Global and regional prevalence of age-related cataract: a comprehensive systematic review and meta-analysis

Investigating the association between cataract and the risk of herpes zoster in a cohort study

Objectives

This cohort study aimed to elucidate whether individuals with cataract are at an increased risk of herpes zoster in Taiwan.

Methods

A cohort of individuals with cataract, aged 20-84 years, was assembled from electronic health records of Taiwan National Health Insurance Program spanning a period of 8 years (2013-2020). Those individuals who had visited an ophthalmology clinic but did not have a cataract diagnosis were selected as the non-cataract group from the same database. The incidence rate of herpes zoster within the follow-up period was calculated between the two groups. The risk of herpes zoster was compared between the two groups using a Cox proportional hazards model, adjusting for potential confounders.

Results

The cohort study included 1,299,685 individuals in the cataract group and 1,138,887 individuals in the non-cataract group. The mean age was 64 years older and about 43.9% of study subjects were male in the cataract group. The mean age was 63.6 years older and about 47.1% of study subjects were male in the non-cataract group. The incidence rate of herpes zoster was 10.84 per 1,000 person-years in the cataract group and 8.64 per 1,000 person-years in the non-cataract group (incidence rate ratio = 1.25, 95% CI = 1.24-1.27, P < 0.001). After adjusting for potential confounders, the hazard ratio was 1.22 for herpes zoster in individuals with cataract when compared with those without cataract (95% CI = 1.21-1.23, P < 0.001).

Conclusion

Our cohort study reveals that individuals with cataract are at an increased risk of developing herpes zoster. Our findings highlight the importance of considering the increased susceptibility to herpes zoster in individuals with cataract and the potential benefits of preventive measures such as herpes zoster vaccination.

APEX1 attenuates ERS-induced paraptosis by inhibiting the P53 pathway in LECs

Age-related cortical cataract (ARCC) is a prominent subtype of cataract, characterized by the presence of vacuoles and spoke-like opacity. Previous studies have suggested that paraptosis is involved in the onset of early ARCC vacuolar degeneration. In this experiment, hydrogen peroxide (H2O2)-induced SRA01/04 cells were used to establish a paraptosis-like cell model, and the function and underlying mechanism of APEX1 in this cell model were explored. Quantitative reverse transcription polymerase chain reaction (qRT-PCR) and Western Blot analyses were conducted to assess the expression of pertinent genes in SRA01/04. Confocal fluorescence microscopy, using ER-tracker kits, was applied to clarify the relationship between the endoplasmic reticulum and intracellular vacuoles. The co-IP assay was used to verify the interaction between APEX1 and P53. The GTRD database was employed to predict the putative target genes combined with P53, and CUT&RUN assay was employed to confirm the enrichment of the P53 and ATF6 promoters following APEX1 overexpression. Firstly, the pathological sections of the vacuolar degeneration zone in the lens cortex of ARCC patients exhibited fiber disarray and vacuole development. Meanwhile, the protein expression of Alix, a specific paraptosis inhibitor, was decreased in low-concentration H2O2-treated SRA01/04 cells. Secondly, we discovered that 4-PBA suppressed the expression of ATF6 and PERK. Moreover, overexpression of APEX1 in SRA01/04 cells improved endoplasmic reticulum morphology, inhibited the interaction between P53 and ATF6, and attenuated paraptosis in SRA01/04. APEX1 regulated P53 and then mediated ATF6 to affect the endoplasmic reticulum stress and paraptosis in H2O2-induced SRA01/04 cells.

Nutrient-Driven Antioxidant Interventions for Prevention of Age-Related and Diabetic Cataracts

Cataract formation remains a significant cause of global visual impairment. Increasing attention has been directed toward antioxidant-based interventions as potential non-surgical strategies to delay or prevent cataractogenesis, particularly in the age-related and diabetic contexts. This review summarizes recent preclinical evidence on nutritional antioxidants for the prevention of age-related and diabetic cataracts. Agents such as trimetazidine, Moringa oleifera stem extract, ginsenoside Rg1, lanosterol nanoparticles, β-casomorphin-7, and cerium oxide-based nanotherapies have been shown to mitigate oxidative damage, modulate redox signaling pathways, and preserve lens clarity. Advances in drug delivery, including topical formulations, nanoparticle carriers, and intravitreal injections, have been proposed to overcome the anatomical and pharmacokinetic barriers associated with the avascular lens. The new data support ongoing translational research to maximize the clinical use of antioxidants and highlight their therapeutic potential in the prevention of age-related and diabetic cataracts.

circ_EPB41 Modulates the miR-15a-5p/Bcl-2 Pathway to Alleviate Oxidative Stress Damage in Lens Epithelial Cells

PURPOSE

This study aimed to investigate the role of circ_EPB41 in regulating oxidative stress-induced apoptosis in lens epithelial cells by targeting the miR-15a-5p/Bcl-2 pathway, highlighting its potential significance in age-related cataract treatment. Growing evidence suggests that circular RNAs and microRNAs play critical roles in age-related cataract development, making circ_EPB41 a promising target.

METHODS

SRA01/04 cells were exposed to 200 µM H2O2 for 24 h to induce oxidative damage and model age-related cataract. Cell viability and apoptosis were assessed using MTT assays and flow cytometry, respectively. The interaction between circ_EPB41 and miR-15a-5p was analyzed through bioinformatics tools and dual luciferase reporter assays. Additionally, the expression levels of Bax, Bcl-2, miR-15a-5p, and circ_EPB41 were measured using RT-qPCR and Western blot analysis.

RESULTS

H2O2-induced SRA01/04 cells showed down-regulation of circ_EPB41 and up-regulation of miR-15a-5p. Circ_EPB41 was found to interact with miR-15a-5p, negatively regulating its expression. Furthermore, miR-15a-5p mimics reversed the effects of circ_EPB41 on oxidative stress in SRA01/04 cells, as evidenced by reduced cell viability, increased apoptosis, elevated Bax levels, and decreased Bcl-2 expression. In contrast, miR-15a-5p inhibitors alleviated H2O2-induced oxidative damage by upregulating Bcl-2 expression.

CONCLUSION

This study is the first to demonstrate that up-regulation of circ_EPB41 protects lens epithelial cells from oxidative stress-induced apoptosis through the miR-15a-5p/Bcl-2 pathway. These findings suggest that circ_EPB41 may hold potential as a novel therapeutic target for age-related cataract treatment.

Metal-phenolic epigallocatechin gallate‑zinc antioxidant nanoparticles for cataract treatment

In cataract, oxidative stress plays an important role. It breaks the balance of the antioxidant defense system by destroying biological macromolecules such as proteins, lipids and nucleic acids in the lens, induces lens opacity, and then leads to the formation of cataract. The antioxidant properties of epigallocatechin gallate (EGCG) are well-established, particularly its ability to scavenge ROS and modulate cellular pathways. However, its therapeutic potential is limited by poor stability and bioavailability. To overcome these challenges, the work is designed to form a metal-phenolic network (MPN) system by coordinating EGCG with zinc ions. MPNs offer distinct advantages for ocular drug delivery, including enhanced structural stability, improved cellular uptake, and the ability to simultaneously target multiple oxidative stress pathways. By doing so, an antioxidant nanoparticle is formed to slow down the turbidity process of the lens induced by oxidative stress and thus prevent the occurrence of cataract. The particle size, zeta potential, ultraviolet absorption spectrum, FTIR, surface morphology and element distribution of EGCG-Zn were determined. In vitro, EGCG-Zn has good biosafety, cell uptake performance and anti-cell damage performance. In addition, from a mechanistic analysis, the particles can scavenge free radicals and reduce the production of intracellular ROS. Similarly, EGCG-Zn can well prevent the damage of reactive oxygen species to intracellular lysosomes, mitochondria, cytoskeleton, DNA synthesis and cell senescence. In the UV-B-induced cataract animal model in rats, EGCG-Zn has good in vivo safety. The transparency of the lens in the experimental group using EGCG-Zn is significantly lower than that in the untreated model group. In conclusion, EGCG-Zn nanoparticles are expected to become an important means in the field of cataract treatment, bringing hope for restoring clear vision to many cataract patients.

Automated Comprehensive Analysis of Preoperative Biometric Parameters in Cataract Patients: A Retrospective Study of over 6000 Eyes

Cataract surgery is one of the most successful surgical procedures, improving vision and quality of life for millions globally. An accurate preoperative measurement is crucial for predicting outcomes, particularly in minimizing postoperative refractive errors through precise intraocular lens (IOL) selection. This study aimed to analyze preoperative biometric data in cataract patients to identify key parameters relevant for clinical decision-making. The study also sought to understand patient demographics and biometrics in a representative population. An automated retrospective analysis was conducted on the preoperative biometric data of 6 163 eyes from 3 118 patients who underwent cataract or clear lens extraction (CLE) surgery in a German clinic over the past 2 years. All measurements were taken using the IOL Master 700 (Carl Zeiss Meditec, Jena, Germany), and data were automatically transferred for analysis using a dedicated software tool. Biometric parameters assessed included axial length (AL), keratometry values (K, TK), anterior chamber depth (ACD), lens thickness (LT), and vitreous length (VL). The age and gender distribution of the cohort was also considered. The biometric data from this large patient cohort largely aligns with published norms for cataract patients. The majority of eyes exhibited ALs and corneal curvatures within expected ranges, supporting accurate IOL power calculations. The study also confirmed a high prevalence of mild astigmatism, suggesting that toric IOLs could address residual astigmatism for better visual outcomes. This study's large sample size adds valuable insights into preoperative cataract patient data and shows the value of an automated analysis.

Photodynamic therapy could serve as a promising approach to prevent posterior capsular opacification

Posterior capsular opacification (PCO) causes the vision that has been restored after cataract surgery to become blurred again. YAG laser treatment for PCO not only incurs additional costs but also poses risks of complications, including glaucoma and retinal disorders. Effective prevention and management of PCO remain an area requiring active research. Photodynamic therapy (PDT) utilizes a photosensitizer (PS) to transform oxygen into reactive oxygen species (ROS) under specific wavelengths of light, thereby inducing apoptosis. Given its minimal invasiveness and high specificity, PDT has been extensively applied in the treatment of conditions characterized by abnormal cell proliferation, such as tumors. Considering the pathogenesis of PCO, PDT has demonstrated promising clinical application potential in ophthalmic disease treatment. This review examines the impact of photodynamic therapy on the biological behavior of lens epithelial cells (LECs) and its efficacy in treating PCO. It also discusses the advantages and disadvantages of different photosensitizers and their clinical application potential.

