Incidence of Glaucoma-Related Adverse Events in the First 5 Years After Pediatric Lensectomy

Importance

Glaucoma can develop following cataract removal in children.

Objective

To assess the cumulative incidence of glaucoma-related adverse events (defined as glaucoma or glaucoma suspect) and factors associated with risk of these adverse events in the first 5 years after lensectomy prior to 13 years of age.

Design, Setting, and Participants

This cohort study used longitudinal registry data collected at enrollment and annually for 5 years from 45 institutional and 16 community sites. Participants were children aged 12 years or younger with at least 1 office visit after lensectomy from June 2012 to July 2015. Data were analyzed from February through December 2022.

Exposures

Usual clinical care after lensectomy.

Main Outcomes and Measures

The main outcomes were cumulative incidence of glaucoma-related adverse events and baseline factors associated with risk of these adverse events.

Results

The study included 810 children (1049 eyes); 443 eyes of 321 children (55% female; mean [SD] age, 0.89 [1.97] years) were aphakic after lensectomy, and 606 eyes of 489 children (53% male; mean [SD] age, 5.65 [3.32] years) were pseudophakic. The 5-year cumulative incidence of glaucoma-related adverse events was 29% (95% CI, 25%-34%) in 443 eyes with aphakia and 7% (95% CI, 5%-9%) in 606 eyes with pseudophakia; 7% (95% CI, 5%-10%) of aphakic eyes and 3% (95% CI, 2%-5%) of pseudophakic eyes were diagnosed as glaucoma suspect. Among aphakic eyes, a higher risk for glaucoma-related adverse events was associated with 4 of 8 factors, including age less than 3 months (vs ≥3 months: adjusted hazard ratio [aHR], 2.88; 99% CI, 1.57-5.23), abnormal anterior segment (vs normal: aHR, 2.88; 99% CI, 1.56-5.30), intraoperative complications at time of lensectomy (vs none; aHR, 2.25; 99% CI, 1.04-4.87), and bilaterality (vs unilaterality: aHR, 1.88; 99% CI, 1.02-3.48). Neither of the 2 factors evaluated for pseudophakic eyes, laterality and anterior vitrectomy, were associated with risk of glaucoma-related adverse events.

Conclusions and Relevance

In this cohort study, glaucoma-related adverse events were common after cataract surgery in children; age less than 3 months at surgery was associated with elevated risk of the adverse events in aphakic eyes. Children with pseudophakia, who were older at surgery, less frequently developed a glaucoma-related adverse event within 5 years of lensectomy. The findings suggest that ongoing monitoring for the development of glaucoma is needed after lensectomy at any age.

Results of a clinical evaluation of a trifocal intraocular lens in Japan

PURPOSE

To evaluate the effectiveness and safety of a new trifocal intraocular lens (IOL) after cataract removal in patients living in Japan.

STUDY DESIGN

Prospective multicenter clinical study.

METHODS

One hundred and thirty-five eyes of 68 patients (19 men, 49 women; mean age, 66.3 ± 7.4 years) were followed for 6 months. Trifocal IOLs with focal points at near, intermediate, and distance were implanted bilaterally in eyes with less than 1 diopter of corneal astigmatism. The visual acuity (VA) at distance, 60 and 40 centimeters (cm), and contrast sensitivities were measured. Patients completed quality-of-life questionnaires preoperatively and postoperatively.

RESULTS

The mean bilateral logarithm of the minimum angle of resolution VA at 5 meters (m), 60 cm, and 40 cm were, respectively: uncorrected, - 0.104 ± 0.095, - 0.065 ± 0.111, and - 0.042 ± 0.105; and distance-corrected, - 0.197 ± 0.076, - 0.112 ± 0.111, and - 0.073 ± 0.111. The contrast sensitivities at distance and near were within the normal range at all spatial frequencies under photopic conditions. Patients reported complete spectacle independence in 75.0% of cases. Total use of spectacles was reported by 1.5% and partial by 20.6%; the purpose of spectacle use was primarily for near visual tasks. Mild-to-moderate glare was reported by 65.7% of patients and halos by 70.1%; only 1.5% of subjects reported severe glare and halos.

CONCLUSIONS

This new trifocal IOL provides equally good uncorrected VAs at distance, intermediate, and near, and decreases spectacle dependence in daily life. Patients frequently report mild-to-moderate glare and halos, and patients should be informed about these before implantation.

