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Original Investigation
December 2018

Association of Cadmium and Lead Exposure With the Incidence of Contrast Sensitivity Impairment Among Middle-aged Adults

Author Affiliations
  • 1Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin–Madison, Madison
  • 2Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin–Madison, Madison
JAMA Ophthalmol. 2018;136(12):1342-1350. doi:10.1001/jamaophthalmol.2018.3931
Key Points

Question  What is the association of blood cadmium and lead levels with the 10-year incidence of contrast sensitivity impairment in a cohort of middle-aged adults?

Findings  In this longitudinal cohort study of 1983 adults, exposure to cadmium, but not lead, and smoking were associated with increased risk for contrast sensitivity impairment in the 10-year follow-up period.

Meaning  Reducing exposure to cadmium, smoking, or both may reduce the burden of contrast sensitivity impairment in middle-aged adults.


Importance  Contrast sensitivity (CS) is an important indicator of visual function that affects daily life, including mobility, visually intensive tasks, safety, and autonomy. Understanding the risk factors for CS impairment could prevent decreases in visual function.

Objective  To determine the incidence of and factors associated with CS impairment in a large cohort.

Design, Setting, and Participants  The Beaver Dam Offspring Study is an ongoing longitudinal cohort study of aging involving adults in Beaver Dam, Wisconsin. Participants who were free of CS impairment in both eyes at baseline were included (N = 1983). Baseline data collection occurred from June 8, 2005, through August 4, 2008, when the participants ranged from 21 to 84 years of age. Two follow-up examinations occurred at 5-year intervals: one was conducted between July 12, 2010, and March 21, 2013, and the other between July 1, 2015, and November 13, 2017. Data analysis was performed from November 27, 2017, to February 27, 2018.

Main Outcomes and Measures  Contrast sensitivity testing was conducted with Pelli-Robson letter sensitivity charts, and incident impairment was defined as a log CS score less than 1.55 in either eye at any follow-up examination. Cadmium and lead levels were measured in whole blood with inductively coupled plasma mass spectrometry. Associations between baseline characteristics and CS impairment incidence were examined using Cox proportional hazard models and quantified as hazard ratios (HRs) with 95% CI.

Results  Of the 1983 participants included, 1028 (51.8%) were female and 955 (48.2%) were male, with a mean (SD) age of 48 (9.3) years. The 10-year cumulative incidence of CS impairment was 24.8% (95% CI, 22.9-26.8), similar in women (24.9%) and men (24.6%), and highest in the oldest age group (65-84 years) at 66.3%. In multivariable models, cadmium level in the highest quintile (HR, 1.35; 95% CI, 1.02-1.78), older age (HR, 1.36; 95% CI, 1.25-1.47), larger waist circumference (HR, 1.06; 95% CI, 1.01-1.11), and more plaque sites (1-3 sites: HR, 1.43; 95% CI, 1.07-1.92; 4-6 sites: HR, 2.75; 95% CI, 1.26-6.05) were among the factors associated with increased risk, while male sex (HR, 0.77; 95% CI, 0.60-0.98) and any alcohol consumption (HR, 0.61; 95% CI, 0.43-0.88) were associated with decreased risk. Results were similar when smoking status replaced cadmium exposure in the models. Lead level was not associated with increased risk.

Conclusions and Relevance  This study’s findings suggest that incident CS impairment was common in the 10-year follow-up, with cadmium, but not lead, exposure associated with increased risk. The associations of diminished CS with other modifiable risk factors found appear to imply that changes in behavior may reduce future incidence of CS impairment.