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Asteroid Hyalosis in an Autopsy Population the University of California at Los Angeles (UCLA) Experience

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Asteroid Hyalosis in an Autopsy Population the University of California at Los Angeles (UCLA) Experience CLINICAL SCIENCES Asteroid Hyalosis in an Autopsy Population The University of California at Los Angeles (UCLA) Experience Amani A. Fawzi, MD; Baotran Vo, BS; Ryan Kriwanek; Hema L. Ramkumar, BS; Chris Cha, BS; Amy Carts; John R. Heckenlively, MD; Robert Y. Foos, MD, DVM†; Ben J. Glasgow, MD Objectives: To study the prevalence and associations ous attachment (PϽ.001). After adjusting for age in a mul- of asteroid hyalosis (AH) in a series of autopsy eyes. tivariate logistic regression analysis, statistical signifi- cance was found only for posterior vitreous attachment Methods: Retrospective review of the University of (P=.002) and male sex (P=.046). No statistically signifi- California at Los Angeles (UCLA) autopsy eye database cant association was found with diabetes mellitus or al- from 1965 to 2000 yielded 10801 patients. The pa- cohol abuse by univariate or multivariate analysis. Analy- tients’ medical histories were reviewed for evidence of sis of the odds ratio showed a strong age effect that diabetes mellitus, hypertension, hyperlipidemia, alco- increased from 5.0 (95% confidence interval, 2.2-11.3) hol abuse, hypercalcemia, hypothyroidism, and chronic in age group 41 to 50 years, compared with 25.4 (95% renal failure. Autopsy records were searched for evi- Wald confidence interval, 8.2-77.9) in the age group of dence of optic atrophy, macular degeneration, posterior patients older than 90 years. vitreous detachment, atherosclerosis, and chronic renal failure. Asteroid hyalosis was diagnosed by examina- Conclusions: A unique epidemiological autopsy co- tion of the autopsy eyes. Univariate and multivariate hort study of AH and its systemic associations yielded a statistical methods were used to analyze our data. higher prevalence of AH than previous studies. Asteroid hyalosis was strongly correlated with age and inversely Results: The prevalence of AH was 1.96% in this au- correlated with posterior vitreous detachment. Unlike topsy population. By ␹2 analysis, AH was significantly cor- some previous reports, we found no statistically signifi- related with age (PϽ.001), male sex (P=.006), age- cant correlation between AH and diabetes mellitus. related macular degeneration (P=.02), hypertension (P=.03), atherosclerosis (PϽ.001), and posterior vitre- Arch Ophthalmol. 2005;123:486-490 STEROID HYALOSIS (AH), were reported in 11 case series and popu- also referred to as aster- lation-based reports in the literature oid hyalitis, asteroid bod- (Table 1)2,3,7,9-16 as well as 1 series of AH ies, or scintillatio nivea, in enucleated eyes.17 One study was popu- was first described by Ben- lation based3; all other reports originated son in 1894.1 The prevalence of AH has from eye clinic populations, which may re- A 2 been reported to range from 0.83% to flect selection bias for diseases that are 1.2%.3 While AH is generally considered more prevalent among outpatients in an Author Affiliations: to have only a minor impact on visual acu- eye clinic, and cannot be extrapolated to Department of Ophthalmology, ity, some patients are disturbed enough by the general population. Statistical meth- Jules Stein Eye Institute their visual symptoms to undergo surgi- ods and patient and control selection cri- (Drs Fawzi, Heckenlively, and cal treatment.4,5 The condition is often uni- teria used in these studies were difficult Glasgow; Messrs Kriwanek and lateral, yet the etiology of AH is not known. to assess and highly variable. Healthy, age- Cha; and Mss Vo, Ramkumar, Knowledge of the conditions predispos- matched controls were used in 1 study,12 and Carts), Department of ing to AH may provide clues for deter- whereas age-matched controls from the Pathology and Laboratory mining the mechanism of the formation same clinic population were used in other Medicine (Drs Foos and of asteroid bodies. Numerous studies studies.2,11,13,16 Several works did not at- Glasgow), The David Geffen have claimed an association between AH tempt to compare patients with AH with School of Medicine at 2,6-12 7,9,10,14,15,17 University of California at and diabetes mellitus (DM). Other controls. Because of small sample Los Angeles. reported associations with AH include sizes, only univariate statistical analyses 7,8 2,13 Financial Disclosure: None. hypercholesterolemia, hypertension, were used in the case-control stud- †Dr Foos died in November increased serum calcium levels,9 and ies.2,11-13,16 Only 1 report collected a large 2004. hyperopia.13 Overall, 547 cases of AH enough sample size to use multivariate sta- (REPRINTED) ARCH OPHTHALMOL / VOL 123, APR 2005 WWW.ARCHOPHTHALMOL.COM 486 ©2005 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/25/2021 