Ten-year incidence of age-related cataract and cataract surgery in an older Australian population. The Blue Mountains Eye Study

Incidence and Outcomes of Cataract in Eyes with Ocular Cicatricial Pemphigoid

PURPOSE

To identify the incidence of cataract and the outcomes of cataract surgery in eyes with ocular cicatricial pemphigoid (OCP).

METHODS

Phakic eyes were identified from the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study and followed for the incidence of visually significant cataract defined as: newly reduced visual acuity 20/50 or worse attributed to cataract; and/or incident cataract surgery. Secondarily, all eyes with OCP that underwent cataract surgery and had a year of follow up thereafter, were included in an analysis of visual outcome.

RESULTS

Three hundred fifty-five phakic eyes (200 patients) with OCP were at risk. Eighty eyes developed visually significant cataract over 1064 eye years (incidence rate = 7.5%/eye-year, 95% confidence interval [CI] = 5.6 to 10.1). Higher age was associated with increased incidence of cataract (adjusted hazard ratio [aHR] = 4.47; 95% CI, 1.95-10.23 for age 60-75 inclusive and aHR = 8.37; 95% CI, 3.60-19.42 for age > 75, each compared with age <60 years). Seventy-nine eyes of 61 patients were monitored for > = 1 year following cataract surgery. Cataract surgery was associated with an improvement of vision around 4 lines, which was sustained through at least 48 months. Poorer pre-operative visual acuity was associated with poorer long-term visual outcome.

CONCLUSIONS

The incidence of cataract was high in this older population. No factors predictive of cataract such as duration of OCP or use of corticosteroids were identified. Visual acuity improved after surgery by a median of 4 lines' gain at one year; poorer long-term outcome among those with initially poorer visual acuity may be secondary to corneal scarring.

Impact of Patient Characteristics and Surgery-Related Risk Factors on Endophthalmitis after Cataract surgery: A Meta-Analysis

INTRODUCTION

Cataracts are the leading cause of blindness worldwide, with a notably high incidence rate. Endophthalmitis is the most severe complication following cataract surgery, often resulting in profound vision loss. This study evaluates the impact of risk factors such as age, sex, diabetes mellitus (DM), hypertension, posterior capsule rupture (PCR), type of surgery, and use of intraocular lens (IOL) material on the risk of endophthalmitis after cataract surgery.

METHODS

English and Chinese public databases were searched from inception to March 1, 2024. We included studies reporting the number of occurrences of endophthalmitis after cataract surgery on potential risk factors, including age, sex, DM status, hypertension status, intraoperative PCR, type of surgery and use of IOL material. The quality of the included studies was assessed using the Newcastle-Ottawa Scale.

RESULTS

A total of 57 studies were included and critically evaluated in the meta-analysis. The results showed that female sex was associated with a lower risk of endophthalmitis (odds ratio [OR]: 0.81; 95% CI: 0.75-0.87; p < 0.001). Individuals with diabetes who underwent cataract surgery were found to have a greater risk of endophthalmitis (I2 = 95%; OR: 4.90; 95% CI: 2.41, 9.95; p < 0.001), but the result may be influenced by publication bias. Individuals with hypertension (OR: 2.88; 95% CI: 1.53, 5.45; p = 0.001) and intraoperative PCR (OR: 9.18; 95% CI: 3.31, 25.43; p < 0.001) were found to have a greater risk of endophthalmitis. Phacoemulsification significantly reduced the risk of endophthalmitis compared with extracapsular cataract extraction (ECCE) (OR: 0.62; 95% CI: 0.45, 0.85) based on network meta-analysis.

CONCLUSION

Male sex, hypertension, intraoperative PCR, and the use of the ECCE surgical approach are associated with a greater risk of postoperative endophthalmitis. Although an age-related trend in elevated risk was observed, this finding should be interpreted cautiously.

Proteomic Changes of Glycolipid Pathways in Age-Related, Diabetic, and Post-Vitrectomy Cataracts

Background: Alterations in glycolipid and glycosphingolipid pathways lead to compromised cell membranes and may be involved in cataract formation. However, the exact role of glycolipids in lens opacification is not completely understood. The aim of the current study is to investigate proteome complexity and the role of glycolipid and glycosphingolipid pathways in cataract formation. Methods: The anterior capsule and phacoemulsification (phaco) cassette contents were collected during cataract surgery from eleven participants with diabetic cataract (DC), twelve participants with age-related cataract (ARC), and seven participants with post-vitrectomy cataract (PVC). Liquid chromatography-mass spectrometry with data-independent acquisition (DIA) was used for the identification and quantification of proteins. Results: The results of this study revealed that the main significantly differentially expressed pathways in the ARC group compared to the DC and PVC groups in phaco cassette samples included the glycolipid metabolic, glycosphingolipid biosynthetic, and glycosphingolipid metabolic processes, with GLA being among the most significant proteins in the ARC group. Similarly, in the anterior capsule samples, the main significantly differentially expressed pathways in the ARC group compared to the DC and PVC groups were the glycolipid metabolic, glycosphingolipid biosynthetic, and glycosphingolipid metabolic processes, with ST3GAL5 being among the most significant proteins in the ARC group. Conclusion: Glycolipid and glycosphingolipid metabolic processes may be involved in cataract formation. ST3GAL5 may modify the cell-to-cell interaction induced by cell surface sugar chains, leading to the formation and progression of cataract. GLA, associated with the breakdown of glycolipids, may lead to cataract formation when a certain threshold is surpassed, secondary to increased glycolipid metabolism.

Evaluation and model to achieve sex parity in cataract surgical coverage in Theni district, India

BACKGROUND/AIMS

To propose an approach to determine the target ratio of cataract surgical rates (CSRs) of female to male subpopulations to increase sex parity in cataract surgical coverage (CSC), based on the sex gap in cataract burden and incidence, and demonstrate its application to Theni district, India.

METHODS

A population-based longitudinal study between January 2016 and April 2018. We recruited 24 327 participants using random cluster sampling. We conducted detailed eye examinations of 7087 participants aged ≥40 years (4098 females, 2989 males). We fit exponential models to the age-specific and sex-specific cataract burden and estimated annual incidence rates. We developed a spreadsheet-based planning tool to compute the target CSR ratio of female to male subpopulations.

RESULTS

Among those aged ≥40 years, cataract burden was 21.4% for females and 17.5% for males (p<0.05). CSC was 73.9% for females versus 78.6% for males (p<0.05), with an effective CSC of 52.6% for females versus 57.6% for males (p<0.05). Treating only incident cataracts each year requires a target CSR ratio of female to male subpopulations of 1.30, while addressing in addition 10% of the coverage backlog for females and 5% for males requires a target CSR ratio of 1.48.

CONCLUSIONS

The female population in Theni district, as in many low-income and middle-income countries, bears a higher cataract burden and lower CSC. To enhance sex parity in coverage, both the higher number of annual incident cataracts and the larger backlog in females will need to be addressed.

Willingness to pay for cataract surgery and its associated factors in selected medical centers in Urmia, Iran

INTRODUCTION

Cataracts represent a significant public health issue and are the most prevalent vision disorder following refractive errors. They can restrict the economic, social, and psychological activities of those affected, thereby diminishing their quality of life. This study was undertaken to examine the willingness to pay for cataract surgery and the factors influencing this decision in selected medical centers in Urmia. The two-stage Heckman model was utilized to aid decision-making in financing this service.

METHODS

This research was a descriptive-analytical study evaluating the economic aspects of health interventions, conducted from the patient's perspective. In this cross-sectional study, a sample size of 217 patients with cataract issues was selected using Michel Carson's table. These patients were from Imam Khomeini Hospital and Aftab Urmia Surgery Center in 2023. Data was collected using a conditional valuation approach to determine the maximum amount patients were willing to pay, as gathered through a questionnaire. The factors influencing the willingness to pay for cataract surgery were estimated using the two-stage Heckman regression model. The final effect value of each variable was calculated using Stata version 14 software.

RESULTS

In this study, 81.11% of participants (176 individuals) expressed a willingness to pay for cataract surgery, with the average amount they were willing to pay being $206.3. However, out of the 217 respondents, 41 rejected the proposed amounts and were not willing to pay anything. The results of the Hemken model indicated that the income of patients and the size of their households significantly influenced their willingness to pay for cataract surgery. However, other variables investigated did not have a significant impact.

CONCLUSION

The study results revealed a significant influence of both income and household size on the likelihood of willingness to pay, as well as the extent of willingness to pay for cataract surgery. Consequently, it is crucial to formulate policies and provisions that guarantee access to cataract services, particularly for individuals from large households with low income and high costs.

Visual Prognosis Following Cataract Surgery in Highly Myopic Patients with Prior History of Verisyse Phakic Intraocular Lens Implantation

Background/Objectives: This study aimed to evaluate the visual outcomes and prognosis after cataract surgery in patients with prior history of Verisyse phakic intraocular lens (pIOL) implantation. Methods: A retrospective cohort study involving 215 Verisyse pIOL implantations and 17 explantations was conducted. The Verisyse pIOL was disenclaved and removed through a superior scleral tunnel incision. Cataract extraction with phacoemulsification was then performed through a temporal clear corneal incision. Results: An occurrence rate of 7.9% of eyes with cataract formation was found. Both uncorrected (UDVA) and corrected visual acuity (CDVA) three months after cataract surgery were significantly improved (0.24 ± 0.30 vs. 0.73 ± 0.48; p < 0.001 and 0.10 ± 0.14 vs. 0.30 ± 0.31; p = 0.004, respectively). The UDVA was 20/20 or better in 41% of eyes and 20/40 or better in 65% of eyes. The CDVA was 20/20 or better in 53% of eyes and 20/40 or better in 88% of eyes. The safety and efficacy indices were 1.96 ± 1.68 and 1.60 ± 1.36, respectively. Conclusions: Various complications including cataracts may develop in these patients. Verisyse pIOLs have a lower incidence of cataract formation and are more likely to lead to age-related cataracts rather than the anterior subcapsular cataracts commonly seen in implantable collamer lens (ICL) patients. Patients with a prior history of Verisyse pIOL can expect to have a good visual prognosis after cataract extraction.

