine from any of the major beverage sources and any of the lipid fractions. In conclusion, the inconsistent relations between caffeine from various sources and blood lipids do not support a significant association of blood lipid levels with caffeine consumption in elderly women.

We conducted a study to determine the prevalence of central islands after refractive excimer laser surgery and the factors associated with their occurrence. A VISX Twenty/Twenty excimer laser was used to perform 157 photorefractive keratectomy (PRK) and 263 photorefractive astigmatic keratectomy (PARK) procedures. Corneal topography was assessed in 156 patients three months postoperatively using a topographic analysis system. Central islands were seen in 67% of patients; 26% had islands of 3.0 diopters (D) or more in height. Occurrence was associated with the laser suction nozzle being fixed during the procedure (P < .05). There was no demonstrable effect of central islands on visual acuity or refractive outcome, nor was there any relation to the amount of attempted correction or type of procedure (PARK or PRK). Central islands with a curvature difference of less than 3.0 D were seen more frequently than an absence of islands, suggesting these may be a "normal" postoperative topographic variation. The effect of nozzle position on island formation suggests that plume removal or corneal hydration may be important, as is corneal epithelial healing.

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Despite improvement in overall quality of published articles, systematic errors exist in the design and reporting of studies related to the prognosis of community-acquired pneumonia. The quality assessment tool employed in this study could be used to guide the development of high-quality outcomes research in the future.

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