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PubMed2001

The relationship of cataract maturity to intraocular pressure in dogs.

OBJECTIVE: To determine the distribution of intraocular pressure, as measured by applanation tonometry, in dogs with cataracts, and compare these tonometric results to the different stages of cataract formation (incipient, immature, mature, and hypermature). Animals studied Retrospection study of canine clinical patients (86 dogs). PROCEDURES: All records of dogs presented from 1991 to 1996 to the university veterinary medical teaching hospital for diagnosis of cataracts and evaluation for cataract surgery were reviewed. The tonometric measurements from the initial ophthalmic examination were selected in cataractous and nonglaucomatous eyes either receiving no topical or no systemic medications. The stage of cataracts was based on the degree of opacification, tapetal reflection, clinical vision, and visibility of the ocular fundus by indirect ophthalmoscopy. The distribution of tonometric results were grouped by the cataract maturity, and compared by anova and Tukey's general linear tests. RESULTS: Intraocular pressure with incipient cataracts ranged from 9 to 17 mmHg (mean 12.7 +/- 1.2 mmHg). Intraocular pressure with immature cataracts ranged from 3 to 27 mmHg (mean 13.6 +/- 0.6 mmHg). For the mature cataracts, IOP ranged from 5 to 22 mmHg (mean 11.9 +/- 0.7 mmHg). For the hypermature cataract group, IOP ranged from 4 to 23 mmHg (mean 10.8 +/- 0.6 mmHg). Comparison of the tonometric results among the different stages of cataract formation indicated a significant difference (P = 0.0086) between only the immature and hypermature groups. CONCLUSIONS: Intraocular pressure in lens-induced uveitis (LIU) is lowered but the relationship to the stage of cataract maturity is less clear. Significant tonometric differences were present between the immature and hypermature cataract groups, but these differences are too small to be clinically useful. Decreased intraocular pressure of dogs with all stages of cataract formation suggests concurrent LIU during all stages of cataract formation, especially with the mature and hypermature stages. The average tonometric measurements in dogs with these cataracts were about two standard deviations below the mean IOP reported in normal dogs.

Animals↗
PubMed2006

Grading infantile cataracts.

PURPOSE: To introduce and describe two methods of grading the severity of infantile cataracts, and thereby propose a useful clinical guide for early surgical intervention. METHODS: Thirty-three subjects, aged 1 week to 8 years, participated in the study. Twenty-two were evaluated soon after birth (1 week), and 11 in childhood (3-8 years). All had isolated infantile cataracts, of which 16 were bilateral and 17 unilateral. Nine cataract types were examined; nuclear (n = 9), lamellar (n = 9), posterior lenticonus (n = 4), persistent hyperplastic primary vitreous (n = 4), posterior polar (n = 3) and single cases of total, cortical, sutural and anterior polar. Grading the infantile cataracts was performed subjectively based on the cataract morphology, density and position using an 11-point (0-10) ordinal scale. Objective measures of the cataracts were performed by scanning and then digitising photo-slit lamp images to provide cataract intensity profiles. Subjects without cataracts acted as controls. RESULTS: Subjective gradings of 0 and 10 were assigned to the clear, cataract-free lens and the total cataract, respectively. Fixed grades of 1 (anterior polar, sutural) and 6 (posterior polar) were assigned to the three remaining cataracts with static morphologies. The five cataracts which were all progressive were given grading ranges, reflecting the initial and likely final morphological states. Objective measures were found to be valuable in indicating the exact position and relative density of the cataract, as well as accurately defining boundaries. CONCLUSIONS: The magnitude and severity of infantile cataracts can be usefully characterised by an 11-point ordinal subjective grading scale. Although subjective grading alone is satisfactory, it can be greatly assisted by objective measures, particularly in the documentation of cataract progression. Cataracts assigned grades 1-4 were considered minor obstructions to vision and therefore not candidates for early surgery. Cataracts graded 5 and above were considered major visual defects, and ideally should be removed early in life.

Cataract↗
PubMed1976

[The frequency of various forms of senile cataract (author's transl)].

On classifying 1000 senile cataracts it was found that in pure cataract forms - starting from the cortex - the typical grey senile cataract (cataracta supranuclearis) mostly occurs with a clear nucleus. The dense permeability cataract (cataracta subcapsularis) most frequently shows a dense grey clouding of the nucleus and in addition a still smaller increase in frequency with a clear nucleus. The cortex was also frequently clear when the nucleus of the lens was a dense cloudy grey. Conversley, starting from pure nuclear cataract forms, the dense grey clouded lens nucleus most frequently accompanies a permeability cataract (cataracta subcapsularis) and - with a second peak - with a clear cortex. The brown (black) nucleus (cataracta brunescens [nigral]) quite predominantly shows a clear cortex. If all the cataracts, including the mixed forms between the various cortical and nuclear cataracts are so classified that the percentage participation of the individual forms of cataract in the entire collective (including the mixed forms) is summarised, then the distribution is: Typical grey senile cataract (cataracta supranuclearis) in 23%. Permeability cataract (cataracta subcapsularis) in 36%. Light brown-grey nuclear cataract (mainly nuclear sclerosis) in 13%, grey nuclear cataract in 37%, brown nuclear cataract in 5%, mature cataract in 4%, hypermature cataract in 1%, intumescent cataract in 11%.

