Survivorship and causes of death among the blind

doi:10.1016/0021-9681(66)90048-8

Journal of Chronic Diseases

Volume 19, Issue 2, February 1966, Pages 179-197

Journal of Chronic D...

https://doi.org/10.1016/0021-9681(66)90048-8 Get rights and content

Abstract

A follow-up study of 11,732 persons first registered as legally blind in Massachusetts during the 20-year period 1940–1959, was conducted in order to determine survival rates, sight-restored rates and probabilities of dying from major causes of death for the blind. Blind persons experienced poorer survivorship than expected at all ages up to 75, with little if any difference apparent at ages 75 and over. Marked differences were noted for asges 25–64. Survival rates for persons with diabetes as the cause of blindness were extremely low in comparison with the general population. Diabetes and heart disease were the two causes of death among the blind that especially showed large excesses in mortality over the expected rates. Sight-restored rates were in general rather low. Throughout, findings were similar for males and females. Data were also compared with material in two previous studies. Limitations in the present study were discussed and further research suggested.

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Cited by (49)

Burden of undetected and untreated glaucoma in the United States
2014, American Journal of Ophthalmology
Citation Excerpt :
Other population-based studies that have looked at more focused geographic or demographic population segments in the US and globally have also reported high proportions of undiagnosed and untreated glaucoma.3,5–9,11–13 Some of these studies have highlighted the importance of establishing effective screening programs6,21,31 to prevent blindness, and the morbidity and mortality associated with glaucoma.10,32–39 In its recommendation statement citing the lack of information to support the benefit of glaucoma screening, the US Preventive Services Task Force (USPSTF) suggested that visual field data from “…the National Health and Nutrition Examination Survey (NHANES) would potentially assist in gathering important information on the prevalence and severity of undetected and untreated glaucoma.”40
To determine the burden of undetected and untreated glaucoma in the noninstitutionalized population over the age of 40 years in the United States of America (US).
Cross-sectional study.
setting: US civilian, noninstitutionalized population from the 2005–2006 and 2007–2008 administrations of the National Health and Nutrition Examination Survey that were 40 years old or older with completed retinal photographs, completed interview question regarding prior diagnosis of glaucoma, and a negative response to questions regarding comorbidities. main outcome measures: Prevalence of self-reported glaucoma history; signs of glaucoma damage seen in retinal photographs and perimetry; prevalence of undiagnosed glaucoma; and comparison of demographic factors using odds ratios to identify populations with highest burden of previously undiagnosed glaucoma.
The study population included 3850 participants who met the inclusion criteria. The 99.5th percentile of the vertical cup-to-disc ratio was 0.67 and the 99.5th percentile of the vertical cup-to-disc ratio asymmetry between eyes was 0.26. Prevalence of undiagnosed glaucoma was 2.9%, increasing with age to 6.6% of the population over 70 years old. Among those with glaucoma, 78% were previously undiagnosed and untreated. Blacks have roughly 4.4 times (95% confidence interval [CI]: 2.9–6.7; P < .0001) and Hispanics have roughly 2.5 times (95%CI: 1.5–4.3; P = .0012) greater odds of having undiagnosed and untreated glaucoma than non-Hispanic whites.
Approximately 2.4 million persons in the US have undetected and untreated glaucoma. Overall, prevalence of both diagnosed and undiagnosed glaucoma is much higher in minorities and the elderly. Among those with definite glaucoma, individuals younger than 60 years of age have a greater proportion of undetected disease.
The role of environmental light in sleep and health: Effects of ocular aging and cataract surgery
2010, Sleep Medicine Reviews
Citation Excerpt :
Light therapy for insomnia is also effective for the institutionalized elderly.152,153 Cataract surgery alone with colorless ultraviolet (UV)-only blocking IOLs has been shown to reduce the incidence of insomnia by 50%,130,154 without altering habitual light exposures. Reduced circadian photoreception due to crystalline lens yellowing and pupillary miosis becomes significant by early middle age.
