Cataracts, Age-Related Macular Degeneration Predict Mortality in Persons Older Than 49 Years

Karla Harby

July 09, 2007

To read this article for CME, click here.

July 9, 2007 — Cataracts and age-related macular degeneration (ARMD) are associated with higher-than-expected mortality rates in persons aged 49 years and older, according to a report compiled 11 years after baseline from the population-based Blue Mountains Eye Study, an epidemiologic study of 3654 Australians. The report appears in the July Archives of Ophthalmology.

Among other findings, the authors report that vascular deaths were more common among those with visual impairment or cataract compared to those without (P = .004 and P < .001, respectively), whereas cancer-related deaths were significantly less frequent (P < .001). Subjects who died during the study period were older and more likely to be male, current smokers, and underweight and to have diabetes, hypertension, and a history of angina, acute myocardial infarction, and/or stroke (P < .001). Being overweight or obese was associated with higher survival rates in this analysis (P < .001).

From 1992 to 1994, researchers in the Blue Mountains Eye Study examined 3654 of 4433 eligible residents aged 49 years and older living in suburban Sydney, Australia, for visual acuity, including the presence of ARMD lesions and cataracts. The researchers also collected baseline data on age, sex, body mass index, diabetes, hypertension, smoking, angina incidence, history of acute myocardial infarction, blood test variables (cholesterol, triglyceride, and fibrinogen levels), history of stroke, alcohol intake, walking disability, educational level, and home ownership.

For this Archives report, the authors collected cumulative mortality data on these subjects as of December 31, 2003, and analyzed the information using age-standardized mortality rates. Mortality data were missing for 21 subjects (0.6%). During the analysis period, 1051 subjects (28.9%) died of any cause, and 483 (13.3%) died of vascular causes.

Among individuals younger than 75 years, the authors found that visual impairment significantly predicted higher all-cause mortality and that evidence of ARMD significantly predicted higher all-cause and vascular mortality. However, the association between visual impairment and mortality from any cause became nonsignificant in statistical models that controlled for economic and biological confounders, the authors write, adding that reduced power could be a contributing factor to this finding.

The authors also noted that the possible mechanisms underlying the association between cataract or ARMD and mortality remain unclear from this analysis. "The implications of these findings remain uncertain: whether such an association indicates that visual impairment, age-related eye disease, or both are makers of aging and frailty, or whether these ocular conditions accelerate aging, thus leading to relatively earlier death in older persons," write Sudha Cugati, MS, from the Centre for Vision Research, Department of Ophthalmology, Westmead Millennium Institute, Westmead, Australia, and colleagues.

The authors reported no relevant financial relationships.

Arch Ophthalmol. 2007;125(7):917–924.


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