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everyone, to Wednesday Nite >> Tomat the Lab.lcome,
I'm Tom Zinnen. I work here at the UW Madison
Biotechnology Center and for UW Extension Cooperative Extension,
and on behalf of the Wisconsin
Public Television, thanks again for coming to Wednesday Nite atn
the Lab.
night, 50 times a year. Tonight I'm delighted to be
able to introduce to
who's both a physician and you Barbara E.K. Klein
She's a professor in the a master of public health.
Visual Sciences and is Department of Ophthalmology and
of Population Health Sciences afhere at the University ofent
Wisconsin Madison.
the Beaver Dam Eye Study which She is also the co-director of
tonight. will be the subject of her talk
on the prevalence and incidence Thisof age-related cataract,ion
macular degeneration and
are all common eye diseases diin an aging population.ch
The study also has examined other aging issues such as
overall health, quality of life and environmental and medicinal
exposures.
Dr. Klein to Wednesday Nite at Please join me in welcoming
[APPLAUSE] the Lab.
very much for coming out >> Barbara Klein: Thank you
I know it wasn't fun walking this evening.
I'll get started and I think through the ice and slush.
the end for questions. there will be plenty of time at
This is the banner story in the Daily Citizen, the Beaver Dam
Daily Citizen, in 1987. After about two years of writing
and rewriting grant proposals to
Study was funded, and the thnewspaper's been a veryye
wonderful supporter of this study.
Let's see, the reason that the
conceived and designed was Beaver Dam Eye Study was
there was very, very little becinformation on the common so,
chronic eye conditions, not esoteric things but things all
of us will likely face with regard to how common they were,
what was the incidence or new development after so many years
of life and then what were risk factors in particular for these
common conditions.
functional end point, which is In particular, we looked at the
visual impairment or legal visual impairment and severe
the causes which are cataracts, blindglaucoma, age-relatedked at
degeneration or macular degeneration, and, as was
pointed out by Tom also,
We got a lot of information about other things as well, some
of which I'll share with you
Retinal vein occlusion as it this evening.
we had anticipated, and this is turnedalso a big problem.n than
Well you may be quite familiar
It's about 39 miles northeast of with where Beaver Dam is.
as well. Madison, not far from Milwaukee
between the two. It's about equal distance
because of the Rose Bowl. We paiSo why Beaver Dam?r red
I've been asked this question innumerable times.
We chose Beaver Dam because it
small communities throughout the was very representative of other
It had the appropriate size population for adequate sample
sizes to test the hypotheses we were interested in.
Beaver Dam had a high participation rate in an earlier
study that we had done. And the community leaders from
all walks of life as well as the
providers, including eye doctors physicians and eye care
time was unusual, all cooperated and optometrists which at the
Also very important was that it was close to Madison, and if
something happened at the field center in Beaver Dam and I was
at my office in the WARF
within an hour. So this is a picture of the
gazebo in Swan Park, and in times past there used to be
springs, excuse me.
People would come to
and they'd be dealt this take the waters in Beaver Dam
Pardon me for a minute.
Sorry.
the project was getting an Well, a very important part of
This is one of our census takers accurate census.
[LAUGHTER] in action.
1987 and 1988 to determine the The census was done between
target age range as well as to actual number of people in the
their current addresses. ascertain or confirm
previous census, the national census, but this was many years
after and we had to update it.
ourselves to the community, in We also wanted to introduce
we would be recruiting study particular each household where
We also collected some very basic information about vision
and self-reported eye conditions.
By doing this, we identified
age. 5,924 people 43 to 84 years of
Each participant received an That was our target range.
up by a call and then a inscheduling of appointments.wed
We did a study evaluation which took about two and a half hours
for each participant. Then we collated all the
information, and those who
received it as well as their wanted the information back
chose to do that. hAnd then, of course, the big
part is the analysis of the wealth of information that came
in after that.
years the first time through Took us about two and a half
back and forth, but the participation rate has beent
tremendous in Beaver Dam. It's been a wonderful community
to work in, and we're still working there.
