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To contact Frederick L. Ferris III, M.D., call Mike Coogan at 301/496-5248.

EDITORIAL: BLINDNESS AND VISUAL IMPAIRMENT

CHICAGO—In an editorial in the April theme issue of the Archives of Ophthalmology on blindness, editorialists Frederick L. Ferris III, M.D., of the National Eye Institute, National Institutes of Health, Bethesda, Md., and James M. Tielsch, Ph.D., of The Johns Hopkins University, Baltimore, describe the rationale for forming The Eye Diseases Prevalence Research Group, an initiative funded by the National Eye Institute of the National Institutes of Health with additional funding from Prevent Blindness America (Schaumburg, Ill.) that has estimated the current and projected prevalence rates of several major eye diseases in the United States.

They state that prevalence data are the most basic measure of the burden of illness on a population, and that "Such population-based data are critical for program management and for identifying areas where basic and clinical research efforts must be increased in order to avoid a demographically induced tidal wave of chronic ocular disease over the next few decades."

The editorialists note that previous studies to assess prevalence rates for various eye diseases were flawed for reasons including underreporting of illness, especially among people of lower socioeconomic status, study populations that were not fully representative of the U.S. population, and other study biases.

The Eye Diseases Prevalence Research Group has used large, population-based studies, along with population data from the 2000 U.S. Census and projected population data to determine the prevalence of cataract, age-related macular degeneration, diabetic retinopathy and other eye disorders.

"Although there are shortcomings to any meta-analyses such as these, such estimates are likely to be reliable, or perhaps more reliable, than estimates that could have been obtained from a nationwide prevalence study, and they are available without waiting many years and spending tens of millions of dollars," the editorialists write.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, April 12, 2004
To contact John H. Kempen, M.D., Ph.D., call John Lazarou at 410/502-8902.

ONE IN 12 DIABETICS OVER AGE 40 HAS VISION-THREATENING EYE DISEASE

CHICAGO—Pooled data from previous studies suggests that approximately 4.1 million U.S. adults 40 years or older have diabetic retinopathy (DR), a disorder of the retina that occurs as a complication of diabetes mellitus (DM), affecting one twelfth of diabetics in this age group, according to an article in the April issue of the Archives of Ophthalmology, a theme issue on blindness, and one of the JAMA/Archives journals.

According to the article, diabetic retinopathy is one of the leading causes of blindness in the United States. It affects the blood vessels in the retina, the light-sensitive layer of cells at the back of the eye. Retinopathy occurs in most people with long-standing DM but its incidence can be reduced with aggressive control of glucose levels and blood pressure, the article states.

John H. Kempen, M.D., Ph.D., of the Wilmer Eye Institute at The Johns Hopkins Medical Institutions, Baltimore, and a member of the Eye Diseases Prevalence Research Group, and colleagues determined the prevalence of diabetic retinopathy among adults 40 years and older in the United States.

The researchers pooled data from eight population-based eye surveys. U.S. prevalence rates were estimated by using prevalence rates for DM reported in the 1999 National Health Interview Study, and 2000 U.S. Census population data.

The researchers found that among an estimated 10.2 million U.S. adults 40 years and older with DM, the estimated prevalence rates for retinopathy and vision threatening retinopathy were 40.3 percent and 8.2 percent, respectively. The estimated prevalence rates for retinopathy and vision-threatening retinopathy among the general U.S. population were 3.4 percent (4.1 million people) and 0.75 percent (899,000 people), respectively.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, April 12, 2004
To contact Monique S. Roy, M.D., call Kaylyn Dines at 973/972-7276.

EYE DISORDER THAT CAN CAUSE BLINDNESS IS HIGH AMONG PEOPLE WITH TYPE 1 DIABETES MELLITUS

CHICAGO—The prevalence of diabetic retinopathy, a disorder of the retina that can cause blindness, associated with type 1 diabetes mellitus is estimated to affect one per 300 adults over the age of 18 years in the United States, according to an article in the April issue of the Archives of Ophthalmology, a theme issue on blindness, and one of the JAMA/Archives journals.

According to the article, diabetic retinopathy (DR) is the most common eye complication associated with diabetes mellitus (DM). The retina is the light-collecting layer of cells at the back of the eye that converts light into signals, which are sent to the brain via the optic nerve where they are translated into images.