Hotspots and trends of artificial intelligence in the field of cataracts: a bibliometric analysis

PURPOSE

To analyze the hotspots and trends in artificial intelligence (AI) research in the field of cataracts.

METHODS

The Science Citation Index Expanded of the Web of Science Core Collection was used to collect the research literature related to AI in the field of cataracts, which was analyzed for valuable information such as years, countries/regions, journals, institutions, citations, and keywords. Visualized co-occurrence network graphs were generated through the library online analysis platform, VOSviewer, and CiteSpace tools.

RESULTS

A total of 222 relevant research articles from 41 countries were selected. Since 2019, the number of related articles has increased significantly every year. China (n = 82, 24.92%), the United States (n = 55, 16.72%) and India (n = 26, 7.90%) were the three countries with the most publications, accounting for 49.54% of the total. The Journal of Cataract and Refractive Surgery (n = 13, 5.86%) and Translational Vision Science & Technology (n = 10, 4.50%) had the most publications. Sun Yat-sen University (n = 25, 11.26%), the Chinese Academy of Sciences (n = 17, 7.66%), and Capital Medical University (n = 16, 7.21%) are the three institutions with the highest number of publications. We discovered through keyword analysis that cataract, diagnosis, imaging, classification, intraocular lens, and formula are the main topics of current study.

CONCLUSIONS

This study revealed the hot spots and potential trends of AI in terms of cataract diagnosis and intraocular lens power calculation. AI will become more prevalent in the field of ophthalmology in the future.

Six-Year Change in Cataract Surgical Coverage and Postoperative Visual Outcomes in Rural Southern China: The Yangxi Eye Study

PURPOSE

The purpose of this study was to investigate a 6-year change in cataract surgical coverage (CSC), effective cataract surgical coverage (eCSC), and visual outcomes in an elderly population in rural southern China.

DESIGN

This is a prospective population-based study with a 6-year follow-up.

METHODS

The study included rural residents aged 50 years and above in southern China with comprehensive eye examinations at baseline and follow-up in 2014 and 2020, respectively.

RESULTS

Five thousand six hundred thirty-eight participants underwent baseline examinations (mean age 66.1±10.2 y, 50.8% women); and 3141 (64.9%) of 4841 eligible survivors attended the 6-year follow-up. Cataract surgical coverage was 41.7% and 40.6% at baseline and follow-up, respectively, while eCSC were 32.6% and 26.6%. In multivariate models, the 6-year likelihood of cataract surgery decreased with older age [odds ratio (OR)=0.97 per year, 95% confidence interval (CI): 0.94, 0.99, P =0.012] and worse baseline presenting uncorrected visual acuity (PVA) in the worse-seeing eye (OR=0.35 per unit logarithm of the minimum angle of resolution (logMAR), 95% CI: 0.25, 0.48, P <0.001), and increased with prior cataract surgical history at baseline (OR=3.88, 95% CI: 1.91, 7.09, P <0.001). The likelihood of receiving effective cataract surgery decreased with worse baseline PVA in the worse eye (OR=0.49 per unit logMAR, 95% CI: 0.24, 0.97, P =0.042) and better-seeing eye (OR=0.68 per unit logMAR, 95% CI: 0.48, 0.95, P =0.026). Posterior capsular opacification was the main reason for PVA <6/18, reporting it in logMAR (0.5) in operated eyes (38.4% at baseline; 28.1% at follow-up).

CONCLUSIONS

World Health Organization has established a global target of increasing eCSC by 30% before 2030, but no increase was found in rural southern China between 2014 and 2020, let alone reaching the World Health Organization target of 56.3%. Strategies to improve surgery incidence should focus on older persons and those with worse preoperative PVA.

Quality of life assessment for nuclear, cortical, posterior subcapsular patients before and after cataract surgery

PURPOSE

The impact of visual outcomes of cataract surgery can be measured using a questionnaire. The aim of our study was to evaluate how patient quality of life changes after cataract surgery and if there are differences between the responses of patients with nuclear, cortical, and posterior subcapsular cataracts, which has not been studied before.

METHOD

We studied 210 cataract patients who were divided into 3 cataract groups based on their cataract type: nuclear (n = 80), cortical (n = 70), and posterior subcapsular (PSC) (n = 60). The patients completed the Visual Function Index (VF-14) questionnaire before, 2 weeks and 1 month after bilateral cataract surgery. The results were analysed using one-way ANOVA (significance level 5 %) and were compared over time and between the cataract groups.

RESULTS

Before the cataract surgery, cortical cataract patients had the lowest questionnaire score compared to nuclear and posterior subcapsular cataract groups (p = 0.08). After cataract surgery, cortical cataract patients experienced the greatest improvement in near distance daily activities, while PSC cataract patients experienced the greatest improvement in far distance daily activities (p = 0.38). Before surgery, nuclear cataract patients had the highest questionnaire scores compared to the other cataract groups (p = 0.08).

CONCLUSION

At the 1 month follow-up, there were no statistically significant differences in questionnaire scores between the cataract groups for any of the questions. Overall, cortical cataract patients showed a trend to experience the greatest subjective improvement in quality of life after cataract removal, followed by nuclear and posterior subcapsular patients.

Patterns and determinants of incident cataract surgery in China from 2011 to 2015 using a nationally representative longitudinal database

OBJECTIVES

To investigate incident cataract surgery and to investigate determinants of cataract surgery uptake in Chinese adults.

DESIGN

This nationally representative longitudinal study recorded self-reported incident cataract surgery, and measured biological, clinical and socioeconomical characteristics at baseline and endline.

SETTING

In the first stage, 150 county-level units were randomly chosen with a probability-proportional-to-size sampling technique from a sampling frame containing all county-level units. The sample was stratified by region and within region by urban district or rural county and per capita gross domestic product. The final sample of 150 counties fell within 28 provinces of China.

PARTICIPANTS

Urban and rural Chinese persons aged 45 years and older.

PRIMARY AND SECONDARY OUTCOME MEASURES

Incident cataract surgery (primary outcome) and the factors associated with incident cataract surgery (secondary outcome).

RESULTS

Among 16 663 people enrolled in 2011, 13 705 (82.2%) attended follow-up in 2015. Among these, 167 (1.22%) reported incident cataract surgery. Those receiving surgery were significantly older (66.2±8.79 vs 58.3±9.18, p≤0.001) and more likely to report: illiteracy (44.9% vs 27.1%, p<0.001), poor baseline distance vision (49.7% vs 20.0%, p≤0.001), poor baseline near vision (37.1% vs 21.8%, p≤0.001), baseline visual impairment (15.6% vs 5.5%, p≤0.001), diabetes (12.0% vs 7.42%, p≤0.05) and higher baseline depression scores (9.7 vs 8.4 on a scale of 0-30, p≤0.05). In linear regression models, older age, worse distance vision, hypertension or diabetes, illiteracy and lower depression score were significantly associated with undergoing surgery. Results were similar in models including only persons aged ≥60 years, except that urban residence was also associated with surgery. When only those aged ≥60 years with poor vision were included, results were again the same, except that higher household expenditure was also associated with surgery.

CONCLUSIONS

In China, cataract surgical rates remain low; underserved groups such as rural dwellers are less likely to receive cataract surgery.

Vitamin D Supplementation and the Incidence of Cataract Surgery in Older Australian Adults

PURPOSE

Observational studies suggest that higher serum 25-hydroxy vitamin D (25(OH)D) concentration may be associated with lower risk of cataract. However, no randomized controlled trials have assessed the effect of vitamin D supplementation on the incidence of cataract. We aimed to assess whether vitamin D supplementation reduces the incidence of cataract surgery.

DESIGN

We conducted an ancillary study of the D-Health Trial, a randomized, double-masked, placebo-controlled trial of monthly vitamin D conducted from 2014 through 2020 within the Australian general population.

PARTICIPANTS

We invited 421 207 men and women 60 to 84 years of age to participate; including an additional 1896 volunteers, 40 824 expressed interest. Those with hypercalcemia, hyperparathyroidism, kidney stones, osteomalacia, or sarcoidosis or those who were taking more than 500 international units (IU) supplemental vitamin D per day were excluded. A total of 21 315 were randomized, and 1390 participants did not fulfil the eligibility criteria for this analysis (linked data available, no cataract within first 6 months), leaving 19 925 included. The median follow-up was 5 years.

METHODS

Participants took 60 000 IU of vitamin D₃ (n = 10 662) or placebo (n = 10 653) orally once per month for a maximum of 5 years.

MAIN OUTCOME MEASURES

The primary outcome for this analysis was the first surgical treatment for cataract, ascertained through linkage to universal health insurance records and hospital data.

RESULTS

Among 19 925 participants eligible for this analysis (mean age, 69.3 years; 46% women) 3668 participants (18.4%) underwent cataract surgery during follow-up (vitamin D: n = 1841 [18.5%]; placebo: n = 1827 [18.3%] ). The incidence of cataract surgery was similar between the two groups (incidence rate, 41.6 and 41.1 per 1000 person-years in the vitamin D and placebo groups, respectively; hazard ratio, 1.02; 95% confidence interval, 0.95-1.09). In prespecified subgroup analyses, the effect of vitamin D supplementation on the incidence of cataract surgery was not modified by age, sex, body mass index, predicted serum 25(OH)D concentration, or ambient ultraviolet radiation.