The role of primary intraocular lens implantation in the risk of secondary glaucoma following congenital cataract surgery: A systematic review and meta-analysis

Objective

This meta-analysis aims to evaluate the incidence of secondary glaucoma in patients under the age of 2 years who underwent congenital cataract surgery with or without primary intraocular lens (IOL) implantation.

Methods

An electronic literature search was performed in Medline, EMBASE, and Web of Science databases to retrieve studies between January 2011 and November 2018. Patients with congenital cataract who did primary IOL implantation, aphakia, or secondary IOL implantation followed by receiving extraction surgery were included in this study. Relevant studies meeting defined eligibility criteria were selected and reviewed systematically by meta-analysis. Long-term incidences of secondary glaucoma, which developed at least one year after cataract surgery, were considered and discussed as clinical outcomes in each cohort. The pooled data were analyzed according to a random effects model.

Results

Eight publications involving 892 eyes were included in the current meta-analysis. In the general population of eyes with congenital cataract, the long-term incidence of secondary glaucoma was lower (P = 0.06) in eyes with primary IOL (9.5%) than in eyes without primary IOL (15.1%), including aphakia and secondary IOL. The pooled risk ratio (RR) favors primary IOL implantation in all patients (RR = 0.63). For bilateral congenital cataract, the incidence was 6.7% in eyes with primary IOL implantation, which is significantly lower than the 16.7% in eyes with aphakia and secondary IOL implantation (P<0.05, RR = 0.44). However, for unilateral congenital cataract surgery, the incidence was very similar in eyes with and without primary IOL (12.4% vs 12.0%, P = 0.61, RR = 0.87).

Conclusions

In patients under 2 years of age, primary IOL implantation for bilateral congenital cataract surgery is associated with a lower risk of secondary glaucoma.

Cataract Surgery in Children from Birth to Less than 13 Years of Age: Baseline Characteristics of the Cohort

OBJECTIVE

To describe baseline characteristics, initial postoperative refractive errors, operative complications, and magnitude of the intraocular lens (IOL) prediction error for refractive outcome in children undergoing lensectomy largely in North America.

DESIGN

Prospective registry study of children from birth to <13 years of age who underwent lensectomy for any reason within 45 days preceding enrollment.

PARTICIPANTS

Total of 1266 eyes of 994 children; 49% female and 59% white.

METHODS

Measurement of refractive error, axial length, and complete ophthalmic examination.

MAIN OUTCOME MEASURES

Eye and systemic associated conditions, IOL style, refractive error, pseudophakic refraction prediction error, operative and perioperative complications.

RESULTS

Mean age at first eligible lens surgery was 4.2 years; 337 (34%) were <1 year of age. Unilateral surgery was performed in 584 children (59%). Additional ocular abnormalities were noted in 301 eyes (24%). An IOL was placed in 35 of 460 eyes (8%) when surgery was performed before 1 year of age, in 70 of 90 eyes (78%) from 1 to <2 years of age, and in 645 of 716 eyes (90%) from 2 to <13 years of age. The odds of IOL implantation were greater in children ≥2 years of age than in those <2 years of age (odds ratio = 29.1; P < 0.001; 95% confidence interval: 19.6-43.3). Intraoperative complications were reported for 69 eyes (5%), with the most common being unplanned posterior capsule rupture in 14 eyes, 10 of which had an IOL placed. Prediction error of the implanted IOL was <1.00 diopter in 54% of eyes, but >2.00 diopters in 15% of eyes.

CONCLUSIONS

Lensectomy surgery was performed throughout childhood, with about two-thirds of cases performed after 1 year of age. Initial surgery seemed safe, with a low complication rate. IOL placement was nearly universal in children 2 years of age and older. The immediate postoperative refraction was within 1 diopter of the target for about one-half of eyes.

Pseudophakic/aphakic corneal edema--morphometric predisposing factors analysis based on the fellow eye examination

PURPOSE

To find morphometric factors predisposing to the development of corneal decompensation following cataract surgery.

MATERIAL AND METHODS

Study group consisted of 50 patients after keratoplasty performed as pseudophakic/aphakic corneal edema (PCE/ACE) treatment. Control group formed 50 patients after cataract removal without signs of corneal decompensation. Specific subgroups were analyzed too. The morphometric data of the fellow eye anterior chamber were obtained with Visante OCTTM.

