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PubMed1999

Effects of age, sex, cataract, and cataract surgery on serum gamma-crystallin concentration.

PURPOSE: To determine if measurement of lens protein in serum is a feasible means to gain information on the physiologic status of the lens in human subjects. METHODS: The gamma-crystallin concentration was measured by a sandwich radioimmunoassay in the sera of 280 subjects aged 25-94 years. Medical records were reviewed for diagnoses of cataract and aphakia. RESULTS: There was no effect of age or sex on the serum gamma-crystallin concentration. There were 57 subjects with cataract and 27 with aphakia. gamma-Crystallin was higher in all cataract groups and lower in aphakia. The mean gamma-crystallin concentrations for selected subject groups were as follows: clear lens 301 pg/ml; pure nuclear cataract 344 pg/ml; pure cortical cataract 439 pg/ml and aphakia 255 pg/ml. CONCLUSIONS: This is the first published report to show that lens protein is measurable in serum and to demonstrate the feasibility of using serum assays of lens proteins to gain information on the physiological status of the lens. Our results confirm the hypothesis that molecular and cellular events leading to cataract cause increased leakiness of lens cell membranes with release of lens proteins appearing in the blood. It is conceivable that measurement of lens proteins in serum might find future use in the evaluation of cataract risk, potentially cataractogenic and anticataractogenic agents, retained lens fragments after phacoemulsification, secondary cataract, phacolytic glaucoma, anaphylactic endophthalmitis, eye injuries, and other eye diseases.

Adult↗
PubMedDate not supplied

Cataract surgery output and cost of hospitalization for cataract surgery in the University of Benin Teaching Hospital.

Cataract is the most common cause of curable blindness in Nigeria. Nigeria has an overall population of approximately 110 million with a blindness prevalence rate of 1%. Cataract is responsible for 30 - 60% of the blindness. A great deal of blindness prevention activity should therefore centre around cataract surgery if we are to clear out cataract back log of over 1/2 a million individuals. Only 106 cataract surgeries were performed in the 24 months reviewed. There were 75 males and 31 females. This study highlights the meagre contribution of teaching hospitals to the prevention of blindness. Several factors including ignorance, poverty, socioeconomic and political tensions and teaching hospital bureaucracy are no doubt responsible for this. Hospitalization for cataract surgery is becoming very unpopular in the developed world as this tends to increase cost of surgery. The need to establish cataract surgery outreach services and adopt day case surgical procedures in our hospitals cannot be over emphasized as strategies for clearing our national cataract backlog.

Adolescent↗
PubMed1996

Risk of retinal detachment following cataract extraction: results from the International Cataract Surgery Outcomes Study.

AIMS: To estimate the risk of retinal detachment (RD) following cataract extraction in Denmark, and to compare the risk with that following cataract extraction in the USA, and with that in a sample of Danish patients who did not have ocular surgery. METHODS: A sample was created from the administrative Danish Hospital Register and included 19,252 patients who underwent first eye cataract surgery between 1985 and 1987, and who were 50 years of age or older. The patients were then followed for 4-6 years using the register data. The design and definition of events were identical to the US National Study of Cataract Outcomes. RESULTS: In Denmark a 4 year cumulative risk of hospitalisation for RD of 0.93% (95% confidence interval (CI) 0.71-1.16) was observed following an extracapsular cataract extraction with a lens implant. A similar cumulative risk of RD was reported from the US study. Thus, no difference in outcomes concerning risk of RD was shown between Denmark and the USA. In a multivariate analysis younger age, male sex, and intracapsular cataract extraction were all associated with higher risk of postoperative RD. A reference group of 7636 people not undergoing any ocular surgery was created and the incidence of RD in this group was calculated. During the sixth year following cataract surgery, the incidence of RD in the cataract group was still 7.5 (95% CI 1.6-22.0) times higher than that observed in the reference group.

