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Nesemann JM, Srinivasan M, Ravindran RD, Edwards T, O'Brien KS, Kim UR, Wilkins JH, Whitcher JP, Lietman TM, Gritz DC, Keenan JD. Relationship between cooking fuel and lens opacities in South India: a 15-year prospective cohort study. Am J Ophthalmol 2022; 243:66-76. [PMID: 35817091 DOI: 10.1016/j.ajo.2022.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/12/2022] [Accepted: 06/22/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Unclean cooking fuels such as wood and kerosene have been associated with cataract in cross-sectional studies. This study sought to determine whether exposure to unclean cooking fuels was associated with subsequent cataract progression. DESIGN Prospective cohort study. METHODS This is a secondary observational analysis of the community-based Antioxidants in Prevention of Cataracts trial (ClinicalTrials.gov ID NCT01664819). The exposure of interest was cooking fuel type, measured at baseline. Main outcome measures were baseline cataract severity and self-reported cataract surgery at a 15-year visit. RESULTS Baseline and 15-year follow-up data were available for 798 and 579 participants, respectively. Wood or kerosene was used by 711/798 (89.1%) baseline participants, including 539/579 (93.1%) participants with complete follow-up. Cooking fuel type was not associated with cataract severity at baseline (p=0.443). Out of 8,334 person-years of follow up, 90 cataract surgeries were observed over 15 years (1.08 surgeries per 100 person-years; 95%CI 0.87-1.32). Use of wood or kerosene was not associated with 15-year incidence of cataract surgery relative to individuals using propane (adjusted p=0.154). Cataract surgery was more common in older individuals (HR 1.1 per year, 95%CI 1.1-1.2, p<0.001), those with baseline myopia (HR 2.1, 95%CI 1.2-3.5, p=0.009) and women (HR 3.5, 95%CI 1.2 to 10.1, p=0.019). CONCLUSIONS This study found no association between unclean cooking fuels and cataract progression over a 15-year period. No other modifiable risk factors were associated with incident self-reported cataract surgery.
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Affiliation(s)
- John M Nesemann
- Francis I Proctor Foundation, University of California, San Francisco, USA; David Geffen School of Medicine, University of California, Los Angeles, USA; International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, United Kingdom.
| | | | | | - Tansy Edwards
- International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Kieran S O'Brien
- Francis I Proctor Foundation, University of California, San Francisco, USA; Department of Ophthalmology, University of California, San Francisco, USA
| | - Usha R Kim
- Casey Eye Institute, Oregon Health Sciences University and Lions VisionGift, Portland, OR, USA
| | - John H Wilkins
- Department of Ophthalmology, University of California, San Francisco, USA
| | - John P Whitcher
- Francis I Proctor Foundation, University of California, San Francisco, USA; Department of Epidemiology & Biostatistics, University of California, San Francisco, USA
| | - Thomas M Lietman
- Francis I Proctor Foundation, University of California, San Francisco, USA; Department of Epidemiology & Biostatistics, University of California, San Francisco, USA; Institute for Global Health, University of California, San Francisco, CA, USA; Johns Hopkins Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD
| | - David C Gritz
- Johns Hopkins Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD
| | - Jeremy D Keenan
- Francis I Proctor Foundation, University of California, San Francisco, USA; Department of Epidemiology & Biostatistics, University of California, San Francisco, USA
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2
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Ruiss M, Findl O, Kronschläger M. The human lens: An antioxidant-dependent tissue revealed by the role of caffeine. Ageing Res Rev 2022; 79:101664. [PMID: 35690384 DOI: 10.1016/j.arr.2022.101664] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/24/2022] [Accepted: 06/04/2022] [Indexed: 11/01/2022]
Abstract
Cataract is the leading cause of blindness worldwide and surgery is the only option to treat the disease. Although the surgery is considered to be relatively safe, complications may occur in a subset of patients and access to ophthalmic care may be limited. Due to a growing and ageing population, an increase in cataract prevalence is expected and its management will become a socioeconomic challenge. Hence, there is a need for an alternative to cataract surgery. It is well known that oxidative stress is one of the main pathological processes leading to the generation of the disease. Antioxidant supplementation may, therefore, be a strategy to delay or to prevent the progression of cataract. Caffeine is a widely consumed high-potency antioxidant and may be of interest for the prevention of the disease. This review aims to give an overview of the anatomy and function of the lens, its antioxidant and reactive oxygen species (ROS) composition, and the role of oxidative stress in cataractogenesis. Also, the pharmacokinetics and -dynamics of caffeine will be described and the literature will be reviewed to give an overview of its anti-cataract potential and its possible role in the prevention of the disease.
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Affiliation(s)
- Manuel Ruiss
- Vienna Institute for Research in Ocular Surgery (VIROS), a Karl Landsteiner Institute, Department of Ophthalmology, Hanusch Hospital, Vienna 1140 Austria.
| | - Oliver Findl
- Vienna Institute for Research in Ocular Surgery (VIROS), a Karl Landsteiner Institute, Department of Ophthalmology, Hanusch Hospital, Vienna 1140 Austria.
| | - Martin Kronschläger
- Vienna Institute for Research in Ocular Surgery (VIROS), a Karl Landsteiner Institute, Department of Ophthalmology, Hanusch Hospital, Vienna 1140 Austria.
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3
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Truscott RJW, Friedrich MG. Molecular Processes Implicated in Human Age-Related Nuclear Cataract. Invest Ophthalmol Vis Sci 2020; 60:5007-5021. [PMID: 31791064 PMCID: PMC7043214 DOI: 10.1167/iovs.19-27535] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
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.
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Affiliation(s)
- Roger J W Truscott
- Illawarra Health and Medical Research Institute, University of Wollongong, Australia
| | - Michael G Friedrich
- Illawarra Health and Medical Research Institute, University of Wollongong, Australia
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4
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Bastawrous A, Mathenge W, Nkurikiye J, Wing K, Rono H, Gichangi M, Weiss HA, Macleod D, Foster A, Burton M, Kuper H. Incidence of Visually Impairing Cataracts Among Older Adults in Kenya. JAMA Netw Open 2019; 2:e196354. [PMID: 31251374 PMCID: PMC6604086 DOI: 10.1001/jamanetworkopen.2019.6354] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 05/11/2019] [Indexed: 01/10/2023] Open
Abstract
Importance Half of all the cases of blindness worldwide are associated with cataract. Cataract disproportionately affects people living in low- and middle-income countries and persons of African descent. Objective To estimate the 6-year cumulative incidence of visually impairing cataract in adult participants in the Nakuru Eye Disease Cohort Study in Kenya. Design, Setting, and Participants This secondary analysis of the Nakuru Eye Disease Cohort Study was conducted from February 2016 to April 2016. This cohort comprised citizens of Nakuru, Kenya, aged 50 years or older who consented to participate in the initial or baseline survey from January 2007 to November 2008, as well as the follow-up conducted from January 2013 to March 2014. All participants at baseline (n = 4364) and follow-up (n = 2159) underwent ophthalmic examination. Main Outcomes and Measures Six-year cumulative incidence of visually impairing cataract, risk factors of incidence, population estimates, and required cataract surgical rates to manage incident visually impairing cataract. Results In total, 4364 individuals (with a mean [SD] age of 63.4 [10.5] years and with 2275 women [52.1%]) had complete eye examinations at baseline, and 2159 participants (with a mean [SD] age of 62.5 [9.3] years and with 1140 men [52.8%]) were followed up 6 years later. The 6-year cumulative incidence of visually significant cataract in either eye was 251.9 per 1000 (95% CI, 228.5-276.8), with an increase with age from 128.9 (95% CI, 107.9-153.2) per 1000 for the group aged 50 to 59 years to 624.5 (95% CI, 493.1-739.9) per 1000 for the group aged 80 years or older. This equated to an annual incidence of visually significant cataract of 45.0 per 1000 people aged 50 years or older. Multivariable analysis showed alcohol consumption (risk ratio [RR], 1.4; 95% CI, 1.1-1.8), diabetes (RR, 1.7; 95% CI, 1.3-2.3), educational level, and increasing age (RR, 3.8; 95% CI, 2.6-5.5 for those aged ≥80 years) were associated with incident visually impairing cataract. Extrapolations to all people aged 50 years or older in Kenya indicated that 148 280 (95% CI, 134 510-162 950) individuals might develop new visually impairing cataract in either eye (visual acuity <6/18 in the worse-seeing eye) and that 9540 (95% CI, 6610-13 750) might become cataract blind in both eyes (visual acuity <3/60 in better-seeing eye). Conclusions and Relevance Adults in Kenya appeared to have a high incidence of visually impairing cataract, making cataract a priority for blindness prevention programs in the region; surgical interventions and awareness of these services are also required.