Aged↗
PubMed1989

Nucleotide levels in human lens: regional distribution in different forms of senile cataract.

Sensitive high-performance liquid chromatography methods were employed to assess regional distribution of adenine, guanosine and uridine nucleotides in clear and cataractous human eye lenses. According to slit-lamp examination, three forms of senile cataract were distinguished: (1) supranuclear or deep cortical cataract (typical senile cataract), (2) primary nuclear cataract (cataracta brunescens) and (3) subcapsular cortical cataract associated either with a supranuclear (3a) or a secondary nuclear cataract (3b). Except for AMP, which was highest in the nuclear fraction, all other nucleotides (ATP, ADP, GTP, and UTP) were predominantly located in the anterior cortex (plus epithelium) of clear as well as cataractous lenses, that is, ATP levels in the nucleus amounted to 20% of those found in the anterior cortex (plus epithelium); ATP levels in the posterior cortex were about 60% of those in the anterior cortex (plus epithelium). Significant differences in the absolute regional nucleotide level existed between the different forms of cataract. Highest ATP levels were found in the anterior cortex (plus epithelium) of clear lenses and deep or supranuclear cortical cataract. The ATP level was slightly diminished in primary nuclear cataract and in supranuclear cortical cataract when associated with an early subcapsular cortical cataract. ATP levels were depressed to less than 30% in the anterior cortex (plus epithelium) of lenses with a subcapsular cortical cataract when associated with either an early secondary nuclear or a mature cataract. Furthermore, the ATP/ADP ratio was decreased in this form of senile cataract. The decrease in lens nucleotide level did not correlate with increased age. These data suggest that decreases in regional ATP level are a secondary event and do not appear to be causally involved in the genesis of the 'cataracta senilis'.

Adenosine Diphosphate↗
PubMed2004

Vitamin E supplementation and cataract: randomized controlled trial.

OBJECTIVE: To determine whether treatment with vitamin E (500 IU daily) reduces either the incidence or rate of progression of age-related cataracts. DESIGN: A prospective, randomized, double-masked, placebo-controlled clinical trial entitled the Vitamin E, Cataract and Age-Related Maculopathy Trial. PARTICIPANTS: Of 1906 screened volunteers, 1193 eligible subjects with early or no cataract, aged 55 to 80 years, were enrolled and followed up for 4 years. INTERVENTION: Subjects were assigned randomly to receive either 500 IU of natural vitamin E in soybean oil encapsulated in gelatin or a placebo with an identical appearance. MAIN OUTCOME MEASURES: The incidence and progression rates of age-related cataract were assessed annually with both clinical lens opacity gradings and computerized analysis of Scheimpflug and retroillumination digital lens images obtained with a Nidek EAS-1000 lens camera. The analysis was undertaken using data from the eye with the more advanced opacity for each type of cataract separately and for any cataract changes in each individual. RESULTS: Overall, 87% of the study population completed the 4 years of follow-up, with 74% of the vitamin E group and 76% of the placebo group continuing on their randomized treatment allocation throughout this time. For cortical cataract, the 4-year cumulative incidence rate was 4.5% among those randomized to vitamin E and 4.8% among those randomized to placebo (P = 0.87). For nuclear cataract, the corresponding rates were 12.9% and 12.1% (P = 0.77). For posterior subcapsular cataract, the rates were 1.7% and 3.5% (P = 0.08), whereas for any of these forms of cataract, they were 17.1% and 16.7%, respectively. Progression of cortical cataract was seen in 16.7% of the vitamin E group and 18.4% of the placebo group (P = 0.76). Corresponding rates for nuclear cataract were 11.4% and 11.9% (P = 0.84), whereas those of any cataract were 16.5% and 16.7%, respectively. There was no difference in the rate of cataract extraction between the 2 groups (P = 0.87). Lens characteristics of the participants withdrawn from the randomized medications were not different from those who continued. CONCLUSIONS: Vitamin E given for 4 years at a dose of 500 IU daily did not reduce the incidence of or progression of nuclear, cortical, or posterior subcapsular cataracts. These findings do not support the use of vitamin E to prevent the development or to slow the progression of age-related cataracts.