CONCLUSIONS

Routinely supplementing older adults who live in an area with a low prevalence of vitamin D deficiency with high-dose vitamin D is unlikely to reduce the need for cataract surgery.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found after the references.

18F-FDG PET/CT Did Not Increase the Risk of Cataract Occurrence in Oncology Patients: A Nationwide Population-Based Cohort Study

This study aimed to evaluate the risk of cataract formation associated with radiation exposure from 18F-FDG PET/CT in oncology patients, using data from Taiwan’s National Health Insurance Research Database. The exposed group (Group E) consisted of oncology patients receiving 18F-FDG PET/CT within the first year of a cancer diagnosis. The comparison group (Group C) included subjects who had never been exposed to 18F-FDG PET/CT radiation and were propensity score-matched by date of enrolment, age, sex, cancer type, associated comorbidities, and CT utilization. Multiple Cox proportional hazard regression analysis was used to estimate the hazard ratio (HR) of cataract risk due to radiation exposure, while adjusting for potential confounding factors. A total of 703 patients and 1406 matched subjects were in Groups E and C, respectively. The incidence of cataract formation was not significantly higher among subjects in Group E (adjusted HR = 1.264; 95% confidence interval [CI] = 0.845–1.891). Our results revealed that 18F-FDG PET/CT was not a significant risk factor for developing cataracts in oncology patients.

Prevalence of cataract among Australian commercial airline pilots

Because little is known about cataract in pilots, we estimated prevalence by anonymously ascertaining all commercial airline pilots diagnosed with cataract 2011-2016 using the electronic Medical Records System of the Australian Civil Aviation Safety Authority. Of 14,163 Australian male commercial pilots licensed in 2011, 1286 aged ≥60 had biennial eye examinations showing a cataract prevalence of 11.6%. Among 12,877 pilots aged <60, based on compulsory eye examinations only when first licensed, prevalence was 0.5%. There was no significant difference by ambient ultraviolet (UV) radiation levels in state of residence though lowest prevalence was seen in the low-UV state of Victoria. Most cataract in pilots ≥60 years was bilateral and of mild severity, while cataract in pilots <60 were more likely to be unilateral and of greater severity.

Application of Andersen-Newman model to assess cataract surgery uptake among older Australian women: findings from the Australian Longitudinal Study on Women's Health (ALSWH)

INTRODUCTION

Although Cataract Surgery Rate is increasing, the availability of surgery is outstripped by the increasing number of cataract cases as populations age.

AIM

The study aimed to identify factors associated with cataract surgery uptake in terms of predisposing, enabling, and need factors in very old Australian women.

METHOD

This study used ALSWH data included 6229 women aged 79-84 to 85-90 years. Women were asked whether they had undergone eye surgery (including cataracts) three years prior to each survey. Generalised estimating equation modelling was used to determine factors associated with these surgeries.

RESULT

At baseline (2005), more than half of the participants either had undergone surgery (43.5%) or had unoperated cataracts (7.6%). Increasing age (AOR = 1.11, 95% CI = 1.07, 1.15) and being current or ex-smokers (AOR = 1.15, 95% CI = 1.03, 1.29) were associated with higher odds of cataract surgery (predisposing factors). Women who had private health insurance had 27% higher odds of having surgery (AOR = 1.27, 95% CI = 1.16, 1.39) (enabling factor). Need factors of more General Practitioner visits (AOR = 1.16, 95% CI = 1.09, 1.25) and skin cancer (AOR = 1.09, 95% CI = 1.01, 1.17) also increased the odds of cataract surgery. Women who had no difficulty seeing newspaper print were more likely to have had cataract surgery (AOR = 1.35, 95% CI = 1.23, 1.48).

CONCLUSION

Need factors are the major drivers of cataract surgery; however, predisposing and enabling factors also play a role, including access to private health insurance. This finding indicates some inequity regarding access to cataract surgery in the Australian setting.

Genotype, Age, Genetic Background, and Sex Influence Epha2-Related Cataract Development in Mice

Purpose

Age-related cataract is the leading cause of blindness worldwide. Variants in the EPHA2 gene increase the disease risk, and its knockout in mice causes cataract. We investigated whether age, sex, and genetic background, risk factors for age-related cataract, and Epha2 genotype influence Epha2-related cataract development in mice.

Methods

Cataract development was monitored in Epha2+/+, Epha2+/-, and Epha2-/- mice (Epha2Gt(KST085)Byg) on C57BL/6J and FVB:C57BL/6J (50:50) backgrounds. Cellular architecture of lenses, endoplasmic reticulum (ER) stress, and redox state were determined using histological, molecular, and analytical techniques.

Results

Epha2-/- and Epha2+/- mice on C57BL/6J background developed severe cortical cataracts by 18 and 38 weeks of age, respectively, compared to development of similar cataract significantly later in Epha2-/- mice and no cataract in Epha2+/- mice in this strain on FVB background, which was previously reported. On FVB:C57BL/6J background, Epha2-/- mice developed severe cortical cataract by 38 weeks and Epha2+/- mice exhibited mild cortical cataract up to 64 weeks of age. Progression of cataract in Epha2-/- and Epha2+/- female mice on C57BL/6J and mixed background, respectively, was slower than in matched male mice. N-cadherin and β-catenin immunolabeling showed disorganized lens fiber cells and disruption of lens architecture in Epha2-/- and Epha2+/- lenses, coinciding with development of severe cataracts. EPHA2 immunolabeling showed intracellular accumulation of the mutant EPHA2-β-galactosidase fusion protein that induced a cytoprotective ER stress response and in Epha2+/- lenses was also accompanied by glutathione redox imbalance.

Conclusions

Both, Epha2-/- and Epha2+/- mice develop age-related cortical cataract; age as a function of Epha2 genotype, sex, and genetic background influence Epha2-related cataractogenesis in mice.

Metformin alleviates oxidative stress-induced senescence of human lens epithelial cells via AMPK activation and autophagic flux restoration

Cataracts are the leading cause of blindness worldwide owing to the increasing proportion of elderly individuals in the population. The purpose of this study was to investigate whether metformin could alleviate the occurrence and development of age‐related cataract (ARC) and the underlying mechanism. In the present study, we established a senescence model induced by oxidative stress, which was confirmed by measuring β‐galactosidase activity, qRT‐PCR and Western blotting. In addition, we showed that metformin alleviated the oxidative stress‐induced senescence of HLE‐B3 cells via the activation of AMPK. Next, we provided evidence that oxidative stress impaired autophagic flux and induced lysosomal dysfunction. Subsequently, we found that metformin restored autophagic flux that had been impaired by oxidative stress by activating AMPK. Additionally, we found that metformin suppressed HLE‐B3 cell senescence by improving lysosomal function and inactivating mTOR. Furthermore, the inactivation of AMPK, impairment of autophagic flux and lysosomal dysfunction were observed in the human lens epithelium of ARC. In summary, our data suggest that the activation of AMPK may be a potential strategy for preventing ARC, and metformin may be an emerging candidate to alleviate the formation and development of ARC.

Modulation of aqueous humor melatonin levels by yellow-filter and its protective effect on lens

Melatonin is mainly secreted by the pineal gland, and it is also produced by various ocular structures such as the lens. It has been recently demonstrated that melatonin ocular synthesis can be induced by blocking the blue component of white light by means of filters. Melatonin exhibits antioxidant properties that can be useful to face light-induced oxidative stress as well as oxidative events associated to ocular pathologies like cataracts. Moreover, as oxidative stress is a main event in cataract development, changes in melatonin levels could happen and be relevant in the progression of this pathology, a subject that remains uncertain. The goal of this work was to analyze the ability of a short wavelength light blocking (yellow) filter to modulate endogenous melatonin concentration and the antioxidant and cytoprotective actions induced by yellow filter's use in lens. Furthermore, we evaluated the potential changes in aqueous humor melatonin concentration from patients with cataracts. In human lens epithelial cells, white light-emitting diode (LED) light challenge reduced melatonin secretion, protein levels of the enzymes involved in melatonin synthesis (hydroxyindole-O-methyltransferase and unphosphorylated and phosphorylated forms of arylalkylamine N-acetyltransferase) and cell viability whereas increased reactive oxygen species production. Yellow filter exposure precluded melatonin secretion reduction and protected cells from oxidative damage. Consistent with cataract patient's results, significantly lower levels of melatonin were observed in aqueous humor of alloxan-induced diabetic cataract rabbits as compared to those of control rabbits. In contrast, aqueous humor melatonin levels of diabetic cataract animals maintaining in cages covered with a yellow filter resembled control values. This recovery seems to be mediated by the induction of melatonin biosynthetic enzymes protein expression. Yellow filter also preserved Nrf2 lens protein expression and superoxide dismutase protein levels and activity in diabetic animals. Modulation of endogenous ocular melatonin concentration using blocking filters might be a promising approach to prevent premature lens opacification.

Changing trends in glaucoma surgery within Australia

BACKGROUND

Limited data are available on glaucoma surgical trends in Australia.

METHODS

Nationwide study of glaucoma surgery in Australia over 17-year period from 2001 to 2018. The Australian Institute of Health, Welfare and Ageing hospitalisation database was used to review age- and gender-specific trends in glaucoma surgeries from 2001 to 2018 in Australian public and private hospitals.

