Purpose: A population-based cataract epidemiological study, the Reykjavik Eye Study, was conducted to determine the prevalence and characteristics of lens opacities in Iceland. The results were compared with those from previous surveys in Japan to determine the influence of race and environmental factors. Methods: 1,635 randomly selected residents of Reykjavik, Iceland, were enrolled, and among them, 1,045 responded and took part in the study. The subjects received ophthalmological examination of both the anterior and the posterior segments. Changes in the crystalline lens were examined and photographed under maximal pupillary dilation. Classification of the opacity types and grading of the extent of lens opacificiation were done using a standardized scheme, and the data were analyzed with Student’s test, the χ² test and the Mantel-Haenszel test. Results: The prevalence of lens opacities in subjects in their 50s, 60s, 70s and in those 80 years and older was 42.7, 61.0, 85.3 and 100%, respectively. Grade II and III lens opacities were found in 2.2% of subjects in their 50s and in 10.5, 35.9 and 62.3% in their 60s, 70s, and over 80 years, respectively. Cortical opacities predominated in all age groups followed by nuclear opacities; subcapsular opacities, on the other hand, were quite rare. A unique type of opacity, i.e., granular opacity, seldom seen among the Japanese, was found in 6.6% of the Icelandic subjects. Conclusions: Our results show that cortical opacity is the major type of opacity in Icelandic subjects, although its prevalence was lower than that in the Japanese subjects. Interestingly, the first appearance of lens opacities of grades II and III in Icelanders was delayed by 10 years compared to the Japanese suggesting fewer or less severe risk factors for cataract formation in Iceland.

The authors have conducted cataract epidemiological studies in four climatically and racially different places and compared the data. The survey places were Noto and Amami in Japan, Reykjavik in Iceland, and Singapore. The evaluation and grading of lens opacities were done using graphic analysis of Scheimpflug and retro-illumination images. The prevalence of nuclear opacity was extremely high in the Singapore group, followed by Amami. The main type of lens opacity was nuclear in the Singapore group and cortical in the Noto and Icelandic groups. The characteristic lens opacity in Amami was in between the above two groups. No significant difference was seen in the prevalence of nuclear opacity between males and females in any of the groups. Although the common factors of the living conditions in the subjects with a high prevalence of nuclear opacity appear to be high UV exposure and high ambient temperature, future investigations should be made to disclose the possible cause.

Ageing is a major risk factor for nuclear lens opacification, and smoking is a major modifiable risk factor. Cortical and nuclear lens opacifications do not share the same modifiable risk factors.

ABSTRACT.Purpose: Cortical lens opacification has been associated with outdoor exposure and UV radiation more than other types of lens opacification. We studied risk factors for cortical lens opacification only, the most common as well as the earliest age related change we observe in the lens. Methods: 1,045 persons, 583 females and 462 males, 50 years and older, underwent a detailed eye examination and answered a questionnaire. Participants with cortical lens opacification grade I, totalling 374 persons, were assigned to case-control study I, and to case-control study II those with cortical lens opacification grades II and III, totalling 82 subjects. 378 age and sex matched persons served as controls. Results: Those who spent more than 4 hours/day outside on weekdays, in their 20's-30's and 40's-50's respectively, were found to have increased risk of moderate to severe cortical lens opacification. Thus the relative risk for grades II & III, was 2.80 (95% CI 1.01-7.80) and 2.91 (95% CI 1.13-9.62) respectively. Ageing and systemic cortical steroids use were also found to be risk factors. Conclusion: Outdoor exposure appears to be associated with increased risk of moderate to severe cortical lens opacification. Ageing is, however, the main risk factor.

No abstract

No abstract

Patients with severe atopic dermatitis are sometimes seen even after 15-20 years of age, despite tl1e fact that this is age when atopic dermatitis subsides in usual cases. We consider the possibility that steroid hormones administered as ointment stagnate in the skin and become oxidized cholesterols. Such substances may induce circulation failure and granulocyte-associated inflammation. We herein report the withdrawal of the above ointment in such patients, resulting in successful treatment within several months. Since they suffered from the withdrawal syndrome for the first two or three weeks, acupuncture was performed. Before therapy, these patients showed elevated levels of granulocytes and eosinophils, and an inverse decreased level of lymphocytes in the blood. The number and proportion of granulocytes are known to increase by sympathetic nerve stimulation.This, therefore, indicated that these patients were in a dominant state of the sympathetic nervous system. During the therapy, this leukocyte pattern became much worse due to the withdrawal syndrome. However, in parallel with the amelioration of inflammation, normalization of the leukocyte pattern was observed. These results revealed that, by some yet-undetermined reasons, patients with atopic dermatitis who had been treated by steroid ointment for long time, showed an unusual pattern of leukocytes (i.e., granulocytosis) and that this leukocyte pattern was normalized by the withdrawal of steroid hormones in parallel with the amelioration of the disease.The onset of atopic dermatitis usually begins at infancy or childhood and some cases experience spontaneous cure before adolescence (3, 12). Primarily, people in childhood show a predominant state of the immune system (i.e., a high level of lymphocytes) (5). However", adults gradually show a decreased level of the immune system (9). The level of granulocytes surpasses that of lymphocytes at l5~20 years old in Japan (our unpublished observation). We speculate that this age-associated change of the Correspondence to: Dr. T. Abo, Department of Immunology, Niigata University School of Medicine, Asahimachi-dori 1, Niigata 951-8510, Japan Fax: + 81-25-227-0766 E-mail: immunol2@med.niigata-u.ac.jp immune system might be responsible for the spontaneous cnre of atopic dermatitis. In other words, many cases of atopic dermatitis naturally subside due to an age-dependent decrease in the number of T cells.

No abstract