Prevalence of cataract in Australia: the Blue Mountains eye study

Association of autoimmune and allergic diseases with senile cataract: a bidirectional two-sample Mendelian randomization study

Background

Many observational studies have been reported that patients with autoimmune or allergic diseases seem to have a higher risk of developing senile cataract, but the views are not consistent. In order to minimize the influence of reverse causality and potential confounding factors, we performed Mendelian Randomization (MR) analysis to investigate the genetic causal associations between autoimmune, allergic diseases and senile cataract.

Methods

Single nucleotide polymorphisms associated with ten common autoimmune and allergic diseases were obtained from the IEU Open genome-wide association studies (GWAS) database. Summary-level GWAS statistics for clinically diagnosed senile cataract were obtained from the FinnGen research project GWAS, which consisted of 59,522 individuals with senile cataracts and 312,864 control individuals. MR analysis was conducted using mainly inverse variance weighted (IVW) method and further sensitivity analysis was performed to test robustness.

Results

As for ten diseases, IVW results confirmed that type 1 diabetes (OR = 1.06; 95% CI = 1.05-1.08; p = 2.24×10-12), rheumatoid arthritis (OR = 1.05; 95% CI = 1.02-1.08; p = 1.83×10-4), hypothyroidism (OR = 2.4; 95% CI = 1.42-4.06; p = 1.12×10-3), systemic lupus erythematosus (OR = 1.02; 95% CI = 1.01-1.03; p = 2.27×10-3), asthma (OR = 1.02; 95% CI = 1.01-1.03; p = 1.2×10-3) and allergic rhinitis (OR = 1.07; 95% CI = 1.02-1.11; p = 2.15×10-3) were correlated with the risk of senile cataract. Celiac disease (OR = 1.04; 95% CI = 1.01-1.08; P = 0.0437) and atopic dermatitis (OR = 1.05; 95% CI = 1.01-1.10; P = 0.0426) exhibited a suggestive connection with senile cataract after Bonferroni correction. These associations are consistent across weighted median and MR Egger methods, with similar causal estimates in direction and magnitude. Sensitivity analysis further proved that these associations were reliable.

Conclusions

The results of the MR analysis showed that there were causal relationships between type 1 diabetes, rheumatoid arthritis, hypothyroidism, systemic lupus erythematosus, asthma, allergic rhinitis and senile cataract. To clarify the possible role of autoimmune and allergy in the pathophysiology of senile cataract, further studies are needed.

Calculation of solar ultraviolet influx in the eye considering the field of view and pupillary dilation due to sunglasses

The media and even the specialized literature report that the ultraviolet (UV) protection for sunglasses is critical, on the grounds that sunglasses can have a counter effect if the lenses do not provide adequate UV protection. They reason that the primary and natural mechanism is that the pupil of the eye contracts to attenuate radiation and protect the inner eye under sun exposure. Therefore, if dark lenses do not provide appropriate UV protection, there is an increased UV incidence in the inner eye due to pupil dilation, which enhances the adverse effects and impacts the ocular tissues more severely than in situations without UV protection. However, no existing literature properly quantified or supported this argument. In this work, the influx of solar UV throughout the pupil of the eye was calculated in two situations: when a person wear sunglasses and when he/she does not. In both situations, the pupil dilation and the field of view (squint) were considered with their dependence on the brightness of the ambient, calculated by modeling the solar irradiation. Finally, it was assessed whether sunglasses with poor UV protection actually increase the UV influx throughout the dilated pupil compared to the non-dilated pupil. A set of 214 sunglasses lenses were tested and the results show that pupil dilation does not play an important role in the UV influx throughout the pupil. It was observed that the FOV is the main player, surpassing the pupil size contribution by up to 314.3%, disproving the common explanation. Because of the major role of the FOV, our results show that sunglasses with UV-A protection below 86% may have a slight potential to increase hazards to the eye compared to not wearing sunglasses at all. These results can have direct impact on sunglasses standards regarding the UV protection linked to the category of the lenses.

Decreasing Lens Irradiation on Brain Imaging: A Multi-CT Scanner Quality Improvement Project

AIMS

Cataracts, a leading global cause of blindness, are associated with ionising radiation exposure. This audit aimed to enhance lens exclusion during non-contrast head computed tomography (CT) scans at Newham University Hospital (NUH) using two CT scanners.

METHODS

A retrospective audit of non-contrast head CT scans at NUH excluded scans for trauma and imaging of orbital structures. A one-week audit in April 2023 assessed lens exclusion, compared to the Royal College of Radiologists (RCR) standards. A total of 101 consecutive scans were analysed and 63 (62%) scans were included in the final study. Thirty-eight percent of the scans were excluded according to the exclusion criteria of head, neck and facial traumas, orbital infections and papilledema. Results were presented, followed by a three-month radiographer re-education period, emphasizing gantry tilt and patient positioning. A reaudit in August 2023 evaluated outcomes. For the reaudit, 183 consecutive scans were analysed, with 131 (72%) scans included in the final study and 52 (28%) scans excluded according to the same exclusion criteria as the first audit.

RESULTS

Lens exclusion in non-contrast head CT scans improved significantly from 0/63 (0%) compliance to 19/131 (14.50%) (p=0005) compliance with the standards. Variability in radiographer practices, 'near misses' and time constraints were identified as challenges. Staff turnover impacted compliance.

CONCLUSION

This audit has shed light on a critical aspect of patient care in the field of radiology. This research underscores the importance of rigorous and standardised protocols in radiological procedures, particularly when it comes to protecting the lens of the eye. By enhancing lens exclusion during non-contrast head CT scans, we have taken a significant step in mitigating the risk associated with ionising radiation exposure. Although substantial improvements were made, achieving the RCR audit standard remained elusive. Ongoing re-education, reaudits and a multidisciplinary approach are necessary to optimise radiographer adherence and reduce ionising radiation exposure to the lens during head CT scans. This quality improvement project proves that continued emphasis on gantry tilt and patient positioning in radiographer education and training can make a significant difference in patient safety. As we move forward, let us remember that even small improvements can make a big difference in safeguarding the health and well-being of patients.

Cataract Surgery-Indications, Techniques, and Intraocular Lens Selection

BACKGROUND

Opacification of the lens of the eye (cataract) is usually due to aging. It is a painless, progressive condition that affects contrast and color perception and alters refraction, leading to visual loss that may be total. In cataract surgery, the turbid lens is replaced by an artificial lens. An estimated 600 000 to 800 000 such procedures are performed in Germany each year.

METHODS

This review is based on pertinent publications retrieved by a selective search in PubMed, including meta-analyses, Cochrane reviews, and randomized controlled clinical trials (RCTs).

RESULTS

Cataract is the most common reversible cause of blindness around the world (approximately 95 million people). The surgical replacement of a turbid lens with an artificial lens is usually carried out under local anesthesia. The standard technique for fragmentation of the nucleus of the lens is ultrasonic phacoemulsification. RCTs have not shown the superiority of the femtosecond laser over phacoemulsification for this purpose so far. The spectrum of artificial intraocular lenses, aside from the conventional type with a single focus, include lenses with multiple foci, extended-depth-of-focus (EDOF) lenses, and astigmatism-correcting lenses.

CONCLUSION

In Germany, cataract surgery is usually performed on an outpatient basis under local anesthesia. Artificial lenses with various additional functions are available nowadays; the choice of lens depends on the needs of the individual patient. Patients must be adequately informed about the advantages and disadvantages of the different lens systems.

Changing Trends in the Disease Burden of Cataract and Forecasted Trends in China and Globally from 1990 to 2030

Aim

To explore the trends in the prevalence and disease burden of cataract from 1990 to 2019, evaluate attributable risk factors, and predict trends over the next decade in China and globally.