Aged↗
PubMed2000

Initial two years of experience with the AAO National Eyecare Outcomes Network (NEON) cataract surgery database.

PURPOSE: To report the results of the first 2 years of experience with an American Academy of Ophthalmology (AAO) cataract surgery registry; to compare patient characteristics, operative procedures, and patient outcomes observed in the registry to those observed in the Cataract PORT study; and to discuss the current shortcomings and potential benefits of a national cataract surgery registry. DESIGN: Observational study of episodes of cataract surgery reported by a self-selected sample of 249 ophthalmologists. PARTICIPANTS: Seven thousand six hundred twenty-six patients undergoing cataract surgery during 1996 and 1997. METHODS: Beginning in January 1996, participation in the AAO cataract surgery registry was offered to all ophthalmologists. Participants could use software or paper data collection forms to submit a common set of data regarding patients' demographics, preoperative ophthalmologic history, physical examination and test results, functional status and symptoms, intraoperative procedures and events, and postoperative outcomes for all patients undergoing first or second eye cataract surgery. Data were transmitted to a central database, where they were aggregated and analyzed. Findings were compared with those observed in the Cataract PORT study, which was conducted in 1991 and 1992. RESULTS: Between January 1, 1996, and February 28, 1998, 249 ophthalmologists submitted data on at least one patient who underwent cataract surgery. A total of 7626 patients undergoing first or second eye surgery were enrolled, with all preoperative, intraoperative, and postoperative data forms submitted for 3342 patients (44%). The preoperative characteristics of patients reported to National Eyecare Outcomes Network (NEON) were similar to those of patients enrolled in the Cataract PORT study except for a higher reported prevalence of ocular comorbidity in NEON patients. Use of retrobulbar anesthesia was reported far less commonly, and use of topical anesthesia, phacoemulsification, and foldable intraocular lenses was reported far more often for NEON than for Cataract PORT study patients. Patient outcomes reported to NEON were similar to those observed in the Cataract PORT study. MAIN OUTCOME MEASURES: Visual acuity, VF-14, Cataract Symptom Score, surgical complications. CONCLUSIONS: During the first 2 years of NEON, ophthalmologist participation in the NEON cataract surgery database was low and consisted of a self-selected and likely nonrepresentative sample of ophthalmologists. The representativeness of patients for whom data were reported is unknown. In addition, complete data were submitted on only a minority of patients who were enrolled. Even so, the preoperative characteristics of patients on whom data were submitted to NEON were similar to those of patients enrolled in the Cataract PORT study. The initial experience with NEON demonstrates that it is technically possible to collect clinical data from, and report aggregated results to, practicing clinicians' offices. In addition, at least some practicing clinicians are willing to spend the time required to participate in the NEON registry. The NEON cataract surgery database thus has the potential to provide a practical means for tracking practice patterns and patient outcomes in real time. If a representative sample of physicians was willing to contribute data systematically and accurately over time, initiatives such as NEON could provide a means for professional societies and physicians to play a leadership role in defining and monitoring quality of care.

Aged↗
PubMed1999

Ultrasonographic classification and phacoemulsification of white senile cataracts.

OBJECTIVE: To classify the white senile cataracts and report the results of phacoemulsification of white cataracts. DESIGN: Prospective, noncomparative case series. PARTICIPANTS: One hundred eyes were included. INTERVENTION: White cataracts were examined biomicroscopically before surgery, and their acoustic structure was analyzed with standardized A-scan echography. White cataract surgery was performed with phacoemulsification via a superior temporal near-limbus corneal approach using a bimanual divide-and-conquer or stop-and-chop technique. Patients were followed after surgery for a period of 9 months. MAIN OUTCOMES MEASURES: The A-scan acoustic structure of white cataracts; successful accomplishment of capsulorrhexis; mean phacoemulsification time, power, and energy; intraoperative and postoperative complications of phacoemulsification; and visual acuity at 9 months after surgery. RESULTS: White senile cataracts were categorized into three different types. Type I included intumescent, white cataracts with cortex liquefaction and high internal acoustic reflections (44 eyes), type II included white cataracts with voluminous nuclei, little amount of whitish solid cortex, and low internal acoustic reflections (49 eyes), and type III included white cataracts with fibrosed anterior capsule and low internal echospikes (7 eyes). Circular capsulorrhexis was completed in 79 eyes and was significantly less successful in eyes with type I intumescent, white cataracts compared with type II white cataracts (P = 0.0034). Mean phacoemulsification time and energy were higher in type II and type III white cataracts. Posterior capsule rupture occurred in ten eyes, and three of these eyes were complicated by vitreous loss. In 95 eyes, the posterior chamber lens was implanted in the capsular bag and in five eyes in the sulcus. After surgery, a transient corneal edema developed in 31 eyes. At the final 6-month examination, the mean postoperative visual acuity was 20/30. CONCLUSION: Current phacoemulsification techniques can safely manage eyes with senile white cataracts. The increased risk of difficulty with continuous capsulorrhexis in type-I and type-III white cataracts and the substantial nuclear hardness in type-II and mainly type-III white cataracts would suggest that current phacoemulsification techniques might not be as successful in these patients as they are in ordinary earlier cataracts.