Table 1. Demographic Data From Studies of Asteroid Hyalosis Asteroid Hyalosis Population Prevalence, %, Bilateral Male-Female Patients With Source Source Selection (Sample Size) Cases, % Ratio Diabetes Mellitus, % Bergren et al2 Eye clinic Cross-sectional study with 0.83 (12 205) 19 0.94:1 29 case-control subgroup Moss et al3 Population Cross-sectional; population 1.2 (4926) 9 2.3:1 8.6 Beaver Dam, based Wis Smith7 Eye clinic Case series NA 11 1.4:1 32 Jervey and Anderson9 Eye clinic Case-control study NA 22 NS NS Hatfield et al10 Eye clinic Case-control study 0.5 NS 3:1 0.5 Luxenberg and Sime11 Eye clinic Case-control study NA 10 1.1:1 40 Yazar et al14 Eye clinic Case-control study NS 0 0.67:1 31 Lamba and Shukla15 Eye clinic Case series NA 17 1.7:1 23 Wasano et al12 Eye clinic Case-control study NS 18 1.3:1 28 Potter and Newcomb13 Eye clinic Observational case series 0.9 (1559) 7 13:1 19 Cockburn16 Eye clinic Case-control study NS 22 1.5:1 19 Present study Autopsy population Cross-sectional; population 1.96 (10 801) 19.8 2.5:1 7.2 based Abbreviations: NA, not available; NS, not stated. tistical analysis.3 However, that report surveyed a popu- lation from Beaver Dam, Wis, that was predominantly 2500 restricted to a white northern European background 2000 (99.4%). In addition, AH was diagnosed retrospectively by inspection of fundus photographs. The photographs 1500 were not interpretable in 3.6% of patients, most of whom were older (mean age, 71 years) and more likely to have 1000 a history of DM and cardiovascular disease. The authors No. of Patients indicated that AH was likely to be underestimated be- 500 cause photographs did not include the periphery and the 0 camera focused on the posterior retina rather than on the ≤10 11-20 21-30 31-40 41-50 51-60 61-70 71-80 81-90 ≥91 vitreous.3 Age, y The limitations of the previous studies prompted us Figure 1. Age distribution of autopsy population. to study the prevalence of several systemic diseases in association with AH. Our study population was large enough to permit multivariant analyses, included a wide ously.19 For analysis, 20227 eyes were studied as a subgroup cross-sectional population reflective of the United States in which PVD was scrutinized. in general, and, to our knowledge, is the only cohort study of the prevalence of AH in human autopsy eyes. STATISTICAL METHODS ␹2 METHODS Univariate analysis and multivariate logistic regression sta- tistical methods were used to analyze our data. In the multi- variate analysis, several models were tested using factors that Retrospective review of the University of California at Los An- were found to be statistically significant on ␹2 analysis (hyper- geles (UCLA) autopsy eye database from 1965 to 2000 in- tension, atherosclerosis, DM, hyperlipidemia, age-related macu- cluded 10801 patients (Figure 1). The patients’ medical rec- lar degeneration). We adjusted for age and sex in all of these ords were reviewed for evidence of DM, hypertension, models. In addition to studying AH cases overall, bilateral AH hyperlipidemia, alcohol abuse, hypercalcemia, hypothyroid- cases were specifically studied in several models in an attempt ism, and chronic renal failure, in addition to autopsy evidence to explore whether there were inherent differences between uni- of optic atrophy, glaucoma, age-related macular degeneration, lateral and bilateral AH. Age-specific prevalence of AH was cal- posterior vitreous detachment (PVD), atherosclerosis, and re- culated using 10-year interval age groups (Figure 2). Statis- nal diseases. Racial backgrounds were categorized according to tical analysis was done using SAS statistical package (SAS the classification provided in the report of the US census for 2000. Institute, Inc, Cary, NC) EXAMINATION OF RESULTS AUTOPSY EYES Autopsy eyes were processed and examined using previously Review of our autopsy database yielded 212 cases (1.96%) described methods.18 Posterior vitreous detachment was diag- of AH, of whom 42 cases (0.4%; 42 of 212 patients nosed by suspension of the eyes in air as reported previ- [19.8%]) were bilateral. In addition to the bilateral cases, (REPRINTED) ARCH OPHTHALMOL / VOL 123, APR 2005 WWW.ARCHOPHTHALMOL.COM 487 ©2005 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/25/2021 0.07 Table 2. Statistical Association of Factors 0.06 for Asteroid Hyalosis 0.05 Logistic Regression 0.04 P Value After Adjustment 0.03 Factor ␹2 P Value for Age and Sex Ͻ Ͻ Prevalence of AH 0.02 Age .001 .001 0.01 White .71 .33 African American .65 .44 0 Asian .91 .84 ≤10 11-20 21-30 31-40 41-50 51-60 61-70 71-80 81-90 ≥91 Male .006 .046 Age, y AMD .02 .78 DM .20 .93 Figure 2. Age-specific prevalence of asteroid hyalosis (AH). Chronic renal failure .65 NA Atherosclerosis Ͻ.001 .25 Hypertension .03 .86 there were 97 cases with only the right eye affected and Alcohol abuse .44 .37 73 with only the left eye affected.
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