Methods

Data was obtained from Global Burden of Disease Study 2019. We calculated the age-standardized prevalence rate (ASR) and annual percentage change (EAPC) to show the trends of cataract in China and different regions. We calculated and reported the proportion of disability adjusted life years (DALYs) attributable to risk factors by sex in China and different regions. Then, the Bayesian age-period-cohort (BAPC) analysis model was also used to predict the prevalence trends from 2020 to 2030 in China and globally.

Results

The ASR increased from 867.09 in 1990 to 991.56 in 2019 per 100,000 with an EAPC of 0.88 in China. The age-standardized DALY rate of females was higher than males. DALY rates were correlated to household air pollution from solid fuels, tobacco, high fasting plasma glucose and high body-mass index. The projective model indicates that the ASR for cataracts will rise to 1101.35×10⁶ for male and 1616.63×10⁶ for female by 2030.

Conclusion

The trends from 1990 to 2030 suggested that the burden of cataract remains high in China. Maintaining good lifestyle habits such as switching to clean energy, reducing cigar intake, controlling blood glucose and weight can reduce the risk of cataracts. As aging increases, China should pay more attention to cataract-induced low vision and blindness and develop public policies to reduce the disease burden.

Pseudophakia and Lens Opacities in 70-Year-Olds in Gothenburg, Sweden; Gender Differences, Impact on Self-Reported Visual Function and Validation of Self-Reported Cataract and Pseudophakia

Purpose

The study aimed at determining the prevalence and sex differences in cataract, pseudophakia, lens opacities and self-reported cataract in 70-year-old people in Gothenburg, Sweden. The purpose was also to identify correlations between lens opacities, visual acuity and subjective visual function, and to validate self-reported cataract and cataract surgery.

Patients and Methods

Population-based cross-sectional study where participants (n=1182) answered questions about self-reported diagnosis of cataract and cataract surgery. A total of 1139 subjects completed the National Eye Institute Visual Functioning Questionnaire-25 (NEI VFQ-25), 560 subjects underwent ophthalmic examination including visual acuity and lens photography. t-test, Pearson chi-square and Mann-Whitney U-test were used for obtaining p-values. ANOVA (analysis of variances, Kruskal-Wallis, one-way) was used to compare VFQ-25 between 3 groups; no cataract, cataract and pseudophakia. To clarify the differences between specific pairs of groups post-hoc test (Bonferroni) was used after ANOVA.

Results

Self-reported cataract was more common in women than in men (27.2% vs 19.1%, p=0.001, chi-square). Cataract surgery was reported by 16.3% of women and 12.6% of men (p=0.072). Upon eye examination, the prevalence of pseudophakia was 16.9% in women compared to 10.2% in men (p=0.020). The prevalence of cataract, including pseudophakia, was 31.9% in women versus 23.8% in men (p=0.033). Significant correlations (Spearman's rho) were found between lens opacities and visual acuity. Self-reported cataract surgery showed a very high specificity and high sensitivity. The composite score from NEI VFQ-25 was lower in people with pseudophakia than in people with/without cataract (p=0.012, Kruskal-Wallis).

Conclusion

The prevalence of cataract including pseudophakia in 70-year-olds in Gothenburg is higher compared to previous studies in similar geographical areas. Also, it is more common in women than in men. The lack of significant sex differences in lens opacities may be due to cataract surgery at an earlier stage. Validation showed very good agreement between pseudophakia and self-reported cataract surgery.

Cross-sectional study of the association between asthma and cataract among 40 years and older in the USA

Background

This study is aimed to assess the association between asthma and cataract in a representative sample in the United States.

Methods

The National Health Interview Survey (NHIS) is the principal source of information on the health of the civilian noninstitutionalized population of the United States. Ten years (2010-2019) of NHIS were analyzed in this study. Asthma and cataract status were collected from relevant questionnaires among participants aged 40 years and older. Multivariate regression analyses were applied to explore the association between asthma and cataract.

Results

From 40,457 participants included, those with asthma had higher prevalence of cataract than those without asthma (29.41% vs 25.87%, p < 0.001). Participants who had asthma had 40% higher odds of cataract compared to those without, after adjusting for potential confounding covariates (Odds Ratio [OR] = 1.40, 95% Confidence Interval [CI]: 1.29-1.52, p < 0.001). When viewing asthma as the outcome, participants who had cataract had 36% higher odds of asthma compared to those without, after adjusting for potential confounding covariates (Odds Ratio [OR] = 1.36, 95% Confidence Interval [CI]: 1.25-1.47, p < 0.001).

Conclusions

With our study, we demonstrated that individuals with asthma were more likely to develop cataract compared with those without asthma. Further RCTs are needed to confirm this potential impact of asthma on cataract and to investigate the underlying mechanisms.

Apoptosis of Lens Epithelial Cells and Expression of NLRP3-related Proteins in Patients with Diabetes and Cataract

AIM

To compare the expression of apoptosis-related factors and Nlrp3-related proteins in the lens epithelial cells (LECs) of patients with diabetes and cataract and patients with age-related cataract (ARC) alone.

METHODS

All patients were divided into four groups according to the presence or absence of diabetes mellitus (DM) and the degree of diabetic retinopathy (DR). LECs were obtained during cataract surgery. The expression levels of cleaved caspase-3, caspase-7, ASC, caspase-1and Nlrp3 in LECs were determined. And analyzed by age, course of DM, and HbA1c levels.

RESULTS

The incidence of LEC apoptosis and positive rates of cleaved caspase-3 and caspase-7 expression were significantly higher in the groups with DM (P<0.05).The positive expression rates of ASC, caspase-1, and Nlrp3 increased with longer duration of DM, increased HbA1c level, or advanced DR (P<0.05).

CONCLUSION

In cataract patients with DM, the expression of apoptosis-related factors in LECs increased. Nlrp3-related protein expression levels, diabetes duration, HbA1c levels, and extent of DR may be potential risk factors for diabetic cataract formation.

Prevalence of pseudophakia: U.S. population-based study

PURPOSE

To determine the current prevalence and trends of pseudophakia in a well-defined U.S. population, calculating values for Olmsted County, Minnesota, from 1988 through 2018.

SETTING

Mayo Clinic, Rochester, Minnesota.

DESIGN

Population-based cohort study.

METHODS

Rochester Epidemiology Project (REP) databases were used to identify all cases of pseudophakia in Olmsted County, Minnesota, between January 1, 1988, and December 31, 2018. Age- and sex-specific prevalence rates were calculated in 1988, 1998, 2008, and 2018 using REP census population estimates and mortality counts. Poisson regression analysis was used to assess changes in prevalence over time. Mortality rates were estimated by Kaplan-Meier analysis.

RESULTS

In 2018, 10 024 county residents were pseudophakic in at least 1 eye, for a total population prevalence of 6.5%. The prevalence increased 67% in the last 10 years and 590% in the last 30 years (P < .001). By 2018, 51% of residents aged 75 years and 88% of residents aged 85 years and older were pseudophakic in at least 1 eye, 53% of residents with pseudophakia aged 65 years and older were bilaterally pseudophakic, and 29% of residents with pseudophakia had lived with pseudophakia for more than 10 years. The prevalence was higher among women than men and increased with age (P < .001). Overall, pseudophakia had a lower all-cause mortality compared with the general Minnesota population (P < .001).

CONCLUSIONS

In 2018, most residents aged 75 years and older were pseudophakic in at least 1 eye. These numbers underscore the changing visual status of older adults and the large number of adults who benefit from cataract surgery.

Prevalence of cataract and cataract surgery in urban and rural Chinese populations over 50 years old: a systematic review and Meta-analysis

AIM

To summarize the data of epidemiological studies on cataract prevalence over 50 years old in urban and rural areas of China from 2000 to 2020, and to analyze the prevalence of cataract and operation rate in China.

