Heavy Lifting and Risk of Retinal Detachment: A Case Control Study

描述(申请人提供)：视网膜脱离(RD)是最常见的眼科急症之一，经常导致不可逆转的视力损害。当可以快速进行修复手术时，视力通常被保留下来，尽管多达40%的人遭受永久性视力丧失。在世界上大部分地区，如果得不到先进的医疗服务，往往会导致失明。直到最近，已知的主要风险因素对 预防：高龄、近视和白内障手术都会增加RD的风险。目前只有一小部分RD病例被认为是可以预防的--那些由急性眼外伤和糖尿病引起的病例。2008年，我们研究团队的一名成员发表了第一项流行病学研究，确定了职业接触重物与RD风险之间的强烈关联：报告有重物搬运病史的人患RD的优势比约为4，与没有重物搬运的人相比。这项第一项研究使用了一种简单的终身繁重的测量方法，现在需要对更多的人群进行更详细的暴露评估，以进一步评估结果。实验和临床证据表明，TIS相关性的生物学合理性是存在的，并可用于基于生物学的暴露评估。如果举重与RD的关联在更大的研究中得到证实，那么负重搬运可以解释职场成年人患RD风险的很大一部分。第一项研究还报告了肥胖和RD风险之间的强烈关联，这一发现具有巨大的潜在公共健康影响，将在拟议的研究中进一步调查。这项拟议研究的目的是通过对视网膜脱离发病病例进行大型病例对照研究，评估因搬运和相关的手工材料处理(MMH)暴露而导致的RD的风险。我们提出了一种将体力与RD联系起来的病理生理学机制，该机制提出了关于暴露时间和可能的暴露度量形式的一系列可检验的假设。这项建议有以下具体目标：目标1：制定职业搬运暴露的指标，以便能够对与RD有关的替代生物假设进行流行病学评估。目的2：在病例对照研究中[使用电话访谈]，测量提举和相关的MMH任务与RD的替代指标之间的关联。肥胖的作用，包括作为举重效果的修饰物，也将被研究。这项研究的发现将有助于指导转化研究开发新的RD预防策略。在NIOSH Nora的几乎所有工业部门，重型搬运和相关的MMH任务都是非常常见的危险。[将咨询将MMH列为优先事项的NIOSH Nora部门委员会，以传播这些发现并将其应用于现有的MMH风险预防计划]。

DESCRIPTION (provided by applicant): Retinal detachment (RD) is one of the most common ophthalmologic emergencies and frequently leads to irreversible damage to vision. When rapid access to repair surgery is available, sight is generally preserved, although up to 40% suffer permanent loss of visual acuity. In large parts of the world without access to advanced medical care, blindness often results. Until recently, the major known risk factors were not very useful in prevention: advancing age, myopia and cataract surgery all increase the risk of RD. Only a minority of RD cases was currently thought to be preventable - those caused by acute eye trauma and by diabetes. In 2008, a member of our research team published the first epidemiologic study identifying a strong association between occupational exposure to heavy lifting and risk of RD: the odds ratio of RD was approximately 4 for those reporting a history of heavy lifting compared to no heavy lifting. This first study used a simple measure of lifetime heavy lifting and now a more detailed exposure assessment for a larger population is needed to further evaluate the results. Experimental and clinical evidence for the biologic plausibility of tis association exists and can be used for a biologically-based exposure assessment. If the lifting - RD association is confirmed in a larger study, heavy lifting could explain a substantial fraction o the risk of RD in working adults. The first study also reported a strong association between obesity and risk of RD, a finding with enormous potential public health impact which will be further investigated in the proposed study. The objective of the proposed study is to evaluate the risk of RD from lifting and related manual materials handling (MMH) exposures by conducting a large case control study of incident cases of retinal detachment. We propose a pathophysiologic mechanism linking physical effort to RD which suggests a hierarchy of testable hypotheses about the timing of exposures and the likely forms of exposure metrics. This proposal has the following specific aims: Aim 1: Develop metrics of occupational exposures to lifting that will enable epidemiologic evaluation of alternative biologic hypotheses of the association with RD. Aim 2: Measure the associations between alternative metrics of lifting and related MMH tasks and RD in a case control study [using telephone interviews]. The role of obesity, including as a modifier of the effect of heavy lifting, will also be studied. The finding of this study will be useful in guiding translational research to develop new prevention strategies for RD. Heavy lifting and related MMH tasks are very common hazards in nearly all the NIOSH NORA industry sectors. [The NIOSH NORA Sector Councils that have prioritized MMH will be consulted to disseminate these findings and apply them in existing MMH risk prevention programs].