Age Factors↗
PubMed2006

Delay of cataract development in the Shumiya cataract rat by the administration of drinking water containing high concentration of magnesium ion.

We discovered that the cataract development in the Shumiya cataract rat (SCR) can be prevented by the administration of deep-sea drinking water (DDW). A standard diet based on the American Institute of Nutrition guidelines (AIN-76) and DDW containing a high mineral concentration such as low, medium and high Mg2+ content (50, 200 and 1000 mg of Mg2+/l, respectively) were used in this study. SCRs were freely fed with combinations of the standard diet and purified water or DDW during 5-15 weeks of age. The opacities of SCR lenses were documented by anterior eye segment analysis system EAS-1000. The onset of opacification of cataractous SCR lenses administered a combination of standard diet and purified water started at 11 weeks of age, and mature cataracts had formed at 13 weeks of age. However, the supplementation of Mg2+ by administration with medium DDW showed the greatest effect of delay of cataract onset in SCR. In addition, even cataractous SCR lenses at 14 weeks of age showed differences in opacity level. The opacification and Ca2+ of the lenses in cataractous SCR administered medium DDW were lower than those administered purified water. In conclusion, the present study demonstrates that administration of DDW potently delays cataract development in SCR, and this may be caused by inhibiting the increase in Ca2+ levels in the lens.

Animals↗
PubMed2006

Involvement of DNase II-like acid DNase in the cataract formation of the UPL rat and the Shumiya cataract rat.

The loss of organelles and DNA is important to ensure transparency of the lenses, and DNase II-like acid DNase (also called DNase IIbeta, DLAD) is related to the loss of organelles and DNA in the lenses. We investigated the relation between the degradation of DNA and DLAD mRNA expression in the lenses of two hereditary cataract rats, the UPL rat (UPLR) and the Shumiya cataract rat (SCR), during cataract development. Undigested DNA was detected in the lens cortexes of normal UPLRs and SCRs, and undigested DNA was degraded in the lens nuclei of normal UPLRs and SCRs. DLAD does not affect common cataract formation, since DLAD mRNA expression levels in the lenses of cataractous SCRs were not changed with an increase in age, and undigested DNA was degraded in the lens nuclei of cataractous SCRs. On the other hand, an accumulation of undigested DNA was found in the lens nuclei of cataractous UPLRs at 46 and 53 d of age with opaque lenses, and the decrease in DLAD mRNA expression levels occurred prior to the accumulation of undigested DNA in the lens nuclei. It is possible that UPLRs are a good model for cataract caused by a decrease of DNA degradation in the lenses.

Animals↗
PubMed2003

The risk of a new retinal break or detachment following cataract surgery in eyes that had undergone repair of phakic break or detachment: a hypothesis of a causal relationship to cataract surgery.

PURPOSE: To determine the risk of new retinal tear or detachment following cataract surgery in eyes that had undergone successful repair of phakic retinal tear or detachment. METHODS: A computerized search of records of patients evaluated at the Barnes Retina Institute from 1990 to 2000 for a diagnosis of phakic retinal tear or detachment was accomplished. The records of successfully treated patients were analyzed by type of tear or detachment, method of treatment, and development of sequential new tears or detachment. Eyes that subsequently underwent cataract surgery were classified by presence and location of intraocular lens as well as operative complications, including capsular rupture, vitreous loss, or retained lens fragments. The frequency of developing new tears or detachment was calculated. RESULTS: The 2,175 eyes identified were subdivided according to those that had undergone repair of retinal break (n = 1,415), subclinical retinal detachment (n = 396), or retinal detachment (n = 364). Of 371 eyes that underwent subsequent cataract surgery, 17 (4.6%) developed a new tear or detachment postoperatively. Factors indicative of higher postoperative risks included myopia, tear or detachment in the fellow eye, sequential onset of new breaks prior to cataract surgery, and complications of cataract surgery. CONCLUSION: In patients who had undergone prior repair of retinal breaks or detachment, cataract surgery was associated with a 4.6% incidence of new breaks or detachment. Cataract surgery appears to be an independent risk factor for retinal tears or detachments. Dilated retinal examination following cataract surgery is advisable in patients who have previously undergone repair of a phakic retinal tear or detachment.

