The prevalence of RVO in this Asian population was lower than Caucasians in the BMES, although the systemic associations of RVO were largely similar to BMES and other studies.

Purpose: To examine the relationship between body mass index (BMI) and other anthropometric measures with retinal vessel diameter in children. Methods: A random cluster sample of 34 schools was selected in the Sydney metropolitan area during 2003-04, and 1740 children aged 6 years participated in The Sydney Childhood Eye Study. Retinal images were taken and vessel diameter was measured using a computer-imaging program. Anthropometric measures, including weight, height, waist circumference, BMI and body surface area (BSA), were obtained and defined using standardized protocols. Data on confounders, including ocular parameters, ethnicity, birth parameters and blood pressure, were similarly collected. Results: Mean BMI was 16.2 kg/m 2 (72.1 s.d.) in 1608 (92.4%) children with complete data. After controlling for age, sex, ethnicity, axial length of the eyeball, birth weight and mean arterial blood pressure, children with BMI above the cardiovascular risk threshold (defined as BMI416.1 kg/m 2 in boys and BMI415.9 kg/m 2 in girls) had mean retinal venular diameter 2.1 mm larger than those with BMI below this threshold (P ¼ 0.026). Increasing weight and BSA were also positively associated with wider retinal venules. Children in the highest quartile of BMI had mean retinal arteriolar diameter 2.2 mm smaller than those in the lowest quartile. Increasing waist circumference and shorter height were also associated with narrower retinal arterioles. Conclusions: In this sample of 6-year-old children, greater BMI, weight and BSA were associated with wider retinal venules, while greater BMI and larger waist circumference were associated with narrower retinal arterioles. These findings suggest a possible effect of increased body mass and adiposity on early microvascular structural alterations in childhood, long before the development of cardiovascular disease.

Purpose To determine the prevalence and risk factors of epiretinal membranes (ERM) in a Japanese population. Patients and Methods The Funagata Study examined 1758 Japanese aged 35 years or older (42% of eligible) from June 2000 to June 2002. A total of 1723 (98.0%) participants had nonmydriatic fundus photographs of the right eye to grade the presence of ERM, using the Blue Mountains Eye Study (BMES) protocol. After age standardization, the prevalence of ERM in the right eyes of the participants included in this study was compared with that reported from right eyes of participants in the BMES and the Beaver Dam Eye Study (BDES). ERM detected in eyes with diabetic retinopathy and other retinal lesions were excluded from the analysis of associations. Multiple logistic regression models were used to determine risk factors for the presence of ERM, adjusting for age and gender. Results There were 84 right eyes with ERM, representing 5.44% of this sample. After age standardization, the prevalence rate (5.7%) was within the range reported in the BMES (3.5%) and the BDES (6.9%). Older age (genderadjusted odds ratio (OR) per 10 years: 1.72, 95% confidence interval (CI): 1.40-2.11) and diabetes (age-gender-adjusted OR: 1.84, 95% CI: 1.01-3.37) were the only two factors associated with ERM. Conclusions We found a similar prevalence of ERM in the Japanese as in mainly white populations. Increasing age and diabetes were risk factors for ERM in this adult Japanese population.

Purpose To examine the impact of symptomatic dry eye on vision-related daily activities. Methods A population-based survey of eye diseases was conducted on 3280 (78.7% response rate) Malay persons aged X40 years, who were randomly selected from designated areas in southwestern Singapore. Participants were administered a standardized dry eye questionnaire consisting of six questions on symptoms, a questionnaire on vision-related daily activities, and underwent a comprehensive systemic and ocular examination. Symptomatic dry eye was defined as one or more self-reported symptoms that were frequently present (ranked as often or all the time). Logistic regression method was used to examine the relationship of symptomatic dry eye with difficulty in performing daily activities. Results In adults without visual impairment, symptomatic dry eye after adjusting for age, gender, and presenting visual acuity was significantly associated with difficulty in vision-related activities such as navigating stairs (odds ratio (OR) ¼ 1.96, 95% confidence interval (CI): 1.28-3.00), recognizing friends (OR ¼ 1.99, 95% CI: 1.45-2.73), reading road signs (OR ¼ 1.87, 95% CI: 1.36-2.57), reading newspaper (OR ¼ 1.50, 95% CI: 1.11-2.04), watching television (OR ¼ 1.90, 95% CI: 1.26-2.87), cooking (OR ¼ 1.94, 95% CI: 1.02-3.71), and driving at night (OR ¼ 2.06, 95% CI: 1.32-3.21). Conclusion Symptomatic dry eye was associated with difficulty in performing vision-dependent tasks, independent of visual acuity and other factors. These findings have public health significance and suggest that the visual dysfunction in dry eye should be further characterized.

Aims To determine 5-year incidence and progression of diabetic retinopathy in an older Australian population-based cohort. Methods During the period 1992-1994, the Blue Mountains Eye Study examined 3654 residents aged 49 þ years (82.4% of those eligible), living in two urban postcode areas, west of Sydney, Australia. Participants were subsequently invited to attend 5-year follow-up exams. After excluding 543 (14.8%) who died during the follow-up period, 2334 persons (75.0%) were re-examined during 1997-1999. The examination included a comprehensive questionnaire, blood pressure measurement, standardised refraction, Zeiss stereo retinal photographs, and estimation of fasting blood glucose. Diabetic retinopathy was graded from the retinal photographs, using the modified Early Treatment Diabetic Retinopathy Scale classification (15-step scale). Results Of participants with diabetes diagnosed at baseline, 150 were re-examined, including 139 with gradable fundus photographs. The cumulative 5-year incidence of diabetic retinopathy was 22.2% before 95% confidence interval (CI) 14.1-32.2%. Retinopathy progression (1 þ steps) was documented in 25.9% (95% CI 18.8-34.0%) of participants with retinopathy and gradable photographs at both visits; in 58.3% of these cases, a 2 þ -step progression was documented. Progression to proliferative retinopathy occurred in only 4.1% of those with retinopathy at baseline. The only baseline risk factors associated with retinopathy progression, after adjusting for age and gender, were increase in fasting blood glucose, odds ratio (OR) 1.2 (95% CI 1.1-1.4)/ mmol/l, and increase in diabetes duration, OR 2.3 (95% CI 1.0-5.3)/10 years. Conclusions These data provide 5-year cumulative incidence of diabetic retinopathy in a defined older population. Increase in diabetes duration and elevated baseline fasting blood glucose level predicted retinopathy incidence.