PhacoTrainer: Automatic Artificial Intelligence-Generated Performance Ratings for Cataract Surgery

Purpose

To investigate whether cataract surgical skill performance metrics automatically generated by artificial intelligence (AI) models can differentiate between trainee and faculty surgeons and the correlation between AI metrics and expert-rated skills.

Methods

Routine cataract surgical videos from residents (N = 28) and attendings (N = 29) were collected. Three video-level metrics were generated by deep learning models: phacoemulsification probe decentration, eye decentration, and zoom level change. Three types of instrument- and landmark- specific metrics were generated for the limbus, pupil, and various surgical instruments: total path length, maximum velocity, and area. Expert human judges assessed the surgical videos using the Objective Structured Assessment of Cataract Surgical Skill (OSACSS). Statistical differences between AI and human-rated scores between attending surgeons and trainees were assessed using t-tests, and the correlations between them were examined by Pearson correlation coefficients.

Results

The phacoemulsification probe had significantly lower total path lengths, maximum velocities, and area metrics in attending videos. Attending surgeons demonstrated better phacoemulsification centration and eye centration. Most AI metrics negatively correlated with OSACSS scores, including phacoemulsification decentration (r = -0.369) and eye decentration (r = -0.394). OSACSS subitems related to eye centration and different steps of surgery also exhibited significant negative correlations with corresponding AI metrics (r ranging from -0.77 to -0.49).

Conclusions

Automatically generated AI metrics can be used to differentiate between attending and trainee surgeries and correlate with the human expert evaluation on surgical performance.

Translational Relevance

AI-generated useful metrics that correlate with surgeon skill may be useful for improving cataract surgical education.

Economic Value of Enhanced Monofocal Intraocular Lenses for Cataract Surgery in Italy

AIM

Cataract is a prevalent health condition, primarily caused by aging, affecting approximately 95 million individuals worldwide. The only effective treatment currently involves surgically removing and replacing the crystalline lens with an artificial intraocular lens (IOL). Various IOLs are available, each with distinct characteristics, costs, and outcomes. This study aimed to assess the value of an enhanced monofocal IOL for cataract surgery, which has been shown to improve intermediate vision and reduce the need for spectacles during intermediate tasks, compared to a conventional monofocal IOL (standard of care), through a cost-utility analysis from both the National Healthcare Service (NHS) and societal perspectives in Italy.

METHODS

A cost-utility model was developed incorporating both healthcare and nonhealthcare costs, as well as productivity losses, using data from a socio-economic questionnaire administered at three clinical centers in Italy. The questionnaire included the EuroQol 5D-5L to assess quality of life. National Healthcare Service costs were based on reimbursement tariffs.

RESULTS

Over a 10-year horizon, estimated costs were 15,723 € (16,643 USD) for the standard IOL group and 11,190 € (11,845 USD) for the enhanced monofocal IOL group from the societal perspective. Since no significant differences in patients' quality of life were observed between the two groups, the innovative IOL may be considered a cost-saving option compared to standard monofocal IOL. From the NHS perspective, only the intervention for lens implantation was considered, resulting in costs of 940 € (994.99 USD) and 900 € (952.65 USD) for enhanced monofocal IOL and standard IOL, respectively. In this perspective, enhanced monofocal IOL was dominated (more costly with the same QALYs) by standard IOL.

CONCLUSIONS

This study fills a literature gap by evaluating the cost-utility of enhanced monofocal IOLs for cataract surgery compared to standard IOLs. While enhanced monofocal IOL is dominated from the NHS perspective due to slightly higher direct healthcare costs, it is cost-saving from a societal perspective by reducing the overall economic burden with comparable patients' quality of life. The broader benefits, including reduced reliance on corrective measures, visits and exams, formal and informal assistance, emphasize its societal value. This highlights the need for a holistic healthcare approach that balances long-term societal savings with short-term healthcare costs.

Azobenzene-Grafted Acrylate Coatings to Modulate Lens Epithelial Cells

Polymeric intraocular lenses (IOLs) are prosthetics used to replace cataracts to restore vision. However, in 20% or more of cases, lens epithelial cells (LECs) remaining after surgery migrate along the IOL and posterior capsule, causing new vision anomalies, termed posterior capsule opacification (PCO). The surface of the polymeric IOL is identified as a leading factor for the development of their failure, and we hypothesize that specialized coatings could mitigate or prevent these failures. Azobenzene was grafted to coatings made of poly(methacrylic acid-co-isodecyl acrylate) (MAAcoIDA) and poly(methyl methacrylate-co-isodecyl acrylate) (MMcoIDA) to produce a library of acrylic coatings. The azobenzene on the surface of these coatings could reversibly photoisomerize with 365 nm light and complex with β-cyclodextrin (β-CD). Human LEC cell line, B3-LECs, grown on these coatings had modulated protein and gene expression, with lower α-smooth muscle actin protein expression and inflammatory interleukin 6 gene expression in cells incubated on all of the variations of MMcoIDA compared to MAAcoIDA. Azobenzene modifications with and without UV and β-CD treatment also modulated cell behavior where cells on azobenzene-modified MAAcoIDA had decreased live/dead ratios after UV treatments, a potential method to reduce LEC viability. The cells on β-CD-treated azobenzene-modified MAAcoIDA had differences in cell adhesion after UV treatments, illustrating that UV light can be applied to modulate cell behavior in conjunction with β-CD. The different coatings present methods to modulate LEC adhesion, death, and behavior, temporarily when dependent on UV treatments.

Chinese generative AI models (DeepSeek and Qwen) rival ChatGPT-4 in ophthalmology queries with excellent performance in Arabic and English

The rapid evolution of generative artificial intelligence (genAI) has ushered in a new era of digital medical consultations, with patients turning to AI-driven tools for guidance. The emergence of Chinese-developed genAI models such as DeepSeek-R1 and Qwen-2.5 presented a challenge to the dominance of OpenAI's ChatGPT. The aim of this study was to benchmark the performance of Chinese genAI models against ChatGPT-40 and to assess disparities in performance across English and Arabic. Following the METRICS checklist for genAI evaluation, Qwen-2.5, DeepSeek-R1, and ChatGPT-40 were assessed for completeness, accuracy, and relevance using the CLEAR tool in common patient ophthalmology queries. In English, Qwen-2.5 demonstrated the highest overall performance (CLEAR score: 4.43 ± 0.28), outperforming both DeepSeek-R1 (4.3 ± 0.43) and ChatGPT-40 (4.14 ± 0.41), with p = 0.002. A similar hierarchy emerged in Arabic, with Qwen-2.5 again leading (4.40 ± 0.29), followed by DeepSeek-R1 (4.20 ± 0.49) and ChatGPT-40 (4.14 ± 0.41), with p = 0.007. Each tested genAI model exhibited near-identical performance across the two languages, with ChatGPT-40 demonstrating the most balanced linguistic capabilities (p = 0.957), while Qwen-2.5 and DeepSeek-R1 showed a marginal superiority for English. An in-depth examination of genAI performance across key CLEAR components revealed that Qwen-2.5 consistently excelled in content completeness, factual accuracy, and relevance in both English and Arabic, setting a new benchmark for genAI in medical inquiries. Despite minor linguistic disparities, all three models exhibited robust multilingual capabilities, challenging the long-held assumption that genAI is inherently biased toward English. These findings highlight the evolving nature of AI-driven medical assistance, with Chinese genAI models being able to rival or even surpass ChatGPT-40 in ophthalmology-related queries.

Molecular Mechanisms of Vitamin E in Ocular Neurodegenerative Disorders: An Update on the Emerging Evidence and Therapeutic Implications

Vitamin E is renowned for its potent antioxidant properties, crucial for shielding cells against oxidative stress and damage. Deficiency in this vitamin can lead to various health issues, including neurodegenerative diseases, due to its pivotal role in preserving cell membrane integrity and combating cellular oxidative damage. While its importance for overall health, including neurodegeneration, is acknowledged, the specific correlation between vitamin E deficiency and distinct ocular neurodegenerative disorders need to be further explored. This review delves into the molecular mechanisms of vitamin E in ocular neurodegenerative disorders; diabetic retinopathy, age-related macular degeneration, glaucoma, and cataracts, and emphasising the therapeutic implications drawn from existing evidence. Relationship between vitamin E and ocular neurodegenerative disorders is widely researched on, with its primary protective mechanisms attributed to its antioxidant and anti-inflammatory properties. However, studies on the supplementation of vitamin E among human subjects present mixed results, suggesting its complexities and variability depending on factors such as the specific disorder, disease stage, genetic differences, and form of vitamin E utilized. In conclusion, while vitamin E holds promise in mitigating ocular neurodegeneration through its antioxidant and anti-inflammatory properties, its supplementation's efficacy remains nuanced and context dependent. More research works are essential to elucidate its precise role and therapeutic potential in combating various ocular neurodegenerative disorders.

Various Cataract Model Eyes for Wet Lab Training Using the Microwave Surgical Device

Purpose This study aims to develop a highly reproducible and efficient method for inducing lens nucleus hardening in porcine eyes using a microwave surgical device. The resulting cataract model eyes simulate key aspects of cataract surgery, offering an effective platform for enhancing surgical training. Methods Freshly enucleated porcine eyes were prepared. A microwave surgical device with a pencil-type electrode (PE) and needle-type electrode (NE) was utilized. The PE was inserted through a scleral incision 4 mm from the corneal limbus, positioned at the center of the lens nucleus, and activated at 50 mW for 30 seconds to create a nucleus cataract model eye. The NE was inserted through a scleral incision 8 mm from the corneal limbus, directed towards the vitreous cavity, and activated at 10 mW for less than 10 seconds to create a posterior polar cataract model eye. The created nucleus cataract model eyes (n=23) were evaluated using a phacoemulsification machine's cumulative dissipated energy (CDE) value. Results Thermal coagulation effectively induced nuclear sclerosis, creating a cloudy nucleus cataract model eye without compromising corneal opacity. The anterior capsule was stained with trypan blue to simulate poor visibility in white cataracts, facilitating capsulorhexis training. The hardened lens nucleus allowed for the practice of phaco-chop and divide-and-conquer techniques with realistic tactile feedback, similar to actual cataract surgery. The mean CDE value of the 23 nucleus cataract model eyes was 8.25, indicating increased nuclear hardness. Additionally, posterior capsule thermal denaturation via the vitreous cavity successfully created a posterior polar cataract model eye. Hydrodelineation and irrigation/aspiration were performed without causing posterior capsular rupture. Conclusion This study presents a novel method to create realistic nucleus and posterior polar cataract models using a microwave surgical device in porcine eyes. These models provide a reproducible and effective platform for surgical training, simulating key aspects of cataract surgery, including capsulorhexis under poor visibility and phacoemulsification techniques.