Aged↗
PubMed2000

Posttransplant cataract: lessons from kidney-pancreas transplantation.

INTRODUCTION: Cataract is a major cause of visual disturbance after transplantation. Although corticosteroid therapy has been linked with posterior subcapsular cataract, its natural history in the cyclosporine era is not well understood. METHODS: Baseline and regular postoperative slit-lamp biomicroscopy and ophthalmic examinations (n=432) were performed in 108 eyes of simultaneous kidney/pancreas (SPK) recipients (n=54) for up to 10 years after transplantation. Triple therapy immunosuppression of cyclosporine, azathioprine, and prednisolone was used. RESULTS: Cataract was present in 40% of eyes at simultaneous kidney/pancreas associated with duration of diabetes, lower insulin dose, and the use of pretransplant hemodialysis (P<0.05-0.01). Cataract became increasing more common 2 years after simultaneous kidney/pancreas, and lens abnormalities were virtually universal at 6-10 years by slit lamp biomicrosopy. The instantaneous hazard rate for new cataract formation was highest within the first 2 years and remained abnormal for the study duration. Nuclear and posterior subcapsular cataract increased significantly after transplantation (P<0.05) and were the predominant types of cataract presenting late. Risk factors for posttransplant cataract formation included older age and high-dose pulse methylprednisolone dose. Visual acuity was reduced by severity of cataract grade, presence of combined nuclear and subcapsular cataract, retinal hemorrhage and underlying diabetic retinopathy (P<0.05-0.001). Cataract formation imposed significant additional impairment of visual acuity above that of diabetic retinopathy. Cataract surgery was undertaken in 14% of eyes, improving visual acuity from mean decimalized score of 0.28 to 0.43, P<0.01 but did not normalize it to the noncataract level of 0.72. CONCLUSION: Transplantation substantially increases all types of cataract, and is highly prevalent by slit lamp examination. High-risk patients are older and diabetic, and received hemodialysis and pulse corticosteroid therapy. In contrast to older studies using high-dose corticosteroid and azathioprine, the pattern of cataract in the cyclosporine era is different with broader cataract types, a weaker association with corticosteroids and a progressive course. Regular screening of visual acuity and appropriate surgery for posterior subcapsular or severe cataract are recommended.

Adult↗
PubMed2005

Smoking and its association with cataract: results of the Andhra Pradesh eye disease study from India.

PURPOSE: To investigate the associations between tobacco smoking and various forms of cataracts among the people of a state in India. METHODS: A population-based cross-sectional epidemiologic study was conducted in the south Indian state of Andhra Pradesh (AP). A total of 10,293 subjects of all ages from one urban and three rural areas, representative of the population of AP, were interviewed, and each underwent a detailed dilated ocular evaluation by trained professionals. Data were analyzed for 7416 (72%) of the subjects aged >15 years. RESULTS: Increasing age was significantly associated with all cataract types and history of prior cataract surgery and/or total cataract. In multivariate analyses, after adjusting for all demographic factors and for history of smoking, females, illiterate persons, and those belonging to the extreme lower socioeconomic status group were found to have a significantly higher prevalence of any cataract, adjusted odds ratio (OR)=1.60 (95% confidence interval [CI]: 1.24-1.96), 1.46 (95% CI: 1.17-1.70), and 1.92 (95% CI: 1.14-3.24), respectively. After adjustment, cigarette and cigar smokers had a significantly higher prevalence of any cataract, adjusted OR=1.51 (95% CI: 1.10-2.06) and 1.44 (95% CI: 1.12-1.84), respectively, compared with those who had never smoked ("never-smokers"). A significantly higher prevalence of nuclear, cortical cataract, and history of prior cataract surgery and/ or total cataract was found among cigarette smokers. A dose-response relationship was seen with respect to cigarette and cigar smoking. After adjustment, compared with never-smokers, cigarette smokers who smoked heavily (>14 "pack-years" of smoking) had a significantly higher prevalence of nuclear cataract (OR=1.65; 95% CI: 1.10-2.59), cortical cataract (OR=2.11; 95% CI: 1.38-3.24), and history of prior cataract surgery and/or total cataract (OR=2.10; 95% CI: 1.05-4.22). Nuclear cataract was significantly higher in cigar smokers (adjusted OR=1.55; 95% CI: 1.16-2.01) and in cigar smokers who smoked heavily (>21 person-years of smoking; OR=1.50; 95% CI: 1.10-1.95), compared with never-smokers. CONCLUSIONS: Consistent with other studies, tobacco smoking was strongly associated with a higher prevalence of nuclear and cortical cataracts and history of prior cataract surgery in this population. These findings suggest yet another need to educate the community on the importance of cessation of tobacco smoking and perhaps incorporating an antismoking message into school health programs.