And I'll tell you a little bit
I'm sort of cutting to the chase more about that in a moment.
the prevalence. Prevalence is a cross-section of
the population at the time of the first exam.
So this is prevalence of visual impairment.
Visual impairment means visual
an in depth refraction and using acuity of 20/40 or worse after
So we call this the best that optimal correction.
And you can see from the slide corrected visual acuity.
uncommon in the youngest age that visual impairment is very
and it stays very low until that group, the 43- to 54-year-olds,
increases to about 20% of last decapeople.o when it
Excuse me again.
This plots the data for legal blindness which is about 2200
or worse in the better eye.
You can see that woman
disadvantaged compared to men. are disproportionately
scale is different but, again, Once again, you notice that the
after age 65. it's Oops, sorry.rease
I'll go now through the individual eye conditions.
So the first one would be cataract.
A picture of me at an earlier stage in my career.
[LAUGHTER]
we use to examine for cataract, and right next to it is a camera
that we use to take photos
I'm also pointing out to one of the study participants where
we're looking at when I look at the lens of the eye.
There are three kinds of
cataract, cortical cataract, and age-related cataract: nuclear
These photographs are taken after the pupil is dilated with
dilating eye drops, and a light beam comes in at 45 degrees from
where the camera is angled so that you get a sort of a
cross-section and you get the impression of sort of layers or
like layers of an onion.
young lens, very little nuclear And on yoursclerosis. relatively
And on your right is someone
center part, is dense or less where the nucclear.which is the
That's a nuclear cataract.
this set, through a dilated pupil but with a different sort
of camera.
retroillumination camera, a bright light is shown into the
eye, and the reflected light
orange appearance. from the retina gives it that
no cataract. On your left is a clear lens,
cataract. On yoExcuse me again.ical
I'm so sorry. This is another form.
This is the posterior subcapsular cataract.
The one on your left again is clear.
This opacity is in the back part
very visually disabling. of the lens, and it tends to be
important? Why is preventing cataract
blindness worldwide. Cataract is the leading cause of
blindness than a variety of Iparasitic infections that usedf
to be quoted as being the most
It's also the leading cause of important.
It's responsible for about 60% loss of vision in the US.
vision. of alSo it's a big problem.ed to
Cataract surgery which is relatively easy to come by in
this country can be complicated,
for surgery or at least you have there are always complications
it can be uncomfortable, it's expensive and it may not be able
for those with limited or no
I think this is going to be a bigger and bigger problem.
It's also not widely available
This again is a summary of the in some Third World countries.
study. data from the first Beaver Dam
are the prevalence of cataract, and you can see once again that
inexorable increase with
we got there, there were a increasing age but by the time
had some cataract surgery, number of people who had already
Rises to be about, cataract is usually with implants in place.
or older. When I group together the three
kinds of cataract you can see,
increasing age because they are all age related, and once again
you can see that women are
This is just a summary of the diprevalence of the threeed.
different kinds.
people had nuclear cataract, not So you can see that 17% of the
Cortical, about 16%. rare.
visually disabling, about 6%, Pand cataract surgery had beent
done in about 3.6% of people. Well, what are the causes of
this? Are there environmental causes
to these problems?
the risk of cataract quite It looks like smoking increases
significantly for nuclear signicataract. most
I would point out that for the
significant all the time. And this may be a sample size
issue.
who smoke 10 pack-years will have a 9% increase in risk.
But most smokers or many smokers
10 pack-years in their lives. So you can see it becomes quite
a significant cause for increase
most common cause of cataract in nuclear csurgery.which is the
A little bit less and not statistically significant for
cortical and a smaller effect on
I'm going the wrong way. posterior subcapsular cataract.
is also associated with Past heavycataract. it appears
And you can see it appears to increase the risk of all three
kinds of cataract.
doing the Rotterdam Eye Study that was patterned after Beaver
Dam, and when I told him we consider heavy drinking to be
four or more drinks per day on a
And he said, that's not heavy drinking, everybody drinks that
much. [LAUGHTER]
But that's not true in Beaver Dam.