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Affiliation(s)
- Andrew Bastawrous
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Wanjiku Mathenge
- Rwanda International Institute of Ophthalmology and Dr Agarwal’s Eye Hospital, Kigali, Rwanda
| | - John Nkurikiye
- Rwanda International Institute of Ophthalmology and Dr Agarwal’s Eye Hospital, Kigali, Rwanda
| | - Kevin Wing
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Hillary Rono
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Kitale Eye Unit and Trans Nzoia County, Kitale, Kenya
- Ministry of Health, Nairobi, Kenya
| | - Michael Gichangi
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | - Allen Foster
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Matthew Burton
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Hannah Kuper
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
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5
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Affiliation(s)
- Stuart Keel
- Centre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia
| | - Mingguang He
- Centre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia.,State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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6
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Keel S, McGuiness MB, Foreman J, Taylor HR, Dirani M. The prevalence of visually significant cataract in the Australian National Eye Health Survey. Eye (Lond) 2019; 33:957-964. [PMID: 30755727 DOI: 10.1038/s41433-019-0354-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 10/29/2018] [Accepted: 11/18/2018] [Indexed: 01/31/2023] Open
Abstract
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.
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Affiliation(s)
- Stuart Keel
- Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, Melbourne, VIC, Australia. .,Department of Surgery, Ophthalmology, University of Melbourne, Melbourne, VIC, Australia.
| | - Myra B McGuiness
- Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, Melbourne, VIC, Australia.,Department of Surgery, Ophthalmology, University of Melbourne, Melbourne, VIC, Australia
| | - Joshua Foreman
- Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, Melbourne, VIC, Australia.,Department of Surgery, Ophthalmology, University of Melbourne, Melbourne, VIC, Australia
| | - Hugh R Taylor
- Indigenous Eye Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Mohamed Dirani
- Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, Melbourne, VIC, Australia.,Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
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7
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Pinna A, Solinas G, Giancipoli E, Porcu T, Zinellu A, D'Amico-Ricci G, Boscia F, Lanzetta P, Avitabile T, Schwartz AG, Carru C. Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency and Late-stage Age-Related Macular Degeneration. Int J Med Sci 2019; 16:623-629. [PMID: 31217728 PMCID: PMC6566738 DOI: 10.7150/ijms.30155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 12/07/2018] [Indexed: 11/30/2022] Open
Abstract
Purpose: Age-related macular degeneration (AMD) is the leading cause of blindness in the elderly in Western Countries. Evidence indicates that Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency, a common genetic abnormality, may protect against ischemic heart and cerebrovascular disease, ocular vascular disorders, and colorectal cancer. This study was undertaken to ascertain whether G6PD deficiency may protect against AMD. Materials and Methods: 79 men with late-stage AMD and 79 male, age-matched cataract controls without AMD were recruited in March-December 2016. Smoking status, clinical history, and drug use were recorded. A blood sample was taken from each participant. Complete blood count, hemoglobin, glucose, creatinine, cholesterol, triglycerides, transaminases, bilirubin, and erythrocyte G6PD activity were measured. Stepwise logistic regression was used to investigate the association between G6PD deficiency and AMD. Results: G6PD deficiency was found in 7 (8.9%) AMD patients and 8 (10.1%) controls, a not statistically significant difference. Stepwise logistic regression disclosed that AMD was significantly associated with increased diastolic blood pressure (OR=1.09, 95% CI=1.03-1.15, P=0.02) and LDL-cholesterol (OR=1.02, 95% CI=1.0001-1.03, P=0.049) and lower values of white blood cell (WBC) count (OR=0.71, 95% CI=0.56-0.88, P=0.02) and aspartate aminotransferase (AST) (OR=0.92, 95% CI=0.85-0.99, P=0.044). Conclusion: Results suggest that G6PD deficiency has no protective effect on nor is a risk factor for AMD. Larger studies are necessary to confirm whether increased diastolic blood pressure and LDL-cholesterol and lower values of WBC count and AST are risk factors for AMD.
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Affiliation(s)
- Antonio Pinna
- Department of Medical, Surgical, and Experimental Sciences, University of Sassari, Sassari, Italy.,Azienda Ospedaliero-Universitaria di Sassari, Sassari, Italy
| | - Giuliana Solinas
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Ermete Giancipoli
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Tiziana Porcu
- Department of Medical, Surgical, and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Angelo Zinellu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | | | - Francesco Boscia
- Department of Medical, Surgical, and Experimental Sciences, University of Sassari, Sassari, Italy.,Azienda Ospedaliero-Universitaria di Sassari, Sassari, Italy
| | - Paolo Lanzetta
- Department of Medicine - Ophthalmology, University of Udine, Udine, Italy
| | | | - Arthur G Schwartz
- Fels Institute for Cancer Research and Molecular Biology, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Ciriaco Carru
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy.,Azienda Ospedaliero-Universitaria di Sassari, Sassari, Italy
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8
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Six-Year Incidence of and Risk Factors for Cataract Surgery in a Multi-ethnic Asian Population: The Singapore Epidemiology of Eye Diseases Study. Ophthalmology 2018; 125:1844-1853. [PMID: 30077615 DOI: 10.1016/j.ophtha.2018.07.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 07/25/2018] [Accepted: 07/27/2018] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To report the 6-year incidence of cataract surgery in an Asian population-based cohort of Malay, Indian, and Chinese persons living in Singapore and factors associated with undergoing cataract surgery over the follow-up period. DESIGN Population-based prospective cohort study. PARTICIPANTS From 2004 through 2011, 10 033 participants (3280 Malays, 3400 Indians, and 3353 Chinese) 40 years of age or older participated in the Singapore Epidemiology of Eye Diseases Study. Six years later, 6762 participants (78.7% of those eligible, including 1901 Malays [72.1% of eligible], 2200 Indians [75.5% of eligible], and 2661 Chinese [87.7% of eligible]) were re-examined. METHODS Detailed eye examinations including slit-lamp biomicroscopy were conducted at both visits. Logistic regression models were used to assess factors associated with cataract surgery after adjusting for age, gender, socioeconomic status, and other risk factors. MAIN OUTCOME MEASURE Incident cataract surgery. RESULTS The age-adjusted 6-year incidence of cataract surgery was 11.0% (9.5%, 12.6%, and 11.1% for Malays, Indians, and Chinese, respectively) and was strongly age related (P < 0.001 for trend). After adjustment, baseline factors associated with incident cataract surgery included older age (odds ratio [OR], 1.13 per 1-year increase; 95% confidence interval [CI], 1.11-1.14), diabetes (OR, 1.90; 95% CI, 1.54-2.33), myopia (OR, 1.78; 95% CI, 1.44-2.20), and baseline presence of any cataract, including nuclear cataract (OR, 3.78; 95% CI, 2.91-4.89), cortical cataract (OR, 3.01; 95% CI, 2.45-3.71), and posterior subcapsular cataract (OR, 5.00; 95% CI, 3.91-6.41). The population attributable risks of cataract surgery related to diabetes and myopia were 17.6% and 19.1%, respectively. CONCLUSIONS One in 10 Malay, Indian, and Chinese Singaporeans 40 years of age or older underwent cataract surgery in at least 1 eye over 6 years. In Asian populations, diabetes and myopia, 2 well-known factors associated with cataract prevalence, are significant and potentially modifiable factors associated with the need for cataract surgery.
