臺灣西南沿海為主要烏腳病盛行區，砷的健康效應在大型血管及微血管上都可看見，而微血管病變有如心臟血管病變及糖尿病病變。砷所引發血管之拴塞效應在高血壓、糖尿病及血管硬化等病變上有加成效果；它們同時是最常見之失明及視網膜病變之主因。研究微血管所引發之視網膜病變讓我們更能明白其他砷中毒所引發之微血管病變，也提供了一個新構想，那就是視網膜病變可能成為生物指標應用在早期篩檢其他微血管之健康效應，如心臟血管病變及腦血管病變。本研究為一橫斷式研究，參與者包括臺灣西南沿海屬烏腳病地區之嘉義布袋鎮(年紀 50-79歲)之居民原本為一14年的世代研究參與者，並且參與民國93年2月作的追蹤檢查而完成指定檢查者。另包括民國94年8月在佳里鎮進行研究之參與者；其人口學特徵及結構和布袋鎮雷同。本研究進行非散瞳式眼底照相之檢查，計算在烏腳病地區長期居住之居民有視網膜病變之盛行率及勝算比。我們將暴露組依糖尿病及高血壓細分成四組，以控制此兩大干擾因子，當我們控制性別、年齡、及糖尿病後發現在無高血壓者累積砷暴露和視網膜病變及硬性滲出物有劑量反應相關性；<12.1、12.2-23.8、>23.9μg/L-year勝算比各為1.00、1.67、2.21 (p = 0.083)和1.00、1.65、2.15 (p = 0.038)。我們可由此推測砷暴露中毒和視網膜病變可能有相關性。

　　The southwestern coast of Taiwan is a major endemic region of arsenic intoxication that is also known as the “blackfoot disease” area. Arsenic has both macro- and micro-vascular effects, including ischemic heart disease and diabetes mellitus. Arsenic may cause vascular occlusions and has additive effects on hypertension, diabetes, and atherosclerosis. These conditions are among the most common causes of blindness and retinopathy. Studying microvascular retinopathy’s association with arsenic exposure will enable us to gain a better understanding of arsenic-induced microvascular health effects. Additionally, it will provide us with an opportunity to evaluate the feasibility of using retinopathy as a biomarker for early screening of other microvascular effects caused by arsenic exposure.

　　We conducted a population-based cross-sectional study to assess the prevalence of retinopathy and its association with arsenic exposure in southwestern Taiwan. The study population includes all the registered members of a 14-year cohort study who were local residents of Putai, Chiayi--a township in the arsenic endemic area in southwestern Taiwan. All participants were between 40 to 79 years old and had completed the follow-up examination for the study on February 2, 2005. Nonmydriatic fundus photographs of all of the participants were examined to assess the prevalence of retinopathy and odds ratios associated with arsenic exposure.

　　We subdivided the participants into four groups according to diabetes and hypertension status, which enabled us to control the effects of these two major confounders. After we adjusted for age, sex, and diabetes, the non-hypertension group exhibited a gradience for both retinopathy and hard exudates in relation to cumulative arsenic doses <12.1, 12.2-23.8, and >23.9 μg/L-year, with odd ratios 1.00, 1.67, and 2.21 (p = 0.083) and 1.0, 1.65, and 2.15 (p = 0.038), respectively. We conclude that arsenic exposure might be associated with retinopathy.

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