RESULTS

Anterior chamber depth and anterior chamber angle width were significantly smaller in study group (p < 0.00001, U-test). With excluded preoperative risk factors: Fuchs dystrophy, acute angle closure glaucoma attack history the significant differences were also observed (p < 0.01). In Fuchs' dystrophy and intraoperative complication subgroups comparison these two anterior chamber parameters were smaller too (p < 0.001). Anterior chamber width was also smaller in study group with p = 0.001. Central corneal thickness was higher in study group with p = 0.013. After exclusion of patients with Fuchs' dystrophy there was no difference in comparison (p = 0.34). The difference in total axial length comparison was insignificant (p = 0.18). Relative anterior microphthalmos was diagnosed in 31 patients of study group (62%) and in 17 of control (34%).

CONCLUSIONS

Small anterior chamber dimensions and higher central corneal thickness due to Fuchs' dystrophy are factors influencing the risk of PCE/ACE development.

Outcome of cataract surgery in Nigeria: visual acuity, autorefraction, and optimal intraocular lens powers--results from the Nigeria national survey

OBJECTIVE

To describe presenting and corrected visual acuities after cataract surgery in a nationally representative sample of adults. Another objective was to describe refractive errors in operated eyes and to determine the optimal range of intraocular lens (IOL) powers for this population.

DESIGN

Cross-sectional, population-based survey.

PARTICIPANTS

Adults aged 40 years and more were selected using multistage stratified sampling and proportional to size procedures. A sample size of 15027 was calculated, and clusters were selected from all states.

METHODS

Individuals who had undergone cataract surgery were identified from interview and examination. All had their presenting visual acuity (VA) measured using a reduced logarithm of the minimum angle of resolution chart and underwent autorefraction. Corrected VAs were assessed using the autorefraction results in a trial set. An ophthalmologist conducted all examinations, including slit-lamp and dilated fundus examination. Causes of visual loss were determined for all eyes with a presenting VA <6/12 using the World Health Organization recommendations. Biometry data were derived from 20449 phakic eyes using the SRK-T formula after excluding those with poor VA or corneal opacities.

MAIN OUTCOME MEASURES

Presenting and corrected visual acuities in pseudo/aphakic individuals and autorefraction findings; biometry profile of Nigerian adults.

RESULTS

Data from 288 eyes of 217 participants were analyzed. Only 39.5% of eyes had undergone IOL implantation at surgery. Only 29.9% of eyes had a good outcome (i.e., ≥6/18) at presentation, increasing to 55.9% with correction. Use of an IOL was the only factor associated with a good outcome at presentation (odds ratio 9.0; 95% confidence interval, 4.3-18.9; P=0.001). Eyes undergoing cataract surgery had a higher prevalence and degree of astigmatism than phakic eyes. Biometry data reveal that posterior chamber IOL powers of 20, 21, and 22 diopters (D) (A constant 118.0) will give a postoperative refraction range of -2.0 D to emmetropia in 71.4% of eyes, which increases to 82.6% if 19 D is also included.

CONCLUSIONS

Postoperative astigmatism needs to be reduced through better surgical techniques and training, and use of biometry should be standard of care.

Aphakic glaucoma after congenital cataract surgery with and without intraocular lens implantation

PURPOSE

To evaluate the incidence and individual risk factors for the development of aphakic glaucoma after congenital cataract surgery.

MATERIAL AND METHODS

We retrospectively reviewed the records of 113 eyes of children who underwent surgery for cataract between 1998 and 2002. Outcome variables studied included intraocular pressure, number of medication changes required over the course of the follow-up, and surgical interventions required.

RESULTS

We enrolled 113 eyes who had cataract extraction with IOL (101 eyes), or lensectomy with anterior vitrectomy (12 eyes). Median age during cataract surgery was 11.5 months. The median time to development of postoperative glaucoma was 3.2 years (range, 6 months-10 years). Mean post cataract surgery follow-up was 6.2 years. Postoperative glaucoma developed in 9.7% of eyes of children with cataract. Postoperative open-angle glaucoma developed in 6 pseudophakic eyes and in 2 aphakic eyes; postoperative closed-angle glaucoma developed in 3 aphakic eyes. The mean follow-up period after the diagnosis of glaucoma was 3.8 years. During the course of follow-up, all of 11 eyes required 1-3 medication changes for controlling glaucoma and 3 of them (31.4%), required surgical intervention.

CONCLUSIONS

Despite modern surgical techniques the incidence of aphakic glaucoma must be considered in all patients after pediatric cataract extraction. Our results show the importance of careful follow up of intraocular pressure after cataract surgery in children. Young patients undergoing cataract surgery should be monitored routinely for glaucoma.