Cataract Extraction↗
PubMed2005

Outcomes of cataract surgery in senile cataract patients at Siriraj Hospital: a prospective observational study.

The present study was done to assess the results of cataract surgery performed in Siriraj Hospital by comparing phacoemulsification and extracapsular cataract extraction techniques in senile cataract patients within a 3-month period. The prospective observational study of a representative sample of 379 patients (409 eyes) who underwent cataract surgery in Siriraj Hospital from January 1, 2004 to March 31, 2004. Identical clinical assessment protocol was used to compare the improvement of postoperative visual acuity and surgical complications between two surgical techniques and different surgeons. Of the 409 eyes, phacoemulsification was performed on 373 eyes (91.2%), and extracapsular cataract extraction was performed on 36 eyes (8.8%). Departmental staff operated on 326 eyes (79.7%) and ophthalmology residents operated on 83 eyes (20.3%). The primary outcome was postoperative visual acuity. Visual acuity was improved > or = 2 Snellen chart lines in 278 of 373 eyes (74.5%) in the phacoemulsification group, and > or = 2 lines in 31 of 36 eyes (86.1%) in the extracapsular cataract extraction group. A small risk of surgical complications was found in the present study. Posterior lens capsule rupture was the most frequent complication found (10/ 409 eyes), followed by corneal injury (9 of 409 eyes). Endophthalmitis was the most severe complication in the present study, occurring in 1 of 409 eyes. There was a significant difference in postoperative visual improvement between phacoemulsification and extracapsular cataract extraction techniques. Final visual acuity in the phacoemulsification group was better than in the extracapsular cataract extraction group.

Age Factors↗
PubMed1995

[Cataract epidemiology survey in the three climatically different areas in Japan--prevalence of cataracts and types of lens opacification].

A cataract epidemiology study of 1,615 subjects from three climatically different places in Japan, village S in Hokkaido, town M in Noto and village Y in Okinawa, was conducted by one study group. Cataract diagnosis and grading of cataracts were objectively done with a photo-documentation system. The percentages of cataracts of over grade I classified by the Japanese Cooperative Cataract Epidemiology Study Group were 46.6%, 64.6% and 38.0% in village S, town M, and village Y, respectively. Those in their 50s, 60s, and 70s in the above places were 24.3%, 51.1% and 71.4% (village S), 38.4%, 65.3% and 84.6% (town M), and 25.2%, 42.9% and 65.4% (village Y), respectively. Cortical cataract was the most common, followed by nuclear and subcapsular types. Although the highest percentage of nuclear cataracts was seen in the subjects of village Y, subcapsular cataract was seen almost equally in the three areas. Lens transparency changes were evaluated by the light scattering intensities in the lens layers through photographed images. Intensity increased with ageing either linearly or exponentially.

Adult↗
PubMed1994

Influence of type and severity of pure forms of age-related cataract on visual acuity and contrast sensitivity. Italian American Cataract Study Group.