RESULTS

Although there was an increase in the absolute number of trabeculectomy procedures from 2926 to 3244 over the 17-year study period, this represented a decline in the age-standardised and gender-standardised number of trabeculectomy procedures from 15.1 to 13.2 procedures per 100 000 persons. However, during this same period, there was a dramatic increase in the number of glaucoma drainage devices (GDD) from 119 to 3262 procedures, representing an age-standardised and gender-standardised increase from 0.6 to 13.3 procedures per 100 000 persons. Negative binomial regression analysis revealed a decrease in trabeculectomy procedures of 1.1% per year, while there was increase in GDD insertions of 16.3% per year (p<0.001 for both). When stratified by age group, there was a statistically significant interaction in both trabeculectomy and GDD rates by age groups over time (p<0.001 for both). Trabeculectomy procedures decreased to a greater extent in those aged >60 years, compared with stable or increasing rates in younger age groups. GDD insertion rates demonstrated a progressively greater increase in older compared with younger age groups.

CONCLUSION

Our findings demonstrate changing trends in the surgical management of advanced glaucoma in Australia, likely reflecting updated evidence regarding the role of GDD surgeries.

Multicenter Evaluation of Time, Operational, and Economic Efficiencies of a New Preloaded Intraocular Lens Delivery System versus Manual Intraocular Lens Delivery

Purpose

To evaluate intraoperative intraocular lens (IOL) delivery time and total surgical case time using the UltraSert preloaded delivery system (System U) during routine cataract surgeries and to compare with the manually loaded Monarch delivery system (System M). Physician satisfaction with System U was also assessed.

Patients and Methods

In this prospective observational study, subjects ≥18 years old underwent cataract surgery in 1 eye and received the AcrySof IQ IOL via the manually loaded System M (n=103) or the AcrySof IQ IOL model AU00T0 via the preloaded System U (n=93). Procedures were digitally recorded by an external camera or by a camera within the operating microscope. Device preparation, IOL delivery, and IOL positioning times were evaluated by 2 independent graders. Pearson χ² test or Fisher exact test was used for categorical variables and Student’s t-test or Wilcoxon rank-sum test for continuous variables (all tests were 2-sided and performed at a 5% α-level). Physician satisfaction levels were assessed using questionnaires.

Results

Lens delivery time was similar for System U and System M (12.9±5.1 and 12.2±6.3 s; P=0.412). Mean device preparation time for System U was significantly shorter compared with System M (30.3±6.6 versus 59.8±31.0 s; P<0.05). This resulted in a significantly shorter total intraoperative time (device preparation + lens delivery) with System U versus System M (43.0±8.6 versus 72.0±32.5 s; P<0.05). Total surgical case time (device preparation + lens delivery + lens positioning and unfolding) was shorter for System U versus System M (56.6±12.6 versus 89.6±34.6 s; P<0.05). Physicians reported greater satisfaction levels with System U compared with other devices.

Conclusion

Use of the preloaded delivery system (System U) resulted in faster device preparation and reduced total surgical time compared with the manually loaded system (System M). System U was intuitive to use, and physicians preferred it to other devices.

Utility of the optical quality analysis system for decision-making in Nd: YAG laser posterior capsulotomy in patients with light posterior capsule opacity

Background

A prospective cohort study was performed to evaluate whether the Optical Quality Analysis System (OQAS) can serve as a valuable additional indicator for appropriate posterior capsulotomy referral.

Methods

One hundred and five eyes from 96 patients undergoing capsulotomy were divided into precapsulotomy logMAR CDVA ≤0.1 group and logMAR CDVA > 0.1 group. CDVA, and the Visual Function 14 index (VF-14) score were estimated before and 1 month after capsulotomy. The objective scattering index (OSI) value was measured by using the OQAS. Posterior capsule opacification (PCO) severity was assessed with Evaluation of PCO 2000 (EPCO 2000) software.

Results

In logMAR CDVA > 0.1 group, the correlations of OSI, logMAR CDVA, EPCO score and VF-14 score were very strong preoperatively. In logMAR CDVA ≤0.1 group, preoperatively, OSI was correlated with logMAR CDVA (r = 0.451), EPCO score (r = 0.789), and VF-14 score (r = 0.852). LogMAR CDVA has weak correlation with VF-14 score (r = − 0.384) and EPCO score (r = 0.566). VF-14 score was correlated with EPCO score (r = − 0.669). In the logMAR CDVA ≤0.1 group, there was no significant difference in logMAR CDVA between precapsulotomy and postcapsulotomy (P > 0.05). In the two groups, all the other optical quality parameters were significantly improved after capsulotomy (P < 0.05). In logMAR CDVA > 0.1 group, the area under the curve of the ROC of the OSI was 0.996 (P = 0.000). In logMAR CDVA ≤0.1 group, the area under the curve of the ROC of the OSI was 0.943 (P = 0.000).

Conclusions

The OSI was useful for evaluating of PCO and prediction of beneficial capsulotomy. Especially for patients with slight PCO and better visual acuity, OSI is more valuable than CDVA and completely objective examination.

Trial registration

The study protocol was registered at the Chinese Clinical Trial Registry. Register: ChiCTR1800018842 (Registered Date: October 13th, 2018).

Structural Features Associated With the Development and Progression of RORA Secondary to Maternally Inherited Diabetes and Deafness

PURPOSE

To investigate the development and progression of retinal pigment epithelial and outer retinal atrophy (RORA) secondary to maternally inherited diabetes and deafness (MIDD).

DESIGN

Retrospective observational case series.

METHODS

Thirty-six eyes of 18 patients (age range, 22.4-71.6 years) with genetically proven MIDD and serial optical coherence tomography (OCT) images were included. As proposed reference standard to diagnose and stage atrophy, OCT images were longitudinally evaluated and analyzed for presence and precursors of RORA. RORA was defined as an area of (1) hypertransmission, (2) disruption of the retinal pigment epithelium, (3) photoreceptor degeneration, and (4) absence of other signs of a retinal pigment epithelial tear.

RESULTS

The majority of patients revealed areas of RORA in a circular area around the fovea of between 5° and 15° eccentricity. Over the observation time (range, 0.5-8.5 years), evidence for a consistent sequence of OCT features from earlier disease stages to the end stage of RORA could be found, starting with loss of ellipsoid zone and subretinal deposits, followed by loss of external limiting membrane and loss of retinal pigment epithelium with hypertransmission of OCT signal into the choroid, and leading to loss of the outer nuclear layer bordered by hyporeflective wedges. Outer retinal tabulations seemed to develop in regions of coalescent areas of RORA.

CONCLUSIONS

The development and progression of RORA could be tracked in MIDD patients using OCT images, allowing potential definition of novel surrogate markers. Similarities to OCT features in age-related macular degeneration, where mitochondrial dysfunction has been implicated in the pathogenesis, support wide-ranging benefits from proof-of-concept studies in MIDD.

Association of Age-Related Cataract With Skin Cancer in an Australian Population

Purpose

Ultraviolet radiation from sunlight contributes to age-related cataract and skin cancer. The EPHA2 gene is implicated in both these diseases. The purpose of this study was to determine whether age-related cataract and skin cancer are associated in a cohort of older Australians.

Methods

A cross-sectional study was performed using the Historical Cohort of the Registry of Senior Australians. Individuals aged ≥65 years or aged ≥50 years and of Aboriginal or Torres Strait Islander descent, who had an aged care eligibility assessment between July 2005 and June 2015, and had a history of cataract surgery and/or skin cancer according to the Australian Government Medicare Benefits Schedule dataset, during the 3-year period prior, were evaluated (N = 599,316). A multivariable logistic regression model was used to determine association and multiple hypothesis correction was employed.

Results

Of the evaluated individuals, 87,097 (14.5%) had a history of cataract and 170,251 (28.4%) a history of skin cancer. Among those with a history of cataract, 20,497 (23.5%), 1127 (1.3%), and 14,730 (16.9%) individuals had a concurrent history of keratinocyte, melanoma, and premalignant/solar keratosis, respectively. Those with a history of cataract were 19% more likely to have a history of skin cancer (odds ratio [OR], 1.19; 95% confidence interval [CI], (1.17–1.21). Co-occurrence of keratinocyte skin cancer was 16% (OR, 1.16; 95% CI, 1.14–1.18), melanoma 21% (OR, 1.21; 95% CI, 1.13–1.29), and premalignant/solar keratosis 19% (OR, 1.19; 95% CI, 1.17–1.22) more in the presence than absence of history of cataract.

Conclusions

Age-related cataract is positively associated with skin cancer and its subtypes, including premalignant lesions in an older Australian population.

Ten-Year Incidence of Cataract Surgery in Urban Southern China: The Liwan Eye Study

PURPOSE

We sought to estimate the 10-year incidence of cataract surgery and its associated factors in an adult urban Chinese population.

DESIGN

Population-based cohort study.

METHODS

The Liwan Eye Study is a population-based study initiated in 2003 with 1405 eligible participants. All baseline participants were invited to return for a 10-year follow-up examination with the same protocol. Having incident cataract surgery was defined as participants with native crystalline lens at baseline who underwent cataract surgery performed in either eye during the 10-year follow-up period. A detailed questionnaire was administrated to collect information regarding income, education, and medical history of hypertension and diabetes at baseline examination.

RESULTS

Seven hundred ninety-one (86.2%) of 918 eligible survivors attended the 10-year follow-up examination, and 778 participants without previous binocular cataract surgery were eligible for analysis. The overall 10-year incidence of any cataract surgery was 73 of 778 patients (9.4% [95% confidence interval 7.4%-11.7%). The incident cataract surgery increased with age, and increased from 1.5% among participants 50 to 54 years of age, to 23.2% for those ≥75 years of age (P < .001); the same trends were also observed for incident unilateral (P < .001) and bilateral surgery (P < .001). In the multivariate logistic regression model, income >¥1000 renminbi (approximately $141.30) (odds ratio [OR] 0.2, P = .023), education level (OR 0.1, P < .001), and presence of diabetes (OR 3.9, P = .038) had a significant positive effect on cataract surgery incidence.