Cataract prevalence, cataract surgical coverage and barriers to uptake of cataract surgical services in Pakistan: the Pakistan National Blindness and Visual Impairment Survey

AIM

To estimate the prevalence of visual impairment and blindness caused by cataract, the prevalence of aphakia/pseudophakia, cataract surgical coverage (CSC) and to identify barriers to the uptake of cataract services among adults aged >or=30 years in Pakistan.

METHODS

Probability proportional-to-size procedures were used to select a nationally representative sample of adults. Each subject underwent interview, visual acuity measurement, autorefraction, biometry and ophthalmic examination. Those that saw <6/12 in either eye underwent a more intensive examination procedure including corrected visual acuity, slit lamp and dilated fundus examination. CSC was calculated for different levels of visual loss by person and by eye. Individuals with <6/60 in the better eye as a result of cataract were interviewed regarding barriers.

RESULTS

16 507 Adults were examined (95.5% response rate). The crude prevalence of blindness (presenting <3/60 in the better eye) caused by bilateral cataract was 1.75% (95% CI 1.55%, 1.96%). 1317 Participants (633 men; 684 women) had undergone cataract surgery in one or both eyes, giving a crude prevalence of 8.0% (95% CI 7.6%, 8.4%). The CSC (persons) at <3/60, <6/60 and <6/18 were 77.1%, 69.3% and 43.7%, respectively. The CSC (eyes) at <3/60, <6/60 and <6/18 were 61.4%, 52.2% and 40.7%, respectively. Cost of surgery (76.1%) was the main barrier to surgery.

CONCLUSION

Approximately 570 000 adults are estimated to be blind (<3/60) as a result of cataract in Pakistan, and 3,560000 eyes have a visual acuity of <6/60 because of cataract. Overall, the national surgical coverage is good but underserved populations have been identified.

Postoperative aphakia in modern cataract surgery

PURPOSE

To study the incidence of aphakia after cataract surgery, the surgical complications that can lead to it, and the visual outcome.

SETTING

Six community-run eye clinics participating in the Swedish National Cataract Register.

METHODS

Data on cataract extractions were collected prospectively from 1997 through 2001. The data also covered the type of surgery and type of intraocular lens, including a "no lens implanted" option. All data were stored in a database. These data were supplemented with data on the intended type of surgery, type of complications, possible second surgery, and visual outcome.

RESULTS

The overall incidence of postoperative aphakia was 0.65%. In 87.1% of cases, the aphakia was not planned, corresponding to an incidence of 0.48%. Unplanned aphakia was significantly related to poor preoperative vision, old age, and the presence of ocular comorbidity. The most frequent reasons for unplanned aphakia were intraoperative capsule problems and vitreous loss. In two thirds of cases, a second operation was performed. In 41% of all cases, the final visual acuity was 0.5 or better and in 27.7%, worse than 0.1.

CONCLUSIONS

During the study period, 1 of every 200 routine cataract surgeries ended in unplanned aphakia. The incidence of surgical complications leading to unplanned aphakia and a final visual acuity worse than 0.1 (20/200) was 7.8 per 10,000 operations in cases with no ocular comorbidity and 27.6 per 10,000 operations in cases with ocular comorbidity.

Postoperative aphakia in modern cataract surgery

PURPOSE

To study the incidence of aphakia after cataract extraction and evaluate the relative risk for this outcome in subgroups of patients based on preoperative conditions.

SETTING

Sixty-two community-run or private clinics participating in the Swedish National Cataract Register.

METHODS

Data on cataract extractions were collected prospectively from 1997 through 2001. The set of data also covered type of surgery and type of intraocular lens (IOL), including a "no lens implanted" option. All data were stored in a database. Database calculations were made of frequencies and risk ratios of postoperative aphakia in the subgroups of patients based on preoperative conditions.

RESULTS

For the entire study period, postoperative aphakia was reported in 1410 of 287,951 surgeries for which complete IOL data were available, corresponding to an overall frequency of 0.49%. The occurrence of ocular comorbidity and poor preoperative visual acuity (< or = 0.1) in the eye to be operated on was significantly related to postoperative aphakia for each year of the study (P<.001). Glaucoma and poor visual acuity (< or =0.1) in the surgical eye meant a 12.8 higher risk for aphakia after surgery than a better visual acuity (>0.1) and no ocular comorbidity.