PURPOSE: To compare the relationship between logMAR visual acuity (VA) and cataract severity and between contrast sensitivity (CS) and cataract severity in pure types of age-related lens opacities. METHODS: Analysis included patients followed in the ongoing Italian-American Study of the Natural History of Age-Related Cataract. Lens opacities were classified and graded according to the Lens Opacities Classification System II (LOCS II). Visual acuity was measured with the Early Treatment Diabetic Retinopathy Study Chart. Contrast sensitivity was measured with the Pelli-Robson chart. RESULTS: Data from 1,076 eyes were used for the analysis (366 clear lenses; 550, 124, and 36 eyes with cortical, nuclear and posterior subcapsular cataract, respectively). In age-adjusted analyses, increasing severity of all three cataract types was associated with progressively higher logMAR VA, which translates into poorer acuity, and lower CS scores. For both VA and CS, the effect of increasing severity was greatest for nuclear and least for cortical opacities. After adjusting for age and VA, CS scores were no longer associated with cataract type and severity, with the exception of advanced cortical opacities. CONCLUSIONS: Increased cataract severity, as determined by LOCS II grading, is strongly associated with both VA and CS scores. Contrast sensitivity scores obtained from testing at low spatial frequency do not seem to offer additional information over standard VA testing in early cortical and posterior subcapsular opacities nor in nuclear cataracts.

Aged↗
PubMed2002

Iris color and incident cataract and cataract surgery: the Blue Mountains Eye Study.

PURPOSE: To assess whether an association exists between iris color and the incidence of cataract and cataract surgery. DESIGN: Population-based cohort study. METHODS: The Blue Mountains Eye Study examined 3654 predominantly Caucasian participants aged 49+ years during 1992-1994, and then 2335 survivors (75.1%) after 5 years. Iris color was determined by comparison with four standard photographs. Slit-lamp and retro-illumination lens photographs were graded for presence and severity of cortical, nuclear, or posterior subcapsular cataract. Incident cataract surgery was recorded by history and from the photographs. RESULTS: Participants with dark brown iris color had an increased incidence of nuclear cataract, odds ratio (OR) 1.8, 95% confidence interval (CI) 1.2 to 2.8, and cataract surgery (OR, 2.5; CI, 1.4-4.2) in multivariate models, compared with participants with blue iris color. CONCLUSION: Incidence data from this study support previous cross-sectional findings linking dark brown iris color with age-related cataract.

Aged↗
PubMed2003

Projected prevalence of age-related cataract and cataract surgery in Australia for the years 2001 and 2021: pooled data from two population-based surveys.

This study aimed to estimate the number of Australians over 50 with cataract in the years 2001 and 2021. Data from two population-based studies were pooled: the Blue Mountains Eye Study and Melbourne Visual Impairment Project and Australian Bureau of Statistics population projections were used. Similar definitions for the three cataract types were used in the two studies (nuclear >/= grade 4, posterior sub-capsular >/= 1 mm, cortical >/= 10% lens area or >/= 25% circumference). Combining the three types and prior surgery, it was estimated that in 2001, 1.7 million Australians had clinically significant cataract in either eye and 320,000 had previously undergone cataract surgery. It was estimated that the number of persons with cataract will rise to 2.7 million by 2021 (over 500,000 will have had cataract surgery). The number of Australians with cataract will grow by two-thirds during the next 20 years, reflecting continued population ageing. Health care delivery systems will need to develop methods to handle this increased workload.

Aged↗
PubMed1998

Socioeconomic barriers to cataract surgery in Nepal: the South Asian cataract management study.