CONCLUSIONS

Approximately 1 in 10 participants ≥50 years of age underwent cataract surgery over 10 years. The incidence was lower than that reported in developed countries, suggesting a substantial unmet demand even in a major urban city in China.

Wholegrain and legume consumption and the 5-year incidence of age-related cataract in the Blue Mountains Eye Study

The present study aims to investigate the effect of wholegrain and legume consumption on the incidence of age-related cataract in an older Australian population-based cohort. The Blue Mountains Eye Study (BMES) is a population-based cohort study of eye diseases among older adults aged 49 years or older (1992-1994, n 3654). Of 2334 participants of the second examination of the BMES (BMES 2, 1997-2000), 1541 (78·3 % of survivors) were examined 5 years later (BMES 3) who had wholegrain and legume consumption estimated from the FFQ at BMES 2. Cataract was assessed using photographs taken during examinations following the Wisconsin cataract grading system. Multivariable-adjusted logistic regression models were used to assess associations with the 5-year incidence of cataract from BMES 2 (baseline) to BMES 3. The 5-year incidence of cortical, nuclear and posterior subcapsular (PSC) cataract was 18·2, 16·5 and 5·9 %, respectively. After adjustment for age, sex and other factors, total wholegrain consumption at baseline was not associated with incidence of any type of cataract. High consumption of legumes showed a protective association for incident PSC cataract (5th quintile: adjusted OR 0·37; 95 % CI 0·15, 0·92). There was no significant trend of this association across quintiles (P = 0·08). In this older Australian population, we found no associations between wholegrain intake at baseline and the 5-year incidence of three cataract types. However, intake of legumes in the highest quintile, compared with the lowest quintile, may protect against PSC formation, a finding needing replication in other studies.

Progression of Retinopathy Secondary to Maternally Inherited Diabetes and Deafness - Evaluation of Predicting Parameters

PURPOSE

To investigate the prognostic value of demographic, functional, and imaging parameters on retinal pigment epithelium (RPE) atrophy progression secondary to maternally inherited diabetes and deafness (MIDD) and to evaluate the application of these factors in clinical trial design.

DESIGN

Retrospective observational case series.

METHODS

Thirty-five eyes of 20 patients (age range, 24.9-75.9 years) with genetically proven MIDD and demarcated RPE atrophy on serial fundus autofluorescence (AF) images were included. Lesion size and shape-descriptive parameters were longitudinally determined by 2 independent readers. A linear mixed-effect model was used to predict the lesion enlargement rate based on baseline variables. Sample size calculations were performed to model the power in a simulated interventional study.

RESULTS

The mean follow-up time was 4.27 years. The mean progression rate of RPE atrophy was 2.33 mm²/year, revealing a dependence on baseline lesion size (+0.04 [0.02-0.07] mm²/year/mm², P < .001), which was absent after square root transformation. The fovea was preserved in the majority of patients during the observation time. In the case of foveal involvement, the loss of visual acuity lagged behind central RPE atrophy in AF images. Sex, age, and number of atrophic foci predicted future progression rates with a cross-validated mean absolute error of 0.13 mm/year and to reduce the required sample size for simulated interventional trials.

CONCLUSIONS

Progressive RPE atrophy could be traced in all eyes using AF imaging. Shape-descriptive factors and patients' baseline characteristics had significant prognostic value, guiding appropriate subject selection and sample size in future interventional trial design.

Rationale and protocol for the 7- and 8-year longitudinal assessments of eye health in a cohort of young adults in the Raine Study

INTRODUCTION

Eye diseases and visual impairment more commonly affect elderly adults, thus, the majority of ophthalmic cohort studies have focused on older adults. Cohort studies on the ocular health of younger adults, on the other hand, have been few. The Raine Study is a longitudinal study that has been following a cohort since their birth in 1989-1991. As part of the 20-year follow-up of the Raine Study, participants underwent a comprehensive eye examination. As part of the 27- and 28-year follow-ups, eye assessments are being conducted and the data collected will be compared with those of the 20-year follow-up. This will provide an estimate of population incidence and updated prevalence of ocular conditions such as myopia and keratoconus, as well as longitudinal change in ocular parameters in young Australian adults. Additionally, the data will allow exploration of the environmental, health and genetic factors underlying inter-subject differential long-term ocular changes.

METHODS AND ANALYSIS

Participants are being contacted via telephone, email and/or social media and invited to participate in the eye examination. At the 27-year follow-up, participants completed a follow-up eye screening, which assessed visual acuity, autorefraction, ocular biometry and ocular sun exposure. Currently, at the 28-year follow-up, a comprehensive eye examination is being conducted which, in addition to all the eye tests performed at the 27-year follow-up visit, includes tonometry, optical coherence tomography, funduscopy and anterior segment topography, among others. Outcome measures include the incidence of refractive error and pterygium, an updated prevalence of these conditions, and the 8-year change in ocular parameters.

ETHICS AND DISSEMINATION

The Raine Study is registered in the Australian New Zealand Clinical Trials Registry. The Gen2 20-year, 27-year and 28-year follow-ups are approved by the Human Research Ethics Committee of the University of Western Australia. Findings resulting from the study will be published in health or medical journals and presented at conferences.

TRIAL REGISTRATION NUMBER

ACTRN12617001599369; Active, not recruiting.

Evaluating the associations between obesity and age-related cataract: a Mendelian randomization study

BACKGROUND

The obesity-cataract association has been inconsistently reported. The fat mass and obesity-related (FTO) single-nucleotide polymorphism (SNP) rs9939609 is a major SNP associated with obesity and has been used as an instrumental variable for obesity in a Mendelian randomization (MR) approach. An interaction between the FTO SNP and macronutrient intake for obesity was suggested previously.

OBJECTIVE

The aim of this study was to assess the associations between obesity and cataract, using FTO SNP rs9939609 as an instrumental variable in an MR approach, and explore interactions of this SNP with macronutrient intake in relation to risk of cataract in a population-based cohort.

METHODS

The Blue Mountains Eye Study (BMES) is a longitudinal population-based study of common eye disease. Of 3654 baseline participants of the BMES (1992-1994), 2334 (75.8% of survivors) and 1952 (76.7% of survivors) were followed 5 and 10 y later. During the 5-y follow-up, 1174 new participants were examined. Cumulative cataract was defined as the presence of cortical, nuclear, or posterior subcapsular (PSC) cataract at any visit, following the Wisconsin Cataract Grading System. Imputed dosage of the FTO SNP rs9939609 was used. Quintiles of macronutrient intake (carbohydrates, protein, fats) were derived from an FFQ. ORs and 95% CIs were estimated using multivariable-adjusted logistic regression models.

RESULTS

After multivariable adjustment, there were no associations between BMI and any cataract types in MR models using rs9939609 as an instrumental variable. However, an interaction between rs9939609 and protein intake for PSC cataract risk was suggested (P = 0.03). In analyses stratified by quintiles of protein intake, each minor allele of rs9939609 was associated with increased odds of PSC (OR: 2.14; 95% CI: 1.27, 3.60) in the lowest quintile subgroup only.

CONCLUSIONS

Obesity was not causally associated with age-related cataract. However, among persons in the lowest quintile of protein intake, obesity may be associated with PSC cataract.

The Combination of Healthy Diet and Healthy Body Weight Is Associated with Lower Risk of Nuclear Cataract in the Blue Mountains Eye Study

BACKGROUND

Greater adherence to dietary guidelines has previously been found to be associated with decreased risk of visual impairment. However, whether or not this association extends to age-related cataract, 1 of the leading causes of visual impairment, is unknown.

OBJECTIVES

The aim of this study was to assess the association between adherence to dietary guidelines, using total diet score, and incidence of age-related cataract.

METHODS

Of 3654 baseline participants of the population-based Blue Mountains Eye Study cohort (1992-1994), 2334 (75.8% survivors) and 1952 (76.7% survivors) were examined after 5 and 10 y, respectively. Cataract was assessed from lens photographs using the Wisconsin Cataract Grading System. Baseline total diet score was calculated from FFQ data following a modified version of the Healthy Eating Index for Australians. OR with 95% CI were estimated using discrete logistic regression analyses, adjusting for age, sex, and other confounders. To test interaction, a cross-product term of 2 factors was included in regression models.

RESULTS

Of 2173 participants (84.7% of those returned for 1 or both follow-ups) with total diet score estimated, 57% were women, mean baseline age was 63.9 ± 8.4y, and mean baseline BMI was 26.3 ± 4.3 kg/m2. After multivariable adjustment, baseline total diet score was not associated with incidence of any cataract. A multiplicative interaction was observed between total diet score and BMI for incident nuclear cataract (P-interaction = 0.04): increasing baseline total diet score was associated with decreased risk of nuclear cataract among participants with BMI <25 (per unit increased total diet score, OR: 0.90; 95% CI: 0.81, 0.99; P = 0.02), but not among participants with BMI ≥25 (OR: 1.00; 95% CI: 0.92, 1.10; P = 0.95).

CONCLUSIONS

Adherence to dietary guidelines had no appreciable influence on cataract development overall in this older Australian population. However, adherence to dietary guidelines combined with healthy BMI is associated with decreased risk of nuclear cataract, an aging marker.