And so we have relatively few heavy drinkers, but they are
apparently at increased risk. Well there are other factors
that are environmental factors
cataract. There's evidence that UVB is
associated with cortical
UVB is the common UV radiation cataract in men.
when you're outdoors, and we that comes in with blue light
Beaver Dam and also there have found an increased risk in
corroborate this. And there may be an association
with CAT scans to the head but
So what have we learned about cataract from the Beaver Dam Eye
Study or from the prevalence
We found that more than 80% of data at any rate?
75 had cataracts, that's pretty people who prevalent.the age of
Women were more likely to be
Smoking, heavy drinking were affected than men.
cataract. UVB exposure, diabetes, past
heavy drinking were associated
Diabetes, steroid use, past heavy drinking were associated
with posterior subcapsular
So they seem to have slight differences in their risk
factors.
protection? Of course the idea is to find
things that you can intervene on
this. to prWell, the data abouttting
multivitamins is tenuous. We found a significant effect
but not strong for cortical cataract.
Some studies find it, some
Something that we found five don't.
statistically significant protective effect of statin
drugs for cataract, in
We have yet to see this preplicated, although the Bluet.
Mountains Eye Study, sister study right now, the Blue
Mountains of Australia right
similar protective rate but it outside of Sydney, found a very
significant. wasn't statistically
It hasn't been tested in a So we have yet to see.
I'm going to move along to trial.
Beaver Dam, age-related macular anotherdegeneration.tion in
And you all may know something
There really was very little about this.
when we started. information about this disease
the incidence and progression Swhen evidence of some of the
disease was already there.
have some information about treatments to prevent or restore
vision in the late stage. So this is one of our field
examiners using this camera.
designed to take photographs of This is the retina.r camera
It's a fundus camera. Not easy to use for the
examiner, not so easy for the patient either, the participant
either. So this montage shows you just a
quick glimpse of fundus, that is
different degrees of this retlesion, or this condition.ave
On the top we see early age-related macular
degeneration, and you see that
there. there are a lot of yellow spots
the optic nerve looks good, but those yellow spots, if you want,
are called drusen, and they're
of the retina, and this person excrescences in the deep layers
all. would likely have no symptoms at
pictures of late age-related On the bottom you see two
The one on your left is called macular degeneration.
is cut off, and essentially the geretina is missing in whattom
appears to be a geographically
And of course you can't see in defined area.
The other one is called neovascular or wet AMD and that
red stuff is blood. There's been new growth of
vessels from the choroid, a vascular layer under the retina,
and this new vessel membrane is very friable and fragile, and it
often breaks, bleeds and people can go to sleep seeing and wake
up and see nothing. Fortunately, you can see that as
early age-related macular degeneration occurred in only
16% of people, the late AMD occurred in only .6%, and the
neovascular in 1.1%.
and tell you just a little bit Let me back up for a minute here
Of course age is a risk factor, and I'll show you that again
graphically.
are disproportionately affected Gender,for neovascular. women
Smoking seems to be the most
factor that's related to it. important obvious environmental
It takes a while but before it And hypertension.
factor that you can find to be rears its ugly head is a risk
This is a graph of the statistically significant.
Again, the tall bars are early prevalence data.
degeneration. You can see that monotonic
increase with increasing age. The difference between men and
women is not so obvious, but it is statistically significant
when you divide them by the wet and the dry type.
And along the bottom, the smaller bars, the yellow and
green, are late lesions.
I'm sorry. Again, very clearly age related.
I talked about in hypertension, So,there's also heavy alcoholat
consumption appears to increase risk.