METHODS

By searching PubMed, EMBASE, Web of Science, Wanfang Data and CNKI, Chinese and English literatures on the prevalence of cataract in China were retrieved, and the relevant characteristic data were extracted. Then, Stata v15SE software was used for Meta-analysis and heterogeneity test. According to the results of heterogeneity, the corresponding effect models were selected to combine the extracted data.

RESULTS

A total of 20 studies were included in this study, with a total of 111 434 cases. Meta-analysis showed heterogeneity. According to the random effect model, the overall prevalence of cataract in Chinese people over 50 years old was 27.45%, that in rural was 28.79%, and that in urban was 26.66%. The overall coverage rate of cataract surgery was 9.19%.

CONCLUSION

The prevalence of cataract is high in China, and there is still room for improvement in surgical coverage, so it is very important to promote cataract screening and prevention.

Effects of hormone replacement therapy on lens opacity, serum inflammatory cytokines, and antioxidant levels

PURPOSE

To evaluate the effect of hormone replacement therapy (HRT) on lens opacity as measured by Scheimpflug densitometry, serum inflammatory cytokines, and antioxidant levels.

METHODS

A total of 264 women who were at least five years beyond menopause were included. The control group of 128 patients (Group 1) did not use HRT at any time after menopause. The treatment group of 136 patients (Group 2) used HRT for5 years or more after menopause. Cortical, nuclear, and posterior subcapsular density; pentacam nucleus staging (PNS); pentacam densitometry of zone (PDZ) as measured using a Scheimpflug imaging system (Pentacam); and antioxidant and inflammatory cytokines activities in serum using multiplex bead analysiswere examined.

RESULTS

Uncorrected visual acuity (logMAR) of group1 was significantly worse than those of group 2 (p < .05). Group1 was significantly more myopic than group 2 (p < .05). Nuclear and posterior subcapsular density, PNS, and percentage of PDZ in group 1 were significantly higher than those of group 2 (p < .05). The serum IL-1m. IL-6, IL-8, and TGF-, concentrations of group 1 were significantly higher than those of group 2, and the serum catalase, superoxide dismutase 1 (SOD 1), and superoxide dismutase 2 (SOD 2) fluorescence intensities of group 1 were significantly lower than those of group 2 (p < .05).

CONCLUSIONS

Long-term use of HRT may have a protective effect against cataract formation. HRT seems to be effective in decreasing inflammation and increasing antioxidant contents in the serum of postmenopausal women.KEY MESSAGESHormone replacement therapy (HRT) decrease lens opacity in postmenopausal women as measured by Scheimpflug densitometry.HRT decrease serum inflammatory cytokines and increase antioxidant levelsin the serum of postmenopausal women.Long-term use of HRT may have a protective effect against cataract formationin postmenopausal women.

Visual Impairment, Major Eye Diseases, and Mortality in a Multi-Ethnic Asian Population and a Meta-analysis of Prospective Studies

PURPOSE

Vision impairment (VI) is associated with poor quality of life and increased risk of falls. Few prospective data are available on Asians. This study investigates the longitudinal impact of VI and the major eye diseases on mortality risk in Asians.

DESIGN

Prospective cohort study with meta-analysis.

METHODS

We conducted a multi-ethnic prospective study of adults (40-80 years old) in the Singapore Epidemiology of Eye Diseases Study (baseline: 2004-2011). All-cause mortality was obtained from the National Death Registry until May 2017. VI was defined by best-corrected visual acuity (BCVA) <20/40 in the better eye. Major eye diseases were assessed using standard protocols. We examined associations using multivariate-adjusted Cox proportional hazards regression models. Finally, we conducted a meta-analysis of the associations between VI and mortality.

RESULTS

Of 9,986 participants, 1,210 deaths occurred (12.1%) over a median follow-up of 8.8 years. Compared to participants with normal vision, persons with VI had increased risk of mortality (hazards ratio [HR]: 1.53; 95% confidence interval [CI:] 1.30-1.81) in multivariate models. In ethnicity-specific analyses, this association was significant across Chinese (HR: 1.63; 95% CI: 1.08-2.48); Malays (HR: 1.31; 95% CI: 1.06-1.62); and Indians (HR: 2.25; 95% CI: 1.61-3.15). Cataract, under-corrected refractive errors (URE), and diabetic retinopathy (DR) were significantly associated with mortality (HRs: 1.30, 1.22, and 1.54, respectively). In a meta-analysis of 12 studies including 58,034 persons, VI was associated with 30% increased risk of mortality (HR: 1.3; 95% CI: 1.2-1.5).

CONCLUSIONS

In this multi-ethnic Asian population, VI and preventable eye conditions (cataract, URE, and DR) were associated with mortality, emphasizing the need for early detection and intervention to prevent and treat VI and major eye diseases.

Age- and Sex-Standardized Prevalence of Age-Related Cataract and Its Determinants; Tehran Geriatric Eye Study (TGES)

PURPOSE

To determine the prevalence of cataract and its relationship with some determinants in individuals above 60 years.

METHODS

Of 3792 subjects that were invited, 3310 participated in the study (response rate = 87.31%). All subjects underwent full optometric, slit lamp, and fundoscopic examinations. Then, their lenses were evaluated according to the World Health Organization cataract grading system after pupil dilation.

RESULTS

Age- and sex-standardized prevalence with 95% confidence interval (CI) of nuclear, cortical, posterior subcapsular cataracts (PSC), any type cataract, and all lens change was 53.09% (49.80 to 56.35), 23.02% (20.87 to 25.32), 5.57% (4.62 to 6.70), 58.78% (55.65 to 61.83), and 72.49% (70.14 to 74.71), respectively. Any type, nuclear, cortical, and PSC cataracts, had a positive association with age and an inverse association with education. Moreover, the prevalence of cortical and PSC cataract had an inverse association with economic status. Among all variables, age was the strongest determinant for cataract and its subtype.

CONCLUSION

This study found a higher prevalence of cataract compared to some previous studies such that about two-thirds of the geriatric population had cataract in the past or at the time of the study. Considering the association of cataract with variables such as economic status and education level, it seems that training and increased awareness and knowledge of the elderly population regarding the importance of eye care by physicians plays an important role in reducing the burden of cataract.

Challenges in Eye Care in the Asia-Pacific Region

The Asia-Pacific region is home to a 4.3-billion population and one of the most rapidly aging regions. Addressing the eye care needs in the region would greatly boost the progress toward achieving universal eye health. Over 20 countries/regions have actively engaged in the "VISION 2020" initiative launched since 1999, and remarkable achievements have been witnessed as demonstrated by an increase in both the number and density of ophthalmologists in almost all countries. Nevertheless, formidable and emerging challenges are to be overcome in the coming century. From 1990 to 2015, the absolute number of blind people increased by 17.9%, largely due to population growth and aging. The Asia-Pacific region, the most populous continent with a rapidly aging population, would inevitably be left to tackle this challenge. Furthermore, a high prevalence of blinding eye diseases imposes great pressure on current eye care services, with South Asia having the highest age-standardized prevalence of moderate to severe visual impairment (17.5%) and mild vision impairment (12.2%) globally, and high-income countries having the highest overall prevalence of myopia, reaching 53.4% with East Asia having the second-highest overall prevalence (51.6%). Moreover, the availability of ophthalmic resources varies greatly in the region, with the density of ophthalmologists ranging from over 114 ophthalmologists per million population in Japan to 0 in Micronesia, and a highly disproportionate urban-rural distribution. This article aims to shed light on challenges faced by the Asia-Pacific ophthalmic community and propose corresponding strategies to tackle those challenges.