The Hsa_circ_0105558/miR-182-5p/ATF6 Cascade Affects H2O2-Triggered Oxidative Damage and Apoptosis of Human Lens Epithelial Cells

Age-related cataract (ARC) is the prevalent cause of useful vision loss. Circular RNAs are related to ARC pathogenesis partly through their competing endogenous RNA (ceRNA) activity. Herein, we defined the action of hsa_circ_0105558 in hydrogen peroxide (H2O2)-driven apoptosis and oxidative damage in human lens epithelial SRA01/04 cells. Hsa_circ_0105558, microRNA (miR)-182-5p and activating transcription factor 6 (ATF6) were evaluated by a qRT-PCR or immunoblotting method. The hsa_circ_0105558/miR-182-5p and miR-182-5p/ATF6 relationships were predicted by bioinformatics analysis and confirmed by dual-luciferase reporter assay. Reactive oxygen species level, glutathione peroxidase level, superoxide dismutase activity, and malondialdehyde level were measured using the matched assay kits. Hsa_circ_0105558 was upregulated in human ARC lens and H2O2-exposed SRA01/04 cells. Suppression of hsa_circ_0105558 attenuated H2O2-driven SRA01/04 cell apoptosis and oxidative damage. Hsa_circ_0105558 targeted miR-182-5p, and reduced miR-182-5p expression reversed the influence of hsa_circ_0105558 depletion on H2O2-driven oxidative damage and apoptosis. ATF6 was a target of miR-182-5p, and miR-182-5p-driven downregulation of ATF6 regulated cell oxidative damage and apoptosis under H2O2 insult. Moreover, hsa_circ_0105558 functioned as a ceRNA to post-transcriptionally control ATF6 expression through miR-182-5p competition. Our study demonstrates that hsa_circ_0105558 modulates SRA01/04 cell oxidative damage and apoptosis under H2O2 insult through the miR-182-5p/ATF6 cascade.

Optimizing pain management and pupil dilation in cataract surgery: a systematic review and meta-analysis of phenylephrine/ketorolac (OMIDRIA®)

PURPOSE

This systematic review and meta-analysis aims to evaluate the efficacy and safety of the combination of phenylephrine 1% and ketorolac 0.3% (OMIDRIA®) for optimizing pain management and maintaining pupil dilation during cataract surgery. Comparisons were made against placebo/vehicle, phenylephrine alone, and epinephrine.

METHODS

A comprehensive search of PubMed, Cochrane CENTRAL, Embase, Scopus, and Web of Science was conducted. Eligible studies were randomized clinical trials and observational studies assessing intracameral phenylephrine/ketorolac against control groups. Key outcomes included pain management, pupil diameter, and adverse events. Data were synthesized using meta-analysis with fixed and random-effects models, and heterogeneity was assessed using the I2 statistic.

RESULTS

Ten studies, including 220,061 patients, were analyzed. The combination of phenylephrine/ketorolac significantly reduced postoperative pain (RR = 0.72, 95% CI: 0.60-0.86) and opioid use (RR = 0.45, 95% CI: 0.23-0.89) compared to vehicle and epinephrine. PE/K also maintained a larger pupil diameter (MD = 0.54 mm, 95% CI: 0.32-0.75) with minimal heterogeneity (I2 = 0%) and reduced the incidence of severe pain (RR = 0.41, 95% CI: 0.27-0.63). No significant differences in adverse events such as elevated intraocular pressure, inflammation, or headaches were observed.

CONCLUSION

Phenylephrine/ketorolac (OMIDRIA®) demonstrates superior efficacy in maintaining intraoperative mydriasis, reducing postoperative pain, and minimizing opioid use without increasing adverse events. This combination offers a preferable alternative to traditional agents, potentially setting a new standard for pain management and pupil dilation in cataract surgery.

Global trends in refractive disorders from 1990 to 2021: insights from the global burden of disease study and predictive modeling

Purpose

This study aims to provide global, regional, and national estimates of the refractive disorders-related burden between 1990 and 2021, stratified by subtypes.

Design

A retrospective analysis was conducted using aggregated data.

Methods

Utilizing data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 (GBD 2021), this population-based study analyzed the burden of refractive disorders from 1990 to 2021. Estimated annual percentage changes (EAPCs) were calculated to quantify temporal trends in age-standardized rates of refractive disorder prevalence and disability-adjusted life-years (DALYs), stratified by age, sex, region, and country. The associations between EAPCs in age-standardized rates and socio-demographic index (SDI) were also examined. Using comprehensive data, we conducted predictive analyses with the Age-Period-Cohort (APC) and Autoregressive Integrated Moving Average (ARIMA) models to forecast disease prevalence and Disability-Adjusted Life Years (DALYs) for informing future public health strategies.

Results

Globally, the age-standardized rates of refractive disorders per 100,000 population decreased in all age groups from 1990 to 2021. Specifically, prevalence rates declined from 2,053.56 (95% uncertainty interval [UI]: 1,835.31-2,275.8) to 1919.66 (95% UI: 1,715.24-2,135.28, EAPC: -0.24), while DALYs reduced from 88.04 (95% UI: 62.19-125.15) to 79.11 (95% UI: 54.94-114.14, EAPC: -0.36). These reductions were primarily driven by a decline in refractive disorders. Notably, both the prevalence and DALYs associated with refractive disorders decreased significantly in the 60 to 64 age group. In low and low-middle SDI countries, there was a significant reduction in both prevalence and DALYs, while high and middle-high SDI countries experienced an increase in these metrics. Benin exhibited the largest increase in prevalence and burden, while India had the most significant decrease. There are notable discrepancies between countries and regions compared to GBD estimates, indicating potential underestimations of refractive disorder prevalence and burden. The APC model details age-specific trends and cohort effects, while the ARIMA model offers strong predictions from historical data. Both models underscore fluctuating disease burdens, stressing the importance of adaptive health policies to meet future healthcare needs.

Conclusion

Over the past three decades, global efforts have significantly alleviated the burden of refractive errors. However, substantial disparities persist across different types of impairment, age groups, and countries' Socio-Demographic Index (SDI). With the conclusion of the COVID-19 pandemic, it is crucial to expand eye care services, particularly in enhancing screening coverage and quality control. This study underscores the importance of addressing diverse population needs and fostering regional cooperation to improve eye health outcomes, providing a comprehensive strategy for future public health initiatives.

Cross-sectional association of oxidative balance score with cataract among US adults: NHANES 1999-2008

Objective

Oxidative stress plays a crucial role in the onset and progression of cataracts. As a comprehensive indicator of an individual's oxidative stress status, OBS integrates dietary antioxidant intake and lifestyle factors, providing a holistic assessment of oxidative-antioxidative balance. However, research on the association between OBS and cataracts remains limited. Therefore, our study aims to bridge this research gap and provide novel epidemiological evidence supporting the role of oxidative stress in cataract prevention.

Methods

A total of 13,409 subjects from the National Health and Nutrition Examination Survey (NHANES) conducted between 1999 and 2008 were selected. The OBS was calculated based on 16 dietary factors and 4 lifestyle factors. Weighted logistic regression and restricted cubic splines (RCS) were employed to assess the association between OBS and cataract.

Results

The prevalence of cataract was found to be 12.2%. The restricted cubic spline analysis did not support a non-linear association between OBS and the prevalence of cataract (p = 0.742). After categorizing participants into quartiles based on OBS, those in the Q4 group exhibited lower odds of developing cataract (OR: 0.827, 95% CI: 0.713, 0.958, p < 0.01) compared to the Q1 group. Subgroup analysis revealed that significant associations were observed only among males, individuals with an education level below high school, those with a poverty income ratio (PIR) ranging from 1.3 to 3.49, and individuals with a Charlson comorbidity index (CCI) of 2 or higher.

Conclusion

The OBS demonstrated a strong negative correlation with cataract prevalence. These results underscore the importance of adhering to an antioxidant-rich diet and lifestyle for cataract prevention, as well as the need to consider individual and population-specific factors in future research and prevention strategies.

Prevalence and risk factors of age-related cataract among adults aged 50 + in Gegharkunik, Armenia

PURPOSE

This study assessed the prevalence of age-related cataract and associated risk factors among people aged 50 years and older in Gegharkunik province of Armenia using the Rapid Assessment of Avoidable Blindness (RAAB) methodology.

METHODS

A cluster sampling technique was used to draw the study sample. Twenty-four clusters were selected with 50 people in each cluster. A structured interviewer-based questionnaire collected information about participants' socio-demographics, visual acuity, cataract status, health characteristics, and health-related behaviours. An ophthalmic examination assessed participants' visual acuity and cataract status. Descriptive statistics and logistic regression were used for data analysis.

RESULTS

The study recruited 1,099 participants. The mean age of the participants was 64.8. The prevalence of cataract was 24.3%. The prevalence of mild to severe visual impairment and blindness after pinhole correction was 17.4% and 1.9% in the sample, respectively. In the adjusted analysis, advanced age, low level of education, and diabetes were associated with cataract, while sex, hypertension, smoking status, and physical activity lost their significance after adjusting for covariates.

CONCLUSION

Regular eye exams and targeted public health programs might be effective for at-risk groups. Community education can improve diabetes management, promote healthier behaviors, and raise awareness, especially in people with lower education levels.

Understanding cataract development in axial myopia: The contribution of oxidative stress and related pathways

Myopia is an evolving global health challenge, with estimates suggesting that by 2050 it will affect half of the world's population, becoming the leading cause of irreversible vision loss. Moreover, myopia can lead to various complications, including the earlier onset of cataracts. Given the progressive aging of the population and the increase in life expectancy, this will contribute to a rising demand for cataract surgery, posing an additional challenge for healthcare systems. The pathogenesis of nuclear and posterior subcapsular cataract (PSC) development in axial myopia is complex and primarily involves intensified liquefaction of the vitreous body, excessive production of reactive oxygen species, impaired antioxidant defense, and chronic inflammation in the eyeball. These factors contribute to disruptions in mitochondrial homeostasis, abnormal cell signaling, lipid peroxidation, protein and nucleic acid damage, as well as the induction of adverse epigenetic modifications. Age-related and oxidative processes can cause destabilization of crystallins with subsequent protein accumulation, which finally drives to a lens opacification. Moreover, an altered redox status is one of the major contributors to the pathogenesis of PSC. This review aims to summarize the mechanisms known to be responsible for the accelerated development of cataracts in axial myopia and to enhance understanding of these relationships.