Increased frequency of cataract surgery in patients over age 50 with pituitary macroadenomas and chiasmal compression

BACKGROUND

Patients with visual loss from macroadenomas compressing their optic apparatus may also have concomitant age-related visual pathology such as cataracts. How these two pathologies interact with each other is not well documented.

OBJECTIVE

The interaction between these two pathologies in elderly patients is the subject of this study.

METHODS

We identified a series of non-functioning macroadenoma patients over age 50 years with tumors compressing the chiasm who underwent transsphenoidal surgery at our institution between 2004 and 2018. Pre- and post-operative visual complaints, tumor size and extent of resection were analyzed. Prevalence of the diagnosis of cataract and prevalence of cataract surgery in each decade were compared with national averages.

RESULTS

We identified 200 patients who met selection criteria. 18% of these patients had a diagnosis of cataract and 12.5% had cataract surgery. Compared with the Eye Diseases Prevalence Research Group (EDPRG) study, the prevalence of cataract surgery was 2.5 times the national average of 5.1%. 32% of these patients had no improvement in their vision after cataract surgery but 76% improved after transsphenoidal surgery.

CONCLUSIONS

We reported a high prevalence of cataract surgery in patients over age 50 in patients with pituitary macroadenomas compressing the optic pathway compared with national averages in patients without adenomas. While visual loss from adenoma likely precipitated more cataract surgeries in this group of patients, some who may not have required it, those patients with cataracts who did not have their cataracts extracted were less likely to recover vision after transsphenoidal surgery. Addressing both pathologies is beneficial.

Cohort profile: design and methods in the eye and vision consortium of UK Biobank

PURPOSE

To describe the rationale, methods and research potential of eye and vision measures available in UK Biobank.

PARTICIPANTS

UK Biobank is a large, multisite, prospective cohort study. Extensive lifestyle and health questionnaires, a range of physical measures and collection of biological specimens are collected. The scope of UK Biobank was extended midway through data collection to include assessments of other measures of health, including eyes and vision. The eye assessment at baseline included questionnaires detailing past ophthalmic and family history, measurement of visual acuity, refractive error and keratometry, intraocular pressure (IOP), corneal biomechanics, spectral domain optical coherence tomography (OCT) of the macula and a disc-macula fundus photograph. Since recruitment, UK Biobank has collected accelerometer data and begun multimodal imaging data (including brain, heart and abdominal MRI) in 100 000 participants. Dense genotypic data and a panel of 20 biochemistry measures are available, and linkage to medical health records for the full cohort has begun.

FINDINGS TO DATE

A total of 502 665 people aged between 40 and 69 were recruited to participate in UK Biobank. Of these, 117 175 took part in baseline assessment of vision, IOP, refraction and keratometry. A subgroup of 67 321 underwent OCT and retinal photography. The introduction of eye and vision measures in UK Biobank was accompanied by intensive training, support and a data monitoring quality control process.

FUTURE PLANS

UK Biobank is one of the largest prospective cohorts worldwide with extensive data on ophthalmic diseases and conditions. Data collection is an ongoing process and a repeat of the baseline assessment including the questionnaires, measurements and sample collection will be performed in subsets of 25 000 participants every 2-3 years. The depth and breadth of this dataset, coupled with its open-access policy, will create a powerful resource for all researchers to investigate the eye diseases in later life.

Ultraviolet radiation and incidence of cataracts in a nationwide US cohort

PURPOSE

We examine the risk of cataract and cataract surgery with measures of ultraviolet radiation (UVR) exposure and UVR sensitivity in a large, nationwide population of indoor workers.

METHODS

Participants from the US Radiologic Technologists Study were followed from age at baseline survey (2003-2005) to age at earliest of cataract diagnosis, cataract surgery, or completion of last survey (2012-2013). UVR-related factors included satellite-based ambient UVR linked to lifetime residences, time spent outdoors across various age periods, history of blistering sunburns, prior diagnosis of keratinocyte carcinoma, and iris color. We used Cox proportional hazards models with age as timescale to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for cataract and cataract surgery.

RESULTS

Participants had a median age of entry of 54.0 years, were 80.0% female, and 95.7% white. Of the 44, 891 eligible participants, 9399 cases of cataract and 3826 cases of cataract surgery were reported. Ambient UVR (quintile 5 vs. 1) was associated with an increased risk of cataract (HR = 1.08; 95% CI: 1.01-1.16) and cataract surgery (HR = 1.16; 95% CI: 1.05-1.29). Lifetime average time spent outdoors was not associated with cataract risk. History of blistering sunburns before and after age 15, but not previous keratinocyte carcinoma diagnosis was associated with both cataract and cataract surgery.

CONCLUSION

Our results suggest a modest role for residence-based ambient UVR and cataract risk among indoor workers in the United States.

Association of Cataract Surgery With Traffic Crashes

Importance

Cataracts are the most common cause of impaired vision worldwide and may increase a driver's risk of a serious traffic crash. The potential benefits of cataract surgery for reducing a patient's subsequent risk of traffic crash are uncertain.

Objective

To conduct a comprehensive longitudinal analysis testing whether cataract surgery is associated with a reduction in serious traffic crashes where the patient was the driver.

Design, Setting, and Participants

Population-based individual-patient self-matching exposure-crossover design in Ontario, Canada, between April 1, 2006, and March 31, 2016. Consecutive patients 65 years and older undergoing cataract surgery (n = 559 546).

Interventions

First eye cataract extraction surgery (most patients received second eye soon after).

Main Outcomes and Measures

Emergency department visit for a traffic crash as a driver.

Results

Of the 559 546 patients, mean (SD) age was 76 (6) years, 58% were women (n = 326 065), and 86% lived in a city (n = 481 847). A total of 4680 traffic crashes (2.36 per 1000 patient-years) accrued during the 3.5-year baseline interval and 1200 traffic crashes (2.14 per 1000 patient-years) during the 1-year subsequent interval, representing 0.22 fewer crashes per 1000 patient-years following cataract surgery (odds ratio [OR], 0.91; 95% CI, 0.84-0.97; P = .004). The relative reduction included patients with diverse characteristics. No significant reduction was observed in other outcomes, such as traffic crashes where the patient was a passenger (OR, 1.03; 95% CI, 0.96-1.12) or pedestrian (OR, 1.02; 95% CI, 0.88-1.17), nor in other unrelated serious medical emergencies. Patients with younger age (OR, 1.27; 95% CI, 1.13-1.14), male sex (OR, 1.64; 95% CI, 1.46-1.85), a history of crash (baseline OR, 2.79; 95% CI, 1.94-4.02; induction OR, 4.26; 95% CI, 2.01-9.03), more emergency visits (OR, 1.34; 95% CI, 1.19-1.52), and frequent outpatient physician visits (OR, 1.17; 95% CI, 1.01-1.36) had higher risk of subsequent traffic crashes (multivariable model).

Conclusions and Relevance

This study suggests that cataract surgery is associated with a modest decrease in a patient's subsequent risk of a serious traffic crash as a driver, which has potential implications for mortality, morbidity, and costs to society.

Risk factors of age-related cataract in a Chinese adult population: the Taizhou Eye Study

IMPORTANCE

Cataract risk factors data will provide epidemic evidence for cataract prevention.

BACKGROUND

This study aimed to study the risk factors for age-related cataract in a Chinese adult population.

DESIGN

This is a population-based, cross-sectional study.

PARTICIPANTS

A total of 10 234 eligible subjects ≥45 years old (response rate: 78.1%) were included in the study.

METHODS

We conducted detailed eye examinations including presenting visual acuity, best-corrected visual acuity, slit lamp examination of lens opacities and fundus examination. Questionnaires about lifestyle were administered. Measurements of blood pressure, heart rate and body mass index were collected. Serological metabolic indicators, including fasting blood glucose, triglycerides, cholesterol, lipoprotein, were also evaluated. We used stepwise multivariate logistic regression model to evaluate the association of these risk factors with any cataract and subtypes of cataract.

MAIN OUTCOME MEASURES

Odds ratios of risk factors for cataract were calculated.

RESULTS

For any cataract, we found age, gender (female), increased outdoor activity, no outdoor eye protection, high myopia, high low-density lipoprotein, low high-density lipoprotein, lower education level and increased pickled food intake were independent risk factors. When further examined the risk factors of different subtypes of cataract, we found that these risk factors also existed, but there were slight differences among different subtypes. In addition, for cortical cataract, lower annual family income and high diastolic pressure were additional independent risk factors.

CONCLUSIONS AND RELEVANCE

Reduced outdoor activity, outdoor eye protection, prevention of high myopia, higher education level, controlled blood pressure, improved high-density lipoprotein and low-density lipoprotein levels and reduced pickled food intake may help to reduce the risk of age-related cataract development.

Cataract Surgery and Visual Acuity in Elderly Japanese: Results of Fujiwara-kyo Eye Study

The aim of this study was to determine the presence of prior cataract surgery and best-corrected visual acuity (BCVA) in an elderly Japanese cohort. The Fujiwara-kyo Eye Study was a prospective, population-based, cross-sectional epidemiological study. The subjects were ≥68 years who lived in the Nara Prefecture and responded to recruitment notices. All of the subjects underwent comprehensive ophthalmological examinations, and the sociodemographic information and medical history, including prior cataract surgery, were obtained by answers to a questionnaire. The associations between the BCVA, age, sex, and history of cataract surgery were determined. A total of 2,873 subjects whose mean age was 76.3 ± 4.9 (mean ± standard deviation) years were studied. The mean BCVA was −0.020 ± 0.14 logarithm of the minimum angle of resolution units, and it was significantly better in the group with education ≥13 years (p < 0.01). Overall, 24.2% of the subjects had undergone cataract surgery, and 41.7% of the subjects ≥80 years had undergone cataract surgery. The incidence of prior cataract surgery increased with increasing age (p < 0.001 for trend). The mean BCVA of eyes with cataract surgery was significantly better than that of eyes without cataract surgery in subjects ≥80 years (p < 0.01). Visual acuity was generally good in this cohort of elderly Japanese subjects. In this cohort, 24.2% of the subjects had undergone cataract surgery, and the subjects ≥80 years had better BCVA than those without cataract surgery.