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9
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Galvani S, Livingston W, Morgan H. The relationship between sight loss and substance use: Users’ perspectives. DRUGS: EDUCATION, PREVENTION AND POLICY 2016. [DOI: 10.3109/09687637.2016.1161009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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10
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Panday M, George R, Asokan R, Ve Ramesh S, Velumuri L, Choudhari NS, Boddupalli SD, Sunil GT, Vijaya L. Six-year incidence of visually significant age-related cataract: the Chennai eye disease incidence study. Clin Exp Ophthalmol 2015; 44:114-20. [PMID: 26290386 DOI: 10.1111/ceo.12636] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 07/30/2015] [Accepted: 08/11/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of this study is to report the 6-year incidence of age-related cataract in a population-based study. DESIGN The design used is a population-based cohort study. PARTICIPANTS A cohort of 2484 phakic subjects, aged 40 years and above at baseline, from a south Indian population was included in the study. METHODS Bilateral phakics with visual acuity of 6/12 or better and cataract less than N2, C2 and P2 on the Lens Opacities Classification System II at baseline were included. Subjects with glaucoma and corneal or retinal diseases were excluded. Incident visually significant cataract was defined as visual acuity of less than 6/18 with a corresponding one grade or greater change in Lens Opacities Classification System II or history of having undergone cataract surgery with evidence of pseudophakia or aphakia at the 6-year follow-up. MAIN OUTCOME MEASURES Six-year incidence of visually significant cataract and associated risk factors data were collected. RESULTS Incident visually significant cataract at 6 years was seen in 158 subjects (6.36%, 95% CI: 5.40-7.32, phakics:pseudophakics/aphakics 70:88). Incidence was higher in the rural cohort as compared with the urban cohort (P < 0.001). Incidence increased with age and was highest in the ≥70 years age group (odds ratio (OR):31.23, 95% CI: 15.20-64.16, P < 0.001). Other associated risk factors included illiteracy (OR 1.75, 95% CI: 1.17-2.61, P = 0.007) and smoking (OR 1.77, 95% CI: 1.08-2.88, P = 0.02). CONCLUSIONS A significant proportion of the population developed visually significant age-related cataract at 6 years. Incident visually significant cataract was significantly greater for the rural cohort between 50 and 69 years old.
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Affiliation(s)
- Manish Panday
- Glaucoma Project, Medical and Vision Research Foundation, Sankara Nethralaya, Chennai, India
| | - Ronnie George
- Glaucoma Project, Medical and Vision Research Foundation, Sankara Nethralaya, Chennai, India
| | - Rashima Asokan
- Glaucoma Project, Medical and Vision Research Foundation, Sankara Nethralaya, Chennai, India.,Elite School of Optometry, Chennai, India
| | - Satyamangalam Ve Ramesh
- Glaucoma Project, Medical and Vision Research Foundation, Sankara Nethralaya, Chennai, India.,Elite School of Optometry, Chennai, India
| | - Lokapavani Velumuri
- Glaucoma Project, Medical and Vision Research Foundation, Sankara Nethralaya, Chennai, India.,Elite School of Optometry, Chennai, India
| | - Nikhil S Choudhari
- Glaucoma Project, Medical and Vision Research Foundation, Sankara Nethralaya, Chennai, India
| | - Sachi Devi Boddupalli
- Glaucoma Project, Medical and Vision Research Foundation, Sankara Nethralaya, Chennai, India
| | - Govindan T Sunil
- Glaucoma Project, Medical and Vision Research Foundation, Sankara Nethralaya, Chennai, India
| | - Lingam Vijaya
- Glaucoma Project, Medical and Vision Research Foundation, Sankara Nethralaya, Chennai, India
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11
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Rao P, Millen AE, Meyers KJ, Liu Z, Voland R, Sondel S, Tinker L, Wallace RB, Blodi BA, Binkley N, Sarto G, Robinson J, LeBlanc E, Mares JA. The Relationship Between Serum 25-Hydroxyvitamin D Levels and Nuclear Cataract in the Carotenoid Age-Related Eye Study (CAREDS), an Ancillary Study of the Women's Health Initiative. Invest Ophthalmol Vis Sci 2015; 56:4221-30. [PMID: 26132781 DOI: 10.1167/iovs.15-16835] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
PURPOSE To investigate the relationship between serum 25-hydroxyvitamin D (25[OH]D) levels and nuclear cataract among participants of the Carotenoids in Age-Related Eye Disease Study (CAREDS), an ancillary study of the Women's Health Initiative (WHI) Observational Study (OS). METHODS Nuclear cataract was assessed from slit lamp photographs (2001-2004) taken 6 years after collecting serum analyzed for 25(OH)D levels at WHI baseline (1994-1998) in 1278 CAREDS participants age 50 to 79 years. Multivariate (age, iris color, smoking, pulse pressure) odds ratios (ORs) for nuclear cataract (nuclear opacities > level 4 or cataract extraction) by quintiles of serum 25(OH)D were estimated using logistic regression. RESULTS No significant association was observed between serum 25(OH)D and nuclear cataract among women of all ages (age-adjusted OR [95% confidence interval (CI)] 0.97 [0.65-1.45]). However, there was a significant age interaction (P for interaction = 0.04). There were no significant associations in the women 70 years or older. In women younger than 70 years, we observed an inverse association between serum 25(OH)D and nuclear cataract (multivariate adjusted ORs [95% CI] 0.54 [0.29-0.99] and 0.66 [0.36-1.20] for quintiles 4 and 5 vs. 1, respectively; P = 0.03). Further adjustment for 25(OH)D determinants (body mass index, vitamin D intake, and UVB exposure) attenuated this association. CONCLUSIONS Serum 25(OH)D levels were unrelated to nuclear opacities in this study sample. However, exploratory analyses suggest a protective association in women younger than 70 years. Further investigations of the relationship between vitamin D and nuclear lens opacities are warranted.
