Senile cataract: survey on cataract patients undergoing cataract surgery, Japan.
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Aged↗
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[Electron microscopic studies of cataractous lenses, medical treatment of cataracts and various cataract operation methods recorded on film].
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Adult↗
Cataract and barriers to cataract surgery in a US Hispanic population: Proyecto VER.
OBJECTIVES: To report the prevalence of visually significant cataract and cataract surgery and to determine demographic and socioeconomic factors that influence use of cataract surgery in a US Hispanic population. METHODS: Proyecto VER is a population-based study of Hispanic individuals, 40 years or older, living in southern Arizona. Visual acuity was measured monocularly, and a dilated ophthalmic examination was performed to determine lens opacities. Visually significant cataract was defined as severe levels of opacity and acuity worse than 20/40. Risk factors were compared between those who obtained cataract surgery in the past and those having visually significant cataract. RESULTS: A majority of the 4774 participants in this study were of Mexican descent; 2.8% had visually significant cataract and 5.1% had undergone bilateral cataract surgery. Among those currently or previously needing surgery, having medical insurance (odds ratio, 2.88; P<.001) and speaking English (odds ratio, 1.80; P = .04) were significantly associated with having obtained surgery in the past. CONCLUSIONS: Visually significant cataract appears to be high among US Hispanic individuals of Mexican descent, as evidenced by rates of cataract and cataract surgery. Language and financial barriers in this population impede access to surgery. Further work to remove these barriers and provide sight restoration is warranted among Hispanic individuals of Mexican descent living in the United States.
Adult↗
Cataract surgical coverage and outcome of cataract surgery in a rural district in Malawi.
BACKGROUND: Cataract is the leading cause of blindness in Malawi. We sought to determine the cataract surgical coverage and the outcome of cataract surgery in a rural district in Malawi to assess past performance of cataract surgical services. METHODS: From July to October 1999 we conducted a multistage random cluster survey to include 1630 residents aged 50 years or more in Chikwawa District. Visual acuity, cause of vision loss, history of cataract surgery and cause of poor vision (if less than 6/60) were assessed. Cataract surgical coverage, sight restoration rate and outcome were calculated by person and eye and for men and women separately. RESULTS: We examined 1384 people (84.9% of target). Twenty-one people (12 men and 9 women) (30 eyes) had received cataract surgery. The cataract surgical coverage rate was 35.6% (44.4% for men and 28.1% for women [odds ratio 2.0, 95% confidence interval 0.6-7.0]) at a visual acuity level of 6/60, and 55.3% (60.0% for men and 50.0% for women [odds ratio 1.5, 95% confidence interval 0.3-6.7]) at a level of 3/60. Only one eye of one subject had received an intraocular lens. Presenting visual acuity was 6/18 or better in 7 eyes (23.3%), 6/24 to 6/60 in 7 eyes, and worse than 6/60 in 16 eyes (53.3%). Among the 16 eyes with visual acuity less than 6/60, the vision could be improved in 8 with provision of aphakic spectacles. INTERPRETATION: Cataract surgical coverage in this population is similar to that reported from other countries in Africa. As in other settings, cataract surgical coverage was lower in women than in men. Poor outcomes in this population are partly due to surgical complications and partly due to a lack of aphakic correction. Surgical promotion programs will need to focus on differentiating intraocular lens surgery from (previously practised) intracapsular cataract extraction surgery.
Blindness↗
Cataracts and cataract surgery in mentally retarded adults.
