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Background: The purpose of the present paper was to describe the 5-year incidence and progression of diabetic retinopathy in the Melbourne Visual Impairment Project (VIP) cohort., Methods: Baseline examinations were conducted from 1992 to 1994 and follow-up data were collected 5 years later. Data collected during the baseline and follow-up studies included medical history (including previous diagnosis of diabetes mellitus) and dilated fundus examination. Two 30 degrees stereoscopic fundus photographs were taken with a Topcon TRC fundus camera, one centred on the optic disc and the other centred on the fovea. Photographs from participants who reported having diabetes were graded for diabetic retinopathy based on an extension of the Modified Airlie House Classification. Grouping of participant data into retinopathy grades was based on the results of the worst eye., Results: The follow-up survey included 82% (n = 121) of those with diabetes at baseline. Prevalence of any retinopathy was 35.7% and macular oedema was 13% at follow up. Diabetic retinopathy was newly detected in 8/73 (5-year incidence = 11.0%, 95% confidence interval (CI) = 3.8-18.1). Disease progression was seen in 9/31 participants (29.0%, 95%CI = 14.9-47.8) who had diabetic retinopathy at baseline. The 5-year incidence of proliferative diabetic retinopathy in people without proliferative diabetic retinopathy at baseline was 2.9% (3/104, 95%CI = 0-6.4). The 5-year incidence of macular oedema in people who did not have macular oedema at baseline was 8.0% (8/100, 95%CI = 2.7-13.3). All people with proliferative diabetic retinopathy at baseline had received laser treatment by the follow-up survey. Twenty-four per cent of people without diabetic retinopathy reported never having had a dilated fundus examination (excluding the VIP examinations)., Conclusion: The 5-year incidence of diabetic retinopathy was 11% in the Melbourne Visual Impairment Project. Most people with proliferative diabetic retinopathy or macular oedema are receiving treatment. However, many people with diabetes are not having regular dilated fundus examinations.

Purpose: To describe the prevalence and risk factors for cataract in an Australian population aged 40 years and older., Methods: Participants were recruited by a household census and stratified, random cluster sampling to represent residents of Victoria, Australia, aged 40 years and older. The following information was collected: initial visual acuity and best-corrected visual acuity, demographic details, health history, dietary intake of antioxidants, lifetime ocular ultraviolet B exposure, and clinical eye examination, including lens photography. Cortical opacities were measured in sixteenths. Cortical cataract was defined as opacity greater than or equal to 4/16 of pupil circumference. Nuclear opacities were graded according to the Wilmer cataract grading scheme, and cataract was defined as greater than or equal to nuclear standard 2.0 of four standards. The height and width of any posterior subcapsular opacity was measured and recorded. Posterior subcapsular cataract was defined as posterior subcapsular opacity greater than or equal to 1 mm2. The worse eye was selected for analysis. Backward stepwise logistic regression was used to quantify independent risk factors for cataract., Results: A total of 3,271 (83% of eligible) of the urban residents, 403 (90% of eligible) nursing home residents, and 1,473 (92% of eligible) rural residents participated. The urban residents ranged in age from 40 to 98 years (mean, 59 years), and 1,511 (46%) were men. The nursing home residents ranged in age from 46 to 101 years (mean, 82 years), and 85 (21%) were men. The rural residents ranged in age from 40 to 103 years (mean, 60 years), and 701 (47.5%) were men. The overall weighted rate of cortical cataract was 11.3% (95% confidence limits, 9.68%, 13.0%) excluding cataract surgery and 12.1% (95% confidence limits, 10.5%, 13.8%) including cataract surgery. The risk factors for cortical cataract that remained in the multivariate logistic regression model were age, female gender, diabetes duration greater than 5 years, gout duration greater than 10 years, arthritis diagnosis, myopia, use of oral beta-blockers, and increased average annual ocular ultraviolet B exposure. Overall, 12.6% (95% confidence limits, 9.61%, 15.7%) of Victorians aged 40 years and older had nuclear cataract including previous cataract surgery, and 11.6% (95% confidence limits, 8.61%, 14.7%) had nuclear cataract excluding previous cataract surgery. In the urban and rural cohorts, age, female gender, rural residence, brown irides, diabetes diagnosed 5 or more years earlier, myopia, age-related maculopathy, having smoked for greater than 30 years, and an interaction between ocular ultraviolet B exposure and vitamin E were all risk factors for nuclear cataract. The rate of posterior subcapsular cataract excluding previous cataract surgery was 4.08% (95% confidence limits, 3.01%, 5.14%), whereas the overall rate of posterior subcapsular cataract including previous cataract surgery was 4.93% (95% confidence limits, 3.68%, 6.17%) . The independent risk factors for posterior subcapsular cataract in the urban and rural cohorts that remained were age in years, rural location, use of thiazide diuretics, vitamin E intake, and myopia., Conclusions: The expected increase in the prevalence of cataract with the aging of the population highlights the need to plan appropriate medical services and public health interventions for primary and secondary prevention. Many of the identified risk factors for cataract in the population have the potential for being modified through public health interventions.

Objective: To compare the distribution of cataract types between psychiatric patients diagnosed with schizophrenia and the general population not exposed to psychotropic medication, and to compare cataract prevalence between users and nonusers of various psychotropic medications in the general community., Design: Case-control., Participants: A total of 151 (93%) eligible patients from a community mental health service and 3271 (83%) eligible residents from the Melbourne Visual Impairment Project (VIP) were examined., Main Outcome Measures: All patients 40 years of age and older from a community mental health service and residents of nine randomly selected areas of Melbourne were eligible. Best-corrected distance visual acuity was determined using a 4-m logarithm of the minimum angle of resolution (LogMAR) chart. The presence of cataract was determined by photographs or slit-lamp examination using direct and indirect retroillumination. Anterior, cortical, nuclear, and posterior subcapsular cataracts were measured. Participants from the Melbourne VIP were classified as to whether they had taken benzodiazepams, phenothiazines, thioxanthenes, butyrophenols, tricyclic antidepressants, or monoamine oxidase inhibitors for at least 12 months during their lifetime., Results: The distribution of cataract type varied between persons with and without schizophrenia. Anterior subcapsular (ASC) cataract was significantly more prevalent (26%) in participants with schizophrenia from the community mental health service than Melbourne VIP participants (0.2%) not exposed to psychotropic medication (chi-square, 1 degree of freedom = 605.5, P = 0.001). This remained significant after controlling for age (odds ratios = 250, 95% confidence interval = 83.3, 1000). The distribution of the age-related cataract was similar across all groups of psychotropic medication users with the exception of the phenothiazine users. They had less of all types of the age-related cataracts, despite being slightly older than the control group (mean age, 60.0 vs. 58.4, t test = 0.85, P = 0.40). However, only cortical cataract in the phenothiazine group was statistically lower (chi-square, 1 degree of freedom = 3.96, P = 0.047)., Conclusion: This study has identified the need to investigate whether other newer agents, especially high-potency medications, cause ASC opacities if a certain threshold of exposure to psychotropic medications must be attained to develop cataract, or if schizophrenia itself is associated with cataract formation.