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Affiliation(s)
- Prethy Rao
- Department of Ophthalmology and Visual Sciences University of Wisconsin, Madison, Wisconsin, United States
| | - Amy E Millen
- Department of Social and Preventive Medicine, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, New York, United States
| | - Kristin J Meyers
- Department of Ophthalmology and Visual Sciences University of Wisconsin, Madison, Wisconsin, United States
| | - Zhe Liu
- Department of Ophthalmology and Visual Sciences University of Wisconsin, Madison, Wisconsin, United States
| | - Rickie Voland
- Department of Ophthalmology and Visual Sciences University of Wisconsin, Madison, Wisconsin, United States
| | - Sheri Sondel
- Department of Ophthalmology and Visual Sciences University of Wisconsin, Madison, Wisconsin, United States
| | - Lesley Tinker
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States
| | - Robert B Wallace
- Department of Epidemiology, University of Iowa, Iowa City, Iowa, United States
| | - Barbara A Blodi
- Department of Ophthalmology and Visual Sciences University of Wisconsin, Madison, Wisconsin, United States
| | - Neil Binkley
- Department of Medicine, University of Wisconsin, Madison, Wisconsin, United States
| | - Gloria Sarto
- Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wisconsin, United States
| | - Jennifer Robinson
- Department of Epidemiology, University of Iowa, Iowa City, Iowa, United States
| | - Erin LeBlanc
- Kaiser Permanente Center for Health Research, Portland, Oregon, United States
| | - Julie A Mares
- Department of Ophthalmology and Visual Sciences University of Wisconsin, Madison, Wisconsin, United States
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Tang Y, Ji Y, Ye X, Wang X, Cai L, Xu J, Lu Y. The Association of Outdoor Activity and Age-Related Cataract in a Rural Population of Taizhou Eye Study: Phase 1 Report. PLoS One 2015; 10:e0135870. [PMID: 26284359 PMCID: PMC4540437 DOI: 10.1371/journal.pone.0135870] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 07/27/2015] [Indexed: 01/15/2023] Open
Abstract
Purpose To study the relationship between outdoor activity and risk of age-related cataract (ARC) in a rural population of Taizhou Eye Study (phrase 1 report). Method A population-based, cross-sectional study of 2006 eligible rural adults (≥45 years old) from Taizhou Eye Study was conducted from Jul. to Sep. 2012. Participants underwent detailed ophthalmologic examinations including uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), intraocular pressure (IOP), slit lamp and fundus examinations as well as questionnaires about previous outdoor activity and sunlight protection methods. ARC was recorded by LOCSⅢ classification system. The prevalence of cortical, nuclear and posterior subcapsular cataract were assessed separately for the risk factors and its association with outdoor activity. Results Of all 2006 eligible participants, 883 (44.0%) adults were diagnosed with ARC. The prevalence rates of cortical, nuclear and posterior subcapsular cataract per person were 41.4%, 30.4% and 1.5%, respectively. Women had a higher tendency of nuclear and cortical cataract than men (OR = 1.559, 95% CI 1.204–2.019 and OR = 1.862, 95% CI 1.456–2.380, respectively). Adults with high myopia had a higher prevalence of nuclear cataract than adults without that (OR = 2.528, 95% CI 1.055–6.062). Multivariable logistic regression revealed that age was risk factor of nuclear (OR = 1.190, 95% CI 1.167–1.213) and cortical (OR = 1.203, 95% CI 1.181–1.226) cataract; eyes with fundus diseases was risk factor of posterior subcapsular cataract (OR = 6.529, 95% CI 2.512–16.970). Outdoor activity was an independent risk factor of cortical cataract (OR = 1.043, 95% CI 1.004–1.083). The risk of cortical cataract increased 4.3% (95% CI 0.4%-8.3%) when outdoor activity time increased every one hour. Furthermore, the risk of cortical cataract increased 1.1% (95% CI 0.1%-2.0%) when cumulative UV-B exposure time increased every one year. Conclusion Outdoor activity was an independent risk factor for cortical cataract, but was not risk factor for nuclear and posterior subcapsular cataract. The risk of cortical cataract increased 4.3% when outdoor activity time increased every one hour. In addition, the risk of cortical cataract increased 1.1% (95% CI 0.1%-2.0%) when cumulative UV-B exposure time increased every one year.
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Affiliation(s)
- Yating Tang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Xuhui District, Shanghai, China
- Myopia Key Laboratory of the Health Ministry & Visual Impairment and Reconstruction Key Laboratory of Shanghai, Shanghai, China
| | - Yinghong Ji
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Xuhui District, Shanghai, China
- Myopia Key Laboratory of the Health Ministry & Visual Impairment and Reconstruction Key Laboratory of Shanghai, Shanghai, China
| | - Xiaofang Ye
- Fudan University and Shanghai Key Laboratory of Meteorology and Health, Pudong Meteorological Service, Shanghai, China
| | - Xiaofeng Wang
- State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, Collaborative Innovation Center for Genetics and Development, School of Life Sciences and Institutes of Biomedical Sciences, Fudan University, Shanghai, China
- Fudan-Taizhou Institute of Health Sciences, 1 Yaocheng Road, Taizhou, Jiangsu Province, China
| | - Lei Cai
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Xuhui District, Shanghai, China
- Myopia Key Laboratory of the Health Ministry & Visual Impairment and Reconstruction Key Laboratory of Shanghai, Shanghai, China
| | - Jianming Xu
- Shanghai Key Laboratory of Meteorology and Health, Pudong Meteorological Service, Shanghai, China
| | - Yi Lu
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Xuhui District, Shanghai, China
- Myopia Key Laboratory of the Health Ministry & Visual Impairment and Reconstruction Key Laboratory of Shanghai, Shanghai, China
- * E-mail:
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Wang W, Zhang X. Alcohol intake and the risk of age-related cataracts: a meta-analysis of prospective cohort studies. PLoS One 2014; 9:e107820. [PMID: 25238065 PMCID: PMC4169623 DOI: 10.1371/journal.pone.0107820] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 08/14/2014] [Indexed: 11/24/2022] Open
Abstract
Purpose Epidemiologic studies assessing the relationship between alcohol consumption and the risk of age-related cataracts (ARCs) led to inconsistent results. This meta-analysis was performed to fill this gap. Methods Eligible studies were identified via computer searches and reviewing the reference lists of these obtained articles. Pooled estimates of the relative risks (RR) and the corresponding 95% confidence Intervals (CI) were calculated using random effects models. Results Seven prospective cohort studies involving a total of 119,706 participants were ultimately included in this meta-analysis. Pooled results showed that there is no substantial overall increased risk of ARC due to heavy alcohol consumption. The estimated RRs comparing heavy drinkers versus non-drinkers were 1.25 (95% CI: 1.00, 1.56) for cataract sugery, 1.06 (95% CI: 0.63, 1.81) for cortical cataracts, 1.26 (95% CI: 0.93, 1.73) for nuclear cataracts, and 0.91 (95% CI: 0.32, 2.61) for posterior subcapsular cataracts (PSCs), respectively. No significant associations between moderate alcohol consumption and cataracts were observed. The pooled RRs comparing moderate drinkers versus non-drinkers were 0.90 (95% CI: 0.64, 1.26) for cataract surgery, 0.97 (95% CI: 0.75, 1.25) for cortical cataracts, 0.91 (95% CI: 0.76, 1.08) for nuclear cataracts, and 0.97 (95% CI: 0.49, 1.91) for PSCs, respectively. Conclusions This meta-analysis suggests that there is no substantial overall increased risk of ARC due to alcohol intake. Because of the limited number of studies, the findings from our study must be confirmed in future research via well-designed cohort or intervention studies.
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Affiliation(s)
- Wei Wang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Xiulan Zhang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, People's Republic of China
- * E-mail:
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Richter GM, Torres M, Choudhury F, Azen SP, Varma R. Risk factors for cortical, nuclear, posterior subcapsular, and mixed lens opacities: the Los Angeles Latino Eye Study. Ophthalmology 2011; 119:547-54. [PMID: 22197433 DOI: 10.1016/j.ophtha.2011.09.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 08/22/2011] [Accepted: 09/02/2011] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To identify sociodemographic and biological risk factors associated with having cortical, nuclear, posterior subcapsular (PSC), and mixed lens opacities. DESIGN Population-based, cross-sectional study. PARTICIPANTS A total of 5945 Latinos aged ≥ 40 years from 6 census tracts in Los Angeles, California. METHODS Participants underwent an interview and detailed eye examination, including best-corrected visual acuity and slit-lamp assessment of lens opacities using the Lens Opacities Classification System II. Univariate and stepwise logistic regression analyses were used to identify independent risk factors associated with each type of lens opacity. MAIN OUTCOME MEASURES Odds ratios for sociodemographic and biological risk factors associated with cortical only, nuclear only, PSC only, and mixed lens opacities. RESULTS Of the 5945 participants with gradable lenses, 468 had cortical only lens opacities, 217 had nuclear only lens opacities, 27 had PSC only opacities, and 364 had mixed lens opacities. Older age, higher hemoglobin A(1c), and history of diabetes mellitus were independent risk factors for cortical only lens opacities. Older age, smoking, and myopic refractive error were independent risk factors for nuclear only lens opacities. Higher systolic blood pressure and history of diabetes were independent risk factors for PSC lens opacities. Older age, myopic refractive error, history of diabetes, higher systolic blood pressure, female gender, and presence of large drusen were independent risk factors for mixed lens opacities. CONCLUSIONS The modifiable and non-modifiable risk factors identified in this study provide insight into the mechanisms related to the development of lens opacification. Improved glycemic control, smoking cessation and prevention, and blood pressure control may help to reduce the risk of having lens opacities and their associated vision loss.