Chronic inflammation that's ascertained by doing studies,
inflammatory markers in the blood appear to increase risk.
For reasons that are not clear
associated with it in Beaver at all, sedentary lifestyle is
And the biggest thing that I put Dam.
factors. in larger font is genetic
this recently. And you may have heard about
three or four years ago when a There was a big explosion about
responsible. particular gene was found to be
actually responsible for is not known, but it's clear that wills
are many different genetic
Are there protective factors? Well, antioxidant multivitamins
may reduce the incident and progression of late wet and dry
AMD, and of course avoiding known risk factors will do it
too.
preparations were tested in a clinical trial called the AREDS,
the Age-Related Eye Disease Study, where there is random
assignment to antioxidant nutrients and zinc or not, a
placebo.
moderate degrees of age-related macular degeneration but no
symptoms before, those people who took the experimental
supplement had a 25% decrease in
disease. progressing to late stage
About 27 people in the group who Not a miracle.
on, about 21 and the group that got it went on, but it's about a
25% reduction.
They're commonly sold in any You may know these preparations.
There are new treatments that have come on even while we've
been in Beaver Dam over the last
Avastin and Lucentis, which were now 20 years.
designed for and used for metastatic cancer, are used now
by intravitreal injection,
wet AMD. that's a needle to the eye, for
Now, it's often true that people This has provided some success.
injections which isn't fun and need to come back for repeated
or inflammation. can be associated with infection
vascular endothelial growth Therefactor inhibitors, or them
anti-drugs, but currently there's no treatment for dry
AMD.
can tell you, but there's It'nothing on the market now. I
So that's the end for macular degeneration, and I hope if you
have questions we'll talk about it after.
I'll talk a little bit about
Now, glaucoma in Beaver Dam, glaucoma.
population, over 99% of the whichpopulation is white.hite
And glaucoma is a much more common disease in people of
African heritage, African Americans or African Caribbean
background. Nevertheless, it occurs in
Beaver Dam. You can see once again the age
trend, but of course if you notice the scale it's not nearly
as common as the other
In people who were 75 and older, conditions.
This is just a grand summary of the diseases that I talked about
so far. So you can see that cataract is
by far the most common
Cataract surgery was also fairly condition.
until later. common, but it doesn't occur
thing, the names vary by the Maculopathy, that's the same
because of the trends in what time you call things.lide
It used to be called senile macular degeneration and that
word was bad. [LAUGHTER]
So now it's maculopathy or age-related
macular degeneration, that's the same thing.
It's the next most common.
common. YAnd then just to show you howry
common visual impairment is and that has importance for quality
of life and so on.
years because the Beaver Dam Eye So I'm jumping ahead now 15
was completed in 1990, but just in November, the last November,
we finished the 20-year follow
We don't have that data ready to up.
So I'm presenting just a little bit of the findings from the
previous exam which would be
baseline for the follow up, 15-y15-year incidence.the
So at the 15-year point, these
severe visual impairment in were thBeaver Dam.auses of
Now, incident means they didn't have this at the baseline exam.
They may have had some
blind. impairment but they weren't
had become blind or had visual But 15 years follow up, 180 eyes
That's the big E on the top of acuity poorer than 2200.
You can see that at 52%, the doctor's eye chart.
I'm sorry, AMD leads it for severe visual impairment..
That's the 52%. Sorry.
12% were due to cataract which
will, in Beaver Dam. is very easy to obtain, if you
community, it's right here near That's sortMadison.ddle-class
12% of those with severe
occlusion. impairment had a retinal vein
turned out to be much more As I was mentioning before, it
this is quite severe visual common than loss.ought because
So that was news to everybody.
Again, we didn't realize that 5%was going to be so common.e.
And then there are a variety of other things.