Adolescent↗
PubMed2005

[The aqueous humour antioxidative capacity in different types and color of the age-related cataract].

BACKGROUND/AIM: Oxidative stress results from increased oxidative processes, decreased antioxidative protection, or both processes simultaneously. Photooxidative stress, as a form of oxidative stress, induced by the energy of solar radiation, today is considered as crucial in the age-related cataractogenesis. Other known and unknown, endogenous and egsogenous factors that contribute to the oxidative stress intensity, can influnce the cataract type and brunescence. Thus the oxidative stress intensity and its form might determine the cataract type and brunescence, and also make the efforts in cataract prevention more complex. Hence, the objective of the present paper was to investigate the current amount of antioxidative capacity in aqueous humour during the cataract genesis of different types and pigmentation of cataract. METHODS: Transversal review of 80 samples of humour aqueous obtained during extracapsular cataract extraction. Aqueouses were analyzed by tiobarbituric acid (TBA) method for the total antioxidant activity estimation, expressed as %iMDA, and by using 0.1 ml of aqueous. RESULTS: The mixed type of cataract showed the statistically significantly lower values of the intensities of antioxidative protection in aqueous humour compared to cortical and nuclear cataracts (p < 0.001, respectively). Between pure nuclear and cortical cataracts we found the small differences of the investigated parameter, but they pointed to the decreased level of antioxidative protection, i.e. the increased intensity of the aqueous humour oxidative stress in the cortical cataract type. A significant correlation betweer the cortical cataract maturation and the %iMDA (p < 0.05) was found. CONCLUSIONS: The role of the oxidative stress, here expressed as the antioxidative capacity of aqueous humour, could not be the same for all the cataract types. The lower level of antioxidative protection of aqueous in brunescent and mixed cataracts may point to the higher intensity of oxidative stress in those cataract types. The correlation betweer the cortical cataract maturity and %iMDA points to the significant decrease of the aqueous antioxidative protection in the cataract progression.

Aged↗
PubMed2000

Attributable risk estimates for cataract to prioritize medical and public health action.

PURPOSE: Cataract is the most common cause of blindness in the world. The purpose of this study was to estimate the population attributable risk associated with identified risk factors for cortical, nuclear, and posterior subcapsular (PSC) cataract in a representative sample of the Victorian population aged 40 years and older. METHODS: Cluster, stratified sampling was used and participants were recruited through a household census. At locally established test sites, standardized clinical examinations were performed to assess cataract and personal interviews were conducted to quantify potential risk factors. Multivariate logistic regression was used to determine the independent risk factors associated with the three types of cataract, and the population attributable risk was calculated. RESULTS: A total of 3271 (83% of eligible) of the urban residents and 1473 (92%) rural residents participated. The urban residents ranged in age from 40 to 98 years (mean, 59 years), and 1511 (46%) were men. The rural residents ranged in age from 40 to 103 years (mean, 60 years), and 701 (48%) were men. The overall prevalence of cortical cataract was 12.1% (95% CL 10.5, 13.8), nuclear cataract 12.6% (95% CL 9.61, 15.7), and PSC cataract 4.93% (95% CL 3.68, 6.17). Significant risk factors for cortical cataract included age, female gender, diabetes for greater than 5 years, gout for greater than 20 years, arthritis, myopia, average annual ocular UV-B exposure, and family history of cataract (parents or siblings). Significant risk factors for nuclear cataract included age, female gender, rural residence, age-related maculopathy, diabetes for greater than 5 years, smoker for greater than 30 years, and myopia. The significant risk factors for PSC cataract were age, rural residence, thiazide diuretic use, and myopia. Of the modifiable risk factors, ocular UV-B exposure explains 10% of the cortical cataract in the community, and cigarette smoking accounts for 17% of the nuclear cataract. CONCLUSIONS: Because of the near universal exposure to UV-B in the environment, ocular protection has one of the highest modifiable attributable risks for cortical cataract and would therefore be an ideal target for public health intervention. Quit smoking campaigns can be expanded to incorporate information about the excess cataract in the community associated with long-term smoking. Nonmodifiable risk factors such as age, gender, and long-term medication use have implications for the timely referral and treatment for those at higher risk of cataract.

