title: Visual impairment, age-related macular degeneration, cataract, and long-term mortality: the Blue Mountains Eye Study.
abstract: OBJECTIVE
  To assess the association of visual impairment, age-related macular degeneration (ARMD), and cataract with long-term mortality.
  
  
  METHODS
  At baseline, 3654 persons 49 years and older were examined in the Blue Mountains Eye Study (1992-1994). Standardized photographic grading was used to assess ARMD and cataract. Mortality and causes of death occurring between baseline and December 31, 2003, were obtained via data linkage with the Australian National Death Index. Age-standardized mortality rates were calculated. Hazard ratios (HRs) and 95% confidence intervals (CIs) were assessed using Cox models. Result Age-standardized mortality was higher in persons with vs without visual impairment (54.0% vs 34.0%), ARMD (45.8% vs 33.7%), and cataract (39.2% vs 29.5%). After adjusting for factors that predict mortality, neither visual impairment (HR, 1.3; 95% CI, 0.98-1.7) nor ARMD (HR, 1.0; 95% CI, 0.8-1.3) was significantly associated with all-cause mortality in all ages. Among persons younger than 75 years, however, ARMD predicted higher all-cause mortality (HR, 1.6; 95% CI, 1.0-2.4). Any cataract (HR, 1.3; 95% CI, 1.0-1.5) and cortical (HR, 1.2; 95% CI, 0.97-1.4), nuclear (HR, 1.2; 95% CI, 0.98-1.5), and posterior subcapsular (HR, 1.3; 95% CI, 1.0-1.7) cataract were also associated with higher all-cause mortality.
  
  
  CONCLUSIONS
  Cataract predicted increased mortality in persons 49 years and older, and ARMD predicted mortality in persons aged 49 to 74 years.
authors.affiliation: Centre for Vision Research, Department of Ophthalmology, Westmead Millennium Institute, University of Sydney, Westmead Hospital, Westmead, New South Wales, Australia.
authors.forename: Sudha
authors.initials: S
authors.lastname: Cugati
authors.forename: Robert G
authors.initials: RG
authors.lastname: Cumming
authors.forename: Wayne
authors.initials: W
authors.lastname: Smith
authors.forename: George
authors.initials: G
authors.lastname: Burlutsky
authors.forename: Paul
authors.initials: P
authors.lastname: Mitchell
authors.forename: Jie Jin
authors.initials: JJ
authors.lastname: Wang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002386:Cataract / Q000401:mortality*; D002423:Cause of Death; D005260:Female; D006801:Humans; D008268:Macular Degeneration / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D010781:Photography; D016016:Proportional Hazards Models; D015996:Survival Rate; D014792:Visual Acuity; D019987:Persons with Visual Disabilities / Q000706:statistics & numerical data*