BACKGROUND: Previous studies have shown that, despite an increasing availability of cataract surgery, important socioeconomic barriers exist in the acceptance of surgery in many rural areas of south Asia. Nepal has developed a comprehensive national network of eye hospitals but the surgical coverage for the treatment of cataract blind is still low. AIMS: To determine the utilisation of cataract surgery and the level of physical and psychosocial impairment and the socioeconomic barriers to surgery in a group of non-acceptors of surgery. METHODS: Of 319 cataract patients identified in a field screening 96 non-acceptors of surgery were interviewed 1 year after an offer to undergo surgery. The interview included questions on visual function, quality of life, and socioeconomic variables on acceptance of cataract surgery. The quality of life questionnaire was based on the field validated protocol addressing the impact of visual impairment on physical and psychosocial functions. The questionnaire was adapted to the local conditions after pretesting. Data were analysed by degree of visual impairment. RESULTS: Of 319 cataract patients identified only 45.5% accepted surgery, with men accepting surgery more readily than women (RR = 1.31; 95% CI = 1.04-1.67) because of a significantly greater acceptance of surgery in men in the non-blind group. The acceptance rate was significantly higher in the blind group (RR = 1.74; 95% CI = 1.36-2.22) compared with those patients having impairment of vision and severe loss of vision. Of 96 non-acceptors interviewed only a further 13% accepted surgery after a second counselling. The most frequent reasons given for not accepting surgery were economic (48%) and logistical (44.8%) constraints followed by fear of surgery (33.3%) and lack of time (18.8%). Half of the subjects complained of problems with self care but only 10% needed help for their most basic every day activities. 17.7% said they needed help to visit neighbours and 26% needed help to attend the field or market. CONCLUSIONS: It was found that in this population with a majority of patients with severe vision loss and blind, even when offered transport and free surgery the utilisation of cataract surgery is below 60%. Medicine tends to be prescriptive based on technological advances that it is able to offer. Medical practice needs to develop a more holistic understanding of the needs of the communities cultivating a greater capability to analyse the role of cultural, social, and economic factors when planning medical services for the population.

Activities of Daily Living↗
PubMed1992

Secondary cataract. An in vivo model for studies on secondary cataract in rabbits.

Secondary cataract formation is the most common postoperative complication following cataract surgery. To study different methods preventing the secondary cataract formation a relevant animal model is required. An in vivo rabbit model for studies on the prevention of secondary cataract formation is presented. The lens nucleus and cortex were removed by phacoemulsification, and two months later the growth of the secondary cataract was estimated by scoring on a scale from 0-4, both central and peripheral, and by measuring the wet mass of the dissected secondary cataract. The model seems to be a relevant way to study different concepts for the prevention of secondary cataract formation.

Animals↗
PubMed1981

Studies on human cataracts. I. Evaluation of techniques of human cataract preservation after extraction.

The effects of several media and temperatures on the features (i.e. classification) of human cataracts have been studied with the aim of defining those storage conditions that least alter the appearance of the cataract after extraction. It was found that distilled water, normal saline, TC 199 medium with extra bicarbonate and 5.5 mM glucose, and silicone oil at 4 degrees, 36 degrees, and 37 degrees C are all unsatisfactory for preserving cataracts for more than 1 hr. Normal saline and TC 199 medium with bicarbonate and glucose are satisfactory for period not exceeding 30 to 60 min at 4 degrees C. The best set of conditions, one that leads to no significant change in the appearance of the cataract, is storage in a small covered glass vial at 4 degrees C with no added fluid. In this moist chamber, no significant changes in cataract classification occurred during a 4 hr period. The effect of -20 degrees C for 15 min on the appearance of a nuclear cataract was negligible, and it was concluded that lenses so treated could be used for a correlation between the nuclear cataract's CCRG classification and its light scattering properties, as studied in Parts II and III.

Cataract↗
PubMed1997

International variation in anesthesia care during cataract surgery: results from the International Cataract Surgery Outcomes Study.

OBJECTIVES: To describe international variation in anesthesia care and monitoring during cataract surgery and to discuss its implications for cost and safety. METHODS: A standardized questionnaire was sent to random samples of ophthalmologists in the United States, Canada, and Barcelona, Spain, and to all ophthalmologists in Denmark. The survey was conducted in 1993 and 1994. Certified ophthalmologists who had performed 1 or more cataract extractions in the previous year were eligible for enrollment. RESULTS: The response rates were 62% in the United States (n=148), 67% in Canada (n=276), 70% in Barcelona (n=89), and 80% in Denmark (n=82). The anesthetic technique for cataract surgery varied significantly between sites (P<.001). Surgeons reported that retrobulbar blocks were used for 46% of the cataract extractions in the United States, 70% in Canada, 66% in Denmark, and 31% in Barcelona. In Barcelona, general anesthesia was used for 23% of the cataract extractions; it was used for less than 3% of the extractions at the other 3 sites. Peribulbar blocks or topical anesthesia was used for the remaining extractions. In the United States, Canada, and Barcelona, surgeons reported that vital functions were monitored during more than 97% of the extractions and anesthesia surveillance was used during more than 78% of the extractions. In Denmark, ophthalmologists reported that vital functions were monitored and anesthesia surveillance was used for 1% of the cataract extractions (P<.001). CONCLUSIONS: Substantial international variation in anesthesia care and monitoring during cataract surgery was observed. The findings suggest a need for further research to determine whether less intensive monitoring is cost-effective.