Effect of different incisions on dry eye symptoms after cataract surgery in diabetic patients

AIM

Diabetic patients suffer from severe dry eye after cataract surgery, and the aim of this study was to investigate the effect of 2.2 mm and 3.0 mm clear corneal incisions on dry eye after phacoemulsification in patients with type 2 diabetes mellitus (T2DM).

METHODS

Clinical data of 104 patients with T2DM who underwent phacoemulsification in the Department of Ophthalmology of The People's Hospital of Yingshang from January 2022 to November 2023 were retrospectively collected. The patients were categorized into 2.2 mm and 3.0 mm groups according to the surgical incision, and their preoperative and postoperative Ocular surface disease index (OSDI), Schirmer I test (SIt), and Fluorescein breakup time (FBUT), as well as anxiety and depression levels, were analyzed.

RESULTS

Before surgery, mild anxiety and depression were present in both groups. At 7 days and 1 month postoperatively, OSDI was significantly higher and SIt and FBUT were substantially lower in both groups, but the above indexes were milder in the 2.2 mm group. Meanwhile, the psychological status of both groups significantly improved at 1 month after surgery, and the improvement was more significant in the 2.2 mm group. At 3 months postoperatively, the dry eye of the two groups was relieved, and the psychological status was also improved.

CONCLUSION

Compared with 3.0 mm, a 2.2 mm clear corneal incision effectively reduced dry eye after phacoemulsification in T2DM patients.

Cellular Senescence in Health, Disease, and Lens Aging

Background: Cellular senescence is a state of irreversible cell cycle arrest that serves as a critical regulator of tissue homeostasis, aging, and disease. While transient senescence contributes to development, wound healing, and tumor suppression, chronic senescence drives inflammation, tissue dysfunction, and age-related pathologies, including cataracts. Lens epithelial cells (LECs), essential for maintaining lens transparency, are particularly vulnerable to oxidative stress-induced senescence, which accelerates lens aging and cataract formation. This review examines the dual role of senescence in LEC function and its implications for age-related cataractogenesis, alongside emerging senotherapeutic interventions. Methods: This review synthesizes findings on the molecular mechanisms of senescence, focusing on oxidative stress, mitochondrial dysfunction, and the senescence-associated secretory phenotype (SASP). It explores evidence linking LEC senescence to cataract formation, highlighting key studies on stress responses, DNA damage, and antioxidant defense. Recent advances in senotherapeutics, including senolytics and senomorphics, are analyzed for their potential to mitigate LEC senescence and delay cataract progression. Conclusions: LEC senescence is driven by oxidative damage, mitochondrial dysfunction, and impaired redox homeostasis. These factors activate senescence path-ways, including p53/p21 and p16/Rb, resulting in cell cycle arrest and SASP-mediated inflammation. The accumulation of senescent LECs reduces regenerative capacity, disrupts lens homeostasis, and contributes to cataractogenesis. Emerging senotherapeutics, such as dasatinib, quercetin, and metformin, show promise in reducing the senescent cell burden and modulating the SASP to preserve lens transparency.

Visual, clinical and quality of life outcomes of a new multifocal IOL with optimized diffractive grating: a non-randomized clinical trial

BACKGROUND

Multifocal intraocular lenses (IOLs) are designed to reduce dependence on spectacles by providing multiple focal points. However, they are associated with photic phenomena such as halos and glare, and may reduce contrast sensitivity. The BIOS Trifocal is a single-piece acrylic diffractive IOL with a closed-loop haptic design, optimized for centration and stability. It features an aspheric, aberration-neutral surface and a precisely engineered diffraction grating for effective energy distribution across multiple distances. This study aims to evaluate the visual, clinical, and quality of life outcomes of the BIOS Trifocal IOL for treatment of cataract and presbyopia.

METHODS

Participants who met the inclusion criteria underwent implantation of the BIOS Trifocal IOL and were assessed at 30 and 90 days post-surgery. The evaluations included measurements of patient-reported outcomes using the NEI-VFQ 25 at postoperative day 30 and uncorrected and corrected distance visual acuity and defocus curves at postoperative day 90. Additionally, intraoperative and postoperative complications were documented. Visual acuity assessments were performed under photopic conditions, with a range of defocus from + 1.5 D to -3.0 D.

RESULTS

Significant improvements were observed in uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and near visual acuity (UNVA) at both 30 and 90 days post-surgery (p < 0.001). The defocus curve demonstrated functional vision from + 1.5 D to -3.0 D, supporting the lens's efficacy for near, intermediate, and far distances. Quality of life, as assessed by the NEI-VFQ 25, showed marked improvement across all domains (p < 0.05), with no significant complications directly attributable to the IOL.

CONCLUSIONS

The BIOS Trifocal IOL presented satisfactory effectivity in the treatment of cataract and presbyopia, providing functional vision across near, intermediate and far distances and maintaining good patient satisfaction.

TRIAL REGISTRATION

This trial was registered at the ReBEC (Registro Brasileiro de Ensaios Clínicos - Brazilian Registry of Clinical Trials)database under the registration code RBR-772s6y at April 6th, 2020.

Patient-Centric Approach for the Treatment of Rheumatoid Arthritis-Associated Interstitial Lung Disease in Older People

PURPOSE OF REVIEW

The purpose of this review is to outline considerations for treating older adults with rheumatoid arthritis-associated interstitial lung disease (RA-ILD) as it relates to infection, comorbidities, cancer, and quality of life.

RECENT FINDINGS

The recent 2023 American College of Rheumatology/American College of Chest Physicians guideline conditionally recommended specific disease-modifying antirheumatic drugs (DMARDs), antifibrotics, and short-term glucocorticoids to treat RA-ILD. Since RA-ILD often affects older adults, we contextualize these pharmacologic options related to infection, gastrointestinal (GI) effects, cancer, cardiovascular disease, and quality of life. Nearly all DMARDs and glucocorticoids are immunosuppressive and increase infection risk. Rituximab, mycophenolate, cyclophosphamide, and glucocorticoids may have particularly high infection risk. Many therapies recommended for treating RA-ILD have potential GI side effects. Antifibrotics have a high rate of nausea and diarrhea. Janus kinase inhibitors may increase risk of cancer and cardiovascular disease in older people. In older individuals, decisions must weigh the risks and benefits of drug options while considering clinical and social factors such as polypharmacy, adherence, cost, convenience, and social support. Management of RA-ILD in older individuals is complex and should consider risks and benefits, while optimizing quality and quantity of life through a shared decision-making process.

Patient-Reported Outcomes of Visual Disturbances with a Trifocal Intraocular Lens: A Meta-Analysis

INTRODUCTION

Diffractive trifocal intraocular lenses (IOLs) provide good vision at distance, intermediate, and near, but can also cause positive dysphotopsias. This meta-analysis pooled published evidence on visual disturbances after bilateral implantation of the PanOptix (TFNTXX) IOL for patients undergoing cataract surgery.

METHOD

A systematic literature search was conducted in PubMed and congress presentations from April 2021 to December 2022 to identify studies with patient-reported outcomes on the incidence of visual disturbances (starbursts, halos, glare) post bilateral implantation of PanOptix IOL during cataract surgery. Random-effects meta-analysis was performed to generate pooled proportions for patient-reported visual disturbances with a 95% confidence interval [CI].

RESULTS

Eleven unique studies were included, spanning 580 patients with bilateral implantation of PanOptix IOL from 10 countries with 1 to 12 months follow-up. In summary, 33.6% of patients with bilateral PanOptix implantation experienced glare, 43.9% experienced halos, and 30.4% experienced starbursts. Among these patients, small percentages reported severe glare (2.9%), severe halos (5.4%), and severe starbursts (3.4%). Only 0.8%, 1.4%, and 2.6% of patients found glare, halos, and starbursts, respectively, to be very bothersome.

CONCLUSION

Halos are the most frequently reported visual disturbances. However, the likelihood of experiencing severe and/or very bothersome visual disturbances (halos, glare, starbursts) is approximately 5% and 3%, respectively, after bilateral implantation of PanOptix IOL. These findings should inform clinical decision-making and treatment choices when selecting the most appropriate IOL implant for cataract surgery.

Cushing's syndrome related to higher rates and earlier onset of cataract: A nationwide retrospective cohort study

PURPOSE

To investigate the risk of cataract in patients with Cushing's syndrome (CS) and evaluate whether disease onset occurs at an earlier age compared to general population.

METHODS

A nationwide retrospective matched-cohort study including individuals diagnosed with endogenous CS from 2000 to 2023. Patients with CS were matched in a 1:5 ratio with a control group individually matched for age, sex, socioeconomic status, and body mass index. The primary outcome was the incidence of cataract and cataract surgery. The Cox proportional hazards model, accounting for death without cataract as a competing risk, was employed to estimate hazard ratio.

RESULTS

The study cohort included 609 patients with CS, 65% women and 35% men, and 3018 controls. The average age at CS diagnosis was 48.1 ± 17 years. Follow-up duration was 14.6 years (IQR 9.8-20.2). The source of hypercortisolism was Cushing's disease (CD) in 259 (42.6%) and adrenal CS (aCS) in 206 patients (33.8%). After CS diagnosis, cataract was observed in 171 patients (28.1%), and 771 controls (25.5%). Patients with CS had a 34% higher risk of developing cataract compared to their matched controls (HR = 1.34, 95% CI 1.03-1.75, p = 0.03). Cataract developed earlier in patients with CS compared to controls, with a mean age of onset at 64.7 ± 9.7 versus 67.6 ± 8.4 years, respectively (p = 0.01). A total of 49 (8.05%) patients had undergone cataract surgery after a diagnosis of CS compared to 177 (5.86%) in the control group (p = 0.07).

CONCLUSION

Patients with endogenous CS have an increased likelihood of developing cataracts and they experienced onset at a younger age. Guidelines should include annual cataract monitoring for CS patients, beginning 3-5 years earlier than the current general recommendations.