Adult↗
PubMed1995

Cataracts after bone marrow transplantation: long-term follow-up of adults treated with fractionated total body irradiation.

PURPOSE: To determine the risk of, and risk factors for, developing cataracts after bone marrow transplantation. METHODS AND MATERIALS: Four hundred and ninety-two adults who underwent bone marrow transplantation in Seattle were followed for 2 to 18 (median, 6) years. Before transplantation, patients received a preparative regimen of chemotherapy plus total body irradiation (TBI) (n = 407) or chemotherapy alone, without TBI (n = 85). TBI was administered in a single dose of 10 Gy (n = 74) or in fractionated doses totaling 12-15.75 Gy (n = 333). The risk of cataracts was determined for groups of patients with respect to the type of preparative regimen received and other pretransplant and posttransplant variables. RESULTS: One hundred and fifty-nine patients (32%) developed cataracts between 0.5 to 11 (median, 2.3) years after transplantation. The probability of cataracts at 11 years after transplantation was 85%, 50%, 34%, and 19% for patients receiving 10 Gy of single-dose TBI, > 12 Gy fractionated TBI, 12 Gy fractionated TBI, and no TBI, respectively (p < 0.0001). Among those developing cataracts, the severity was greater in patients after single-dose TBI (59% probability of surgical extraction) than after > 12 Gy fractionated TBI, 12 Gy fractionated TBI, or no TBI (33%, 22% and 23%, respectively). Patients given corticosteroids after transplant had a higher probability of cataracts (45%) than those without steroids (38%) (p < 0.0001). In a proportional hazards regression model, the variables that were correlated with an increased probability of cataracts were single-dose TBI (relative risk (RR) = 2.46) and steroid therapy (RR = 2.34), while a decreased probability of cataracts was correlated with a nonTBI preparative regimen (RR = 0.41). The yearly hazard of developing cataracts in recipients of single-dose TBI was highest during the third year after transplantation, while in recipients of fractionated TBI, the hazard was distributed among years one through seven. The probability of cataracts in all groups reached a plateau at 7 years after transplantation, after which the development of cataracts was extremely unlikely. CONCLUSION: TBI is the major risk factor for developing cataracts after BMT. Single-dose TBI results in the highest risk of cataracts. However, the risk of cataracts in recipients of fractionated-TBI is significantly higher than in patients who receive no TBI. In addition to TBI, steroid therapy is an independent risk factor for cataracts after BMT.

Adolescent↗
PubMed1997

Prevalence of cataract in Australia: the Blue Mountains eye study.

PURPOSE: The authors determined the age and gender-specific prevalence of nuclear, cortical, and posterior subcapsular cataract (PSC) in a representative sample of older Australians. METHODS: As part of a population-based study of eye disease in the Blue Mountains, west of Sydney, 3654 people aged 49 to 96 years underwent a detailed eye examination, including lens photography (slit-lamp and retroillumination). The photographs were assessed by masked graders using the Wisconsin Cataract Grading System, with acceptable reproducibility. RESULTS: Past cataract surgery had been performed in either eye of 6.0% and in both eyes of 2.9% of participants in this study, equally in men and women. Moderate or advanced nuclear opacities were present in 53.3% of women and 49.7% of men. Moderate cortical cataract was present in 25.9% of women and 21.1% of men. Posterior subcapsular cataract was less frequent, found in 6.2% of women and 6.5% of men. After adjusting for age, these gender differences were statistically significant only for cortical cataract. The age-specific prevalence rates found for early and late cataract or for past cataract surgery are very similar to rates reported in the Beaver Dam Eye Study (BDES), Wisconsin, using the same definitions. Comparison of age-specific rates for each cataract type indicated lower rates for nuclear cataract, slightly lower rates for PSC and slightly higher rates for cortical cataract compared with the BDES. However, the rates for nuclear cataract were the only statistically significant differences between the two studies. Previously described susceptibility of the lower nasal lens to cortical cataract was confirmed, supporting a potential role of sunlight exposure in its development. CONCLUSIONS: The Wisconsin cataract grading system was used in an older Australian population with acceptable reproducibility. The Blue Mountains Eye Study found similar age-specific prevalence rates for most of the types and stages of cataract compared with the BDES.

Aged↗
PubMed1998

Non-destructive analysis of the conformational changes in human lens lipid and protein structures of the immature cataracts associated with glaucoma.