Monique S. Roy, M.D., of the University of Medicine and Dentistry of New Jersey - New Jersey Medical School, Newark, and colleagues estimated the prevalence of DR among people with type 1 DM in the United States using data from two large studies and population data from the 2000 U.S. Census. Type 1 diabetes usually develops at a young age (frequently in childhood) and generally requires treatment with insulin.

The researchers found that among 209 million Americans 18 years and older, an estimated 889,000 have type 1 DM diagnosed before age 30. Among people with type 1 DM, the prevalence of diabetic retinopathy was 74.9 percent for blacks, and 82.3 percent for whites. The prevalence of vision-threatening retinopathy was 30 percent for black persons and 32.3 percent for whites. The researchers also found that the prevalence of DR due to type 1 DM diagnosed before age 30 in the general population 18 years and older is estimated at 767,000 persons having DR of any degree of severity (0.37 percent) and 376,000 people having vision-threatening retinopathy (0.18 percent).

"Retinopathy due to type 1 DM is an important public health problem in the United States, affecting one per 300 persons 18 and older, and one per 600 persons with advanced, vision-threatening retinopathy," the authors write.

"The estimated population prevalences of DR of any level and of VTDR [vision-threatening diabetic retinopathy] are highest in the 40- through 49-year and the 50-year-and-older age groups, most likely because older persons who had the onset of DM prior to age 30 years had a longer average duration of the disease," write the researchers. "The prevalence of DR in the general population declines thereafter, reflecting a decreasing prevalence of type 1 DM in older age groups (possibly due to early mortality among persons with type 1 DM)."

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, April 12, 2004
To contact Nathan Congdon, M.D., M.P.H., call John Lazarou at 410/502-8902.

LEADING CAUSES OF BLINDNESS FOR BLACKS AND WHITES DIFFERENT

CHICAGO—The leading cause of blindness for white persons is age-related macular degeneration (AMD), while the leading causes of blindness for black persons are cataracts and glaucoma, according to an article in the April issue of the Archives of Ophthalmology, a theme issue on blindness, and one of the JAMA/Archives journals.

AMD is a disorder of the retina that affects mostly older people and causes gradual vision loss. Cataracts are caused by increasing opacity in the lens of the eye, and glaucoma is damage to the optic nerve caused by elevated pressure in the eye. According to information in the article, blindness and low vision are major causes of impairment among Americans. However, few population-based studies of national scope have been carried out in the United States to estimate the prevalence of visual impairment.

Nathan Congdon, M.D., M.P.H., of the Wilmer Eye Institute at The Johns Hopkins Medical Institutions, Baltimore, and The Eye Diseases Prevalence Research Group, and colleagues estimated the prevalences of various causes of blindness and low vision in the United States by age, race/ethnicity, and gender, and estimated the change in these prevalence figures over the next 20 years. The researchers based their estimates on recent population-based studies in the United States, Australia and Europe, and applied these estimates to 2000 U.S. Census data and to projected U.S. population figures for 2020 to determine the number of Americans with visual impairment.

The researchers found that an estimated 937,000 (0.78 percent) Americans older than 40 were blind. An additional 2.4 million Americans (1.98 percent) had low vision. "The leading cause of blindness among white persons was age-related macular degeneration (54.4 percent of the cases), while among black persons, cataract and glaucoma accounted for more than 60 percent of blindness," the authors write. Cataracts were the leading cause of low vision. Among Hispanics, the leading cause of blindness was glaucoma.

The authors project that the number of blind persons in the United States will increase by 70 percent to 1.6 million by 2020, with a similar rise in the number of people with low vision.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, April 12, 2004
To contact John H. Kempen, M.D., Ph.D., call John Lazarou at 410/502-8902.

APPROXIMATELY ONE-THIRD OF PEOPLE OLDER THAN 40 HAVE VISION DISTURBANCES

CHICAGO—Refractive errors (inability of the eye to focus properly) affect about one-third of people 40 years and older in the United States and Western Europe, and one-fifth of Australians 40 or older, according to an article in the April issue of the Archives of Ophthalmology, a theme issue on blindness, and one of the JAMA/Archives journals.

Refractive errors prevent the eyes from focusing correctly and cause blurry vision. Myopia (nearsightedness) and hyperopia (farsightedness) are examples of specific types of refractive errors. Usually, these errors can be easily corrected with glasses, contact lenses or refractive surgery. However, the high prevalence of refractive errors and the costs of correcting these errors make these conditions a substantial public health and economic problem in many parts of the world.