PURPOSE: To examine the prevalence of cataracts and cataract surgery in a population of mentally retarded adults. METHODS: The prevalence of cataracts and cataract surgery was examined in a retrospective chart review. A total of 119 consecutive patients from the Southside Virginia Training Center for mentally retarded adults were seen in the authors' ophthalmology clinic during a 3-year period from January 1, 1999 to December 31, 2001. Intraocular lens (IOL) implantation and postoperative complications were noted in patients who had undergone previous cataract surgery. RESULTS: Of the 119 patients seen, 64 (54%) had cataracts or a history of cataract surgery. Thirteen (20%) of these 64 patients had a history of cataract surgery (21 eyes total). Seventeen (81%) of these 21 eyes had IOL implantation (14 posterior-chamber IOLs [PCIOLs] and three anterior-chamber IOLs). Postoperative surgical complications occurred in 7 (33%) of 21 eyes and included anterior uveitis in three (14%) eyes, posterior capsular opacification in two (10%) eyes, rhegmatogenous retinal detachment in one (5%) eye, dislocated PCIOL in one (5%) eye, pseudophakic bullous keratopathy in one (5%) eye, and cystoid macular edema in one (5%) eye. There were no cases of postoperative endophthalmitis or retained lens fragments. CONCLUSIONS: The prevalence of cataracts in adult mentally retarded patients is higher in this series (P<0.001) than in the world literature. However, if only visually significant cataracts are considered, the results are consistent with previous studies. Postoperative complications were common. Patients experienced higher rates of anterior uveitis (P=0.001) and pseudophakic bullous keratopathy (P=0.002) in this study than in previous studies. In this population, careful preoperative screening is recommended to select those patients most likely to benefit from cataract surgery and least likely to experience severe postoperative complications.
Adult↗
Congenital cataract surgery in children with cataract as an isolated defect and in children with a systemic syndrome: a comparative study.
PURPOSE: To compare visual acuity outcome in two groups of children who underwent congenital cataract surgery. The first group is one in which an isolated cataract occurred; the second group is one in which cataract occurred in conjunction with a systemic disease. METHODS: A review of 46 charts: 36 children (50 eyes) with congenital cataract as an isolated defect, and 10 children (16 eyes) with cataract as part of a systemic disease. RESULTS: One third of the eyes with isolated cataract had postoperative visual acuity better than 6/12, although none of the patients in the syndrome group had visual acuity better than 6/12. This difference was statistically significant (p = 0.01). Of the various ocular pathologies associated with congenital cataract, only nystagmus was found to be more prevalent in the syndrome group (40%) as compared with the isolated cataract group (11%) (p = 0.05). Surgery was performed during the first 2 years of life in 54% of the eyes in the isolated cataract group, and in 87% of the eyes in the syndrome group (p = 0.01). There was no difference in the prevalence of the postoperative complications between the two groups. CONCLUSION: Children who underwent congenital cataract surgery developed poorer visual acuity if the cataract was a part of a systemic disease as compared with children without a systemic syndrome.
Abnormalities, Multiple↗
LOCS III versus the Oxford Clinical Cataract Classification and Grading System for the assessment of nuclear, cortical and posterior subcapsular cataract.
PURPOSE: To compare two methods of cataract grading for nuclear cataract, cortical cataract and posterior subcapsular cataract. METHODS: The Melton Eye Study is an English community-based epidemiological study of the natural history of eye disease in people aged 55 to 74 years. The lenses of both eyes of 560 subjects were graded at the slit lamp using two cataract grading systems. The Oxford Clinical Cataract Classification and Grading System (OCCCGS) employs standard diagrams and Munsell colour samples for the grading of cortical, posterior subcapsular and nuclear cataract. The Lens Opacities Classification System III (LOCS III) uses photographic transparencies of the lens as standards. In both systems a decimalised score is assigned. We also graded the LOCS III standard images using the OCCCGS. Interobserver variation was calculated for both grading systems. Linear calibration lines are plotted for each type of lens opacity. RESULTS: The relationship between LOCS III and OCCCGS for nuclear cataract and posterior subcapsular cataract is linear. The relationship for cortical cataract is linear once the LOCS III scores are squared. The intervals between the LOCS III images when ranked by the human eye using the OCCCGS are linear. Interobserver variation for both systems is good. CONCLUSIONS: The linear calibration lines may be used to convert from one system to another and will be useful in comparing studies or performing meta-analysis. These results show that data from cataract studies using different clinical grading schemes can be compared.
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Rapid assessment of visual impairment due to cataract and cataract surgical services in urban Argentina.