Previous study has supposed a possible mechanism of exacerbating cataract formation in cataractous human lens capsules induced by hypertension or glaucoma. To clarify the glaucoma-induced cataract formation of the eyes lens, changes in the human lens lipid and protein structures of immature cataractous patients with or without glaucoma were investigated. Two normal lenses, ten immature cataractous lenses without any complication and four immature cataractous lenses with glaucoma were used after surgical operation. Each de-capsulated human lens sample was sliced with a number 15 surgical blade. The intact nuclear lens regions were used for non-destructive analysis. The lens lipid and protein structures, as well as compositions of these lens samples, were determined using a Fourier transform infrared (FTIR) microspectroscopy with second-derivative, de-convolution and curve-fitting methods. The results indicate that the IR spectrum of glaucomatous lenses appeared as a shoulder only at 2853 cm-1, thus the composition of the symmetric CH2 stretching band at 2853 (2852) cm-1 decreased more significantly in glaucomatous lens to only one half of that in normal and immature cataractous lenses. The composition of the asymmetric CH3 stretching band at 2965 cm-1 for normal lens decreases markedly from 32 to 20% for immature cataractous lenses with or without glaucoma. The compositional ratio of component at 2965 cm-1 to component at 2928 (2930) cm-1 for normal lenses was about 0.702, and that ratio for cataractous lenses without glaucoma was 0.382 but for glaucomatous lenses was 0.377. The maximum peak position of amide I band for IR spectra of the normal lens, immature cataractous lenses without complications or glaucomatous lenses appeared respectively at 1632, 1630 or 1622 cm-1, assigned to beta sheet structure. A marked difference in peak intensity of amide I band for the normal lenses and immature cataractous human lenses with or without glaucoma was observed. The peak intensity ratio of amide I/amide II (1632/1545 cm-1) for normal lenses was in the range of 2.20-2.33, whereas in the spectra of immature cataractous lenses without glaucoma this ratio (1630/1545 cm-1) was 1.28-1.41 but was 1.04-1.13 for glaucomatous lens in the intensity ratio of 1622/1545 cm-1. The intensity of the glycogen bands in the wavenumber region 1135-1076 and 1069-1032 cm-1 was found to increase for the immature cataractous lenses with or without glaucoma, as compared with the normal ones. The peaks ranging from 1633 to 1610 cm-1 assigned to beta-sheet structure also exhibited a pronounced compositional difference, particularly in glaucomatous lenses. The human lens lipid and protein secondary structures were more affected by glaucoma. Higher protein side chains and reduced lipid content contributed predominantly to the CH stretching vibrations of normal lens structure, whereas high lipid content and less protein side chains dominated the CH stretching vibrations of cataractous lenses with or without glaucoma. Decrease alpha-helix and random coil structures but enhanced beta-sheet structure in the immature cataractous human lens induced by glaucoma might result from the formation of intermolecular hydrogen-bonding insoluble protein aggregates that modify the secondary structure of protein in lenses.

Adult↗
PubMed2004

Coverage of cataract surgery per person and per eye: review of a community-based blindness survey in Oman.

BACKGROUND AND OBJECTIVE: The data from a national survey of blindness and common eye diseases in Oman in 1996 were reviewed. The objective was to compare the calculation of cataract surgery services coverage on a per eye and per person basis. The advantages and limitations of both methods of program management are evaluated. METHODS AND MATERIALS: The information on cataract status, visual status and past history/evidence of cataract surgery was collected for 11,415 Omani subjects. The coverage of existing cataract services was calculated per eye and per person. The rates by gender, age groups, regional groups and type of cataract were also compared. RESULTS: The cataract surgery services could address more than 60% of the reported persons with blinding cataract (vision less than 3/60) and more than half of the eyes with blinding cataract. The services could cover more than one-fourth of the persons with cataract (with any grade of vision defect) and less than one-fourth of the eyes with cataract. If the coverage of cataract services for blinding cataract is calculated using persons as the denominator, it is nearly 10% higher than that calculated using eyes as the denominator. CONCLUSIONS: The two methods of calculating the coverage of cataract services give different results and both are useful for monitoring ophthalmic services. A national program should implement a system for reporting the visual and cataract status of the fellow eye so that coverage rates could be calculated by person and by eye and the impact of the cataract services in relation to time, place, gender and resources could be reviewed.

Adult↗
PubMed2004

Risk factors for age related cataract in a rural population of southern India: the Aravind Comprehensive Eye Study.