John H. Kempen, M.D., Ph.D., of the Wilmer Eye Institute at The Johns Hopkins Medical Institutions, Baltimore, and a member of The Eye Diseases Prevalence Research Group, and colleagues pooled data from six studies with a combined total of 29,281 participants. The researchers applied the data from the six studies to population data for the year 2000 and projected population data for 2020 from the United States, Western Europe and Australia.

The researchers found the estimated crude prevalence for moderate hyperopia to severe hyperopia was:

• 9.9 percent (11.8 million people) for the United States
• 11.6 percent (21.6 million people) for Western Europe
• 5.8 percent (0.47 million people) for Australia

• 25.4 percent (30.4 million people) for the United States; 4.5 percent of whom (5.3 million people) had more severe forms of myopia
• 26.6 percent (49.6 million people) for Western Europe; 4.6 percent of whom (8.5 million people) had more severe forms
• 16.4 percent (1.3 million people) for Australia; 2.8 percent of whom (0.23 million people) had more severe forms

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, April 12, 2004
To contact David S. Friedman, M.D., M.P.H., call John Lazarou at 410/502-8902.

PREVALENCE OF AGE-RELATED MACULAR DEGENERATION PROJECTED TO INCREASE SUBSTANTIALLY BY 2020

CHICAGO—Due to the rapidly aging population, the number of people in the United States with age-related macular degeneration (AMD), the leading cause of blindness in people older than 65 years, will increase from 1.75 million people to almost 3 million people by the year 2020, according to an article in the April issue of the Archives of Ophthalmology, a theme issue on blindness, and one of the JAMA/Archives journals.

AMD is a disorder of the retina (the light-sensitive layer of cells at the back of the eye) that can cause gradual vision loss, and is the leading cause of blindness among European-descended people older than 65 years. According to the article, recent research has demonstrated that the likelihood of vision loss from AMD can be reduced with high-dose vitamin supplementation and with certain laser procedures. Policy planners need estimates of the prevalence of AMD to determine the benefit of these and future therapies, the article states, but current estimates are conflicted.

David S. Friedman, M.D., M.P.H., of the Wilmer Eye Institute, at The Johns Hopkins Medical Institutions, Baltimore, and a member of The Eye Diseases Prevalence Research Group, and colleagues estimated the prevalence and distribution of AMD in the United States by pooling findings from large, population-based studies conducted over the past 20 years. The researchers applied the prevalence rates to 2000 U.S. Census data and to the projected U.S. population figures for 2020 to estimate the expected increase in AMD in the future.

The researchers found that the overall prevalence of AMD in the U.S. population 40 years and older is estimated to be 1.47 percent, with an estimated 1.75 million people having AMD. The prevalence of AMD increases dramatically with age, with more than 15 percent of white women older than 80 years having some form of AMD. More than 7 million people had drusen (deposits on the retina which are partially responsible for AMD), and were therefore at a substantial risk of developing AMD.

The researchers report that, "Owing to the rapidly aging population, the number of persons having AMD will increase by 50 percent to 2.95 million in 2020." They also found that AMD was far more prevalent among white people compared to black people.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, April 12, 2004
To contact Nathan Congdon, M.D., M.P.H., call John Lazarou at 410/502-8902.

PREVALENCE OF CATARACTS EXPECTED TO INCREASE SUBSTANTIALLY IN COMING DECADES

CHICAGO—The number of persons in the United States affected by cataracts is estimated to rise to 30.1 million people in the next 20 years, an increase of 50 percent, according to an article in the April issue of the Archives of Ophthalmology, a theme issue on blindness, and one of the JAMA/Archives journals.

According to information in the article, cataract is the leading cause of blindness in the world today and is also the leading cause of vision loss in the United States, responsible for about 60 percent of all Medicare costs related to vision. A cataract occurs when the lens of the eye becomes clouded or opaque, resulting in poor vision or vision loss. Cataract is more common in older people. The effect of age-related cataract is expected to increase as the U.S. population continues to age, the article states. However, few precise estimates have been made of the prevalence of cataract in the United States on a national basis.

Nathan Congdon, M.D., M.P.H., of the Wilmer Eye Institute at The Johns Hopkins Medical Institutions, Baltimore, and a member of The Eye Diseases Prevalence Research Group, and colleagues determined the prevalence of cataract in men and women over age 40 in the United States based on large, population-based studies. Prevalence rates were applied to 2000 U.S. Census data and projected population figures for 2020 to obtain overall estimates.