Aims/hypothesis The aim of the study was to examine the relationship of retinal vascular calibre with glucose intolerance, diabetes and retinopathy in a population-based cohort. Methods The Australian Diabetes, Obesity and Lifestyle study recruited adults aged ≥25 years old from across Australia. Participants were classified using an oral glucose tolerance test as having normal glucose tolerance (NGT), impaired glucose tolerance (IGT), impaired fasting glucose (IFG), known diabetes or newly diagnosed diabetes. Digital retinal photographs were taken of all participants with diabetes, IGT and IFG, and a sample of those with NGT, and graded for the presence of retinopathy. Retinal vascular calibre was measured from photographs by a computerassisted method.Results Of the 1,998 participants with gradable retinal images, 16% had known diabetes, 17% newly diagnosed diabetes, 42% IGT, 6% IFG and 19% NGT. After multivariable adjustment, retinal arteriolar calibre was significantly larger in people with known diabetes (178.9 μm) compared with participants with NGT (174.6 μm, p=0.02), IGT/IFG (175.5 μm, p=0.02) or newly diagnosed diabetes (175.6 μm, p=0.047). One SD increase in mean arteriolar calibre was associated with higher odds of diabetes compared with NGT (odds ratio [OR]=1.28, 95%CI=1.06-1.55). After multivariable adjustment, each SD increase in venular calibre was associated with higher odds of having retinopathy in persons with IGT/IFG (OR=1.78, 95% CI=1.36-2.34) or in persons with diabetes (OR=1.68, 95% CI=1.23-2.29). Conclusions/interpretation Diabetes is associated with larger retinal arteriolar calibre and retinopathy with larger retinal venular calibre. The contrasting associations may reflect different underlying pathophysiological processes in the natural history of diabetes.

Purpose To describe the relationship of retinal vascular calibre with diabetes and diabetic retinopathy in an Asian population. Methods A total of 3280 (78.7% response) subjects, aged 40-80 years, of Malay ethnicity residing in Singapore participated in this population-based, cross-sectional study. Retinal vascular calibre was measured and summarized using a validated computer programme from digital retinal photographs. Diabetic retinopathy signs were graded from photographs using the modified Airlie House classification. Results Of the 3004 subjects with data for this analysis, 682 (22.7%) had diabetes, of whom 194 (28.4%) had retinopathy. After multivariable adjustment, retinal arteriolar calibre was significantly wider in persons with diabetes (141 vs 139 lm, Po0.001); venular calibre was not associated with diabetes (P ¼ 0.93). Among participants with diabetes, venular calibre increased from 218.7 lm in those without retinopathy to 231.1 lm in those with moderate and 231.4 lm in those with severe retinopathy (P for trend ¼ o0.001); arteriolar calibre was not associated with diabetic retinopathy. Conclusions This study shows wider retinal arterioles in diabetes and wider venules in those with diabetic retinopathy in an Asian population. These findings confirm earlier data on white population, supporting the concept that a quantitative assessment of retinal vasculature may provide further insights into early diabetic microvascular damage.

Purpose To assess the 5-year incidence of vascular retinopathy and its associations in an older nondiabetic population. Methods The Blue Mountains Eye Study examined 3654 residents aged 49 þ years (82.4% response rate) during 1992-1994, and re-examined 2335 (75.1% of survivors) during 1997-1999. Retinopathy lesions (microaneurysms, haemorrhages, hard or soft exudates) were assessed from 6-field retinal photographs in persons without diabetes. Incident retinopathy was assessed in those at risk. Hypertensive status was defined following the WHO/International Society of Hypertension guidelines. Results Of the 2335 re-examined, 195 had retinopathy lesions at baseline and 1725 were at risk of retinopathy after excluding subjects with diabetes (n ¼ 261), retinal vein occlusion (n ¼ 52) or missing/un-gradable photographs (n ¼ 102). The cumulative 5-year incidence was 9.7% (95% confidence intervals (CI) 8.3-11.1%). Age was the only factor significantly associated with incident retinopathy (P for trend ¼ 0.012). Neither fasting blood glucose (age-sex-adjusted P ¼ 0.147) nor hypertension (adjusted P for trend ¼ 0.43) was associated with incident retinopathy. Of the 195 with retinopathy lesions at baseline, 3.5% developed diabetes, 13.3% progressed, and 72.3% regressed/disappeared over 5 years. Progression was positively associated with elevated blood pressure (BP) (adjusted odds ratio (OR) 1.3, 95% CI 1.1-1.6 per 10 mmHg systolic BP) and inversely associated with fasting glucose level (OR 0.36, CI 0.14-0.92 per mmol/l increase). Aspirin use was weakly associated with regression (OR 2.4, CI 1.0-6.0). Conclusions Over 5 years, retinopathy developed in 10% of older people without diabetes, while 72% of baseline lesions regressed. Age was significantly associated with the development of these lesions.