Environmental illumination profoundly influences human health and well-being. Recently discovered photoreceptive retinal ganglion cells (pRGCs) are primary mediators of numerous circadian, neuroendocrine and neurobehavioral responses. pRGCs provide lighting information to diverse nonvisual (non-image-forming) brain centers including the suprachiasmatic nuclei (SCN) which serve as the body's master biological clock. The SCN exert functional control over circadian aspects of physiology. The timing and strength (amplitude) of SCN rhythmic signals are affected by light exposure. Light deficiency may attenuate SCN function and its control of physiological and hormonal rhythms which in turn can result in a cascade of adverse events. Inadequate pRGC photoreception cannot be perceived consciously, but may aggravate many common age-associated problems including insomnia, depression and impaired cognition. In this review we (1) summarize circadian physiology, emphasizing light's critical role as the most important geophysical timing cue in humans; (2) analyze evidence that typical residential lighting is insufficient for optimal pRGC requirements in youth and even more so with advancing age; (3) show how ocular aging and cataract surgery impact circadian photoreception; and (4) review some of the diverse morbidities associated with chronodisruption in general and those which may be caused by light deficiency in particular.
Trabeculectomy with Mitomycin C for Neovascular Glaucoma: Prognostic Factors for Surgical Failure
2009, American Journal of Ophthalmology
Citation Excerpt :
NVG caused by DR is a debilitating disease because it could lead to visual loss in both eyes. Studies have shown that visual loss is associated with increased mortality.22,23 The increased mortality rate may be attributable to the severity of the underlying disease that causes NVG, the deterioration of the overall health condition in patients with loss of vision, or accidents such as falls in patients with poor vision.24,25
To evaluate the prognostic factors for surgical outcomes of trabeculectomy with mitomycin C (MMC) for neovascular glaucoma (NVG).
Retrospective cohort study.
We reviewed the medical records of 101 patients (101 eyes) with NVG treated at Kumamoto University Hospital. The primary endpoint was persistent intraocular pressure ≥ 22 mm Hg, deterioration of visual acuity to no light perception, and additional glaucoma procedures. Multivariate analysis was performed using the Cox proportional hazards model.
The mean follow-up period was 29.3 months (range, 0.5 to 142.3 months). The probability of success 1, 2, and 5 years after trabeculectomy was 62.6%, 58.2%, and 51.7%, respectively. The multivariate model showed that younger age (relative risk [RR], 0.96/year; P = .0007) and previous vitrectomy (RR, 1.62; P = .02) were prognostic factors for surgical failure among all NVG patients. Additionally, an eye with unremoved proliferative membrane and/or unrepaired retinal detachment (RD) after vitrectomy (RR, 1.59; P = .05) was a probable prognostic factor in a subgroup of 66 eyes with previous vitrectomy, and having a fellow eye with NVG (RR, 1.73; P = .003) was a significant prognostic factor in 82 eyes with NVG attributable to diabetic retinopathy.
The prognostic factors for surgical failure of trabeculectomy with MMC for NVG were younger age and previous vitrectomy in all NVG patients, and having a fellow eye with NVG in patients with disease caused by diabetic retinopathy. Persistent proliferative membrane and/or RD after vitrectomy might contribute to poorer outcomes of trabeculectomy.
Cataract: Window for systemic disorders
2007, Medical Hypotheses
Cataract is the leading cause of visual handicap throughout the world, and almost all elderly individuals develop lens opacities. Epidemiological studies have shown that nuclear cataracts in young adults are associated with higher mortality. Many cataractogenic stressors induce endoplasmic reticulum (ER) stress, which in turn induces the unfolded protein response (UPR). The UPR can damage or kill a wide range of cell types and may be involved in many human diseases. We hypothesize that a cataract can be considered a window that can indicate the presence of systemic disorders. This is important because cataract is easily detected during a routine ocular examination. The slightest opacity in any region of the lenses, especially in younger patients, may be a sign of systemic disorders. Earlier detection of systemic disorders can save the lives of patients. If our hypothesis is correct, then elimination of known ER/cataractogenic stressors from individuals with cataracts should be the one of the first steps for treatments of the systemic disorders. We discuss the potential risk factors and beneficial effects of removal of such risk factors in patients with early cataracts. All patients with cataract should be referred for comprehensive medical examination.