The researchers estimated that 20.5 million (17.2 percent) of Americans older than 40 years have cataract in either eye. Women are almost 40 percent more likely to develop cataract than men. The total number of persons who have cataract is estimated to rise to 30.1 million by 2020, the researchers write.

Other articles from the April issue of the Archives of Ophthalmology:

VISION 2020: The Right to Sight
A global initiative to eliminate avoidable blindness
Louis Pizzarello, M.D., of Southampton, N.Y., and colleagues summarize the status of VISION 2020, an initiative that aims to eliminate avoidable blindness in the world by 2020 and targets the world's leading causes of avoidable visual impairment: cataract, trachoma (an infectious disease), childhood blindness (including vitamin A deficiency), refractive errors, glaucoma and diabetic retinopathy.

Stem Cell Therapy for Ocular Disorders
Leonard A. Levin, M.D., Ph.D., of the University of Wisconsin Medical School, Madison, and colleagues present a summary of stem cell research and its applications to eye diseases. The authors discuss stem cell use for retinal diseases and glaucoma, and review current practices and challenges in using stem cells.

Doctor, What Vitamins Should I Take for My Eyes?
Julie A. Mares, Ph.D., of the University of Wisconsin - Madison, and colleagues present guidelines for clinical practice on recommending the use of nutritional supplements for reducing the development of eye diseases that are common among older people, based on current evidence. Results of the Age-Related Eye Disease Study (AREDS) suggest that nutritional supplements may be one of the most promising means discovered to date, of slowing the progression of age-related macular degeneration (AMD), and may help prevent or slow the progress of other eye disease.

Eyes, Brains, and Autos
Matthew Rizzo, M.D., of the University of Iowa, Iowa City, and colleagues discuss current policies, tests and countermeasures for drivers with visual impairment. Visual disorders, including glaucoma, macular degeneration, and diabetic retinopathy pose a driving safety risk.

For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.

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To contact Frederick A. Spencer, M.D., call Sandra Gray at 508/856-2000.

DURATION OF HOSPITAL STAY HAS SHORTENED FOR PATIENTS WITH HEART ATTACK

CHICAGO—From 1986 to 1999, the average length of hospital stay for patients with acute myocardial infarction (AMI, or heart attack) has significantly declined, without increases in death rates after discharge, according to an article in the April 12 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.

According to the article, the length of hospital stay for patients with AMI has evolved from prolonged bed rest and rehabilitation of more than six weeks in the 1950s, to hospital stays of less than one week today. In the United States, the typical length of stay for patients with an uncomplicated AMI is approximately five days, the article states. However, considerable variation exists in the duration of hospitalization for patients with AMI.

Frederick A. Spencer, M.D., from the University of Massachusetts Medical School, Worcester, and colleagues conducted a population-based study to describe trends in duration of hospitalization after AMI and patient characteristics associated with variations in length of stay, and the effects of shorter times in the hospital on death rates at one and three months after discharge.

The researchers studied data from 4,551 patients discharged after AMI from all Worcester, Mass. hospitals in eight annual periods from 1986 to 1999.

The researchers observed significant declines in the average length of stay between the 1986-1988 period (which included 896 patients) and the 1997-1999 period (which included 1,330 patients), from 11.7 days in the earlier period to 5.9 days in the later. Patients who stayed in the hospital longer were more likely to be older, female, and have cardiac complications. Patients enrolled in a health maintenance organization, Medicare, Medicaid, or with no insurance were less likely to have an increased length of stay. Crude mortality rates did not change appreciably between the earlier and later periods (one month mortality, 3.5 percent vs. 2.7 percent, respectively, and three month mortality, 7.0 percent vs. 5.9 percent, respectively). However, patients who stayed in the hospital longer than 14 days had increased odds of death within the 30- or 90-day post discharge time period than patients who stayed six to eight days (about twice as likely to die).

"The average length of stay declined from approximately 12 days in the 1986-1988 period to six days in the 1997-1999 period," the authors write. "However, we found no negative association between declining length of stay and short-term mortality after hospital discharge for AMI."

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To contact Jinnet B. Fowles, Ph.D., call Jeremiah Whitten at 952/993-6057.

MANY PATIENTS INTERESTED IN READING THEIR OWN MEDICAL RECORDS

CHICAGO—Many patients report that they are interested in reading their own medical records, according to an article in the April 12 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.