Global regional and national burden of cataract attributable to high body mass index from 1990 to 2019

OBJECTIVES

In order to estimate long-term trends of the years lived with disability (YLDs) for cataract due to high body mass index (BMI).

DESIGN AND PARTICIPANTS

Data were retrieved from the Global Burden of Disease (GBD) 2019. The global cases, age-standardised rates (ASR) of YLDs for cataract attributable to high BMI were described by age, sex, geographical location and sociodemographic index (SDI). The estimated average annual percentage change (AAPC) was analysed to quantify the trends of ASR of YLD from 1990 to 2019.

PRIMARY OUTCOME MEASURES

Years lived with disability.

RESULTS

Globally, there were 370.4 (95% UI: 163.2 to 689.3) YLDs due to cataract attributed to high BMI in 2019, more than triple the number in 1990. Moreover, the ASR of YLD increased during 1990-2019, with AAPC of 1.54 (95% CI: 1.41 to 1.66). In 2019, the burden of cataract due to high BMI was higher in females and the elderly population. North Africa and the Middle East were the high-risk areas of cataract attributable to high BMI in 2019, with Saudi Arabia being the country with the heaviest burden. In terms of SDI, low-middle SDI regions had the greatest number of cataract-related YLDs due to high BMI in 2019.

CONCLUSION

The global YLDs for cataract due to high BMI have shown a notable increase from 1990 to 2019. Addressing BMI control may contribute to cataract prevention, highlighting a potential public health impact, particularly in low-SDI locations and among the elderly.

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.

A comprehensive investigation of identifying miRNA biomarkers and their potential role in age-related cataract by meta-analysis and bioinformatics analysis

PURPOSE

Age-related cataract (ARC) remains one of the leading causes of blindness globally. Despite the satisfactory outcomes of surgical interventions, significant disparities in access to medical care prevent many patients from receiving effective treatment. Thus, identifying reliable biomarkers and therapeutic targets to expand treatment options for ARC is essential. Recent evidence indicates that microRNAs (miRNAs) play a role in the development of cataracts and may serve as promising biomarkers. Consequently, this study aims to investigate miRNAs' levels and potential functions in ARC.

METHODS

We conducted a meta-analysis following the PRISMA guidelines by searching three databases from inception to March 31, 2023. The quality of the articles was assessed using the NOS. Subsequently, the targets of the miRNAs identified in the meta-analysis were predicted using six databases, and their GO functions and KEGG pathway enrichment information were analyzed via DAVID.

RESULTS

An initial search yielded 225 publications, from which 22 miRNAs across 37 studies were selected for our meta-analysis. We identified eight differentially expressed miRNAs (DEmiRNAs) in ARC, comprising two up-regulated miRNAs (miR-124 and miR-125a) and six down-regulated miRNAs (miR-15a, miR-23b, miR-34a, miR-221, miR-222, and miR-378a). A total of 972 targets for these miRNAs have been confirmed, and subsequent bioinformatics analysis has revealed their potential functions and pathways in various ARC-related processes.

CONCLUSIONS

This study indicates that eight differentially expressed miRNAs (miRNA-15a, miRNA-23b, miRNA-34a, miRNA-124, miRNA-125a, miRNA-221, miRNA-222, and miRNA-378a) may serve as biomarkers for ARC. Bioinformatics analyses suggest varied potential roles for each miRNA, providing a framework for future research in ARC. This systematic evaluation represents the initial depiction of the miRNA-biomarker landscape in ARC.

KEY MESSAGES

What is known MicroRNAs(miRNAs) could serve as biomarkers for age-related cataract(ARC) since their abundances are associated with ARC and can play a role in cataractogenesis. However, existing studies have reported inconsistent results regarding the miRNA level in ARC. Therefore, achieving a consensus on the role of miRNAs in ARC is essential to clarify their involvement. What is new This study suggested that eight differentially expressed miRNAs (miRNA-15a, miRNA-23b, miRNA-34a, miRNA-124, miRNA-125a, miRNA-221, miRNA-222, and miRNA-378a) may serve as biomarkers for ARC. Our bioinformatics analysis identified various potential roles for each miRNA, which could guide future research on ARC.

Postoperative evaluation of visual and cognitive functions following cataract surgery in patients with age-related cataracts: a prospective longitudinal study

Introduction

Cataracts are associated with a decline in both cognitive and visual functions. This study examines postoperative changes in cognitive and visual functions in patients with age-related cataracts, focusing on the differential effects of unilateral and bilateral cataract surgeries on these functions. Additionally, the study evaluates changes in cognitive function following cataract surgery in individuals with mild cognitive impairment (MCI).

Methods

A cohort of patients (n = 35, 59 eyes) aged 60 years and older (69.9 ± 7.0 years) with age-related cataracts who underwent unilateral or bilateral cataract surgery between May and June 2024 was selected. Cognitive and visual functions were evaluated preoperatively and at 1 week, 1 month, and 3 months postoperatively. Cognitive function was evaluated using the Montreal Cognitive Assessment (MoCA). Visual function was assessed using a binocular visual function testing system based on virtual reality (VR) technology, which evaluated low spatial frequency suppression, simultaneous vision, stereopsis, and perceptual eye position under 3D viewing conditions without glasses. Based on preoperative MoCA scores, patients were classified into cognitively normal and mild cognitive impairment (MCI) groups.

Results

Patients with age-related cataracts demonstrated significant improvements in both cognitive and visual functions at 1 week, 1 month, and 3 months postoperatively, compared to preoperative assessments (p < 0.05). Specifically, both the bilateral surgery group and the MCI group exhibited substantial improvements in cognitive function at these time points (p < 0.05). Additionally, the bilateral surgery group outperformed the unilateral surgery group in cognitive function throughout the follow-up period (p < 0.05). In terms of visual function, the bilateral surgery group showed significant improvements in low spatial frequency suppression, simultaneous vision, and stereopsis at 1 week, 1 month, and 3 months postoperatively, compared to preoperative measurements (p < 0.05).

Conclusion

Both cognitive and visual functions significantly improved after cataract surgery. Bilateral cataract surgery is more effective in increasing the cognitive functions than unilateral surgery. Additionally, cataract surgery plays a critical role in facilitating cognitive recovery in patients with mild cognitive impairment (MCI).

Targeted Activation of OGG1 Inhibits Paraptosis in Lens Epithelial Cells of Early Age-Related Cortical Cataract

Purpose

To investigate potential modes of programmed cell death in the lens epithelial cells (LECs) of patients with early age-related cortical cataract (ARCC) and to explore early-stage intervention strategies.

Methods

Anterior lens capsules were collected from early ARCC patients for comprehensive analysis. Ultrastructural examination of LECs was performed using transmission electron microscopy. Cell death-associated protein markers were quantified via Western blot analysis, including those for paraptosis (ALIX, GRP78), apoptosis (cleaved caspase 3 and caspase 9), pyroptosis (N-GSDMD), and ferroptosis (GPX4). Intracellular vesicle-organelle colocalization was assessed through immunofluorescence. OGG1 protein expression and activity were evaluated through multiple methods, including Western blot, laser micro-irradiation, and immunofluorescence. The therapeutic potential of the OGG1 activator TH10785 on paraptosis was investigated using an ex vivo rat lens model.

Results

Morphologic changes revealed significant endoplasmic reticulum (ER) swelling in ARCC patient LECs, with no characteristic apoptotic features. Paraptosis-related proteins exhibited significant alterations, while other cell death pathway markers (apoptosis, pyroptosis, and ferroptosis) remained unchanged. In the reactive oxygen species-induced paraptosis model, vesicular structures showed exclusive colocalization with ER-specific fluorescence. Elevated levels of the DNA damage marker 7,8-dihydro-8-oxoguanine were observed concurrent with decreased OGG1 activity. The OGG1 activator TH10785 showed efficacy in suppressing LECs paraptosis in ex vivo rat lens cultures.

Conclusions

Paraptosis was identified in the LECs of patients with early ARCC. TH10785 activates OGG1 to suppress paraptosis in LECs, suggesting a novel therapeutic approach for early ARCC intervention.

Risk and protective factors of late in-the-bag intraocular lens dislocations: systematic review

TOPIC

To identify and review published articles addressing risk and protective factors of late in-the-bag (ITB) intraocular lens (IOL) dislocations.

CLINICAL RELEVANCE

Prevention of this complication is of great importance considering the great number of cataract cases and its vision-threatening capacity.

METHODS

A structured search on PubMed (MEDLINE) using both Medical Subject Headings and key words was conducted. In addition, the reference lists of the resulting articles were screened for further publications. Articles were eligible if they included 20 or more patients. Hazard and odds ratios were analyzed if they were calculated in the original study. The relative frequency of risk factors was recorded if hazard or odds ratios were not available. The threshold for clinical significance was set at 10%. Risk-of-bias in individual studies was evaluated using the revised Cochrane risk-of-bias tool in randomized trials (RoB 2.0) and the Cochrane risk-of-bias in nonrandomized studies of intervention tool.

RESULTS

Database search identified 3474 records, and no further records were obtained from the reference lists. After exclusion of records not related to the topic, 177 articles were assessed for eligibility. Of these, 39 were considered eligible and read in full. 3 studies were prospective, while all other investigations were retrospective. In total, 18 614 cases of late ITB dislocations were analyzed across all studies. The risk of bias within studies was considerable because only 3 studies were prospective and statistical significance of risk factors was assessed in only 5 studies.

CONCLUSIONS

Typical patient age of this condition is between 70 and 85 years, and there seems to be a slight male predominance. Risk factors with a good level of evidence include preoperative trauma and zonular dehiscence, previous vitrectomy, retinitis pigmentosa, pseudoexfoliation, high myopia, glaucoma/previous glaucoma surgery, corneal endothelial damage, and uveitis. Hydrophilic, quadripode, and haptic-angulation IOLs are further risk factors. Capsular tension rings, Nd:YAG capsulotomy, 3-piece IOLs, and IOLs with large optic diameters protect from ITB dislocations. Typically, no risk factors can be identified in approximately one-fourth of patients.

Visual outcomes and complications after phacoemulsification and small incision manual cataract surgery in two eye hospitals

PURPOSE

To evaluate and compare the visual outcomes and complications of cataract surgery in two referral eye hospitals in southern Nigeria.

METHODS

Case records of patients who underwent elective cataract surgery at two referral eye hospitals from February 2017-2022 were collected retrospectively. Demographics, preoperative visual acuity (VA), anterior and posterior segment details, intraoperative and postoperative complications, VA at day 1, 1 week, and 1 month postoperatively were analyzed. The visual outcomes and complications of the phacoemulsification (PHACO) and manual small incision cataract surgery (MSICS) groups were compared. VA after cataract surgery was graded according to the WHO criteria.