What's notable is that diabetic retinopathy, which we thought
was going to be a much more common cause of visual loss, is
now responsible for about the same amount of severe visual
impairment as is the retinal
probably because there have been vein occlusion, and that's
in the care for people with great striddiabetes.u may know,
And tight glycemic control has
remarkably for all complications really improved things
retinopathy but also cataract ofthat occurs more commonly inc
people with diabetes. So this is a real giant step
forward in medical care.
at the incidence. At We measured things at thelook
baseline, we looked at the
of poor vision and we looked at incithe risk factors for it.ment
Actually, I guess here I'm just going to tell you what happened
to those people over the course of time.
Not the risk factors for poor vision, we may get to that.
But people who had lost vision
a nursing home. wThey were more likely, as youin
might expect, to have falls and fractures.
We've got good history on that. They were more likely to give up
driving.
because they know themselves Many people give up driving
But that's a big problem in Beaver Dam which is a rural
community.
up your independence. OnceSo that's a hard thing.give
It's a big change in life.
have a host of other medical And they were more likely to
I want to just show you just a problems.
disease wise over the course of ttime and why it's so important
to have a longitudinal follow up.
At the top you can see that when
had some early lesions of AMD. we first saw this person they
yellow spots. The coloration of the photo is a
little different compared to the
accept that people with different pigmentations have
different color in their fundus.
your lower left. There's a little bit more at
picture on the right, which is And by the time you get to the
the baseline exam, there's a big in this case only 10 years from
anymore but you can see a sort patch where the retina isn't
atrophic lesions and you can of white area and you can see
from the new vessel. also see some blood and that's
macular degeneration and wet. And what happens is that the
central vision is lost. They tend to keep peripheral
vision, side vision is good, but
or if you're trying to track when you want to read something
it. somSo, there was a very highe of
incidence of late AMD of both varieties in people who were 75
years or older at the baseline
So in other words, it really exam.
cause of loss of vision as you gets to be a very significant
But it's not all bad news. get older.
are born more recently were at At any specific age people who
than those people born at an less risk for developing AMD
And I'll try and walk you through a slide of this, but let
me just talk this part out. For example, the five-year
incidence, over a five-year course of early AMD in people
examined when they were 65 to 69
born in 1918 to 1922, 10% in was 14% among people who were
years more recently than that, those people born just four
recently, and 4% amongst those 6% again in those born in more
So there's a very step wise decrement in the incidence of
new disease.
In other words, the way you would look at it here is that
you can see the increased incidence with increasing age
but at each age group in each set of four bars the people to
the right-hand side in the group
compared to those at the other of four were born most recently
And you can see until about the last group when we run out of
numbers that people who were
systematic decrease in born more recently have a
We don't know why that's true, incidence.
doing, presumably living better is good for everything, and it's
probably true that many, many things have improved since the
earliest decades. And we don't have any idea
really what exposures in life,
to you, are increasing or have except for the few I mentioned
Well, I sort of gave you a increased the risk.
the eye diseases, but the Beaver whirlwind trip through some of
been borrowed by many, many Dstudies around the world.ve
There's the age study which is
India, the ARIC which is an atherosclerosis study in this
country, the Baltimore Eye
I could go on and on and on. Study, Barbados Eye Study,
of studies that have borrowed protocols and other things and
people who have come to work
So more data is available around with us.
In the most recent Beaver Dam exam phase we have added an
interesting new examination tool.
Excuse me once again.
This is called an OCT.
But it shows you, it's painless. It's a really fancy gizmo.
a photograph, and you sit still and it shows you, in depth, thee
layers of the retina. So you can get a better idea of
what's going on really. Let's see if I can get this to
work. So you get a photograph like
this and then using this fancy
looks like histologic sections new technology, it takes what
Let's see, there you go. through the retina.
through the retina at different So it's tlevels.ive slices
And you can see, this happens to
swelling in the macular area. be aAnd you can see where ita or
balloons up that there are cysts
edema fluid. that are filled with fluid,
very important in trying to Sunderstand the development ofe
some of these diseases.