Accuracy of Using Generative Adversarial Networks for Glaucoma Detection During the COVID-19 Pandemic: A Systematic Review and Bibliometric Analysis

Background

Glaucoma leads to irreversible blindness. Globally, it is the second most common retinal disease that leads to blindness, slightly less common than cataracts. Therefore, there is a great need to avoid the silent growth of this disease using recently developed generative adversarial networks (GANs).

Objective

This paper aims to introduce a GAN technology for the diagnosis of eye disorders, particularly glaucoma. This paper illustrates deep adversarial learning as a potential diagnostic tool and the challenges involved in its implementation. This study describes and analyzes many of the pitfalls and problems that researchers will need to overcome to implement this kind of technology.

Methods

To organize this review comprehensively, articles and reviews were collected using the following keywords: (“Glaucoma,” “optic disc,” “blood vessels”) and (“receptive field,” “loss function,” “GAN,” “Generative Adversarial Network,” “Deep learning,” “CNN,” “convolutional neural network” OR encoder). The records were identified from 5 highly reputed databases: IEEE Xplore, Web of Science, Scopus, ScienceDirect, and PubMed. These libraries broadly cover the technical and medical literature. Publications within the last 5 years, specifically 2015-2020, were included because the target GAN technique was invented only in 2014 and the publishing date of the collected papers was not earlier than 2016. Duplicate records were removed, and irrelevant titles and abstracts were excluded. In addition, we excluded papers that used optical coherence tomography and visual field images, except for those with 2D images. A large-scale systematic analysis was performed, and then a summarized taxonomy was generated. Furthermore, the results of the collected articles were summarized and a visual representation of the results was presented on a T-shaped matrix diagram. This study was conducted between March 2020 and November 2020.

Results

We found 59 articles after conducting a comprehensive survey of the literature. Among the 59 articles, 30 present actual attempts to synthesize images and provide accurate segmentation/classification using single/multiple landmarks or share certain experiences. The other 29 articles discuss the recent advances in GANs, do practical experiments, and contain analytical studies of retinal disease.

Conclusions

Recent deep learning techniques, namely GANs, have shown encouraging performance in retinal disease detection. Although this methodology involves an extensive computing budget and optimization process, it saturates the greedy nature of deep learning techniques by synthesizing images and solves major medical issues. This paper contributes to this research field by offering a thorough analysis of existing works, highlighting current limitations, and suggesting alternatives to support other researchers and participants in further improving and strengthening future work. Finally, new directions for this research have been identified.

Prevalence of visual impairment among older Chinese population: A systematic review and meta-analysis

Background

To evaluate the prevalence of visual impairment (VI) among elderly Chinese population.

Methods

All population-based studies on VI prevalence among elderly Chinese populations were searched and only studies with clear definitions of diagnosis were selected. Meta-analysis methods were used to estimate the pooled prevalence and its 95% confidence interval (95%CI) of moderate and severe visual impairment (MSVI) and blindness both by presenting visual acuity (PVA) and best corrected visual acuity (BCVA). Subgroup analysis of gender, district, geographical location, age, education level and examined year were also conducted.

Results

72 studies with 465 039 individuals were included and analyzed. Using PVA, the pooled prevalence of MSVI is 10.9% (95% CI = 9.4%-12.6%) and blindness is 2.2% (95% CI = 1.8%-2.8%), while prevalence of MSVI and blindness by BCVA was 5.4% (95% CI = 4.6%-6.2%) and 2.2% (95% CI = 1.9%-2.5%), respectively. Females, rural residents, older age and lower educational level were risk factors for MSVI and blindness.

Conclusions

VI causes a great health burden among Chinese populations, particularly affecting female subjects, subjects dwelling in rural area, older subjects and subjects with lower educational level.

Factors Influencing Contrast Sensitivity Function in Eyes with Mild Cataract

This study was aimed to evaluate the relationship between the area under the log contrast sensitivity function (AULCSF) and several optical factors in eyes suffering mild cataract. We enrolled 71 eyes of 71 patients (mean age, 71.4 ± 10.7 (standard deviation) years) with cataract formation who were under surgical consultation. We determined the area under the log contrast sensitivity function (AULCSF) using a contrast sensitivity unit (VCTS-6500, Vistech). We utilized single and multiple regression analyses to investigate the relevant factors in such eyes. The mean AULSCF was 1.06 ± 0.16 (0.62 to 1.38). Explanatory variables relevant to the AULCSF were, in order of influence, logMAR best spectacle-corrected visual acuity (BSCVA) (p < 0.001, partial regression coefficient B = −0.372), and log(s) (p = 0.023, B = −0.032) (adjusted R² = 0.402). We found no significant association with other variables such as age, gender, uncorrected visual acuity, nuclear sclerosis grade, or ocular HOAs. Eyes with better BSCVA and lower log(s) are more susceptible to show higher AULCSF, even in mild cataract subjects. It is indicated that both visual acuity and intraocular forward scattering play a role in the CS function in such eyes.

Implementing ICHOM standard set for cataract surgery at IPO-Porto (Portugal): clinical outcomes, quality of life and costs

BACKGROUND

This paper fills a gap in the applied research field, for a local context, by addressing the topics of describing cataract surgery' clinical outcomes; quality of life (QoL); and costs of the patients treated after the implementation of the ICHOM standard set.

METHODS

This is a retrospective observational study using real-world data (RWD). We included all patients subjected to cataract surgery at the Portuguese Institute of oncology - Porto (IPO-Porto), Portugal, after 3 months follow up period completed between 5th June 2017 and 21st May 2018. The following inclusion criteria: corrected visual acuity of ≤ 6/10 or other significant visual disturbance due to lens opacity or the existence of a large anisometropia. A circuit was implemented based on the ICHOM standard for cataract, to measure clinical variables (e.g. visual acuity) and QoL (CATQUEST-9SF) before and after surgery, and cost of treatment. The results were explored by means of a paired-sample t-test, considering normality assumptions.

RESULTS

Data refers to 268 patients (73 P25-P75:32-95 years old), regarding 374 eyes. The cataract surgery had a positive effect on visual acuity (p < 0.001), refraction (right and left cylinder; p < 0.001) and all QoL dimensions. The vast majority of patients, around 98%, reported improvements in QoL. Based on IPO-Porto administrative records, the direct cost of treating cataracts (per eye) is of 500€, representing a total cost of 187,000€ for the number of patients operated herein.

CONCLUSION

This study reports the successful implementation of the ICHOM standard set for cataracts in a Portuguese institution and confirms that cataract surgery provides a rapid visual recovery, with excellent visual outcomes and minimal complications in most patients, while also having a positive impact on patients' quality of life.

The Associations Between Older Driver Licensure Laws with Travel and Passenger Behaviors Among Adults Aged 65 Years or Older (United States, 2003-2017)

Introduction: The aging population has been rapidly growing in the United States (U.S.). In line with this trend, older adults’ mobility and transportation safety are an increasing priority. Many states have implemented driver licensure laws specific to older adults to limit driving among the elderly with driving skill decline. Evaluations of these laws have primarily focused on their safety benefits related to older drivers’ fatal crash rate or injury rate. However, very few studies investigated licensure law effects on older adults’ mobility. Objective: The objective of our study is to evaluate the association between older driver licensure laws and older adult daily traveling and passenger exposure. Methods: The 2003–2017 American Time Use Survey (ATUS) data were linked with statewide driver licensure law provisions. Adults aged 55–64 years were used as the reference group to control for the effects of non-licensure-law factors (e.g., economic trend). We used modified Poisson regressions with robust variance to estimate the relationships between licensure law provisions and the likelihoods of older men and women’s daily traveling and passenger behaviors. Results: Laws requiring a vision test at in-person renewal were associated with increased daily traveling likelihood for women aged 75 years or older, primarily as a passenger. Laws requiring a knowledge test were related to a reduced daily overall traveling likelihood for women aged 75 years or older. Conclusions: In general, licensure law provisions are not strongly related to older adults’ mobility, in particular for older male adults. Older female adults’ daily mobility may be more likely to be influenced by the change of licensure laws than older male adults. The existence of gender-based disparities in responding to licensure laws requires future studies to account for the gender difference in estimating the effects of those traffic policies on older adults’ mobility and traffic safety.

