L A Wright’s research while affiliated with Cincinnati Eye Institute and other places

The purpose of the study was to estimate the prevalence of and risk factors for chronic glaucoma in a sample of African Caribbean people over 35 years of age living in the London Borough of Haringey. A cross-sectional voluntary sample of persons were subjected to detailed ophthalmic assessment including automated tangent screen suprathreshold visual field testing, applanation tonometry and stereoscopic disc evaluation in 50 community-based survey clinics over an 8 month period. Cases and suspects were referred to Moorfields Eye Hospital for more detailed assessment and confirmation of the diagnosis. Of 873 eligible persons examined (out of a total of 1022), 32 definite cases of glaucoma were identified, a prevalence of 3.9%; 42% of these had been previously diagnosed. Approximately 10% of the sample required further assessment and follow-up when ocular hypertensives and glaucoma suspects were included. An age-standardised comparison with the findings of the Roscommon survey revealed a relative risk for glaucoma for Haringey blacks compared with Irish whites of 3.7. Significant risk factors for glaucoma included age, African birthplace and darker skin colour. Neither diabetes nor hypertension reached significance. Despite the lack of a population base, this study provides strong evidence that the 4 times greater risk of glaucoma estimated for American blacks compared with whites applies equally to the United Kingdom population. Community-based facilities are required to raise awareness of the risk among this ethnic minority in this country and case-finding resources should be provided to meet local needs.

A matched-control study of plasma retinol, alpha-tocopherol, carotenoid, and cholesterol concentrations and the polyunsaturated fatty acid content of plasma and erythrocyte phospholipids was undertaken in 65 elderly patients with age-related maculopathy and 65 control subjects matched for age and sex. Despite the high statistical power of the study and large variations between subjects in the variables under consideration, no significant differences were noted between patients and control subjects. However, several statistically significant differences were noted between male and female subjects independent of their classification with maculopathy or as controls and age: plasma cholesterol, total phospholipids, alpha-tocopherol, and beta-cryptoxanthin concentrations were higher in females than in males. The mean plasma cholesterol concentration for the upper tertile of the whole sample was 7.6 mmol/L. Plasma concentrations of total carotenoids, alpha-carotene, and beta-carotene, but not alpha-tocopherol, were significantly lower in smokers than in non-smokers. The results of this study do not provide any evidence in favor of changing the dietary intake of polyunsaturated fatty acids or fat-soluble vitamins to protect against age-related maculopathy.

To determine the prevalence of visual disability and common eye disease among elderly people in inner London. Cross sectional random sample survey. Inner London health centre. Random sample of people aged 65 and over taken from practice's computerised age-sex register. Presenting binocular Snellen 6 m distance acuity and best monocular 3 m Sonksen-Silver acuity to classify prevalence of blindness by World Health Organisation criteria (less than 3/60 in better eye) and American criteria for legal blindness (better eye equal to 6/60 or less) and of low vision by WHO criteria (best acuity 6/18) and visual impairment by American criteria (less than 6/12 or 20/40 but greater than 6/60 or 20/200 in better eye). Principal cause of visual loss by diagnosis, referral indication by cause to hospital eye service, and proportion of cases known to primary care. 207 of 288 (72%) eligible people were examined. 17 (8%) housebound subjects were examined at home. The prevalence of blindness was 1% by WHO criteria and 3.9% by American criteria. The prevalence of low vision (WHO criteria) was 7.7%. The prevalence of visual impairment (American criteria) was 10.6%. Cataract accounted for 75% of cases of low vision. Only eight out of 16 patients with low vision were known by their general practitioner to have an eye problem. 56 subjects (27%) would probably have benefited from refraction. Comparisons with studies in the United States and Finland suggested higher rates in this sample, mainly due to the prevalence of disabling cataract. There seems to be a considerable amount of undetected ocular disease in elderly people in the community.

This study reports the prevalence of defective stereopsis in an elderly population. Of 728 individuals over the age of 65 who attempted a Frisby stereotest, only 27% had full stereopsis and 29% had no stereopsis. In the elderly population defective stereopsis is a common finding in the absence of any other ocular morbidity. The prevalence of defective stereopsis increased with age. This finding was noted as a part of a survey of eye health of elderly people living in an inner city. The finding was not associated with any symptoms. The significance of this finding is discussed.