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Affiliation(s)
- Grace M Richter
- Doheny Eye Institute and Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA
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Zhang JS, Xu L, Wang YX, You QS, Wang JD, Jonas JB. Five-year incidence of age-related cataract and cataract surgery in the adult population of greater Beijing: the Beijing Eye Study. Ophthalmology 2010; 118:711-8. [PMID: 21146222 DOI: 10.1016/j.ophtha.2010.08.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Revised: 07/28/2010] [Accepted: 08/11/2010] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To estimate the 5-year incidence of cataract and cataract surgery in an adult Chinese population. DESIGN Population-based study. PARTICIPANTS The Beijing Eye Study 2006 included 3251 (73.2%) subjects (≥45 years) of 4439 subjects who participated in the 2001 survey and returned for re-examination. METHODS Nuclear, cortical, and posterior subcapsular lens opacities were assessed based on standardized slit-lamp-based photographs and retroilluminated photographs of the lens using a modification of the grading score of the Age-Related Eye Disease Study. MAIN OUTCOME MEASURES Incidence of any type of cataract and of cataract surgery. RESULTS The 5-year incidence of nuclear cataract was 5.98% (95% confidence intervals [CI], 5.96%-6.00%), that of cortical cataract was 11.14% (95% CI, 11.12%-11.17%), that of posterior subcapsular cataract was 5.47% (95% CI, 5.45%-5.48%), and that of cataract surgery was 2.01% (95% CI, 2.00%-2.02%). The incidence of any cataract (16.82%; 95% CI, 16.79%-16.86%) was significantly associated with higher age (P<0.001) and female gender (P<0.001). It was not significantly associated with the area of habitation (P = 0.78), smoking (P = 0.95), or alcohol consumption (P = 0.12). Differentiation into the 3 cataract types revealed that the incidence of nuclear cataract additionally was associated with rural region (P<0.001) and smoking (P<0.001). The incidence of cortical cataract additionally was associated with nonsmoking (P = 0.02). The incidence of cataract surgery was significantly (P<0.001) associated with age only. CONCLUSIONS As in white persons, the age-adjusted incidence of all types of cataract types increased with age and it was associated with female gender. When compared with data in the literature, the incidence rates of all cataract types did not vary markedly between Chinese in greater Beijing and white persons. In contrast, the incidence of cataract surgery was considerably lower in this Chinese population.
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Affiliation(s)
- Jing Shang Zhang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Mares JA, Voland R, Adler R, Tinker L, Millen AE, Moeller SM, Blodi B, Gehrs KM, Wallace RB, Chappell RJ, Neuhouser ML, Sarto GE. Healthy diets and the subsequent prevalence of nuclear cataract in women. ACTA ACUST UNITED AC 2010; 128:738-49. [PMID: 20547952 DOI: 10.1001/archophthalmol.2010.84] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To assess the association between healthy diet scores and prevalence of nuclear cataract in women. METHODS The association between healthy diet scores, which reflect adherence to the US dietary guidelines, and prevalence of nuclear cataract determined 4 to 7 years later was assessed in a sample of Women's Health Initiative Observational Study participants (aged 50-79 years) residing in Iowa, Wisconsin, and Oregon. Scores on the 1995 Healthy Eating Index, which reflect adherence to 1990 guidelines, were assigned from responses to food frequency questionnaires at the Women's Health Initiative baseline (1994-1998). Presence of nuclear cataract was determined from slitlamp photographs and self-reports of cataract extractions were assessed from May 1, 2001, to January 31, 2004, in 1808 women participating in the Carotenoids in Age-Related Eye Disease Study. RESULTS Having a high 1995 Healthy Eating Index score was the strongest modifiable predictor of low prevalence of nuclear cataract among numerous risk factors investigated in this sample. The multivariate-adjusted odds ratio for high vs low quintile for diet score was 0.63 (95% confidence interval, 0.43-0.91). Higher prevalence of nuclear cataract was also associated with other modifiable factors (smoking and marked obesity) and nonmodifiable factors (having brown eyes, myopia, and high pulse pressure). Vitamin supplement use was not related to cataract. CONCLUSION These data add to the body of evidence suggesting that eating foods rich in a variety of vitamins and minerals may contribute to postponing the occurrence of the most common type of cataract in the United States.
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Affiliation(s)
- Julie A Mares
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, WI 53726-2336, USA.
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Pinna A, Pes A, Zinellu A, Carta A, Solinas G. Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency and senile cataract in a Sardinian male population, Italy. Ophthalmic Epidemiol 2009; 16:395-9. [DOI: 10.3109/09286580903312293] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Tan JSL, Wang JJ, Younan C, Cumming RG, Rochtchina E, Mitchell P. Smoking and the Long-Term Incidence of Cataract: The Blue Mountains Eye Study. Ophthalmic Epidemiol 2009; 15:155-61. [DOI: 10.1080/09286580701840362] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kanthan GL, Wang JJ, Rochtchina E, Tan AG, Lee A, Chia EM, Mitchell P. Ten-year incidence of age-related cataract and cataract surgery in an older Australian population. The Blue Mountains Eye Study. Ophthalmology 2007; 115:808-814.e1. [PMID: 17900695 DOI: 10.1016/j.ophtha.2007.07.008] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2006] [Revised: 07/03/2007] [Accepted: 07/05/2007] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To estimate the 10-year incidence of cataract and cataract surgery in an older Australian population. DESIGN Prospective population-based study. PARTICIPANTS Persons at least 49 years old living in 2 postcode areas west of Sydney, Australia. METHODS Eye examinations were performed at baseline and at 5- and 10-year follow-up visits. Lens photographs were taken and graded by masked graders using the Wisconsin Cataract Grading System. MAIN OUTCOME MEASURES Incidences of nuclear cataract, cortical cataract, posterior subcapsular cataract (PSC), and cataract surgery. RESULTS Ten-year person-specific incidences were 36.0% for nuclear cataract, 28.0% for cortical cataract, 9.1% for PSC, and 17.8% for cataract surgery. Corresponding rates were 31.7%, 24.4%, 8.2%, and 14.4%, respectively, in men and 39.3%, 30.8%, 9.8%, and 20.1%, respectively, in women. The incidence for each type of cataract and cataract surgery was positively associated with age (P<0.0001). Women had a significantly higher incidence than men for nuclear cataract (P = 0.04), cortical cataract (P = 0.007), any cataract (P = 0.0006), and cataract surgery (P = 0.03) after adjusting for age. There was no significant gender difference for PSC. The mean age at cataract surgery was 75.8 years, and there was no significant gender difference (P = 0.9). Among persons who developed any cataract, 22% had more than one type and 1.3% had all 3 types present. Nuclear cataract and PSC were significantly associated with visual impairment (visual acuity worse than 20/40). CONCLUSION Age- and gender-specific cataract incidences in this study were similar to those reported from the U.S. Beaver Dam Eye Study. In this study, 72% of the participants were affected by cataract or had had cataract surgery over the 10-year follow-up period.