AIM: To present results of a rapid assessment on visual impairment due to cataract and on cataract surgical services in the Northwestern districts of Buenos Aires, Argentina. These results will enable health managers to plan effective interventions in this area in line with VISION 2020. METHODS: One hundred fifteen clusters of 40 persons of 50 years and older in each cluster (4600 eligible persons) were selected by systematic sampling from the Northwestern districts of Buenos Aires, Argentina. This area consists of 10 districts with a total population of 2,716,573 (2001 census), from whom 4302 persons were examined (coverage 93.5%). The visual acuity was measured with a tumbling E-chart and the lens status with distant direct ophthalmoscopy. RESULTS: Cataract is the major cause of bilateral blindness (54.2%). The age and sex adjusted prevalence of bilateral cataract blindness (presenting VA < 20/400) in people of 50 years and older was 0.5% (95% CI: 0.4-0.8%), an estimated number of 2,985 persons. The cataract surgical coverage at this level was 70% for males and 78% for females. The prevalence of bilateral cataract and VA < 20/200 in persons of 50 years and older was 0.8% (95% CI: 0.6-1.1), an estimated 4,705 persons. In this last group, the surgical coverage was 66% (persons) and 57% (eyes). Of all operated eyes, 10% could not see 20/200. 'Cannot afford' (32%), 'unaware of cataract' (21%) and 'contraindication for surgery' (18%) were mentioned most as reason why surgery had not been done. CONCLUSION: The cataract problem is getting under control in this area. Coverage indicators are fairly high, and the outcome data better than in other studies. The cataract surgical rate could be raised further by awareness campaigns and by making cataract surgery more affordable.
Argentina↗
Optometrist referrals for cataract and "Action on Cataracts" guidelines: are optometrists following them and are they effective?
PURPOSE: To assess the information included in optometrist referrals for cataract to the Hospital Eye Service with reference to the recommendations made by the Department of Health in "Action on Cataracts" and the resultant surgical listing rates. METHODS: We prospectively collected and analysed the information included in three different types of optometrist referrals for cataract over 8 weeks. Referrals containing "full information" as recommended in "Action on Cataracts" confirmed cataract as the cause of visual loss with a detrimental effect on the patient's lifestyle, and a willingness for surgery. The referral outcomes were assessed in terms of listing rate and the reasons for not listing, for each type of referral form. RESULTS: A total of 412 referrals were analysed. Of these, 50% (208) were "conventional" referrals via the general practitioner (GP) [39% (n = 162) using the General Ophthalmic Services (GOS) 18 referral form and 11% (n = 46) an optometrist's custom letter]; 35% (n = 143) were direct referrals and 15% (n = 61) were GP referrals with no optometrist information (these results were excluded from further analysis). The listing rates for optometric referrals were 78% (n = 272) overall, 83% (n = 119) for direct and 74% (n = 153) for conventional referrals. "Full information" was included in 17% (n = 8) of letter referrals and 10% (n = 16) of GOS 18 referrals. The listing rates were 83% for referrals with full information and 73% for referrals specifying only that cataracts were the cause of visual loss. The listing rates for referrals with partial information were 78% for "cataract" plus "effect on lifestyle" and 67% for "cataract" plus "willingness for surgery". The most common reason for not listing a patient for surgery was "no effect on lifestyle", accounting for 42% (n = 32). CONCLUSION: We recommend that all referrals for cataract should confirm a detrimental effect on lifestyle and the patient's willingness for surgery, in addition to confirming cataract as the main cause of visual loss.
Cataract↗
Epidemiologic aspects of cataract surgery. III: Frequencies of diabetes and glaucoma in a cataract population.
A Danish data source was examined to determine age and sex specific rates of diabetes and glaucoma in a large cataract extracted population. Comparisons with population rates were done. An excess prevalence of diabetes in the cataract population below 70 years was found. For cataract extracted males and females below the age of 40 years, the diabetes prevalence was 15 to 25 times the prevalence in a general population. This prevalence excess decreases with age to normal levels at 75 years of age. Furthermore, we found higher relative frequencies of diabetes among cataract extracted females than among males. Mean age at time of surgery was significantly lower for the diabetic cataract patients. Also for primary glaucoma, an excess prevalence was found in the cataract population. For cataract extracted males and females aged 40 to 49 years the glaucoma frequency was 4-5 times the frequency in a general population. This excess relative frequency decreases with age. The glaucomatous cataract patients have a higher mean age at the time of cataract surgery. A large number of factors seems to contribute to the excess frequencies of diabetes and glaucoma found in the cataract extracted population.