CONCLUSIONS

This national 5-year survey showed that in routine cataract surgery performed during the study, 1 of every 200 operations ended in postoperative aphakia. Poor visual acuity (< or =0.1) in the eye to be operated on combined with ocular comorbidity was the highest risk factor for postoperative aphakia.

Biostatistical analysis of pseudophakic and aphakic retinal detachments

Removal of the crystalline lens increases the risk of rhegmatogenous retinal detachment (RD) by creating changes in the ocular environment that predispose to development of retinal breaks. The evolution of cataract surgery from intracapsular cataract extraction (ICCE) to extracapsular cataract extraction (ECCE) and phacoemulsification has reduced the incidence of RD, while advances in vitreoretinal surgery have resulted in improved outcomes when retinal detachment does occur. The incidence of RD varies between 0.4-3.6% for ICCE and between 0.55-1.65% for ECCE. In eyes having undergone phacoemulsification the incidence is similar to those of ECCE and ranges between 0.75-1.65%. In this article the authors review the incidence and risk factors associated with pseudophakic and aphakic RD. The risk factors discussed include pre-operative risk factors such as age, status of the fellow eye and myopia, and surgical risk factors such as vitreous loss, posterior capsular integrity and Nd : YAG capsulotomy.

Impact of a sight-saver clinic on the prevalence of blindness in northern KwaZulu

The prevalence of blindness in the Ingwavuma district of northern KwaZulu was 1% (95% confidence interval 0.75 - 1.25) in 1990, and the prevalence of blindness due solely to age-related cataract was 0.39% (95% CI 0.24 - 0.54). Eight sight-saver clinics were held between 1990 and 1993. Nine hundred and thirteen patients were seen and 113 cataract extractions performed at a cost of R62,000. The prevalence of blindness due solely to age-related cataract was reduced by 25% to 0.29% (95% CI 0.17 - 0.41). The overall prevalence of blindness was reduced by 4% to 0.96% (95% CI 0.72 - 1.20). The provision of aphakic spectacles to aphakic patients whose spectacles have either been lost or broken would effect a further 11% reduction to 0.85% (95% CI 0.63 - 1.07). The establishment of a permanent sight-saver clinic staffed by an ophthalmic medical assistant who is working full-time in this capacity would facilitate an improvement in the delivery of eye care in the area.

[The development of early complications after cataract extraction with IOL implantation in patients with an elevated level of antibodies to deoxyribonucleic acid]

The immune system of the eye is closely connected with the immune system of homeostasis regulation of the body. The present research was aimed at the detection of the correlations between blood serum levels of autoantibodies to native and denatured DNA and the clinical course of the postoperative period after IOL implantation to cataract patients. Increased titers of both antibody types were found prognostically valuable. If only one parameter is increased (antibody titer to one DNA), the prognostic value of the test is reduced by 30%.

Aphakia and artificial lens implants in the civil airman population

The Federal Aviation Administration allows civilian airmen with aphakia to fly with waivered certificates. This study analyzes, in the civil airman population, the distribution of aphakia and intraocular lens (I.O.L.) implant by type (unilateral, bilateral), class of airman medical certificate, and gender, for a 4-year period (1982-85). Medical records were individually evaluated for all certified airmen who were carrying FAA-specific codes for the pathology categories during the study period. The prevalence of both aphakia and I.O.L. increased most for bilateral type and second-class certificate holders. During the study period, the prevalence of aphakia increased most for males and I.O.L. increased most for females. The incidence declined in both pathology categories during the later years of the study period. Implications for aeromedical certification of the increasing prevalence of aphakia and I.O.L. in the civil airman population are discussed. The modification of surgical procedures for cataract extraction and evolution of I.O.L. devices strongly suggests continued specialized aeromedical certification and clinical research review.

Prevalence of cataracts in a population-based study of persons with diabetes mellitus

Persons with diabetes mellitus have been found to be at increased risk of developing cataracts when compared with nondiabetic persons. This report describes the study of characteristics which may be related to this problem in a population-based sample of diabetic persons. Prevalence of surgical aphakia and cataract increased with increasing age in both younger and older onset diabetic persons. Females had higher rates than males. In multivariate analyses, for younger onset persons, longer duration of diabetes, older age at examination, increased severity of retinopathy, diuretic usage and higher glycosylated hemoglobin levels were significantly associated with greater prevalence of cataract. In older onset persons, age at examination, increased severity of retinopathy, diuretic usage, lower intraocular pressure, smoking and lower diastolic blood pressure were significantly associated with greater prevalence of cataract. Longitudinal data concerning the relationship of some of these characteristics to subsequent development or progression of cataract are necessary before considering the possibility of preventive trials in this condition.