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Affiliation(s)
- Gowri L Kanthan
- University of Sydney Department of Ophthalmology, Center for Vision Research, Westmead Millennium Institute, Westmead Hospital, Sydney, Australia
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Shinohara T, White H, Mulhern ML, Maisel H. Cataract: Window for systemic disorders. Med Hypotheses 2007; 69:669-77. [PMID: 17337126 DOI: 10.1016/j.mehy.2006.11.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2006] [Accepted: 11/09/2006] [Indexed: 12/22/2022]
Abstract
Cataract is the leading cause of visual handicap throughout the world, and almost all elderly individuals develop lens opacities. Epidemiological studies have shown that nuclear cataracts in young adults are associated with higher mortality. Many cataractogenic stressors induce endoplasmic reticulum (ER) stress, which in turn induces the unfolded protein response (UPR). The UPR can damage or kill a wide range of cell types and may be involved in many human diseases. We hypothesize that a cataract can be considered a window that can indicate the presence of systemic disorders. This is important because cataract is easily detected during a routine ocular examination. The slightest opacity in any region of the lenses, especially in younger patients, may be a sign of systemic disorders. Earlier detection of systemic disorders can save the lives of patients. If our hypothesis is correct, then elimination of known ER/cataractogenic stressors from individuals with cataracts should be the one of the first steps for treatments of the systemic disorders. We discuss the potential risk factors and beneficial effects of removal of such risk factors in patients with early cataracts. All patients with cataract should be referred for comprehensive medical examination.
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Affiliation(s)
- Toshimichi Shinohara
- Department of Ophthalmology, University of Nebraska Medical Center, 985840 Nebraska Medical Center, Omaha, NE 68198-5840, United States.
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Xu L, Cui T, Zhang S, Sun B, Zheng Y, Hu A, Li J, Ma K, Jonas JB. Prevalence and risk factors of lens opacities in urban and rural Chinese in Beijing. Ophthalmology 2006; 113:747-55. [PMID: 16650668 DOI: 10.1016/j.ophtha.2006.01.026] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2005] [Revised: 01/04/2006] [Accepted: 01/06/2006] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To determine the prevalence of lens opacities in the elderly Chinese population in an urban and a rural region of Beijing. DESIGN Population-based cross-sectional study. PARTICIPANTS The study included 4439 subjects of 5324 subjects invited to participate (response rate, 83.4%). The subjects were divided into a rural part (1973 subjects [44.4%]) and an urban part (2466 subjects [55.6%]). The study was limited to participants age 40 and older, and the mean age was 56.2+/-10.6 years (range, 40-101 years). METHODS Nuclear, cortical, and posterior subcapsular lens opacities were assessed based on standardized slit-lamp photographs of the lens using a modification of the grading score of the Age-related Eye Disease Study (AREDS). MAIN OUTCOME MEASURES Grading score of the AREDS. RESULTS Lens data were provided for 4378 subjects (98.6%) of 4439 persons examined, which consisted of 8724 eyes. Prevalence of any cataract surgery was 1.3% (95% confidence interval [CI]: 1.0-1.7), which was statistically independent of gender (P = 0.51; odds ratio [OR]: 0.86; 95% CI: 1.00-1.34), rural area versus urban region (P = 0.25), and level of education (P = 0.84). Prevalence of any nuclear lens opacity was 82.0% (95% CI: 80.8-83.2); prevalence of any cortical lens opacity was 10.3% (95% CI: 9.4-11.3); and prevalence of any posterior subcapsular opacity was 4.3% (95% CI: 3.7-4.9). If grade 2 of nuclear lens opacity was considered to be normal, prevalence of nuclear cataract was 50.3% (95% CI: 48.8-51.8), and the overall prevalence of any cataract was 53.1% (95% CI: 51.6-54.6), increasing from 6.5% (95% CI: 5.2-7.8) in those subjects 40 to 49 years of age to 52.3% (95% CI: 47.4-55.3) in those who were 50 to 59 years of age, and to 97.8% (95% CI: 96.4-99.2) in those 70 years and older (P<0.001). Frequencies of any cortical cataract and any subcapsular posterior cataract were 10.3% (95% CI: 9.4-11.3) and 4.3% (95% CI: 3.7-4.9), respectively. CONCLUSIONS Cataracts are common among adult Chinese residents in Beijing, with age as the most important associated factor. In view of the relatively low rate of cataract surgery performed so far, one may expect a marked increase in the number of cataract surgeries to meet the visual needs of the growing elderly population in China.
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Affiliation(s)
- Liang Xu
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital and Capital University of Medical Science, Beijing, China
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Kelly SP, Thornton J, Edwards R, Sahu A, Harrison R. Smoking and cataract: review of causal association. J Cataract Refract Surg 2006; 31:2395-404. [PMID: 16473237 DOI: 10.1016/j.jcrs.2005.06.039] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2005] [Accepted: 03/02/2005] [Indexed: 11/24/2022]
Abstract
Several risk factors for the development of cataract have been identified. This review evaluates epidemiologic literature that has examined tobacco smoking as a risk factor for cataract formation using established causality criteria. Twenty-seven studies were included in this review. Evidence suggests that smoking has a 3-fold increase on the risk for incident nuclear cataract development. There was also evidence of dose response, temporal relationship, and reversibility of effect. There was limited evidence of an association between smoking and posterior subcapsular cataract, but little or no association with cortical cataract. Thus, the literature review indicated a strong association between smoking and the development of cataract, particularly nuclear cataract. The association fulfills the established criteria for causality. The association between smoking and other types of cataract is less distinct and requires further evaluation.
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Affiliation(s)
- Simon P Kelly
- Eye Unit, Bolton Hospitals NHS Trust, Bolton, United Kingdom.
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Durant JS, Frost NA, Trivella M, Sparrow JM. Risk factors for cataract subtypes waterclefts and retrodots: two case–control studies. Eye (Lond) 2005; 20:1254-67. [PMID: 16227982 DOI: 10.1038/sj.eye.6702087] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
UNLABELLED Waterclefts and retrodots are independently associated with visual impairment, yet a review identified no data on risk factors. PURPOSE To investigate risk factors for these two human lens cataract subtypes. METHOD Two nested case-control studies: The host study comprised 1078 subjects (55 years) attending the Somerset and Avon Eye Study (SAES). In total, 197 watercleft cases (Oxford grade 0.2 in either eye) and 199 retrodot cases (Oxford grade 1.0 in either eye) were individually age/gender matched to controls. Detailed ophthalmic and potential risk factor data were collected, including body mass index (BMI), smoking, alcohol, diabetes, hypertension, analgesics, vitamin supplementation, nutrition, sunlight exposure, dehydration, hormonal (women), blood lipids, glucose, urea, creatinine, uric acid, and vitamin levels. RESULTS For waterclefts, univariable analysis identified BMI, alcohol intake, vitamin status, sunlight, urea, creatinine, and uric acid as possible risk factors. Multivariable analysis identified two independent associations. Total number of 'any' analgesics in the previous year: adjusted P<0.01 (U-shaped risk profile, unadjusted high vs medium use (=reference) OR 2.39, 95% CI 1.35-4.26 with medium use vs none (=reference) OR 0.43, 95% CI 0.26-0.72); total sunlight: adjusted P=0.03 (unadjusted highest exposure vs lowest (=reference) OR 3.25, 95% CI 1.11-9.50). For retrodots, univariable analysis identified alcohol, HRT, and lipids. Multivariable analysis identified two independent associations. Mean number of alcohol units consumed per month, adjusted P=0.02 and HDL cholesterol levels, adjusted P=0.02 (unadjusted ORs NS both). CONCLUSION This is the first available published information on risk factors for the human cataractous lens features waterclefts and retrodots.