Anesthesia↗
PubMed1984

Classification of human cataractous change by the American Cooperative Cataract Research Group method.

The American Cooperative Cataract Research Group (CCRG) has adopted a system of classifying cataractous changes in excised human cataracts that is based on separate and independent photographic documentation of opacification and nuclear colour. The classification data can be simplified according to the needs of the scientist in his or her effort to measure clinically or scientifically significant associations between laboratory measures and cataractous change. The association between nuclear colour and the extent of cortical opacification and the intensity of nuclear opacification has been studied and found to be insignificant. These results justify the recommendation that nuclear colour be abandoned as the single index of severity of any type of senile cataractous change. The adaptability of this system to in vivo use in epidemiological and other studies of the natural history of cataractous change is discussed. Its limitations are outlined. The system may offer a basis for international cooperation in cataract classification.

Cataract↗
PubMed1994

A dose-response effect between a sunlight index and age-related cataracts. Italian-American Cataract Study Group.

To explore the existence of a dose-response relationship between sunlight exposure and risk of age-related cataracts, we analyzed data collected from 1008 patients with cataracts and 469 control subjects enrolled in the Italian-American Case-Control Study of Age-Related Cataracts. Fourteen variables related to sunlight exposure history were included in the questionnaire administered to the study participants. A sunlight index was constructed and its relationship to the presence of cataracts was modeled by logistic regression. After adjustments for potential confounding variables and for age and sex, a significant dose-response effect (P = 0.01) was detected between the sunlight exposure index and the presence of pure cortical cataracts. With the exception of corticonuclear cataracts, all the other mixed types of opacity also showed a dose-response association with the sunlight index. These data support the hypothesis that sunlight exposure is a risk factor in the development of cortical cataracts, and demonstrate the existence of a dose-response relationship in this association.

Aged↗
PubMed2003

Delay of cataract development in hereditary cataract UPL rats by disulfiram and aminoguanidine.

The UPL rat is a newly developed hereditary cataract model. We previously found that the administration of disulfiram, a dimer of diethyldithiocarbamate that possesses antioxidant activity, and aminoguanidine, which is known to inhibit inducible nitric oxide synthase, inhibits cataract development in selenite-induced cataract rats. In this study, we investigated the anti-cataract effects and mechanism of disulfiram and aminoguanidine on UPL rats. The opacities of UPL rat lenses, as documented by the anterior eye segment analysis system, EAS-1000 (Nidek, Aichi, Japan), increased from 39 days, and apparently mature cataracts were observed at 53 days. Accompanied with the increase in lens opacity, glutathione concentrations in UPL rat lenses decreased. The Na(+) to K(+) and water-insoluble to water-soluble protein ratios, as well as the Ca(2+) contents in UPL rat lenses increased with the development of cataracts. Oral administration of disulfiram and aminoguanidine delayed the lens opacification as well as the changes in glutathione, Na(+) to K(+) ratio, water-insoluble to soluble protein ratio, and Ca(2+) content in UPL rat lenses. The opacity and Ca(2+) content of UPL rat lenses were closely associated. The present study demonstrates that disulfiram and aminoguanidine have potency of the delay of cataract development in UPL rats, probably caused by inhibiting the rise in Ca(2+) levels.

Aging↗