Visual Impairment and Eye Diseases in HIV-infected People in the Antiretroviral Therapy (ART) Era in Rakai, Uganda

PURPOSE

Antiretroviral therapy reduced infectious eye diseases (EDs) in HIV-infected people. There is limited data on age-related EDs and visual impairment (VI) in people living with HIV. We report prevalence of VI and spectrum of EDs in HIV-infected people in an ART era in Rakai, Uganda.

METHODS

A philanthropic campaign during 2009-2012 provided ophthalmic services to HIV+ patients in care. Unilateral presenting visual acuity (VA) was assessed by a trained staff in HIV clinics using a 6-m Snellen chart. A slit-lamp examination by an ophthalmologist evaluated eyes with impaired acuity. A retrospective chart review was later conducted retrieving data of patients participating the ophthalmic service. VI was defined referencing WHO's ICD-11. Ophthalmic diagnosis was summarized by VI level. Logistic regressions estimated demographic associations with cataract diagnosis.

RESULTS

688 HIV+ patients were evaluated, median age was 44 (IQR: 37-50) years, 69% were female. Fifty-one percent were on ART (median duration 4, IQR: 2-5 years). Crude prevalence of moderate/severe VI and blindness were both 2%. The main diagnoses were refractive error (55%), conjunctivitis (18%), cataract (15%), and pterygium (11%). Cataract prevalences were 10%, 12%, and 26% among age groups of 19-34, 35-49, and ≥50 years, respectively. Cataract was found in 73% of the HIV+s with blindness and in 63% of those with moderate/severe VI. Older age and male sex were significantly associated with higher cataract prevalence.

CONCLUSION

VI in HIV+ patients in Rakai was mainly due to refractive error and cataract. Cataract was common in all age groups.

Common variants in SOX-2 and congenital cataract genes contribute to age-related nuclear cataract

Nuclear cataract is the most common type of age-related cataract and a leading cause of blindness worldwide. Age-related nuclear cataract is heritable (h² = 0.48), but little is known about specific genetic factors underlying this condition. Here we report findings from the largest to date multi-ethnic meta-analysis of genome-wide association studies (discovery cohort N = 14,151 and replication N = 5299) of the International Cataract Genetics Consortium. We confirmed the known genetic association of CRYAA (rs7278468, P = 2.8 × 10⁻¹⁶) with nuclear cataract and identified five new loci associated with this disease: SOX2-OT (rs9842371, P = 1.7 × 10⁻¹⁹), TMPRSS5 (rs4936279, P = 2.5 × 10⁻¹⁰), LINC01412 (rs16823886, P = 1.3 × 10⁻⁹), GLTSCR1 (rs1005911, P = 9.8 × 10⁻⁹), and COMMD1 (rs62149908, P = 1.2 × 10⁻⁸). The results suggest a strong link of age-related nuclear cataract with congenital cataract and eye development genes, and the importance of common genetic variants in maintaining crystalline lens integrity in the aging eye.

Here, the authors report a multi-ethnic genome wide association meta-analysis of 12 studies from the International Cataract Genetics Consortium. They find six new loci associated with age-related nuclear cataract, in addition to replicating the association at CRYAA, and suggest a strong genetic link between age-related nuclear and congenital cataracts.

Prevalence and risk factors for age-related cataract in Sweden

BACKGROUND

Cataract is a major cause of visual impairment worldwide. There is a paucity of prevalence studies from Sweden. Therefore, we report the prevalence of cataract and its risk factors in a population-based study of older adults in Sweden.

METHODS

The Tierp Glaucoma Survey was conducted in the municipality of Tierp, Sweden, including 760 subjects aged 65-74 years. The presence of cataract was determined based on retroillumination, with lens opacities evident on slit-lamp examination. To assess risk factors for cataract, odds ratios (ORs) were calculated, adjusted for age and gender.

RESULTS

A total of 234 individuals were found to have cataract, 12 of whom had undergone cataract surgery. The prevalence adjusted for nonparticipation was 31.5% (95% confidence interval [CI] 29.4-33.6), 35.2% (95% CI 28.7-41.8) in females and 26.2% (95% CI 19.8-32.6) in males. Cataract was associated with age ≥70 years (OR 1.93; 95% CI 1.41-2.64), female gender (OR 1.54; 95% CI 1.12-2.11), and myopia (OR 2.3; 95% CI 1.16-3.56), while pseudoexfoliation, smoking, diabetes, hypertension, and ischaemic heart disease were not.

CONCLUSION

Nearly one-third of the sample were estimated to have lens opacities, or had undergone cataract surgery, making cataract a frequent disorder of older age. The study provided further evidence that increasing age, female gender, and myopia are associated with cataract.

[Gender medicine in ophthalmology : The "small difference" between women and men]

Gender-specific or sex-specific medicine is part of "personalized" medicine. After differences in heart diseases between women and men were first identified and increasingly published in the field of cardiology since the 1980s, differences between the sexes have also become the focus of interest in other disciplines. Immunological and hormonal aspects indicate significant differences, e.g. in the severity of the disease or the response to treatment. Even in ophthalmology epidemiological differences in some diseases are known but so far these do not lead to a different approach in the practical treatment of patients. This CME article aims to raise awareness of gender medicine also in the field of ophthalmology and at the same time to promote understanding of these differences by presenting the fundamental differences between the sexes.

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

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

Vision-related quality of life and visual function in a 70-year-old Swedish population

PURPOSE

To investigate vision-related quality of life (VRQoL), visual function and predictors of poor vision in a population of 70-year-olds.

METHODS

Self-reported ocular morbidity and responses to the National Eye Institute Visual Functioning Questionnaire-25 (NEI VFQ-25) in a cross-sectional population study (N = 1203) in Gothenburg, Sweden, were compared with results from ophthalmic examination (N = 560).

RESULTS

The most common self-reported ophthalmic morbidities were cataract (23.4%), age-related macular degeneration (AMD; 4.7%), glaucoma (4.3%) and diabetic retinopathy (1.4%). Cataract was more prevalent in women (p = 0.001). The composite score from NEI VFQ-25 for the entire cohort was 91.4 (standard deviation: 27.5). When comparing composite score for different eye diseases, persons with cataract or AMD exhibited lower scores (p = 0.029 and 0.018, respectively). Best-corrected visual acuity (BCVA) was normal (≥0.5 decimal) in 98.9%; two individuals had low vision (<0.3). Men exhibited better BCVA (median: -0.08 logMAR) than women (-0.06; p = 0.005). Visual field defects were observed in 16.3% and uncorrected refractive errors in 61.5%. Poor vision was reported by 7.4% of participants with presenting visual acuity (PVA) ≥0.5 (decimal), while 66.7% with PVA <0.5 reported good vision. Of 27 individuals with PVA <0.5, 55.6% obtained a BCVA of ≥1.0 with the right correction. Low contrast sensitivity was a significant predictor of experiencing poor vision (p = 0.008), while PVA and visual field defects were not.

CONCLUSIONS

Low contrast sensitivity is a predictor of experiencing poor vision. There is a discrepancy between subjective/objective visual function and a high prevalence of uncorrected refractive errors. Women have more cataract, and men demonstrate slightly better visual acuity.