Adult↗
The deficit in cataract surgery in England and Wales and the escalating problem of visual impairment: epidemiological modelling of the population dynamics of cataract.
BACKGROUND: The pool of old cases of cataract, the expected new cases, and the shortfall in cataract surgery and consequently the numbers dying with poor vision without the benefit of cataract surgery are regarded as escalating problems worldwide. Successive governments and the professional ophthalmic bodies have not had the wherewithal to estimate the magnitude or interaction of these elements in the population of the UK. This study has collected and applied the best available epidemiological data on cataract prevalence, incidence and service utilisation, and demography to address the problem of control of the cataract pool in the population of England and Wales. METHODS: Data from recent surveys undertaken by the authors, both on prevalence of vision impairing cataract and on patterns of cataract surgery, were used together with demographic and service utilisation information obtained from government departments. These were integrated within a holistic model, which was run under varied assumed levels and patterns of service provision. RESULTS: The study shows that there is a serious pool of unoperated vision impairing cataract in the population aged 65 and older, reflecting a shortfall in cataract surgery. Continuing with the present level and pattern of service provision, the pool will increase to over 2.5 million by the year 2001. In addition, more than 700 000 will die with unoperated impaired vision. CONCLUSIONS: Targeting of existing or new additional operations to those below the visual acuity of 6/12 will have relatively little effect on numbers dying without surgery, but should have a substantial controlling effect on the pool of vision impairing cataract in the population.
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Cataract blindness and barriers to uptake of cataract surgery in a rural community of northern Nigeria.
AIMS: A population based cross sectional survey was conducted to determine the magnitude of cataract blindness and the barriers to uptake of cataract services in a rural community of northern Nigeria. METHODS: 1461 people out of 1924 registered eligible people were examined. The study population was chosen by two stage cluster random sampling. In the first sampling stage 15 villages were randomly chosen while in the final stage 170 people who were 40 years and over were selected in each village. Each selected person had visual acuity recorded for both eyes. Those with vision of less than 3/60 in the better eye were assessed for cataract. People with cataract were asked why they had not sought medical attention. RESULTS: A blindness prevalence of 8.2% (95% CI 5.8%-10.5%) was found among the sampled population. Cataract was responsible for 44.2% of the blindness. Thus, a cataract blindness prevalence of 3.6% was found. The cataract surgical coverage (people) was 4.0% and the couching coverage (people) was 18%. The main barrier to seeking cataract surgery was cost of the service (61%). CONCLUSION: Some regions of the world still have high burden of cataract blindness that needs attention. Such areas need an effective free cataract outreach programme.
Adult↗
Comparative analysis of the eye function and complications after removal of complicated cataract due to uveitis and senile cataract.
PURPOSE: retrospective, comparative analysis of the effectiveness of the results among patients who underwent removal of complicated cataract due to uveitis and senile cataract. MATERIAL AND METHODS: Patients with cataract enrolled in this study were divided into two groups. Group 1 comprised 30 eyes with complicated cataract due to uveitis. The main causes of uveitis were: rheumatoid arthritis in 8 eyes, ankylosing spondylitis in 7, Reiter syndrome in 3, psoriatic arthritis in 3, systemic sarcoidosis in 2, post-traumatic uveitis in 1. In 6 patients (6 eyes) the etiology of uveitis was unknown. Group 2 comprised 30 eyes with senile cataract. In 5 patients in each group there were coexisting glaucoma. In both groups phacoemulsification or phacoaspiration and foldable three piece IOL implantation were performed. The follow-up period was 12 months. Best corrected visual acuity and intra and postoperative complications were taken into consideration. RESULTS: There were no differences in gender and cataract hardness between the two groups. Significantly younger patients were in group 1 p< 0.01. Mean preop./ postop. visual acuity was better in group 2 as compared with group 1: 0.4/ 0.8 and 0.2/ 0.5, respectively, p < 0.01. In both groups however, the preoperative visual acuity was significantly lowest in patients with coexisting glaucoma: group 1, 0.1 p < 0.01 and in group 2: 0.25 p < 0.001. Significantly more frequent intraoperative complications were observed in group 1 as compared with group 2 e.g., corneal burn 10% and 6.6%, local sphincter damage 10% and 0%, zonular rupture 10% and 3.3% respectively. Similarly, in the late postoperative period more frequent complications were observed in group 1 than in group 2 e.g.: secondary cataract 50% and 13.3%, IOL decentration 40% and 6.6%, capsule contraction 80% and 10%, glaucoma 10% and 3.3% respectively. Recurrence of uveitis was observed in 30% of eyes in group 1. CONCLUSIONS: Although the modern microsurgical technology and IOL implantation have led to more effective treatment of senile cataract, the surgery of complicated cataract due to uveitis is still not free from complications. Future surgical strategy of complicated cataract owing to uveitis has to comprise the most adequate qualification criteria e.g. choice of the optimal period for surgery and the most convenient surgical technique as well as the most effective perioperative anti-inflammatory treatment.