Penetrating keratoplasty combined with extracapsular cataract extraction

In my previous prospective study of 132 eyes, the incidence of clinically significant cystoid macular edema was 42% in aphakic penetrating keratoplasty, 33% in combined keratoplasty and cataract extraction with vitrectomy, and only 4% in combined keratoplasty and cataract extraction without vitrectomy. In the present study we added 26 aphakic and 11 pseudophakic keratoplasties and 17 procedures combining keratoplasty with extracapsular cataract extraction. Grafts were clear in 94% of patients, and 43% had visual acuity of 20/40 or better. Clinically significant cystoid macular edema occurred in 35% of aphakic and 27% of pseudophakic keratoplasties. Cystoid macular edema did not occur in combined keratoplasty and extracapsular cataract extraction.

The prevalence of cataract in insulin-dependent and non-insulin-dependent-diabetes mellitus

In an epidemiological study of 533 diabetics - 227 treated with insulin and 306 treated with oral hypoglycaemic agents (OHA) - the prevalence of cataract/aphakia and lens opacities was in total higher (P less than 0.01) in type 2 diabetics (= non-insulin-dependent diabetes) compared with type 1 diabetics (= insulin-dependent diabetes). Type 2 diabetics were characterized by a higher age than type 1 diabetics (P less than 0.01). Thus, an age-specific comparison between type 1 and type 2 diabetics showed no difference (P greater than 0.05) in the occurrence of cataract/aphakia in type 1 diabetics (P less than 0.01) in the age interval 50-64 years. Cataract/aphakia and lens opacities correlated positively (P less than 0.01) with the current age and presence of retinopathy within both groups of diabetics. In type 1 diabetics the duration of diabetes was related to cataract/aphakia. A comparison of this study with the results of previous population studies of cataract in non-diabetics indicates that cataract/aphakia occurs more frequently in diabetics exclusively below the age of 65-70 years.

Prevalence of ocular disease in a population study of subjects 65 years old and older

During a two-year period a randomly selected age-stratified sample of subjects 65 years old and older living in Gisborne, New Zealand, was examined by an ophthalmologist to investigate visual acuity and the prevalence of the major disorders of vision in old age. A total of 481 subjects (a response rate of 86.2%) completed the study. When the results were weighted to remove the effect of stratified sampling, the following prevalence rates for the population 65 years and over were obtained: cataract, 30.1% with no sex difference and an increasing prevalence with increasing age; senile macular degeneration, 6.4% with no sex difference and an increasing prevalence with increasing age; glaucoma, 3.6% with no sex difference except for women 90 years old or older who had a higher rate. The prevalence of glaucoma increased with increasing age in women, but in men there was no clear pattern; diabetic retinopathy, 0.5%. In the population 65 years old and older, we estimated that 81% of the men and 68.8% of the women had best corrected visual acuities of 6/9 (20/30) or better in the better eye.

Senile lens changes and diabetes in two population studies

Clinical and epidemiologic studies of the association between senile cataract and diabetes have produced what initially appears to be conflicting evidence. Three studies of extracted cataract have found a positive association in persons less than 70 years old. Conversely, two studies of senile lens changes (including aphakia) reported no association with diabetes. These apparently disparate findings led to the hypothesis that the diseases are in fact not associated, but that diabetics are more likely to be referred to ophthalmologists and therefore to have cataracts removed. We tested this hypothesis with data from two population surveys, the Framingham Eye Study and the Health and Nutrition Examination Survey (HANES). Both studies showed a marked excess prevalence of senile cataract (including aphakia) in diabetics less than 65 years old (relative risks of 4.02 and 2.97, respectively). Beyond the age of 64 years, the HANES study but not the Framingham study showed an excess prevalence, although it was less marked (relative risks of 1.63 and 1.02, respectively). For senile lens changes other than cataract, both studies showed little, if any, association with diabetes. Our results for cataract (whether removed or not) were generally consistent with those of previous studies of extracted cataract for persons under the age of 70 years and for persons aged 70 years or more. The two studies that reported no association between lens changes and diabetes provided information inadequate to support or refute the foregoing findings. The various studies failed to support increased referral of diabetics to ophthalmologists as an explanation for the observed association. All these studies found the association in persons less than 70 years old, whether the cataract had been removed or not.