Widespread sex dimorphism in aging and age-related diseases

Although aging is a conserved phenomenon across evolutionary distant species, aspects of the aging process have been found to differ between males and females of the same species. Indeed, observations across mammalian studies have revealed the existence of longevity and health disparities between sexes, including in humans (i.e. with a female or male advantage). However, the underlying mechanisms for these sex differences in health and lifespan remain poorly understood, and it is unclear which aspects of this dimorphism stem from hormonal differences (i.e. predominance of estrogens vs. androgens) or from karyotypic differences (i.e. XX vs. XY sex chromosome complement). In this review, we discuss the state of the knowledge in terms of sex dimorphism in various aspects of aging and in human age-related diseases. Where the interplay between sex differences and age-related differences has not been explored fully, we present the state of the field to highlight important future research directions. We also discuss various dietary, drug or genetic interventions that were shown to improve longevity in a sex-dimorphic fashion. Finally, emerging tools and models that can be leveraged to decipher the mechanisms underlying sex differences in aging are also briefly discussed.

Molecular Processes Implicated in Human Age-Related Nuclear Cataract

Human age-related nuclear cataract is commonly characterized by four biochemical features that involve modifications to the structural proteins that constitute the bulk of the lens: coloration, oxidation, insolubility, and covalent cross-linking. Each of these is progressive and increases as the cataract worsens. Significant progress has been made in understanding the origin of the factors that underpin the loss of lens transparency. Of these four hallmarks of cataract, it is protein-protein cross-linking that has been the most intransigent, and it is only recently, with the advent of proteomic methodology, that mechanisms are being elucidated. A diverse range of cross-linking processes involving several amino acids have been uncovered. Although other hypotheses for the etiology of cataract have been advanced, it is likely that spontaneous decomposition of the structural proteins of the lens, which do not turn over, is responsible for the age-related changes to the properties of the lens and, ultimately, for cataract. Cataract may represent the first and best characterized of a number of human age-related diseases where spontaneous protein modification leads to ongoing deterioration and, ultimately, a loss of tissue function.

Current Trends in the Pharmacotherapy of Cataracts

Cataracts, one of the leading causes of preventable blindness worldwide, refers to lens degradation that is characterized by clouding, with consequent blurry vision. As life expectancies improve, the number of people affected with cataracts is predicted to increase worldwide, especially in low-income nations with limited access to surgery. Although cataract surgery is considered safe, it is associated with some complications such as retinal detachment, warranting a search for cheap, pharmacological alternatives to the management of this ocular disease. The lens is richly endowed with a complex system of non-enzymatic and enzymatic antioxidants which scavenge reactive oxygen species to preserve lens proteins. Depletion and/or failure in this primary antioxidant defense system contributes to the damage observed in lenticular molecules and their repair mechanisms, ultimately causing cataracts. Several attempts have been made to counteract experimentally induced cataract using in vitro, ex vivo, and in vivo techniques. The majority of the anti-cataract compounds tested, including plant extracts and naturally-occurring compounds, lies in their antioxidant and/or free radical scavenging and/or anti-inflammatory propensity. In addition to providing an overview of the pathophysiology of cataracts, this review focuses on the role of various categories of natural and synthetic compounds on experimentally-induced cataracts.

Intake of Vegetables and Fruits and the Risk of Cataract Incidence in a Japanese Population: The Japan Public Health Center-Based Prospective Study

Background

Although the consumption of vegetables and fruits is reported to influence the risk of cataract, no prospective study of this association from Asia has yet appeared. Here, we investigated the association between vegetable and fruit intake and cataract incidence in a large-scale population-based prospective cohort study in Japan.

Methods

This study included 32,387 men and 39,333 women aged 45–74 years who had no past history of cataract and had completed a dietary questionnaire of the Japan Public Health Center-based Prospective Cohort Study. The incidence of cataract was evaluated after 5-year follow-up. We used multiple logistic regression analyses to estimate the sex-specific odds ratios (ORs), with adjustment for confounding factors.

Results

We identified 1,836 incident cataracts in 594 men and 1,242 women. In men, the OR for cataract was decreased with higher intake of vegetables (OR_{Q5 vs Q1}, 0.77; 95% confidence interval [CI], 0.59–1.01; P_trend across quartile categories = 0.03) and cruciferous vegetables (OR_{Q5 vs Q1}, 0.74; 95% CI, 0.57–0.96; P_trend = 0.02). In contrast, the OR for cataract was increased with higher intake of vegetables among women (OR_{Q5 vs Q1}, 1.28; 95% CI, 1.06–1.53; P_trend = 0.01). Green and yellow vegetable and fruit intake were not associated with cataract in either sex.

Conclusions

This study suggests that vegetables may reduce the risk of cataract in men, but not in women.

The Impact of Sociodemographic and Socioeconomic Factors on the Burden of Cataract in Small Island Developing States (SIDS) in the Caribbean from 1990 to 2016

Purpose: To study the impact of sociodemographic and socioeconomic factors on the cataract burden in Caribbean small island developing states (SIDS) using disability-adjusted life-years (DALYs).Methods: National and regional age and sex specific cataract DALY numbers and rates from 1990 to 2016 for Caribbean SIDS, were extracted from the Global Burden of Disease Study 2016. The human development index (HDI), healthcare access and quality (HAQ) index, and the World Bank's classification of economies were used as socioeconomic status indicators. The Gini coefficient, Atkinson, Theil and concentration indices were used to measure health inequality. Paired Wilcoxon signed rank test, Pearson correlation, and linear regression analyses were performed to evaluate the sociodemographic and socioeconomic factors associated with differences in cataract burden.Results: Men had higher age-standardized DALY rates than women (P < .001) with median rates of 90.72 (Interquartile range [IQR], 87.8-94.2) and 83.94(IQR, 80.9-86.5), respectively. The burden of cataract increased with age. Upper-middle income countries had higher age-standardized DALY rates than high income countries (P < .001), with median rates of 90.1 (IQR, 86.8-93.4) and 79.8 (IQR, 77.5-81.8), respectively. Age-standardized DALY rates were inversely correlated with HDI (r = - 0.61, β = - 51.56 [P < .05]) and HAQ (r = - 0.68, β = - 0.46 [P < .01). Between-country inequality was negligible, and the burden of cataract is greater among the poor.Conclusion: Global trends of socioeconomic factors were confirmed. Significantly, men had higher age-standardized DALY rates than women. This is an area for further research.

The PACAP-derived peptide MPAPO facilitates corneal wound healing by promoting corneal epithelial cell proliferation and trigeminal ganglion cell axon regeneration

It is well known that the cornea plays an important role in providing protection to the eye, but it is fragile and vulnerable. To clarify the biological effects and molecular mechanisms of the pituitary adenylate cyclase activating polypeptide (PACAP)-derived peptide MPAPO (named MPAPO) to promote corneal wound healing, we applied a mechanical method to establish a corneal injury model and analyzed the repair effects of MPAPO on corneal injury. MPAPO significantly promoted corneal wound repair in C57BL/6 mice. In addition, we established injury models of epithelial cells and trigeminal ganglion cells with H₂O₂. The results show that when the concentration of MPAPO is 1 μM, it can significantly promote the repair of injured corneal epithelial cells and the regeneration of trigeminal ganglion cell axons. MPAPO repairs epithelial cells through the promotion of GSK3β phosphorylation by binding to PAC1 and activating AKT. β-catenin escapes the phosphorylation of GSK3β and enters the nucleus to promote the expression of cyclin D1, accelerate cell cycle progression and promote cell proliferation. MPAPO promotes axonal regeneration by binding to the PAC1 receptor and activating adenylate cyclase activity, followed by the cAMP activation of protein kinase A activity and the promotion of CREB phosphorylation. Phosphorylated CREB promotes Bcl₂ expression and axonal regeneration. In conclusion, our data support the role of MPAPO to facilitate corneal wound healing by promoting corneal epithelial cell proliferation and trigeminal ganglion cell axon regeneration.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Systemic medications and cortical cataract: the Singapore Epidemiology of Eye Diseases Study

BACKGROUND/AIMS

To evaluate the association between systemic medications and cortical cataract prevalence in an Asian population.