Pardon me.
that I have about eye disease. This really concludes the part
can present to you about a few I have a little bit more that I
Dam. of the other facets of Beaver
I'll go on. So here's just something else
about Beaver Dam. Falls are a big problem
as I noted to you before. It costs about $19 billion
annually for the healthcare budget to take care of the
variety of things that are
It's a sixth of the cost of the incurrIraq war.a fall.
It causes fractures and all sorts of disability and, on
occasion, even death. So falls are a big problem.
Here are some of the causes that
associated with falls. in the literature have been
environmentally related. Some of them are just
disorders. Some are gait and balance
vertigo or dizziness. SOthers, some people just haveh
what are called drop attacks, they just lose consciousness.
Some confusion. Some postural hypotension.
In other words, you stand up
drops, boom, you go over. And then there are visuale
disorders that are associated with falls.
As well as your garden variety
And then some, they call them other, they can't identify the
particular cause. But what are the risk factors
for falls?
and balance deficits are the It seems as though the weakness
risk factors, while the postural most common or the strongest
And then there are various hypotension is less common.
cognitive disorders and mobility things in between including
So it is my purpose to limitation.
with respect to vision and other quantitate the risk of falls
in Beaver Dam. potentially modifiable functions
follow up and, at that time, I used data from the 15-year
survivors from the original group and that was 77% of people
who were still alive to come in.
of the things I'll show you for And we hadabout 2,256.ta on some
We asked people, during the past
landed on the floor or ground or 12 months have you fallen and
table or a stair? If they said yes we asked, them
how many times have you fallen
We give them one fall for in the nothing.months?
You live in Wisconsin, falling
have nothing to do with your is not a rare event and it may
icy sidewalk like mine. So we give them one for nothing.
But we used as our outcome two
And we looked at a variety of vision measures.
Here are the ones that we had in
We had what's called the logMAR, Beaver Dam.
Snellen chart. it's just a variation of the
small ones at the bottom. Then we used something called
contrast sensitivity. And this gives you an idea of
how people function in less than
And then we have a near vision perfect lighting.
measure certain things. It certainly tells you a lot
about how vision affects
have trouble reading. peoWe considered these all ashey
measures of frailty.
of frailty in the people of And we diBeaver Dam.f measures
We did a timed walk.
out, same for everybody, and we Wtimed how long it took them to
walk there. We did a chair stand.
These, incidentally, are
aging. standard measures in studies of
without using their hands from a We asked people to stand up
of 19 and a half inches. chair at a certain height
grip strength. We used a dynamometer to get
cardiovascular disease and other It's a very good measure in
events and also mortality. studies of subsequent cardiac
expiratory flow rate, which is a And then we did a peak
test. And in Beaver Dam we are poor
men and women.
of your Uncle Sam. We depend on the largess
of course, are age and sex. We also looked at things that we
thought would be related and
blood pressure, height, weight, thwaist and hip diameter,ere
glycosylated hemoglobin.
questions about other And we asconditions. of other
We asked about physical activity, cancer, cardiovascular
disease, arthritis, other diseases and medication status.
I won't walk you through all of this.
These are just giving you an
variables that we were idea of some of the risk
Now, I want to walk you through interested this. Beaver Dam.
These are four vision measures. Now I only showed you three of
them before.
include here is the walking The fourtaround vision.re that I
In other words, people came in
first thing we did was say read with thour eye chart.s, the
So we call that the walking around vision.
Many people's vision could be improved, and that's the best
corrected vision. We did that for distance and
near, but we wanted to know how many people were actually
walking around with suboptimal
At any rate, what you can see are four sets of three bars.