Development of topical ophthalmic In Situ gel-forming estradiol delivery system intended for the prevention of age-related cataracts

The goal of this study was to develop and characterize an ion-activated in situ gel-forming estradiol (E2) solution eye drops intended for the prevention of age-related cataracts. Accordingly, in situ gelling eye drops were made using gellan gum as an ion-activated gel-forming polymer, polysorbate-80 as drug solubilizing agent, mannitol as tonicity agent, and combination of potassium sorbate and edetate disodium dihydrate (EDTA) as preservatives. The formulations were tested for the following characteristics: pH, clarity, osmolality, antimicrobial efficacy, rheological behavior, and in vitro drug release. Stability of the formulation was also monitored for 6 months at multiple storage conditions per ICH Q1A (R2) guidelines. The solution eye drops resulted in an in-situ phase change to gel-state when mixed with simulated tear fluid (STF). The gel structure formation was confirmed by viscoelastic measurements. Drug release from the gel followed non-fickian mechanism with 80% of drug released in 8 hr. The formulations were found to be clear, isotonic with suitable pH and viscoelastic behavior and stable at accelerated and long-term storage conditions for 6 months. In vitro results suggest that the developed formulation is suitable for further investigation in animal models to elucidate the ability of estrogen to prevent and delay cataracts.

The Association between Systemic Glucocorticoid Use and the Risk of Cataract and Glaucoma in Patients with Rheumatoid Arthritis: A Systematic Review and Meta-Analysis

Objective

Glucocorticoids (GCs) are often used to treat Rheumatoid Arthritis (RA) despite their many side effects and the availability of other effective therapies. Cataract and glaucoma are known side effects of GCs but the risk of them developing in the setting of GC use for RA is unknown. The aim was to perform a systematic review and meta-analysis to determine the association between GCs and the risk of developing cataract and/or glaucoma in RA.

Methods

A systematic search was carried out using MEDLINE, EMBASE, and Web of Science. All RCTs comparing GC use to non-use in RA populations were sought. Observational studies reporting cataract and/or glaucoma amongst GC users and non-users were also included. Data extracted included incidence/prevalence of cataract and/or glaucoma in each arm, dose and duration of therapy. Two independent reviewers performed quality assessment.

Results

28 RCTs met eligibility criteria, however only 3 reported cataracts and glaucoma, suggesting significant under-reporting. An association between GC use and the development of cataracts in RA patients was seen in observational studies but not RCTs. There was no statistically significant association between GC use and the development of glaucoma, although data were sparse. There were insufficient data to determine the impact of dose and duration of therapy.

Conclusion

The current literature suggests a possible association between GC use and the development of cataract. However, this risk cannot be accurately quantified in RA from the available evidence. RCTs have not adequately captured these outcomes and well-designed observational research is required.

The effects of a low-energy, high frequency liquid optic interface femtosecond laser system on lens capsulotomy

The introduction of femtosecond laser assisted cataract surgery (FLACS) is a paradigm changing approach in cataract surgery, the most commonly performed surgical procedure. FLACS has the potential to optimize the creation of an anterior lens capsulotomy, a critical step in accessing the cataractous lens. The merits of using a laser instead of a manual approach include a potentially more circular, consistent, and stronger aperture. In this study we demonstrated for the first time in both a porcine and human experimental setting that with a low energy, high repetition FLACS system, that a circular, smooth and strong capsulotomy was achievable. While there was no demonstrable difference in the resistance to rupture before or after the removal of the nucleus, larger capsulotomies had an increase in tensile strength. The LDV Z8 system appeared to create circular, rupture-resistant and smooth capsulotomies in both porcine and more importantly human globes.

One of the most well-established age-related changes in neural activity disappears after controlling for visual acuity

Numerous studies using a variety of imaging techniques have reported age-related differences in neural activity while subjects carry out cognitive tasks. Surprisingly little attention has been paid to the potential impact of age-associated changes in sensory acuity on these findings. Studies in the visual modality frequently report that their subjects had "normal or corrected- to-normal vision." However, in most cases, there is no indication that visual acuity was actually measured, and it is likely that the investigators relied largely on self-reported visual status of subjects, which is often inaccurate. We investigated whether differences in visual acuity influence one of the most commonly observed findings in the event-related potentials literature on cognitive aging, a reduction in posterior P3b amplitude, which is an index of cognitive decision-making/updating. Well-matched young (n=26) and old adults (n=29) participated in a visual oddball task. Measured visual acuity with corrective lenses was worse in old than young adults. Results demonstrated that the robust age-related decline in P3b amplitude to visual targets disappeared after controlling for visual acuity, but was unaffected by accounting for auditory acuity. Path analysis confirmed that the relationship between age and diminished P3b to visual targets was mediated by visual acuity, suggesting that conveyance of suboptimal sensory data due to peripheral, rather than central, deficits may undermine subsequent neural processing. We conclude that until the relationship between age-associated differences in visual acuity and neural activity during experimental tasks is clearly established, investigators should exercise caution attributing results to differences in cognitive processing.

Age and Smoking Related Changes in Metal Ion Levels in Human Lens: Implications for Cataract Formation

Age-related cataract formation is the primary cause of blindness worldwide and although treatable by surgical removal of the lens the majority of sufferers have neither the finances nor access to the medical facilities required. Therefore, a better understanding of the pathogenesis of cataract may identify new therapeutic targets to prevent or slow its progression. Cataract incidence is strongly correlated with age and cigarette smoking, factors that are often associated with accumulation of metal ions in other tissues. Therefore this study evaluated the age-related changes in 14 metal ions in 32 post mortem human lenses without known cataract from donors of 11 to 82 years of age by inductively coupled plasma mass spectrometry; smoking-related changes in 10 smokers verses 14 non-smokers were also analysed. A significant age-related increase in selenium and decrease in copper ions was observed for the first time in the lens tissue, where cadmium ion levels were also increased as has been seen previously. Aluminium and vanadium ions were found to be increased in smokers compared to non-smokers (an analysis that has only been carried out before in lenses with cataract). These changes in metal ions, i.e. that occur as a consequence of normal ageing and of smoking, could contribute to cataract formation via induction of oxidative stress pathways, modulation of extracellular matrix structure/function and cellular toxicity. Thus, this study has identified novel changes in metal ions in human lens that could potentially drive the pathology of cataract formation.

Factors Associated with Cataract in Korea: A Community Health Survey 2008-2012

PURPOSE

To investigate sociodemographic factors, health behaviors, and comorbidities associated with cataracts in a large, nationally representative Korean sample.

MATERIALS AND METHODS

This cross-sectional study included 715554 adults aged 40 years or older who participated in the 2008-2012 Community Health Survey. Significant risk factors were identified using multivariate logistic regression analysis for self-reported cataract, and a nomogram for analysis of cataract risk was generated.

RESULTS

Roughly 11% of participants (n=88464) reported being diagnosed with cataracts by a doctor. Age was the most important independent risk factor [adjusted odds ratio (aOR)=1.11, 99% confidence interval (CI), 1.11-1.11 for each increasing year]. Significant comorbidities with descending order of effect size (aOR, 99% CI), included diabetes mellitus (1.78, 1.71-1.85), osteoporosis (1.62, 1.56-1.69), arthritis (1.54, 1.48-1.59), hepatitis B infection (1.46, 1.31-1.63), atopic dermatitis (1.50, 1.33-1.69), angina (1.46, 1.35-1.57), allergic rhinitis (1.45, 1.36-1.55), dyslipidemia (1.38, 1.31-1.45), asthma (1.35, 1.26-1.44), and hypertension (1.23, 1.19-1.28). Subjects who sleep less than 6 hours/day were more likely to have cataract than subjects who sleep more than 9 hours/day as a reference group (aOR=1.22, 99% CI, 1.11-1.34).

CONCLUSION

While the most important cataract risk factor was age, the ten comorbidities mentioned above were also significant risk factors. Interestingly, longer duration of sleep was associated with a protective effect against cataract development.

The Association of Outdoor Activity and Age-Related Cataract in a Rural Population of Taizhou Eye Study: Phase 1 Report

Purpose

To study the relationship between outdoor activity and risk of age-related cataract (ARC) in a rural population of Taizhou Eye Study (phrase 1 report).

Method

A population-based, cross-sectional study of 2006 eligible rural adults (≥45 years old) from Taizhou Eye Study was conducted from Jul. to Sep. 2012. Participants underwent detailed ophthalmologic examinations including uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), intraocular pressure (IOP), slit lamp and fundus examinations as well as questionnaires about previous outdoor activity and sunlight protection methods. ARC was recorded by LOCSⅢ classification system. The prevalence of cortical, nuclear and posterior subcapsular cataract were assessed separately for the risk factors and its association with outdoor activity.