RESULTS

A total of 3923 eyes underwent cataract surgery. The mean age was 65.30±17.50 years, and the majority (63.0%) were females. Approximately 1271 (32.4%) had unilateral cataracts, while 2652 (67.6%) were affected bilaterally. PHACO and MSICS were performed in 87.9% and 12.1% of cases, respectively. The proportion of eyes with good VA increased from 0.01% to 93.80% for PHACO-operated eyes and 2.50% to 92.30% for MSICS-operated eyes. Out of the 686 (17.49%) eyes with preexisting ocular pathology, the most common was glaucoma (281, 40.96%). More intraoperative complications occurred in the MSICS group (12.45%) compared to PHACO (5.89%), which was statistically significant (P-value<0.001). More postoperative complications (early and late) were seen in the MSICS group compared to the PHACO group, which was statistically significant.

CONCLUSION

Even though MSICS is performed more often in complicated cases, the study shows that experienced surgeons who perform PHACO and MSICS surgeries achieve similar visual acuity outcomes and complication rates.

Health and well-being of maturing adults with classic galactosemia

Long-term outcomes in classic galactosemia (CG) have been studied previously, but all prior studies have relied on cohorts of patients that were small in number, or heavily skewed toward children and young adults, or both. Here, we extend what is known about the health and well-being of maturing adults with CG by analyzing the results of anonymous custom surveys completed by 92 affected individuals, ages 30-78, and 38 unaffected sibling controls, ages 30-79. The median age for patients was 38.5 years and for controls was 41 years. These study participants hailed from 12 different countries predominantly representing Europe and North America. Participants reported on their general life experiences and outcomes in seven different domains including: speech/voice/language, cognition, motor function, cataracts, bone health, psychosocial well-being, and gastrointestinal health. We also queried women about ovarian function. Our results indicated a prevalence of long-term complications across all outcome domains that aligned with levels previously reported in younger cohorts. Given the sample size and age range of participants in this study, these findings strongly suggest that the adverse developmental outcomes commonly linked to CG are not progressive with age for most patients. We also tested four candidate modifiers for possible association with each of the outcomes followed, including: days of neonatal milk exposure, rigor of dietary galactose restriction in early childhood, current age, and home continent. We observed no associations that reached even nominal significance, except for the following: cataracts with neonatal milk exposure (p = 2.347e-04), cataracts with age (p = 0.018), and bone health with home continent (p = 0.03).

Prevalence of cataracts in Iran based on the Persian eye cohort study

The PERSIAN eye cohort study is a population-based study that evaluates the overall prevalence of cataracts and their subtypes (nuclear sclerosis, cortical, and PSC) in Iran. In this study, from January 2015 to September 2021, 16,016 participants over 35 years of age from four provinces who were selected by random cluster sampling were examined. Demographic information, education, socioeconomic status, and place of residence were collected through interviews. The cataract status of the study participants was examined by two experienced ophthalmologists using slit lamp photography. The average age of the study participants was 49.52 ± 9.31 and 8891 (55.5%) were female. The overall prevalence of each type of cataract, nuclear sclerosis, cortical, and PSC was 18.90%, 12.65%, 9.20%, and 3.08%, respectively. The results indicated that the prevalence of any type of cataract (adjusted OR = 0.85, 95% CI: 0.78-0.92, p < 0.001) and NS cataract (adjusted OR = 0.80, 95% CI: 0.73-0.88, p < 0.001) is lower in women. The risk of developing cataracts increased exponentially with aging. The prevalence of any type of cataract and cortical subtype was higher in rural than urban populations. Also, the risk of developing cataracts decreased with an increase in education level and socioeconomic status and some Iranian races such as Arabs, Azari, and Guilak were also at a higher risk of cataracts. The results of this study indicate the importance of a comprehensive regard of cataract as one of the causes of avoidable blindness in Iran due to its higher prevalence than the global average.

Sex-specific associations of prenatal Chinese famine exposure with cataract risk at age sixty: a cross-sectional study

BACKGROUND

Age-related cataract (ARC) is among the most common blinding eye disorders among the elderly. Prenatal nutrition may cause irreversible damage to the development of the ocular crystalline lens. Nevertheless, the potential association between prenatal malnutrition and age-related cataract has not been thoroughly examined. We investigated the prevalence of cataract at the age of 60 after prenatal exposure to Chinese famine (1959-1961) and particularly evaluated whether there was a disparity in this effect between men and women.

METHODS

We utilized the health examination medical record system of a large-scale comprehensive hospital to screen individuals born in Chongqing, China and undergoing eye health examinations. Participants were categorized based on their year of birth into the famine-exposed group (1960) and the non-exposed group (1963), with their medical records at age 60 extracted from the database. Univariate and multivariate logistic regression analyses were conducted to investigate the association between famine exposure and the risk of developing ARC by age 60.

RESULTS

The prevalence of ARC was significantly higher in the famine-exposed group (60.26%) compared to the non-exposed group (47.90%) (P < 0.001). After adjusting for diabetes history, body mass index (BMI), fasting blood glucose (FBG) level, and high-density lipoprotein (HDL) level using multivariate logistic regression analysis, the risk of ARC remained significantly higher in the famine-exposed group (OR:1.63; 95%CI:1.31-2.03). Subgroup analysis by sex indicated that women exposed to famine (OR: 1.77; 95% CI: 1.25-2.52) exhibited a higher risk of ARC compared to men (OR: 1.53; 95% CI: 1.16-2.03).

CONCLUSIONS

Prenatal exposure to famine might increase the risk of ARC among Chinese adults at age 60, and women exhibit a higher susceptibility than men.

Diabetes and Cataracts Development-Characteristics, Subtypes and Predictive Modeling Using Machine Learning in Romanian Patients: A Cross-Sectional Study

Background and Objectives: Diabetes has become a global epidemic, contributing to significant health challenges due to its complications. Among these, diabetes can affect sight through various mechanisms, emphasizing the importance of early identification and management of vision-threatening conditions in diabetic patients. Changes in the crystalline lens caused by diabetes may lead to temporary and permanent visual impairment. Since individuals with diabetes are at an increased risk of developing cataracts, which significantly affects their quality of life, this study aims to identify the most common cataract subtypes in diabetic patients, highlighting the need for proactive screening and early intervention. Materials and Methods: This study included 201 participants with cataracts (47.6% women and 52.4% men), of whom 105 also had diabetes. With the use of machine learning, the patients were assessed and categorized as having one of the three main types of cataracts: cortical (CC), nuclear (NS), and posterior subcapsular (PSC). A Random Forest Classification algorithm was employed to predict the incidence of different associations of cataracts (1, 2, or 3 types). Results: Cataracts have been encountered more frequently and at a younger age in patients with diabetes. CC was significantly more frequent among patients with diabetes (p < 0.0001), while the NS and PSC were only marginally, without statistical significance. Machine learning could also contribute to an early diagnosis of cataracts, with the presence of diabetes, duration of diabetes, or diabetic polyneuropathy (PND) having the highest importance for a successful classification. Conclusions: These findings suggest that diabetes may impact the type of cataract that develops, with CC being notably more prevalent in diabetic patients. This has important implications for screening and management strategies for cataract formation in diabetic populations.

Visual, Refractive, Functional, and Patient Satisfaction Outcomes After Implantation of a New Extended Depth-of-Focus Intraocular Lens

Purpose

To describe the visual, refractive, functional, and patient satisfaction outcomes of the Bi-Flex POB-MA 877PEY (Elon®, Medicontur Medical Engineering Ltd. Zsámbék, Hungary) extended depth-of-focus intraocular lens (EDoF IOL).

Patients and Methods

This was a prospective longitudinal descriptive study. Patients who underwent cataract surgery with the implantation of Bi-Flex POB-MA 877PEY IOL were included. Monocular refractive outcomes and visual acuity at distance, intermediate, and near were evaluated 1- and 3-month post-op. Binocular contrast sensitivity (CSV-1000, VectorVision, USA), binocular defocus curve, and patient satisfaction with the Visual Functioning Questionnaire (VFQ) were assessed at 3-month post-op.

Results

20 Bi-Flex POB-MA 877PEY IOL were implanted bilaterally in 10 patients. The mean age of the patients was 68.60±4.45 years. At 1-month post-op the monocular Corrected Distance Visual Acuity (CDVA), intermediate (CIVA) and near (CNVA) was 0.02±0.03, 0.29±0.08, and 0.40±0.05 LogMAR respectively. At 3-month post-op the CDVA decrease to 0.05±0.06 LogMAR (p=0.042), and CIVA and CNVA remained stable at 3-month post-op (p>0.05). No statistical differences were found in post-op spherical equivalent at 1 and 3 month (-0.03±0.19 D and -0.03±0.13 D; p=1.000). 100% of eyes were within ±0.5 D at 1 month and 3-month post-op. Binocular defocus curve shows a peak of maximum visual acuity (VA) at 0 D (0.00±0.04 LogMAR), and a constant and progressive decrease at -1.50 D, and -2.50 D (0.15±0.08 LogMAR and 0.33±0.10 LogMAR, respectively). Contrast sensitivity decreased at high spatial frequencies. In patient satisfaction at 3 months post-op, VFQ reveals that 90% of patients revealed no or minor difficulty with glare/flare and 100% of patients have no or minor difficulty with halos. In overall satisfaction, 80% of patients rate their vision between 8 and 9 from a scale from 0 to 10.

Conclusion

The Bi-Flex POB-MA 877PEY EDoF IOL provides good visual outcomes for distance, and adequate intermediate vision, with low visual disturbances.

Next generation brain health: transforming global research and public health to promote prevention of dementia and reduce its risk in young adult populations

Efforts to prevent dementia can benefit from precision interventions delivered to the right population at the right time; that is, when the potential to reduce risk is the highest. Young adults (aged 18-39 years) are a neglected population in dementia research and policy making despite being highly exposed to several known modifiable risk factors. The risk and protective factors that have the biggest effect on dementia outcomes in young adulthood, and how these associations differ across regions and groups, still remain unclear. To address these uncertainties, the Next Generation Brain Health team convened a multidisciplinary expert group representing 15 nations across six continents. We identified several high-priority modifiable factors in young adulthood and devised five key recommendations for promoting brain health, ranging from individual to policy levels. Increasing research and policy focus on brain health across the life course, inclusive of younger populations, is the next crucial step in the efforts to prevent dementia at the global level.