AIM: To determine risk factors for lens opacities and age related cataract in an older rural population of southern India. METHODS: A cross sectional population based study of 5150 people aged 40 years and above from 50 clusters from three districts in southern India. The lens was graded and classified after dilation using LOCS III system at the slit lamp for cataract. Definite cataract was defined as nuclear opalescence >/=3.0 and/or cortical cataract >/=3.0 and/or PSC >/=2.0. RESULTS: Definite cataracts were found in 2449 (47.5%) of 5150 subjects and the prevalence of cataract increased with age. The age adjusted prevalence of cataract was significantly lower in males (p = 0.0002). Demographic risk factors-increasing age and illiteracy-were common for the three subtypes of cataract; females were more likely to have cortical cataracts and nuclear cataracts. Additionally, nuclear cataracts were associated with moderate smoking (OR:1.28, 95% CI:1.01 to 1.64), lean body mass indices (OR: 1.37, 95% CI: 1.17 to 1.59) and higher waist to hip ratios (OR: 0.67, 95% CI: 0.54 to 0.82); cortical cataracts with hypertension (OR: 1.39 95% CI:1.11 to 1.72), pseudoexfoliation (OR:1.53,95% CI:1.17 to 2.01), and moderate to heavy smoking; and posterior subcapsular cataracts with diabetes (OR:1.55, 95% CI:1.12 to 2.15), lean body mass (OR:1.32, 95% CI:1.11 to 1.57), and high waist to hip ratios (OR: 0.77, 95% CI: 0.62 to 0.94). CONCLUSIONS: Risk factors for age related cataract in this population do not appear to be different from those reported in other populations. Further studies are required to identify the reason for the high prevalence of age related cataract and to understand better the role of each risk factor for cataractogenesis in this population.

Adult↗
PubMed2001

[Binocular vision after cataract surgery in children--long-term results].

PURPOSE: To evaluate quality of binocular vision in dependence on type of cataract, time of surgery and type of aphakic correction with minimal 5 years follow up. METHODS: 127 children divided into 3 groups: Group A--24 children with monolateral congenital cataract, Group B--56 children with bilateral congenital cataract, Group C--47 children with traumatic cataract. Binocular vision results were evaluated 5-10 years after cataract surgery subordinated on the type of aphakic correction-PC IOL, contact lenses, spectacles, type of cataract (congenital mono or bilateral, traumatic) and time of cataract surgery. RESULTS: Group A: Binocular vision in 56% children with cataract surgery in the first 3 months of age and only 20% of binocular vision in children operated later. Binocular vision results in dependence on aphakic correction (46% in contact lens subgroup, 44% in PCIOL subgroup without statistically significant differences. Group B: Binocular vision in 76% of children operated in the first 3 months of age, and 79% of children operated later. Binocular vision in 68% of children in spectacle aphakic correction subgroup, 67% of children in contact lenses subgroup, and 75% of children in primary or secondary implanted PC IOL subgroup. Group C: Binocular vision in 80% of children with contact lenses subgroup, and in 84% of children with implantation PC IOL. CONCLUSION: Better results of binocular vision quality have children with cataract extraction in the first three months of age then children operated later in group with monolateral congenital cataract. Primary or secondary implantation of PC IOL was find to the better aphakic correction for the binocular visual results in the groups with bilateral congenital cataract and traumatic cataract than other types of aphakic correction. Amblyopia is a major determinate of visual outcome in childhood cataract. The timing of surgery--the early cataract removal will continue to be more important than the method of aphakic optical correction, especially in the case of monolateral congenital cataract.

Cataract↗
PubMed2004

Functional vision with cataracts of different morphologies: comparative study.

PURPOSE: To evaluate the influence of cataract morphology on the functional vision of patients with age-related cataract and normal macular function and compare subjectively perceived functional impairments to distance visual acuity, reading acuity, and maximum reading speed between cataract types. SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS: Seventy-five patients awaiting first-eye cataract surgery were asked to characterize their visual difficulties in everyday life using a German version of the VF-14 questionnaire. Cataracts were categorized and graded using the Lens Opacities Classification System III. Monocular and binocular visual acuity and reading performance were determined in randomized order. RESULTS: There were significant differences in functional vision between nuclear cataracts and posterior subcapsular cataracts (PSC); the VF-14 score and the self-reported visual satisfaction were significantly lower in PSC patients (P<.05). Posterior subcapsular cataracts significantly increased self-reported impairment in distance and near vision, although the visual acuity was comparable to that in the other groups (P =.9). Significant differences in functional vision were also seen between PSC and nuclear-cortical cataracts (P<.05). No significant differences in functional vision were found between nuclear cataracts and nuclear-cortical cataracts (P>.05). CONCLUSIONS: The VF-14 questionnaire reliably evaluated functional differences caused by different cataract morphologies; these differences were underestimated when only visual acuity was measured. Patients with PSC had increased functional impairment, indicating that cataract surgical intervention is indicated at an earlier stage in these patients. The significant differences between the morphological types of cataract should be taken into consideration when the benefit of cataract surgery is to be measured on the basis of functional improvement.

Activities of Daily Living↗