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Dorey CK, Granata L, Nichols CR, Cheng KM, Craft NE. Dietary modulation of lens zeaxanthin in quail. Exp Eye Res 2005; 81:464-77. [PMID: 15913607 DOI: 10.1016/j.exer.2005.03.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2004] [Revised: 03/10/2005] [Accepted: 03/18/2005] [Indexed: 11/16/2022]
Abstract
Although higher dietary intake of lutein/zeaxanthin has been associated with reduced risk for cataracts, the impact of dietary supplements on lens lutein (L) or zeaxanthin (Z) has not been examined. If higher lens carotenoids do reduce risk for cataract, it would be essential to know whether dietary carotenoids can elevate carotenoids in the adult vertebrate lens. In this study, a covey of Japanese quail were hatched and raised 6 months on carotenoid-deficient diet, then switched to deficient diet supplemented with low or high 3R,3R'-zeaxanthin (5 or 35 mgkg(-1) food) or beta-carotene (50 mgkg(-1) food). Controls included a group of covey-mates that remained on the deficient diet and another raised from birth on the high Z (35 mg Zkg(-1)) diet. At 1 year of age, carotenoids and tocopherols in the lens and in the serum were analysed by HPLC, and compared by analysis of variance. Serum Z was significantly elevated in deficient birds fed the lower or higher Z supplement for 6 months (P<0.0001 for each). Serum Z in birds maintained on the higher Z supplement for 1 year was much higher than that in deficient birds (P<0.0001), but not different from deficient birds given the higher Z supplement. As in humans, the predominant lens carotenoids were lutein (L) and zeaxanthin (Z), and the total carotenoid concentration was of lower magnitude than the concentration of alpha-tocopherol. Responses to Z supplementation were sex-related. Female quail had 5-10 times higher serum concentrations of both Z and L than males (P<0.0001, <0.001), and they also had higher lens Z concentrations than males (P<0.0006); possible effects of estrogen on lens carotenoids are discussed. Lens Z concentration was strongly and positively correlated with serum Z in females (r=0.77; P<0.002). Deficient adult females supplemented with the 35 mgkg(-1) dose of Z for 6 months had a mean lens Z concentration (0.252+/-0.06 microgg(-1) protein) close to that in females fed with the supplement from birth (0.282+/-0.15 microgg(-1) protein). Birds fed with the higher dietary Z supplement for 6 or 12 months had significantly higher lens Z than birds fed lower or no dietary Z (P<0.0001). Lens L was not altered by dietary supplementation with either Z or beta-carotene. beta-Carotene supplements did not result in detectable lens beta-carotene, and had no effect on lens Z. Neither Z nor beta-carotene supplementation had a significant effect on serum or lens tocopherol concentrations. These studies in quail provide the first experimental evidence that lens carotenoids in adult vertebrates can be manipulated by dietary Z supplements.
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Lewis A, Congdon N, Munoz B, Bowie H, Lai H, Chen P, West SK. Cataract surgery and subtype in a defined, older population: the SEECAT Project. Br J Ophthalmol 2004; 88:1512-7. [PMID: 15548802 PMCID: PMC1772435 DOI: 10.1136/bjo.2004.045484] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2004] [Indexed: 11/04/2022]
Abstract
AIM To describe the distribution of cataract subtypes present before surgery among a defined population of older, bilaterally pseudophakic individuals. METHODS This was a cohort study of bilaterally pseudophakic individuals participating in the Salisbury Eye Evaluation (SEE), and their locally resident siblings. Subjects underwent slit lamp and retroillumination photography and grading using the Wilmer Cataract Grading System. For all individuals determined to be bilaterally pseudophakic, an attempt was made to determine for each eye the type(s) of cataract present before surgery, based on previous SEE photographs (for SEE participants) and/or medical records obtained from the operating ophthalmologist (for both SEE participants and their siblings). RESULTS The mean age of 223 participants providing data in this study was 78.7 (SD 5.2) years, 19.3% of subjects were black and 60.1% female. The most common surgically removed cataract subtype in this population was pure nuclear (43.5%), followed by nuclear combined with posterior subcapsular cataract (PSC) (20.6%), and nuclear combined with cortical (13.9%); less common types were pure cortical (4.9%), pure PSC (4.5%), and PSC combined with cortical (2.7%). Factors such as sex and source of lens data (study photograph versus clinical record) did not significantly affect the distribution of lens opacity types, while PSC was significantly (p = 0.01) more common among younger people and nuclear cataract was significantly (p = 0.001) more common among white compared to black people. CONCLUSION Epidemiological studies have suggested that the different subtypes of cataract are associated with different risk factors. As studies begin to identify new prevention strategies for cataract, it would appear likely that different strategies will be efficacious against different types of cataract. In this setting, it will be helpful to know which cataract types are most frequently associated with surgery. Among this older, majority white population, nuclear cataract showed a clear predominance among individuals having undergone surgery in both eyes. This may be contrasted with both clinic and population based studies of younger people, which have generally found PSC cataract to predominate.
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Affiliation(s)
- A Lewis
- Dana Center for Preventive Ophthalmology, Johns Hopkins University Schools of Medicine and Public Health, Wilmer 120, 600 N Wolfe Street, Baltimore, MD 21287, USA
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Foster PJ, Wong TY, Machin D, Johnson GJ, Seah SKL. Risk factors for nuclear, cortical and posterior subcapsular cataracts in the Chinese population of Singapore: the Tanjong Pagar Survey. Br J Ophthalmol 2003; 87:1112-20. [PMID: 12928278 PMCID: PMC1771847 DOI: 10.1136/bjo.87.9.1112] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AIM To describe risk factors for nuclear, cortical, and posterior subcapsular (PSC) cataracts in Chinese Singaporeans. METHODS A population based cross sectional study was carried out on ethnic Chinese men and women aged 40-81 years. A stratified, clustered, disproportionate (more weights to older people), random sampling procedure was used to initially select 2000 Chinese names of those aged 40-79 years from the 1996 electoral register in the Tanjong Pagar district in Singapore. Eligible subjects (n = 1717) were invited for a standardised ocular examination and interview at a centralised clinic, following which an abbreviated examination was conducted for non-respondents in their homes. Cataract was graded clinically using to the Lens Opacity Classification System (LOCS) III system. The main outcome measures were adjusted odds ratio for risk factors for specific cataract types (nuclear, cortical and PSC), any cataract and cataract surgery, examined in multiple logistic regression models. RESULTS Out of the 1232 (71.8%) examined, 1206 (70.2%) provided lens data for this analysis. Increasing age was associated with all cataract types, any cataract, and cataract surgery. There was no significant sex difference in presence of any cataract, specific cataract types or cataract surgery. After controlling for age, sex, and other factors, diabetes was associated with cortical cataract (3.1; 95% CI: 1.6 to 6.1), PSC cataract (2.2; 95% CI 1.2 to 4.1), any cataract (2.0; 95% CI: 0.9 to 4.5), and cataract surgery (2.3; 95% CI: 1.3 to 4.1). Lower body mass index was associated with cortical cataract (1.8; 95% CI: 1.1 to 2.9; lowest versus highest quintile) and any cataract (2.3; 95% CI: 1.3 to 4.0). Current cigarette smoking was associated with nuclear cataract (1.7, 95% CI: 1.0 to 2.9; more than 10 cigarettes per day versus none). A non-professional occupation was associated with nuclear cataract (2.9; 95% CI: 1.5 to 5.8; for production or machine operators and 2.6; 95% CI: 1.2 to 5.5; for labourers or agricultural workers, both versus professionals). Lower education was associated with nuclear cataract (2.3; 95% CI: 1.0 to 5.2, none versus tertiary), while lower household income was associated with PSC cataract (4.7, 95% CI: 1.1 to 20.0; income <S$2000 versus >S$4000). CONCLUSIONS Age related cataracts are associated with a variety of risk factors among Chinese people in Singapore, similar to those reported in European, Indian, and African derived populations. These data support common aetiological mechanisms for age related cataracts, irrespective of ethnic origin.
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Affiliation(s)
- P J Foster
- Singapore National Eye Centre and Singapore Eye Research Institute, Singapore.