Open-Angle Glaucoma and Cardiovascular Mortality. The Blue Mountains Eye Study
2006, Ophthalmology
To evaluate the association between open-angle glaucoma (termed glaucoma) and 9-year mortality in an older population-based cohort.
Population-based cohort.
Three thousand six hundred fifty-four persons aged 49 to 97 years (82.4% of the eligible population), residents of the Blue Mountains, west of Sydney, Australia.
At baseline (1992–1994), glaucoma was diagnosed from congruous typical glaucomatous visual field changes (full-threshold fields) and optic disc cupping (stereo-optic disc photography). Demographic information from baseline participants was matched with the Australian National Death Index data (December 2001) to obtain the number and causes of deaths. Cox proportional hazards regression analysis, controlling for age, male gender, diabetes, hypertension, heart disease, stroke, use of oral β-blockers, current smoking history, alcohol use, myopia, and nuclear cataract were performed to assess hazard ratios for cardiovascular mortality. Adjustments for all-cause mortality also included history of cancer.
Cardiovascular and all-cause mortality.
At baseline, glaucoma was diagnosed in 108 participants (3.0%). Of 873 deaths (23.9%) before January, 2002, 312 people (8.5%) died of cardiovascular events. The age-standardized all-cause mortality was 24.3% in persons with and 23.8% in those without glaucoma, whereas cardiovascular mortality was 14.6% in persons with and 8.4% in those without glaucoma. After multivariate adjustment, those with glaucoma had a nonsignificant increased risk of cardiovascular death (relative risk [RR], 1.46; 95% confidence interval [CI], 0.95–2.23). Increased cardiovascular mortality was observed mainly in glaucoma patients aged <75 years (RR, 2.78; 95% CI, 1.20–6.47). Further stratified analyses showed that cardiovascular mortality was higher among those with previously diagnosed glaucoma (RR, 1.85; 95% CI, 1.12–3.04), particularly in those also treated with topical timolol (RR, 2.14; 95% CI, 1.18–3.89).
Findings from the Blue Mountains Eye Study demonstrate an increased cardiovascular mortality in persons with previously diagnosed glaucoma. There was a suggestion of higher cardiovascular mortality in glaucoma patients using topical timolol that merits further study.
Age-related maculopathy: A risk indicator for poorer survival in women: The Copenhagen City Eye Study
2005, Ophthalmology
To examine patient survival in age-related maculopathy in a 14-year follow-up study.
Population-based 14-year cohort study.
Nine hundred forty-six residents, aged 60 to 80 years, living in the Østerbro district of Copenhagen, Denmark, participated in the first examination conducted from 1986 to 1988. These participants were followed until death or until May 1, 2002, whichever came first.
Participants underwent an extensive ophthalmologic examination at Rigshospitalet, the National University Hospital of Copenhagen. Standardized protocols for physical examination, blood samples, and data from the National Central Person Register, the National Death Register, and the National Patient Register were used.
Mortality and age-related maculopathy.
By May 1, 2002, 60.9% (577 of 946) of the participants of the baseline study cohort had died. The adjusted 14-year cumulative mortality hazard ratio for subjects with early and late age-related maculopathy at baseline was 1.26 (95% confidence interval [CI], 1.06–1.51). We identified a strong correlation between mortality and age-related maculopathy among women (relative risk, 1.59; 95% CI, 1.23–2.07) but not among men.
When adjusting for survival-related factors, age-related maculopathy is a significant risk indicator for poorer survival in women and may be a marker of underlying serious systemic factors or aging processes specific to women.

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Survivorship and causes of death among the blind

Abstract

J. chron. Dis.

Mortality of the blind

Statist. Bull. Metrop. Life Insur. Co.

Length of Life

A stochastic study of the life table and its applications: III. The follow-up study with the consideration of competing risks

Biometrics

Massachusetts State Life Tables: 1949–1951

Vital Statist. Spec. Rep.