METHODS

The Singapore Epidemiology of Eye Diseases Study recruited 10 033 Chinese, Malay and Indian residents aged 40+ years living in Singapore. Information on medication use was collected at interview using questionnaires. The presence and severity of cortical cataract were assessed from lens photographs using the modified Wisconsin Cataract Grading System. Associations between medications and the presence of cortical cataract were assessed using logistic regression. Associations between medications and greater severity of cortical cataract (none, minimal, early and late) were assessed using ordinal logistic regression.

RESULTS

A total of 8965 participants were included, the mean age was 57.6 (SD=9.8) years, and 4555 (50.8%) were women. After adjusting for age, gender, ethnicity, body mass index, smoking status, socioeconomic status, hypertension, hyperlipidaemia, diabetes, duration of diabetes and cardiovascular disease, ACE inhibitors (OR=1.27; 95% CI 1.05 to 1.55), fibrates (OR=1.57; 95% CI 1.05 to 2.35), alpha-glucosidase inhibitors (AGIs) (OR=1.85; 95% CI 1.13 to 3.02) and insulin (OR=1.80; 95% CI 1.11 to 2.93) were significantly associated with the presence of cortical cataract. Further adjusting for concurrent medication use did not alter these associations. Consistently, the four medications were also associated with a greater severity level of cortical cataract.

CONCLUSION

ACE inhibitors, fibrates and AGIs were associated with increased prevalence of cortical cataract in this Asian population, independent of the presence of hypertension, hyperlipidaemia and diabetes, respectively. Whether they contribute to the risk of cortical cataract needs confirmation in longitudinal studies.

Refraction and Change in Refraction Over a 20-Year Period in the Beaver Dam Eye Study

Purpose

Hyperopic shifts in refraction have been consistently reported in adults over 40, followed by myopic shifts after age 70. Although potential factors underlying these changes in refraction in older adults have been investigated previously, the studies were restricted by the limited longitudinal data available. The authors of this study sought to better characterize the long-term trajectory of refraction in older adults using 20 years of prospective data.

Methods

The impact of cohort effects on refraction over 20 years was examined. Generalized estimating equations were used to evaluate the etiologic factors underlying refraction and changes in refraction measured over a 20-year period (1988–2010) among adults over age 40 from the Beaver Dam Eye Study.

Results

Only individuals with nuclear cataract experienced a myopic shift in refraction, showing a 0.25 diopter (D) decrease (95% confidence interval [CI]: −0.44 D to −0.07 D) over a five-year period. Individuals with mild and moderate nuclear sclerosis showed varying degrees of hyperopic shifts over five years (0.22 D: 95% CI: 0.20 D–0.25 D; 0.23 D: 95% CI: 0.20 D–0.27 D, respectively).

Conclusions

Nuclear cataract is the primary contributor to the myopic shift among older individuals. Birth cohort effects on baseline refraction but not change in refraction were observed.

Aldose Reductase Polymorphisms, Fasting Blood Glucose, and Age-Related Cortical Cataract

Purpose

To determine whether there is an association between polymorphisms of the AKR1B1 gene and cortical cataract in the presence of hyperglycemia.

Methods

In the second cross section of the Blue Mountains Eye Study (BMES), 3508 participants (2334 at 5-year follow-up and 1174 newly recruited participants) were examined during 1997 to 2000. Cataract was graded from lens photographs using the Wisconsin Cataract Grading System. Fasting blood glucose (FBG) was measured. Continuous imputed dosages of minor alleles of 17 AKR1B1 single nucleotide polymorphisms (SNPs) were assessed for associations with prevalent cortical cataract. Gene-environment interactions between SNPs and FBG were examined. Odds ratios (OR) and 95% confidence intervals (CI) for prevalent cortical cataract were estimated using logistic regression adjusting for age, sex, smoking, hypertension, education, and myopia. A P value of 0.005 was considered statistically significant after correction for 10 independent tests. Replication of significant associations found in the BMES sample was conducted in the Singapore Epidemiology of Eye Diseases (SEED) study (n = 10,033).

Results

No polymorphism was associated with prevalent cortical cataract. A significant interaction was observed between rs9640883 and FBG (Pinteraction = 0.004), with increased cortical cataract prevalence associated with rs9640883 minor allele dosage in those with FBG >6.0 mM (strata-specific OR 1.72, 95% CI 1.09-2.72). No similar association was found in participants with normal FBG (OR 0.85, 95% CI 0.69-1.04). This interaction was not evident in the SEED study.

Conclusions

The identified interaction between rs9640883 and FBG in relation to cortical cataract was not replicated but may warrant further investigation.

The prevalence of visually significant cataract in the Australian National Eye Health Survey

PURPOSE

To describe the prevalence of visually significant cataract in Indigenous and non-Indigenous Australians.

METHODS

A total of 3098 non-Indigenous Australians aged 50 years and over and 1738 Indigenous Australians aged 40 years and over, residing in 30 randomly selected Australian sites, were examined as part of the population-based National Eye Health Survey (NEHS). For those with visual acuity worse than 6/12, photos of the anterior and posterior segment were taken with a nonmydriatic fundus camera and assessed for cataract. Visually significant cataract was assigned in eyes with best-corrected visual acuity worse than 6/12 and cataract that was determined to be the primary cause of vision loss in that eye.

RESULTS

In total, 99.2% (4797/4836) participants had complete data for visual acuity and cataract assessment. The overall weighted prevalence of visually significant cataract was 2.7% (95% CI: 2.0, 3.5) in non-Indigenous Australians and 4.3% (95% CI: 3.1, 5.9) among Indigenous Australians. After adjusting for age and gender, the odds of visually significant cataract were almost three times higher among Indigenous participants compared to non-Indigenous participants (adjusted odds ratio (OR) 2.95, 95% CI: 2.03, 4.29). Only 54.8% of non-Indigenous Australians and 38.9% of Indigenous Australians with visually significant cataract self-reported a known history of cataract.

CONCLUSIONS

Our results suggest that continued efforts are required to build sustainable cataract surgery services within Indigenous communities. Furthermore, given the significant ageing of the Australian population, maintaining high cataract surgery rates amongst the non-Indigenous population is critical to reduce cataract-related vision loss.

Impact of cataract on health-related quality of life in a longitudinal Japanese chronic obstructive pulmonary cohort

Cigarette smoking increases the risk of developing both cataract and chronic obstructive pulmonary disease (COPD). The prevalence of cataract and the clinical characteristics of COPD patients with cataract were retrospectively investigated in a 2-year observational COPD cohort. We analyzed 395 patients with complete data on ophthalmologic evaluation (319 subjects with COPD and 76 subjects at risk of COPD). There was no difference in the prevalence of cataract between COPD patients and those at risk (47.0% vs. 42.1%, p = 0.44). Age ≥ 75 years, low body mass index, and hypertension were independently associated with cataract as a comorbidity in COPD. The incidence of exacerbation within 2 years was significantly higher in COPD patients with cataract than those without cataract (36.6% vs. 18.3%, p = 0.0019). COPD patients with cataract exhibited significantly higher COPD assessment test score compared to those without cataract (13.7 ± 8.9 vs. 11.5 ± 7.2, p = 0.0240). Overall St George's Respiratory Questionnaire score and each component were significantly worse in COPD patients with cataract compared to those without cataract. COPD patients with cataract exhibited poor health-related quality of life and frequent exacerbations. The association between cataract and exacerbations of COPD deserves further attention.