According to the article, the momentum to involve patients in all aspects of their health and health care is increasing, but little is known about whether patients would want to review their own medical records if given the opportunity.

Jinnet B. Fowles, Ph.D., of the Park Nicollet Institute, Minneapolis, and colleagues conducted a mail survey of 4,500 adults who had a recent clinic visit. The response rate was 81 percent.

The researchers found that 36 percent of respondents were very interested in reading their medical records, and another 43 percent were somewhat interested in doing so. Patients who wanted to read their own medical records were more likely to report seeking other health information, such as finding the Internet to be a very important source of health information and having a subscription to a health newsletter. They were also more likely to have used a health resource book in the last month, have concerns about errors in their care, and lack trust in their physician.

The most common reasons for patients wanting to look at their medical record were to see what their physician had said about them (74 percent), to be more involved in their health care (74 percent) and to understand their condition better (72 percent).

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, April 12, 2004
To contact Paul E. Morrissey, M.D., call Kristen Cole at 401/863-2476.

PATIENTS WHO RECEIVE KIDNEYS FROM OLDER DONORS DO WELL

CHICAGO—Recipients of kidneys from donors 55 years and older appear to have good outcomes, according to an article in the April issue of the Archives of Surgery, one of the JAMA/Archives journals.

According to the article, in the United States, the percentage of deceased kidney donors aged 55 and older has increased during the last decade. This is the result of both lower death rates (particularly from trauma) in people aged 18 to 35, and an increased acceptance of kidneys from older deceased donors. Although survival of the transplanted kidney may be diminished when it is from an older donor, giving these kidneys to older recipients, particularly those facing prolonged waiting times on dialysis, may be preferable to continuing with dialysis, the article states.

Paul E. Morrissey, M.D., from Brown Medical School, Providence, R.I., and colleagues investigated the risk of kidney allograft (the transplanted kidney) failure among patients treated at an academic transplant center in older (55-79 years) vs. younger (18 - 54 years) donors.

The researchers studied the records of 324 patients who received a kidney from an adult (18 or older) donor. Patients were divided into four groups based on donor status (living or deceased) and donor age (54 years or younger, or 55 years and older).

The researchers found that recipients of kidneys from donors 55 years or older were significantly older themselves (53.6 years vs. 43.6 years). Seven allografts (12.7 percent) failed from 55 transplants from donors 55 years and older, compared with 41 allografts (15.2 percent) from 269 younger donors. Kidney function was better following kidney transplant using younger donors, but kidney function was acceptable in all groups. Allograft survival at one, two, and three years after transplant did not differ when comparing older vs. younger donors.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, April 12, 2004
To contact Timothy J. Babineau, M.D., M.B.A., call Gina DiGravio at 617/638-8491.

OPERATIVE TIME INCREASES WHEN TRAINING SURGICAL RESIDENTS IN THE OPERATING ROOM

CHICAGO—There is an increase in operative time required to complete some surgical procedures associated with training surgical residents in the operating room, according to an article in the April issue of the Archives of Surgery, one of the JAMA/Archives journals.

According to the article, it is widely believed that the amount of time required to perform an operation increases when the procedure also involves training a surgical resident. The article states that this increase in time does not translate into a financial burden for the hospital. In addition, although not part of this study, other research has shown no deleterious effects of increased operative time.

Timothy J. Babineau, M.D., M.B.A., from Boston University School of Medicine, and colleagues compared the operative times of academic surgeons performing four common surgical procedures before and after the introduction of a post-graduate resident into the operating room at a community teaching hospital. Between January 1, 2001 and June 30, 2002, four academic surgeons performed operations without a resident. During that time, they either operated alone for hernia surgeries, or assisted each other for laparoscopic cholecystectomy (gall bladder removal), colectomy (removal of part of the colon), and carotid endarterectomy (removal of plaque from an artery that supplies blood to the brain). From July 1, 2002 through March 31, 2003, these same four surgeons were assisted on the same procedures by a resident physician in the third year of a post-graduate surgical training program.

The researchers found the amount of time required to perform each of the procedures increased with the addition of the surgical resident.

• Hernia surgery - increase of eight minutes
• Laparoscopic cholecystectomy - increase of 23 minutes
• Carotid endarterectomy - increase of 44 minutes
• Partial colectomy - increase of 60 minutes