Risk Factors for Cataracts in Patients with Diabetes Mellitus

Background: Diabetes mellitus (DM) is one of the most impactful health problems worldwide. It affects ocular health in multiple ways and is one of the leading causes of vision loss. Our study aimed to evaluate the most important systemic risk factors related to the occurrence of cataracts in patients with DM. Method: This study evaluated a final number of 319 participants who were previously diagnosed with DM. For all patients, we retrieved data regarding DM status, metabolic control, demographic and anthropometric indices, and generally associated comorbidities from their medical charts. A comprehensive eye examination was performed on all patients. Results: The main studied risk factors were hypertension, cardiovascular disease (CVD), chronic kidney disease (CKD), diabetic polyneuropathy (DPN), dyslipidemia, and hepatic steatosis, which were present among the entire population. Hypertension (67.6%), DPN (53.3%), and dyslipidemia (46.6%) were highly prevalent in the cataract subgroup, and CKD (p < 0.001) and DPN (p = 0.019) were found to be predictive factors for the probability of cataract occurrence. Ophthalmologic evaluation was used to assess the presence of ocular complications, such as diabetic retinopathy (DR) and diabetic maculopathy. DR reached statistically significant values in the occurence of cataracts. Patients' age and DM-related factors, such as disease duration (p < 0.001) and HbA1c values (p = 0.029), significantly increased the risk of cataracts. Smoking was self-reported by 24.8% of the patients, with a significant impact on the occurrence of cataracts (p = 0.04). Conclusions: Patients with DM who exhibit a longer disease duration and poor glycemic control in conjunction with systemic comorbidities present a higher risk of developing cataracts; consequently, a strict therapeutic approach regarding these risk factors is needed.

The Effects of Dexamethasone on Human Lens Epithelial Cells and the Analysis of Related Pathways with Transcriptome Sequencing

BACKGROUND

The goal of this study was to investigate the effects of dexamethasone on human lens epithelial cells (HLECs) and the potential mechanisms.

METHODS

HLECs (HLE-B3) were cultured in vitro to assess the effects of dexamethasone on cell size at different concentrations. Immunofluorescence staining was used to detect specific protein expression in HLE-B3 cells. The cell size was observed using phase-contrast microscopy, and the length and area were quantitatively measured with ImageJ software for statistical analysis. Flow cytometry was used to verify these outcomes. The means of three groups were statistically analyzed using one-way analysis of variance, whereas the means of two groups were statistically analyzed with the parametric Student's t-test. Additionally, high-throughput transcriptome sequencing was performed to compare messenger RNA (mRNA) expression levels between different concentrations of dexamethasone treatment groups and the control group, to identify potential signaling pathways. Subsequently, we performed quantitative Polymerase Chain Reaction (qPCR), immunofluorescence staining, and molecular docking experiments on the key differentially expressed genes.

RESULTS

Dexamethasone affected the size of HLE-B3 cells. Both 0.25 and 0.5 μmol/L dexamethasone increased cell length and area, exhibiting no significant difference between the two treatment groups. Flow cytometry showed that dexamethasone increased cell size and granularity, with 0.25 μmol/L dexamethasone leading to larger cell areas and higher intracellular granularity. High-throughput transcriptome sequencing revealed significant upregulation of lysophosphatidic acid receptor 1 (LPAR1) and the pathways related to the glucocorticoid (GC) receptor.

CONCLUSIONS

Certain concentrations of dexamethasone impact the morphology and biological functions of HLECs. As a subtype of G protein-coupled receptors, LPAR1 on the cell membrane may interact with dexamethasone, affecting cell size and inhibiting autophagy via the phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT)/mammalian target of rapamycin (mTOR) pathway. These discoveries offer crucial biological insights into how dexamethasone influences the morphology and function of HLECs and the pathogenesis of GC-induced cataracts, offering potential molecular targets for future therapeutic strategies.

Diagnostic Assessment of Nuclear Cataracts Using a Smartphone-Attachable Slit-Lamp Device: A Cross-Sectional Study in Vietnam

Purpose The purpose of this study was to compare the accuracy and agreement in nuclear cataract opacity classification between the Smart Eye Camera (SEC) device, and the slit-lamp. Methods A cross-sectional study was conducted with a convenient sampling of 221 eyes from 139 patients with phakic eyes, visiting IVISION Eye Center, Ho Chi Minh City, Vietnam, from November 1, 2023, to April 30, 2024. Two grading systems, Lucio-Buratto (Buratto) and World Health Organization (WHO), were used to compare the effectiveness of the two devices, with statistical analysis using Spearman's correlation coefficient and Cohen's kappa to evaluate the agreement level. Results Results showed no significant difference in Buratto and WHO grading between the two devices (p > 0.05), indicating consistency between the two measurement methods. Spearman's correlation coefficient demonstrated a strong correlation between the results from both devices, with r = 0.797 for Buratto and r = 0.579 for WHO (p < 0.001). The reliability was confirmed by high weighted-kappa values (k = 0.774 for Buratto and k = 0.539 for WHO). Conclusion The SEC's comparable effectiveness to the slit-lamp supports its potential utility in blindness-prevention screening efforts.

A survey exploring ophthalmologists' attitudes and beliefs in performing immediate sequential bilateral cataract surgery in Singapore

BACKGROUND

To evaluate current practice patterns of Immediate Sequential Bilateral Cataract Surgery (ISBCS) by ophthalmologists in Singapore and assess their attitudes towards performing ISBCS in future cataract care.

METHODS

An anonymised electronic survey, modified to local context from a similar study conducted in the United Kingdom, was distributed to members of the College of Ophthalmologists, Academy of Medicine, Singapore, from 20 June to 1 September 2023. An initial screening question on prior experience with ISBCS directed the rest of the survey. Questions explored ophthalmologists' current ISBCS practice patterns and the importance of factors affecting their willingness to perform ISBCS. Results were descriptively analysed.

RESULTS

Results collated 2 months upon survey dissemination saw a total of 58 respondents from 235 eligible members (24.7% response rate). Of these, 16 (27.6%) were currently performing ISBCS, 37 (63.8%) had never performed, and 5 (8.6%) had stopped performing. In considering ISBCS, patient convenience (n = 11, 68.8%) and reduced hospital visits (n = 8, 50.0%) were the most important factors nominated. The most important barriers to performing ISBCS were medico-legal issues (n = 31, 83.8%) and risk of endophthalmitis (n = 27, 73.0%), followed by perceived lack of evidence for its effectiveness (n = 19, 51.4%).

CONCLUSION

This is one of the first studies evaluating ophthalmologists' sentiments towards performing ISBCS in an Asian country. It highlights some of the most pertinent barriers and concerns that ophthalmologists face in performing and offering ISBCS. This study provides a better understanding of the potential role and prospects of ISBCS in future cataract care in Singapore.

Investigating the impact of OCT imaging of the crystalline lens on the accuracy and precision of cataract assessment

PURPOSE

To determine if supplementing standard clinical assessments with Optical Coherence Tomography (OCT) imaging of the crystalline lens improves the accuracy and precision of lens opacity assessment and associated clinical management decisions by optometrists.

METHODS

Fifty optometrists registered in the UK or Éire undertook a clinical vignette study where participants graded lens opacities and made associated clinical management decisions based on the image(s)/information displayed. Three forms of vignettes were presented: (1) Slit-lamp (SL) images of the lens, (2) SL and OCT images and (3) SL, OCT and visual function measures. Vignettes were constructed using anonymised data from 50 patients with varying cataract severity, each vignette being presented twice in a randomised order (total vignette presentations = 300). The accuracy of opacity and management decisions were evaluated using descriptive statistics and non-parametric Bland-Altman analysis where assessments from experienced clinicians were the reference. The precision of assessments was examined for each vignette form using non-parametric Bland-Altman analysis.

RESULTS

All (n = 50) participants completed the study, with 36 working in primary eyecare (primary eyecare) settings and 14 in hospital eyecare services (HES). Agreement was highest where vignettes contained all clinical data (i.e., SL, OCT and visual function data-grading: 51.0%, management: 50.5%), and systematically reduced with decreasing vignette content (p < 0.001). A larger number of vignettes containing imaging and visual function measures exhibited below reference (i.e., less conservative) grading compared with vignettes containing imaging data alone (all p < 0.05). HES-based optometrists were more likely to grade lens opacities lower than clinicians working in primary eyecare (p < 0.001). Good measurement precision was evident for all vignettes, with a mean bias close to zero and limits of agreement below one grading step for all conditions.

CONCLUSIONS

The addition of anterior segment OCT to SL images improved the accuracy of lens opacity grading. Structural assessment alone yielded more conservative decision making, which reversed once visual functional data was available.

Refractive Outcomes Following Combined Cataract and Microinvasive Glaucoma Surgery

PURPOSE

To compare refractive outcomes in eyes undergoing cataract extraction (CE) alone, CE with goniotomy (CE/goniotomy), and CE with Schlemm's canal stent (CE/SCS) insertion.

DESIGN

Retrospective cohort study.

PARTICIPANTS

Eyes from the Bascom Palmer Glaucoma Repository undergoing CE/goniotomy, CE/SCS insertion, or uncomplicated CE alone between July 2014 and February 2022 were identified.

METHODS

Refraction data were analyzed at postoperative month (POM) 1 and 6 with Kruskal-Wallis and Dunn's tests. Anisometropia was defined as a spherical equivalent (SE) difference of ≥2D.

MAIN OUTCOME MEASURES

The primary outcome was mean refraction at POM1 and POM6 across the 3 surgical groups. Secondary outcomes were comparisons of refraction and visual acuity (VA) among different goniotomy and Schlemm's canal stent (SCS) devices, as well as incidence of anisometropia.