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Klein BEK, Klein R, Lee KE, Meuer SM. Socioeconomic and lifestyle factors and the 10-year incidence of age-related cataracts. Am J Ophthalmol 2003; 136:506-12. [PMID: 12967805 DOI: 10.1016/s0002-9394(03)00290-3] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE To investigate the association of socioeconomic and lifestyle factors with incidence of age-related cataracts. DESIGN Population-based longitudinal epidemiologic study. METHODS Persons aged 43 to 86 years (n = 4,926) living in Beaver Dam, Wisconsin, were examined in 1988 to 1990, 1993 to 1995, and 1998 to 2000. Medical histories were obtained, and photographs of the lenses were taken at each visit. Photographs were graded according to standard protocols. RESULTS Socioeconomic and lifestyle factors considered were income, education, occupation, smoking, alcohol, caffeine, and multivitamin use. After adjustment for age and sex, income (or education) was inversely and smoking was directly related to the 10-year cumulative incidence of nuclear cataract. None of the factors were significantly associated with incident cortical or posterior subcapsular cataract. We found no evidence in these analyses to suggest that history of multivitamin use altered the relationships of smoking to the incidence of cataracts. In models adjusting for all other significant risk factors, the individual significance values for each individual factor differed little from the models adjusting only for age and sex. CONCLUSIONS Incident nuclear cataract was associated with income and smoking 10 years earlier. There were no significant lifestyle exposures associated with incident cortical and posterior subcapsular cataract.
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Affiliation(s)
- Barbara E K Klein
- Department of Ophthalmology and Visual Sciences, University of Wisconsin Medical School, Madison, Wisconsin 53726-2397, USA.
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Tsai SY, Hsu WM, Cheng CY, Liu JH, Chou P. Epidemiologic study of age-related cataracts among an elderly Chinese population in Shih-Pai, Taiwan. Ophthalmology 2003; 110:1089-95. [PMID: 12799231 DOI: 10.1016/s0161-6420(03)00243-4] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The purpose of this study was to determine the prevalence and risk factors for age-related cataracts in a metropolitan elderly Chinese population in Shihpai, Taipei, Taiwan. DESIGN Population-based cross-sectional study. PARTICIPANTS A total of 2045 subjects at least 65 years of age were invited to participate, and 1361 (66.6%) participated in the survey. METHODS An eye examination, including lens opacity grading, was conducted by ophthalmologists using the Lens Opacity Classification System III (LOCS III). A structured questionnaire was used for data collection. Interviewers also collected information on subjects' blood pressure, lifestyle (cigarette smoking and alcohol intake), medical history, and waist and hip circumferences. MAIN OUTCOME MEASURES Subjects were defined as having age-related cataracts if there was any type of lens opacity with an LOCS III grade of more than 2 in one or both eyes. When both eyes of an individual had age-related cataracts, the more affected eye was used for analysis. RESULTS Among the 1361 participants, 806 were diagnosed with age-related cataracts. The prevalence was 59.2% (95% confidence interval, 56.6%-61.8%). Women had a higher prevalence of cataracts than men (64.0% vs. 56.1%, P = 0.004). The prevalence of age-related cataracts increased with age (P = 0.001). Nuclear opacity was the most prevalent type (38.9%), followed by cortical opacity (21.9%) and posterior subcapsular opacity (9.2%). On the basis of the final logistic regression model, after controlling for all other covariates, increased age and female gender were factors that were associated with an increased risk for all types of cataracts. Besides age and gender, the most significant risk factor for nuclear cataracts was current cigarette smoking; the significant predictors for cortical cataracts were higher systolic blood pressure, a history of cigarette smoking in the past, and history of diabetes; the significant predictor for posterior subcapsular cataracts was higher systolic blood pressure. CONCLUSIONS The increasing prevalence of age-related cataracts with age highlights the need to seek appropriate medical services and for preventative interventions. Elderly people often ignore the importance of seeking vision services and care to prevent blindness or visual impairment. These findings suggest that the elderly need to be educated regarding the importance of eye care by physicians and hygiene authorities in Taiwan.
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Affiliation(s)
- Su-Ying Tsai
- Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
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Chia EM, Mitchell P, Rochtchina E, Lee AJ, Maroun R, Wang JJ. Prevalence and associations of dry eye syndrome in an older population: the Blue Mountains Eye Study. Clin Exp Ophthalmol 2003; 31:229-32. [PMID: 12786773 DOI: 10.1046/j.1442-9071.2003.00634.x] [Citation(s) in RCA: 281] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This report describes the prevalence of self-reported dry eye syndrome and associations with systemic and ocular factors in an older Australian population. Participants of the Extension Blue Mountains Eye Study, aged 50 or older (mean age 60.8 years, n = 1174) completed a comprehensive eye examination and dry eye questionnaire. At least one dry eye symptom was reported by 57.5% of participants, with 16.6% reporting moderate to severe symptoms, more frequent in women (age-adjusted odds ratio [OR] 1.5, 95% confidence interval [CI] 1.1-2.2). Three or more symptoms were reported by 15.3% of participants, also more frequent in women (age-adjusted OR 1.7, CI 1.2-2.4). No age-related trends or significant ocular associations were observed. After adjusting for age and sex, systemic factors significantly associated with dry eye syndrome included history of arthritis, asthma, gout, use of corticosteroids, antidepressants and hormone replacement therapy. In this older population, dry eye syndrome was common and has associations with female gender and systemic diseases.
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Affiliation(s)
- Ee-Munn Chia
- Department of Ophthalmology, University of Sydney, Sydney, New South Wales, Australia
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Ljubimov AV, Atilano SR, Garner MH, Maguen E, Nesburn AB, Kenney MC. Extracellular matrix and Na+,K+-ATPase in human corneas following cataract surgery: comparison with bullous keratopathy and Fuchs' dystrophy corneas. Cornea 2002; 21:74-80. [PMID: 11805512 DOI: 10.1097/00003226-200201000-00016] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To examine the distribution of extracellular matrix (ECM) and basement membrane (BM) components and of Na+,K+-ATPase in postcataract surgery (PCS) corneas. These corneas were from patients who never developed pseudophakic or aphakic bullous keratopathy (PBK/ABK) after cataract surgery. PCS corneas were compared with PBK/ABK and Fuchs' dystrophy corneas. METHODS The distribution of PBKIABK ECM and BM markers and of all three Na+,K+-ATPase alpha subunits was studied by immunofluorescence in 10 healthy, 11 PCS, 16 PBK/ABK, and 12 Fuchs' dystrophy corneas. RESULTS Fibrotic ECM proteins, tenascin-C and fibrillin-1, were found in only 1 of 10 healthy and in 2 of 11 PCS corneas. In contrast, these proteins were expressed in all PBK/ABK and more than half of the Fuchs' dystrophy corneas. BM components in PCS corneas were altered to a greater extent (40-60%), especially fibronectin and laminin-10. A decreased epithelial immunostaining for Na+,K+-ATPase alpha subunits was seen in approximately 40% of PCS corneas and in approximately two thirds of PBK/ABK and Fuchs' dystrophy corneas. However, the endothelial staining was normal in all groups. CONCLUSIONS Because tenascin-C and fibrillin-1 were mostly found in diseased but not in PCS corneas, their expression may be related to later, clinical stages of corneal edema development. However, BM components abnormal in PBK/ABK and Fuchs' dystrophy corneas were also altered in PCS corneas without clinical evidence of ocular disease. This may result from subclinical corneal changes resulting from cataract surgery, lens removal, exposure to the intraocular lens, or endothelial cell damage. Alterations of epithelial Na+,K+-ATPase point to the importance of epithelial changes in the development of corneal edematous diseases.
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Affiliation(s)
- Alexander V Ljubimov
- Ophthalmology Research Laboratories, Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
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