The national and subnational prevalence of cataract and cataract blindness in China: a systematic review and meta-analysis

Background

Cataract is the second leading cause of visual impairment and the first of blindness globally. However, for the most populous country, China, much remains to be understood about the scale of cataract and cataract blindness. We aimed to investigate the prevalence of cataract and cataract blindness in China at both the national and subnational levels, with projections till 2050.

Methods

In this systematic review and meta-analysis, China National Knowledge Infrastructure (CNKI), Wanfang, Chinese Biomedicine Literature Database (CBM-SinoMed), PubMed, Embase, and Medline were searched using a comprehensive search strategy to identify all relevant articles on the prevalence of cataract or cataract blindness in Chinese population published from January 1990 onwards. We fitted a multilevel mixed-effects meta-regression model to estimate the prevalence of cataract, and a random-effects meta-analysis model to pool the overall prevalence of cataract blindness. The United Nations Population Division (UNPD) data were used to estimate and project the number of people with cataract and cataract blindness from 1990 to 2050. According to different demographic and geographic features in the six geographic regions in China, the national numbers of people with cataract in the years 2000 and 2010 were distributed to each region.

Results

In males, the prevalence of any cataract (including post-surgical cases) ranged from 6.71% (95% CI = 5.06-8.83) in people aged 45-49 years to 73.01% (95% CI = 65.78-79.2) in elderly aged 85-89 years. In females, the prevalence of any cataract increased from 8.39% (95% CI = 6.36-10.98) in individuals aged 45-49 years to 77.51% (95% CI = 71.00-82.90) in those aged 85-89 years. For age-related cataract (ARC, including post-surgical cases), in males, the prevalence rates ranged from 3.23% (95% CI = 1.51-6.80) in adults aged 45-49 years to 65.78% (95% CI = 46.72-80.82) in those aged 85-89 years. The prevalence of ARC in females was 4.72% (95% CI = 2.22-9.76) in the 45-49 years age group and 74.03% (95% CI = 56.53-86.21) in the 85–89 years age group. The pooled prevalence rate of cataract blindness (including post-surgical cases) by best corrected visual acuity (BCVA)<0.05 among middle-aged and older Chinese was 2.30% (95% CI = 1.72-3.07), and those of cataract blindness by BCVA<0.10 and cataract blindness by presenting visual acuity (PVA)<0.10 were 2.56% (95% CI = 1.94-3.38) and 4.51% (95% CI = 3.53-5.75) respectively. In people aged 45-89 years, the number of any cataract cases was 50.75 million (95% CI = 42.17-60.37) in 1990 and 111.74 million (95% CI = 92.94-132.84) in 2015, and that of ARC rose from 35.77 million (95% CI = 19.81-59.55) in 1990 to 79.04 million (95% CI = 44.14-130.85) in 2015. By 2050, it is projected that the number of people (45-89 years of age) affected by any cataract will be 240.83 million (95% CI = 206.07-277.35), and that of those with ARC will be 187.26 million (95% CI = 113.17-281.23). During 2000 and 2010, South Central China consistently owed the most cases of any cataract, whereas Northwest China the least.

Conclusions

The prevalence of cataract and cataract blindness in China was unmasked. In the coming decades, cataract and cataract blindness will continue to be a leading public-health issue in China due to the ageing population. Future work should be prioritized to the promotion of high-quality epidemiological studies on cataract.

THE CURRENT SURGICAL MANAGEMENT OF LARGE, RECURRENT, OR PERSISTENT MACULAR HOLES

PURPOSE

To evaluate the current surgical options available for the management of large (>400 μm), recurrent, or persistent macular holes (MHs).

METHODS

A review of the literature was performed, focusing on the epidemiology, pathophysiology, diagnosis, and surgical treatments of large, recurrent, or persistent MHs. Based on this review, a comprehensive overview was provided regarding the topic of large, recurrent, or persistent MHs and focused on recent surgical management updates.

RESULTS

For large MHs, variations of the inverted internal limiting membrane flap technique demonstrated promising rates of primary hole closure and significant visual acuity improvements. For recurrent or recalcitrant MHs, early repeat vitrectomy with extension of the internal limiting membrane peel remains the most straightforward and optimal surgical technique to achieve secondary closure. Regardless of the surgical approach, the goal of each technique described is to induce or aid in stimulating gliosis within the MH to maximize closure.

CONCLUSION

Despite the high success rate of modern MH surgery, large, recurrent, or persistent MHs remain a challenge for retinal surgeons. This review provides a detailed summary on the rationality and efficacy of current surgical options.

The national and subnational prevalence of cataract and cataract blindness in China: a systematic review and meta-analysis

Background

Cataract is the second leading cause of visual impairment and the first of blindness globally. However, for the most populous country, China, much remains to be understood about the scale of cataract and cataract blindness. We aimed to investigate the prevalence of cataract and cataract blindness in China at both the national and subnational levels, with projections till 2050.

Methods

In this systematic review and meta-analysis, China National Knowledge Infrastructure (CNKI), Wanfang, Chinese Biomedicine Literature Database (CBM-SinoMed), PubMed, Embase, and Medline were searched using a comprehensive search strategy to identify all relevant articles on the prevalence of cataract or cataract blindness in Chinese population published from January 1990 onwards. We fitted a multilevel mixed-effects meta-regression model to estimate the prevalence of cataract, and a random-effects meta-analysis model to pool the overall prevalence of cataract blindness. The United Nations Population Division (UNPD) data were used to estimate and project the number of people with cataract and cataract blindness from 1990 to 2050. According to different demographic and geographic features in the six geographic regions in China, the national numbers of people with cataract in the years 2000 and 2010 were distributed to each region.

Results

In males, the prevalence of any cataract (including post-surgical cases) ranged from 6.71% (95% CI = 5.06-8.83) in people aged 45-49 years to 73.01% (95% CI = 65.78-79.2) in elderly aged 85-89 years. In females, the prevalence of any cataract increased from 8.39% (95% CI = 6.36-10.98) in individuals aged 45-49 years to 77.51% (95% CI = 71.00-82.90) in those aged 85-89 years. For age-related cataract (ARC, including post-surgical cases), in males, the prevalence rates ranged from 3.23% (95% CI = 1.51-6.80) in adults aged 45-49 years to 65.78% (95% CI = 46.72-80.82) in those aged 85-89 years. The prevalence of ARC in females was 4.72% (95% CI = 2.22-9.76) in the 45-49 years age group and 74.03% (95% CI = 56.53-86.21) in the 85-89 years age group. The pooled prevalence rate of cataract blindness (including post-surgical cases) by best corrected visual acuity (BCVA)<0.05 among middle-aged and older Chinese was 2.30% (95% CI = 1.72-3.07), and those of cataract blindness by BCVA<0.10 and cataract blindness by presenting visual acuity (PVA)<0.10 were 2.56% (95% CI = 1.94-3.38) and 4.51% (95% CI = 3.53-5.75) respectively. In people aged 45-89 years, the number of any cataract cases was 50.75 million (95% CI = 42.17-60.37) in 1990 and 111.74 million (95% CI = 92.94-132.84) in 2015, and that of ARC rose from 35.77 million (95% CI = 19.81-59.55) in 1990 to 79.04 million (95% CI = 44.14-130.85) in 2015. By 2050, it is projected that the number of people (45-89 years of age) affected by any cataract will be 240.83 million (95% CI = 206.07-277.35), and that of those with ARC will be 187.26 million (95% CI = 113.17-281.23). During 2000 and 2010, South Central China consistently owed the most cases of any cataract, whereas Northwest China the least.

Conclusions

The prevalence of cataract and cataract blindness in China was unmasked. In the coming decades, cataract and cataract blindness will continue to be a leading public-health issue in China due to the ageing population. Future work should be prioritized to the promotion of high-quality epidemiological studies on cataract.