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

描述（由申请人提供）：视网膜脱离（RD）是最常见的眼科急症之一，经常导致不可逆的视力损害。当可以快速进行修复手术时，视力通常会得到保留，尽管高达40%的人会永久丧失视力。在世界大部分地区，由于得不到先进的医疗服务，常常导致失明。直到最近，已知的主要风险因素在 预防：年龄增长、近视和白内障手术都会增加RD的风险。只有少数RD病例目前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，我们研究小组的一名成员发表了第一项流行病学研究，确定了职业暴露于举重和RD风险之间的强相关性：与无举重史相比，报告有举重史的人RD的比值比约为4。第一项研究使用了一种简单的终身举重措施，现在需要对更大人群进行更详细的暴露评估，以进一步评估结果。存在该相关性的生物相容性的实验和临床证据，可用于基于生物学的暴露评估。如果举重与RD的关联在更大规模的研究中得到证实，举重可以解释工作成年人RD风险的很大一部分。第一项研究还报告了肥胖与RD风险之间的强相关性，这一发现具有巨大的潜在公共卫生影响，将在拟议研究中进一步研究。 拟定研究的目的是通过对视网膜脱离事件病例进行大型病例对照研究，评价因移位和相关手动材料处理（MMH）暴露导致的RD风险。我们提出了一个病理生理机制，将体力劳动与RD联系起来，这表明了关于暴露时间和暴露度量的可能形式的可检验假设的层次结构。 该提案具有以下具体目标：目标1：制定职业暴露于举重的指标，以便对与RD相关的替代生物学假设进行流行病学评价。目标二：在病例对照研究中测量举重和相关MMH任务的替代指标与RD之间的关联[使用电话访谈]。还将研究肥胖的作用，包括作为举重效果的调节剂。 本研究的发现将有助于指导转化研究，以开发新的RD预防策略。在几乎所有NIOSH诺拉工业部门中，重型起重和相关MMH任务都是非常常见的危险。[The将咨询NIOSH诺拉部门委员会，这些委员会将优先考虑MMH，以传播这些发现，并将其应用于现有的MMH风险预防计划中。

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].