The black bar in each is poor vision, and what you can see
when you look up the axis, the Y
taller than the others. In other words, people who did
poorly on the best corrected
walking around vision, and the vision far and near, the poorest
all had a higher risk of two or poorest cmore falls.sitivity,
We also looked to see if there
between the two eyes which we defined in a certain way, and we
found that lo and behold if the two eyes did not see equally,
the risk for falling was
It may be intuitive to some of greater.
that, but not everybody is aware you if you've had to deal with
We then showed here the different measures of frailty
that I showed you before, and it
bona fide risk factors for shows that in each case they are
People who could not stand up from a chair without help,
people who took the longest time
people who had the poorest hand grip strength, and those with,
the poorest pulmonary function
falls. all were at increased risk of
these measures and we called We put together an index of all
one point for each bad thing you this a frailty index and you got
So either if you had a poorer measure on any one of the vision
tests, if you couldn't stand
your hands, if you had the from the chair without using
the poorest hand grip strength slowest time to walk the course,
function. So we had a scale that went from
nothing wrong to all five of
the greater the number of tfrailties the more likely youat
were to have a fall.
related to falls are things that Other things that were also
People who are older were more you might find intuitive.
Women were more likely to fall likely to fall.
If they had two or more what we call co-morbidities, other
illnesses that we could identify, cardiovascular
disease, cancer, arthritis, whatever, two or more had
increased risk. And then medications, this is a
very interesting one, but people
medications. in Beaver Dam take a lot of
increased risk of falling with And you can see that there's an
medications. an increased number of
medications or the reason that Now I don't know if it's the
sure. We didn't have enough in any one
class to be sure. Things you worry about of course
are sedatives and things of that
blood pressures medications and sort, but ton and on.any others,
Things that we thought might be related that weren't were use of
vitamin supplements, some specific medications like
sedatives, statins were not protective, hormone replacement
therapy which some women were still taking at the time,
physical activity didn't come in, neither did portliness, body
mass index or the waist/hip ratio, and blood pressure didn't
either. Well, in any study you do there
are limitations, things that you
or you couldn't afford to but would you thought was bad.etter
We, for example, didn't have a
think is quite important. And also people who had very bad
diseases didn't participate.
these tests in order to get counted, and people who were
quite severely disabled couldn't
So my conclusion is that people with poor visual function had a
higher frailty score and had an increased risk of history of
falls.
a good measure to evaluate I think the frailty score may be
falling. persons at increased risks of
some of these. And something can be done for
some of them, not for Physical everything. help for
But also doctors paying attention to medications and so
on and counseling patients would
So longitudinal follow up, I be helpful.
important having long-term can't emphasize enough how
many of the problems here. measures is for understanding
evaluation from '88 to '90 and As I said, we had baseline
times. we had reexaminations these many
getting to the data analysis, Abut that's a big step yet.t
We still have a lot of work to
This will allow us to calculate change over time, incidence of
new diseases, we add other risk factors that have become more
and more important over the years.
We've added some protocols that will give us more information
like the OCT. Did we do anything good for the
people in Beaver Dam? They've been very good to us.
They've been a wonderful
But we did diagnose 90 people with diabetes who didn't know
they had it, 947 people with
significant carotid narrowing, increased cholesterol, 124 with
Beaver Dam study. thThere's a parallel study onthe
hearing where they got funded,
carotid artery narrowing. And we found that 729 people had
hearing loss, all of whom did not know that they had the
condition.
the Beaver Dam Eye Study is that So the border implications of
nationally for disease we have estimates that are used
published in a variety of ways. As I told you, we freely share
our protocols so there can be international collaborations and
also we can compare across
very insightful. countries which sometimes is
the cohort have provided And the incidence studies and
incidence and changes over time, increased information on the
The Beaver Dam Eye Study has as I mentioned before.
It started out as an eye study. Now, as I mentioned, we have a
hearing loss component which is also where they do the IMT or
the carotid measurements. There's also a health outcome
study, finding how sort of
these people. quWe are hot now on geneticgst
studies of all the age-related
really a very, very promising eye carea of research.is is
And I guess that's about it.
attention, and I'm more than I thank you very much for your
might have. h[APPLAUSE] u