Adult↗
Cataract in senescence accelerated mouse (SAM). 2. Development of a new strain of mouse with late-appearing cataract.
A new strain of mouse with late-appearing hereditary cataract was developed in the Senescence Accelerated Mouse (SAM-R/3). At the beginning of the selection of the new strain (generation 4), 5% of mice which lived over 20 weeks had cataract, at least unilaterally. During selection and brother-sister inbreeding, the incidence increased and reached 68% of 78 mice whose lifespan exceeded 20 weeks, in the 12th generation. In recent populations, (generations 9-14), the cataract began to appear around 10 weeks of age and about 81% of 64 females and 49% of 47 males had cataract after 32 weeks of age. Inflammatory lesions of the cornea and eyelids began to occur later in life and the incidence was lower than that of cataract. This observation suggested to us that the cataract of this new strain was not congenital in origin but rather was age-related and did not occur consequently after the onset of inflammatory lesions around the lens tissue. Stereomicroscopic examination of the lens revealed that many of these cataracts occurred initially at the posterior area and that the mature cataract showed a characteristic protrusion at the posterior pole and nuclear dislocation. Histology of the mature cataract also revealed protrusion of the posterior pole and showed degeneration and liquefaction of lens cortex, nuclear dislocation and destruction of posterior lens capsule. The wet weight, water and protein contents showed that the lens of this strain developed normally and that the untoward events were the result but not the cause of cataract. The SAM-R/3 strain should prove to be a suitable murine model for investigation of age-related changes in the lens, and cataractogenesis.
Aging↗
Cataract: the relation between myopia and cataract morphology.
The association between high myopia and cataract is already well established and an association between simple myopia and cataract has been suggested, but it has not been clear to what extent the myopia precedes the cataract or is the result of it. The present study compares the refraction of a group of 100 British patients at the time of first presentation with cataract in whom the refraction was also known four years previously, with a group of matched controls in whom the refraction was also known four years previous to presentation. The study shows that simple myopia does not appear to predispose to cataract. It is the development of the cataract itself, in particular nuclear sclerosis, which causes the refractive change towards myopia. The myopic change precedes the development of cataract, and patients over the age of 55 showing a myopic change in refraction have a very high probability of developing nuclear sclerotic cataract. The healthy aging eye and eyes with cortical cataract or subcapsular cataract, but without nuclear sclerosis, continue to show a gradual hypermetropic change with time.
Adult↗
Congenital and infantile cataract in the United Kingdom: underlying or associated factors. British Congenital Cataract Interest Group.