Results

Of all 2006 eligible participants, 883 (44.0%) adults were diagnosed with ARC. The prevalence rates of cortical, nuclear and posterior subcapsular cataract per person were 41.4%, 30.4% and 1.5%, respectively. Women had a higher tendency of nuclear and cortical cataract than men (OR = 1.559, 95% CI 1.204–2.019 and OR = 1.862, 95% CI 1.456–2.380, respectively). Adults with high myopia had a higher prevalence of nuclear cataract than adults without that (OR = 2.528, 95% CI 1.055–6.062). Multivariable logistic regression revealed that age was risk factor of nuclear (OR = 1.190, 95% CI 1.167–1.213) and cortical (OR = 1.203, 95% CI 1.181–1.226) cataract; eyes with fundus diseases was risk factor of posterior subcapsular cataract (OR = 6.529, 95% CI 2.512–16.970). Outdoor activity was an independent risk factor of cortical cataract (OR = 1.043, 95% CI 1.004–1.083). The risk of cortical cataract increased 4.3% (95% CI 0.4%-8.3%) when outdoor activity time increased every one hour. Furthermore, the risk of cortical cataract increased 1.1% (95% CI 0.1%-2.0%) when cumulative UV-B exposure time increased every one year.

Conclusion

Outdoor activity was an independent risk factor for cortical cataract, but was not risk factor for nuclear and posterior subcapsular cataract. The risk of cortical cataract increased 4.3% when outdoor activity time increased every one hour. In addition, the risk of cortical cataract increased 1.1% (95% CI 0.1%-2.0%) when cumulative UV-B exposure time increased every one year.

Changes in lens opacities on the age-related eye disease study grading scale predict progression to cataract surgery and vision loss: age-related eye disease study report no. 34

PURPOSE

To investigate whether the 2-year change in lens opacity severity on the Age-Related Eye Disease Study (AREDS) lens grading scale predicts progression to cataract surgery or loss of visual acuity by 5 years.

DESIGN

Prospective cohort study within a randomized clinical trial of oral supplements.

PARTICIPANTS

The AREDS participants whose eyes were phakic at baseline and free of late age-related macular degeneration throughout the study.

METHODS

Baseline and annual lens photographs of AREDS participants (n = 3466/4757; 73%) were graded for severity of cataracts using the AREDS system for classifying cataracts from photographs. Clinical examinations conducted semiannually collected data on cataract surgery and visual acuity. Association of the change in lens opacities at 2 years with these outcomes at 5 years was analyzed with adjusted Cox proportional hazard models.

MAIN OUTCOME MEASUREMENTS

Progression of lens opacities on stereoscopic lens photographs at 2 years, cataract surgery, and visual acuity loss of 2 lines or more at 5 years.

RESULTS

The adjusted hazard ratios (HRs) for association of progression to cataract surgery at 5 years were: nuclear cataract increase of 1.0 unit or more compared with less than 1.0-unit change at 2 years, 2.77 (95% confidence interval [CI], 2.07-3.70; P < 0.001); cortical cataract increase of 5% or more in lens opacity in the central 5 mm of the lens compared with less than 5% increase at 2 years, 1.91 (95% CI, 1.27-2.87; P = 0.002); and posterior subcapsular cataract increase of 5% or more versus less than 5% in the central 5 mm of the lens, 8.25 (95% CI, 5.55-12.29; P < 0.001). Similarly, HRs of vision loss of 2 lines or more at 5 years for this degree of lens changes at 2 years were the following: nuclear, 1.83 (95% CI, 1.49-2.25; P < 0.001); cortical, 1.13 (95% CI, 0.78-1.65; P = 0.519); and posterior subcapsular cataract, 3.05 (95% CI, 1.79-5.19; P < 0.001).

CONCLUSIONS

Two-year changes in severity of lens opacities on the AREDS lens grading scale are predictive of long-term clinically relevant outcomes, making them potential surrogate end points in follow-up studies.

Risk factors for cataracts in systemic lupus erythematosus (SLE)

Cataract is the most common ocular damage in systemic lupus erythematosus (SLE). We analyzed data from the Hopkins Lupus Cohort longitudinally to identify the factors that predict onset of cataract prior to 60 years of age. The Hopkins Lupus Cohort is a clinical cohort of patients with SLE seen quarterly. This analysis was based on the follow-up experience prior to age 60 of 2,109 SLE patients who had not had a cataract prior to cohort entry. Patients saw their ophthalmologist every 6 months. Cataract was defined by the SLICC/American College of Rheumatology Damage Index. The rate of incident cataract was calculated in subsets of the follow-up defined by patient characteristics and history. Multivariable logistic regression models were fit to identify predictors of cataract while controlling for potential confounding variables. The analysis was based on 11,887 persons-years of follow-up, with median follow-up time of 4.1 years per patient. The incidence of cataract was 13.2/1,000 persons-years. Adjusting for other predictors, a cumulative prednisone dose equivalent to 10 mg/day for 10 years was a strong predictor of cataract (RR = 2.9, P = 0.0010). Disease activity measured by SELENA-SLEDAI (P = 0.0004) and higher systolic blood pressure (P = 0.0003) were associated with cataract. Duration of SLE, diabetes mellitus, smoking, cholesterol, renal involvement, immunological profile and medication history other than prednisone were not associated with cataract. Cataract development in SLE patients is multifactorial with prednisone, systolic blood pressure and disease activity all playing a role.

Alcohol intake and the risk of age-related cataracts: a meta-analysis of prospective cohort studies

Purpose

Epidemiologic studies assessing the relationship between alcohol consumption and the risk of age-related cataracts (ARCs) led to inconsistent results. This meta-analysis was performed to fill this gap.

Methods

Eligible studies were identified via computer searches and reviewing the reference lists of these obtained articles. Pooled estimates of the relative risks (RR) and the corresponding 95% confidence Intervals (CI) were calculated using random effects models.

Results

Seven prospective cohort studies involving a total of 119,706 participants were ultimately included in this meta-analysis. Pooled results showed that there is no substantial overall increased risk of ARC due to heavy alcohol consumption. The estimated RRs comparing heavy drinkers versus non-drinkers were 1.25 (95% CI: 1.00, 1.56) for cataract sugery, 1.06 (95% CI: 0.63, 1.81) for cortical cataracts, 1.26 (95% CI: 0.93, 1.73) for nuclear cataracts, and 0.91 (95% CI: 0.32, 2.61) for posterior subcapsular cataracts (PSCs), respectively. No significant associations between moderate alcohol consumption and cataracts were observed. The pooled RRs comparing moderate drinkers versus non-drinkers were 0.90 (95% CI: 0.64, 1.26) for cataract surgery, 0.97 (95% CI: 0.75, 1.25) for cortical cataracts, 0.91 (95% CI: 0.76, 1.08) for nuclear cataracts, and 0.97 (95% CI: 0.49, 1.91) for PSCs, respectively.

Conclusions

This meta-analysis suggests that there is no substantial overall increased risk of ARC due to alcohol intake. Because of the limited number of studies, the findings from our study must be confirmed in future research via well-designed cohort or intervention studies.

Incidence rate and occurrence of visually significant cataract formation and corneal decompensation after implantation of Verisyse/Artisan phakic intraocular lens

Purpose

To evaluate the incidence rate and indications for explantation of Verisyse phakic intraocular lenses (pIOLs) over a 13.6 year period.

Subjects and methods

Case series describing six cases of explantation of Verisyse pIOLs, out of 213 eyes with Verisyse pIOLs, implanted over a 13.6 year period by one surgeon at one institution, with mean follow-up of 5.6 years per eye.

Results

Four pIOLs were removed to facilitate extraction of a visually significant cataract, one was removed due to both cataract formation and development of corneal decompensation, and another was removed due to development of localized peripheral corneal decompensation. The incidence rate of pIOL removal was five per 1,000 patient-years with pIOL. Mean time from insertion of pIOL to cataract removal was 9.3 years (range 4.0–12.6 years). Mean time from insertion of pIOL to development of corneal decompensation was 10 years (range 6.9–13 years). There was no increase in the rate of cataract extraction in the pIOL population compared to the general population.

Conclusion

Cataracts may develop in patients with pIOLs, necessitating removal of the pIOL. Corneal decompensation is a serious complication that appears to be directly related to pIOLs. Corneal decompensation can occur up to 13 years following implantation of pIOLs, and long-term follow-up is important to monitor for this complication.

Cataract subtype risk factors identified from the Korea National Health and Nutrition Examination survey 2008-2010

Background

To assess the socio-demographic and health-related risk factors associated with cataract subtypes in Korea.

Methods

A total of 11,591 participants (aged ≥40 years) were selected from the Korean National Health and Nutrition Examination Survey between 2008 and 2010. The Korean Ophthalmologic Society conducted detailed ophthalmologic examinations on these participants based on the Lens Opacity Classification System III. Risk factors for developing any type of cataract, and its subtypes (nuclear, cortical, posterior subcapsular and mixed), were identified from univariate and multivariate logistic regression analysis.

Results

The prevalence of cataracts was 40.1% (95% CI, 37.8 − 42.3%) in participants over 40 years old. Older age, lower monthly household income, lower education, hypercholesterolemia, hypertension, and diabetes mellitus (DM) were independent risk factors for development of any cataract. Older age, lower monthly household income, lower education, hypercholesterolemia, and DM were independent risk factors for development of pure cortical cataracts. Older age, lower education, metabolic syndrome, and DM were independent risk factors for development of pure nuclear cataracts. Older age and DM were independent risk factors for development of pure posterior subcapsular cataracts. Older age, lower monthly household income, lower education, and DM were independent risk factors for development of mixed cataracts.

Conclusion

Although socioeconomic disparities are related to cataract development, this study identified several “modifiable” risk factors that may help to lower the incidence of cataracts and associated vision loss. Improved control of blood pressure, blood, glucose, and cholesterol may help to reduce the incidence of cataracts in the general Korean population.