RESULTS

A total of 8360 eyes (150 CE/goniotomy, 395 CE/SCS, and 7815 CE alone) from 6059 patients were analyzed. At POM1, mean SE in the CE/goniotomy, CE/SCS, and CE alone groups was -0.36 ± 0.91D, -0.31 ± 0.85D, and -0.39 ± 0.88D respectively (P = 0.019). Mean logarithm of the minimum angle of resolution VA was 0.10 ± 0.20, 0.08 ± 0.19, and 0.14 ± 0.26 respectively (P = 0.002, CE/SCS vs. CE alone). No statistically significant differences were noted at POM6. Anisometropia occurred at POM1 in 2 patients (13.3%) in the CE/goniotomy-CE group, 1 patient (3.2%) in the CE/SCS-CE group, and 184 patients (4.9%) in the CE-CE group (P = 0.217). At POM6, mean SEs were -0.38 ± 0.97D (CE/goniotomy), -0.35 ± 0.81D (CE/SCS), and -0.40 ± 0.91D (CE alone; P = 0.473). No significant differences in overall refractive outcomes were observed with different SCS or goniotomy devices. Among primary open-angle glaucoma/normal-tension glaucoma eyes, mean SE at POM1 was -0.36 ± 0.73D (CE/goniotomy), -0.24 ± 0.84D (CE/SCS), and -0.45 ± 0.81D (CE alone; P < 0.001).

CONCLUSIONS

Concurrent SCS insertion or goniotomy with CE was associated with some statistically significant differences in postoperative refraction and VA, although these small magnitude differences were unlikely to be clinically meaningful.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found after the references in the Footnotes and Disclosures at the end of this article.

LncRNA MEG3 regulates ferroptosis of lens epithelial cells via PTBP1/GPX4 axis to participate in age-related cataract

Age-related cataract (ARC) is regarded as the principal cause of vision impairment among the aged. The regulatory role of long noncoding RNAs (LncRNAs) in ARC remains unclear. The lncRNA maternally expressed gene 3 (MEG3) has been reported to promote ARC progression, and the underlying mechanism was further investigated in this study. Lens epithelium samples were collected to verify the expression of MEG3. Lens epithelial cells (LECs) were treated with H2O2 to mimic microenvironment of ARC in vitro. Cell viability, reactive oxygen species, and ferroptosis were evaluated during the in viro experiments. In the present work, lncRNA MEG3 was highly expressed in ARC group, compared with normal group. MEG3 was induced, cell viability and glutathione peroxidase 4 (GPX4) level were inhibited, and ferroptosis was promoted in H2O2 treated LECs. LncRNA MEG3 silence reversed the effects of H2O2 on viability and ferroptosis in LECs. Thereafter, lncRNA MEG3 was found to bind to PTBP1 for GPX4 degradation. Silencing of GPX4 reversed the regulation of lncRNA MEG3 inhibition in H2O2-treated LECs. To sum up, lncRNA MEG3 exhibited high expression in ARC. In H2O2-induced LECs, inhibition of lncRNA MEG3 accelerated cell viability and repressed ferroptosis by interaction with PTBP1 for GPX4 messenger RNA decay. Targeting lncRNA MEG3 may be a novel treatment of ARC.

Age-related cataract without surgery is related to exacerbated depression symptoms: a cross-sectional study of Chinese adults from Anhui, China

Objective

The present study sought to evaluate the relationship between age-related cataracts, a prevalent ocular condition among the elderly, and the occurrence of depressive symptoms within a cohort of Chinese adults residing in Anhui, China.

Methods

A survey involving 252 Chinese individuals aged 65 years and older was conducted at Lu'an People's Hospital. Depressive symptoms were assessed using the Hamilton Depression Scale (HAMD) consisting of 17 items, while age-related cataracts were clinically classified according to the Lens Opacities Classification System (LOCS) III. Depressive symptoms were identified by a HAMD score exceeding 7. Logistic regression analyses were employed to determine the odds ratios (OR) and 95% confidence intervals (CI) pertaining to the association between age-related cataracts and depressive symptoms.

Results

Cataract patients aged 65 years and older had significantly higher scores of depressive symptoms than those under 65 years (mean scores of 8.17 ± 3.26 versus 5.18 ± 1.86, p < 0.001). In addition, patients aged 65 years and above exhibited a diminished quality of life relative to patients aged under 65 years. The findings indicated that adults experiencing depressive symptoms reported lower monthly incomes (p = 0.036), lower educational attainment (p = 0.044), and living alone (p = 0.007). Furthermore, fewer elderly patients with depressive symptoms received surgical treatment (15 patients) than those without depressive symptoms (61 patients), with a significant difference (p = 0.011). Multivariate analysis revealed that the presence of depressive symptoms was significantly correlated with a lack of formal education (p = 0.048), reduced income (p = 0.003), solitary living arrangements (p = 0.025), and the presence of cataracts without surgical intervention (p = 0.007).

Conclusion

These findings suggested a significant association between age-related cataracts and depressive symptoms among older adults. Specifically, cataracts that remain untreated surgically were notably linked to depression in elderly patients. It is recommended that initiatives and resources be directed toward surgical treatment programs for cataracts in individuals exhibiting depressive symptoms.

Uncovering genetic loci and biological pathways associated with age-related cataracts through GWAS meta-analysis

Age-related cataracts is a highly prevalent eye disorder that results in the clouding of the crystalline lens and is one of the leading causes of visual impairment and blindness. The disease is influenced by multiple factors including genetics, prolonged exposure to ultraviolet radiation, and a history of diabetes. However, the extent to which each of these factors contributes to the development of cataracts remains unclear. Our study identified 101 independent genome-wide significant loci, 57 of which are novel. We identified multiple genes and biological pathways associated with the cataracts, including four drug-gene interactions. Our results suggest a causal association between type 1 diabetes and cataracts. Also, we highlighted a surrogate measure of UV light exposure as a marker of cataract risk in adults.

Development and construction of a cataract risk prediction model based on biochemical indices: the National Health and Nutrition Examination Survey, 2005-2008

Purpose

The aim of this study is to develop and validate a novel multivariable prediction model capable of accurately estimating the probability of cataract development, utilizing parameters such as blood biochemical markers and age.

Design

This population-based cross-sectional study comprised 9,566 participants drawn from the National Health and Nutrition Examination Survey (NHANES) across the 2005-2008 cycles.

Methods

Demographic information and laboratory test results from the patients were collected and analyzed using LASSO regression and multivariate logistic regression to accurately capture the influence of biochemical indicators on the outcomes. The SHAP (Shapley Additive Explanations) scale was employed to assess the importance of each clinical feature, excluding age. A multivariate logistic regression model was then developed and visualized as a nomogram. To assess the model's performance, its discrimination, calibration, and clinical utility were evaluated using receiver operating characteristic (ROC) curves, 10-fold cross-validation, Hosmer-Lemeshow calibration curves, and decision curve analysis (DCA), respectively.

Results

Logistic regression analysis identified age, erythrocyte folate (nmol/L), blood glucose (mmol/L), and blood urea nitrogen (mmol/L) as independent risk factors for cataract, and these variables were incorporated into a multivariate logistic regression-based nomogram for cataract risk prediction. The area under the receiver operating characteristic (ROC) curve (AUC) for cataract risk prediction was 0.917 (95% CI: 0.9067-0.9273) in the training cohort, and 0.9148 (95% CI: 0.8979-0.9316) in the validation cohort. The Hosmer-Lemeshow calibration curve demonstrated a good fit, indicating strong model calibration. Ten-fold cross-validation confirmed the logistic regression model's robust predictive performance and stability during internal validation. Decision curve analysis (DCA) demonstrated that the nomogram prediction model provided greater clinical benefit for predicting cataract risk when the patient's threshold probability ranged from 0.10 to 0.90.

Conclusion

This study identified blood urea nitrogen (mmol/L), serum glucose (mmol/L), and erythrocyte folate (mmol/L) as significant risk factors for cataract. A risk prediction model was developed, demonstrating strong predictive accuracy and clinical utility, offering clinicians a reliable tool for early and effective diagnosis. Cataract development may be delayed by reducing levels of blood urea nitrogen, serum glucose, and erythrocyte folate through lifestyle improvements and dietary modifications.

Oxidative Stress in Cataract Formation: Is There a Treatment Approach on the Horizon?

Cataracts, a leading cause of blindness worldwide, are closely linked to oxidative stress-induced damage to lens epithelial cells (LECs). Key factors contributing to cataract formation include aging, arterial hypertension, and diabetes mellitus. Given the high global prevalence of cataracts, the burden of cataract-related visual impairment is substantial, highlighting the need for pharmacological strategies to supplement surgical interventions. Understanding the molecular pathways involved in oxidative stress during cataract development may offer valuable insights for designing novel therapeutic approaches. This review explores the role of oxidative stress in cataract formation, focusing on critical mechanisms, such as mitochondrial dysfunction, endoplasmic reticulum stress, loss of gap junctions, and various cell death pathways in LECs. Additionally, we discuss emerging therapeutic strategies and potential targeting options, including antioxidant-based treatments.

Assessing the therapeutic role of trehalose and hyaluronic acid: implications for patient care

OBJECTIVE

This Systematic review aims to assess the efficacy of trehalose and hyaluronic acid in enhancing ocular recovery post-cataract surgery, focusing on their impact on tear film stability, ocular surface integrity, and patient-reported outcomes.

METHODS

A comprehensive search was conducted across MEDLINE, PubMed, and Cochrane Library databases to identify randomized controlled trials investigating the efficacy of trehalose, hyaluronic acid, or their combination in post-cataract surgery care. The inclusion criteria focused on peer-reviewed studies in English, detailing outcomes relevant to ocular recovery such as tear film stability, ocular surface integrity, patient-reported discomfort, or visual acuity (VA). The quality of the included studies was assessed using the Cochrane Risk of Bias Tool and synthesized the data qualitatively.

RESULTS

Four qualitative investigations met the inclusion criteria. The studies collectively assessed the efficacy of a 3% trehalose and 0.15% hyaluronic acid eye drop solution in reducing postoperative eye symptoms compared to various control solutions. Parameters measured included tear break-up time (TBUT), Fluorescein staining, tear production (Schirmer test), and Ocular Surface Disease Index (OSDI) scores. The results indicated significant improvements in tear film stability and ocular surface health for the treatment groups compared to controls, with a notable decrease in patient-reported discomfort. The study showed an improvement of - 18 (± 14.6) in the treatment group compared to - 7 (± 8.0) in the control group for OSDI. For TBUT, the treatment group improved by 3 (± 1.2) s, whereas the control group improved by 0.3 (± 0.71) s. VA, measured on a scale of 0-100, increased to 17 (± 0.7) in the treatment group compared to 15 (± 1.1) in the control group.

CONCLUSIONS

Trehalose and hyaluronic acid may be beneficial in the postoperative period by enhancing tear film stability and ocular surface health. While the results are promising, further research is needed to confirm these findings, understand the mechanisms of action, and explore broader applications.