PURPOSE: Prevention of visual impairment and blindness in childhood due to congenital and infantile cataract is an important international goal. Preventive strategies require information about etiology that is currently unavailable for many regions of the world. From a national epidemiologic study, the underlying or associated factors in newly diagnosed cases of congenital or infantile cataract in the United Kingdom are reported, and the implications for future etiological research are discussed. METHODS: All children with congenital or infantile cataract newly diagnosed during 1 year in the United Kingdom were ascertained independently through two national active surveillance schemes comprising ophthalmologists and pediatricians, respectively. Detailed information about cases, including disease causes, was collected from reporting clinicians using standard questionnaires. RESULTS: Of 243 children with newly diagnosed congenital or infantile cataract, 160 (66%) had bilateral disease. Isolated cataract was more common in bilateral than unilateral cases (61% versus 47%, P = 0.05) as was cataract associated with a systemic disorder (25% versus 6%, P < 0.001). Conversely, cataract with associated ocular anomalies was more common in unilateral than bilateral cases (47% versus 14%, P < 0.001). No underlying or associated risk factors for cataract could be identified in 92% of unilateral and 38% of bilateral cases, although putative prenatal and perinatal risk factors were reported in a proportion of these idiopathic cases. Hereditary disease was associated with 56% of bilateral but only 6% of unilateral cases. Prenatal infections and other systemic factors were reported in only 6% of bilateral and 2% of unilateral cases. CONCLUSIONS: Given the high proportion of idiopathic congenital and infantile cataract, the scope for primary prevention in the United Kingdom is currently limited. There is a need for further etiological research, to examine the roles of environmental and genetic risk factors for idiopathic cataract.
Adolescent↗
Restoration of accommodation.
PURPOSE OF REVIEW: This review examines the current status of accommodation restoration concepts with reference to the recent, published peer-reviewed literature with an emphasis on physiological aspects of accommodation and presbyopia. RECENT FINDINGS: The mechanisms of accommodation and the causes of presbyopia are described. The physiological amenability of the accommodative structures in the presbyopic eye to accommodation restoration is discussed. General theoretical concepts of accommodation restoration are introduced. The methods that have been used to assess accommodation restoration, including the use of animal models, drug stimulated accommodation, subjective near-vision tests and objective measurements, are reviewed. SUMMARY: While physiological and clinical evidence supports the notion that accommodation can be restored to the presbyopic eye, progress in this potentially exciting area is hindered by the scarcity of good, large-scale clinical studies using objective measurement techniques to evaluate the outcomes of accommodation restoration concepts.
Accommodation, Ocular↗
The association of cataract and cataract surgery with the long-term incidence of age-related maculopathy: the Beaver Dam eye study.
OBJECTIVE: To examine the association between cataract and cataract surgery and the 10-year incidence of age-related maculopathy (ARM). METHODS: A population-based cohort study of persons aged 43 to 86 years at baseline, living in Beaver Dam, Wis, of whom 3684 participated in a 5-year and 2764 in a 10-year follow-up. We used standardized protocols for physical examination, blood collection, health history, slitlamp and retroillumination photography of the lenses to determine the presence of cataract, and stereoscopic color fundus photography to determine the presence of ARM. We used the Kaplan-Meier (product-limit) survival approach and discrete linear logistic regression in analyses. MAIN OUTCOME MEASURES: The risk ratios (RRs) of persons with cataract or cataract surgery at baseline. RESULTS: While controlling for age, sex, systolic blood pressure, history of heavy drinking and smoking, and vitamin use, cataract at baseline was associated with incidence of early ARM (RR, 1.30; 95% confidence interval [CI], 1.04-1.63), soft indistinct drusen (RR, 1.38; 95% CI, 1.08-1.75), increased retinal pigment (RR, 1.38; 95% CI, 1.07-1.79), and progression of ARM (RR, 1.37; 95% CI, 1.06-1.77). We found no association with the incidence of late ARM. In contrast, cataract surgery before baseline was associated with incidence of late ARM (RR, 3.81; 95% CI, 1.89-7.69), increased retinal pigment (RR, 1.89; 95% CI, 1.18-3.03), retinal pigment epithelial depigmentation (RR, 1.95; 95% CI, 1.17-3.25), pure geographic atrophy (RR, 3.18; 95% CI, 1.33-7.60), exudative macular degeneration (RR, 4.31; 95% CI, 1.71-10.9), and progression of ARM (RR, 1.97; 95% CI, 1.29-3.02), but not with the incidence of early ARM. CONCLUSIONS: These findings indicate an association of cataract with subsequent risk for early ARM. Cataract surgery increased the risk for late ARM.
Adult↗