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PubMed1994

Pediatric cataracts--diagnosis and treatment.

This paper discusses the causes and treatment of congenital and acquired cataracts in children. Although congenital cataracts are relatively uncommon, they are one of the leading causes of serious visual impairment in neonates. Successful visual rehabilitation of these patients is predicted on prompt diagnosis and surgical and optical intervention. The issue of deprivation amblyopia and the critical period of visual development are integral to their effective treatment. Acquired cataracts are more common than congenital cataracts. They are usually easier to treat because vision developed before the formation of the cataract and deprivation amblyopia is not present. The treatment of pediatric cataracts is made more complicated than cataracts in adults because of the growth and development of the eye and the inevitable necessity of treating amblyopia.

Amblyopia↗
PubMed1994

Assessing retinal/neural function in patients with cataract using oscillatory displacement thresholds.

Oscillatory displacement threshold (ODT) measurement has been proposed as a useful means of assessing retinal/neural function behind cataract. In order to examine the qualitative predictive ability of this technique, the influence of age, simulated cataract, and various posterior segment disorders upon ODT's were investigated. In a separate investigation, thresholds were measured in 30 cataract patients on the eve of surgery, and again 6 to 8 weeks postoperatively. ODT's were found to increase with age (p < 0.001) and were highly resistant to the effects of image degradation as produced by simulated cataract. In addition, thresholds were sensitive to the presence of retinal/neural disorders (p << 0.001). Although not completely independent of the presence of cataract, higher ODT's were measured in cataract patients with coexistent retinal/neural dysfunction than was the case for patients with normal posterior segments (p < 0.001). Preoperative ODT measurement may offer a means of distinguishing between the optical and retinal/neural components of visual impairment in patients with cataract.

Adolescent↗
PubMed1996

Management of coincident glaucoma and cataract.

Cataract and glaucoma are two very common conditions that frequently are coincident within the same patient. The surgical treatment of the patient with both cataract and glaucoma has changed considerably in the era of small-incision cataract surgery. Additionally, many surgeons are employing antimetabolites routinely in combined phacoemulsification and trabeculectomy. This article reviews the literature as it pertains to combined cataract and glaucoma surgery within the 1-year scanning period. This is not a comprehensive review in that many very important articles are excluded because they were published either before or after the scanning period. The important topics included within this article involve the use of mitomycin C in combined surgery, the comparison of combined phacoemulsification and combined standard extracapsular procedures, long-term results of combined cataract and glaucoma surgery, the survival of filtration blebs after cataract extraction in eyes that had previous trabeculectomy, new techniques of combined surgery including clear corneal cataract extraction combined with trabeculectomy, and the effect of phacoemulsification on intraocular pressure in patients with and without glaucoma.

Cataract↗
PubMed2001

Indications for cataract surgery.

This review article will attempt to guide ophthalmologists in deciding the indications for cataract surgery. It will consider this year's visual function questionnaires, ancillary vision tests, and postoperative outcome measures to assess visual function. Cultural factors, age, and gender are a few of the confounding variables in trying to assess visual function. The indications for cataract surgery in the 21st century have evolved dramatically since cataract surgery was first performed in the 1700s. The physicians' dictum in the Hippocratic oath of "do no harm" has determined the indications for cataract surgery over time. Today, doing no harm means operating on cataracts earlier than previously, as this is technically easier than in previous years, when poorer surgical techniques prevailed. However, are we operating on cataracts too early? This review will attempt to highlight the relevant factors that will help to determine the indications for cataract surgery.

Activities of Daily Living↗
PubMedDate not supplied

Early-onset unilateral electric cataract: a rare clinical entity.

Electrical injury may result in cataracts, which usually occur bilaterally. In this report, we present a rare complication of such an injury presenting as a unilateral cataract in a 33-year-old woman with a painless but gradual worsening of vision in her left eye 3 weeks after sustaining a high-voltage electrical injury. A cataract did not develop in the right eye during 26 months of follow-up. The patient underwent successful cataract surgery with an excellent return of vision. Electrical injuries may result in the formation of a unilateral cataract and therefore an ophthalmic examination should be performed regularly in the early recovery period of such injuries. Cataract surgery with intraocular lens implantation results in an excellent return of vision in patients with electrical cataract who do not have any other ocular damage.

Adult↗
PubMed2003

Cataract extraction and cognitive function in older women.

BACKGROUND: Oxidative damage is critical in the etiology of cataract. Therefore, associations between cataract and other health endpoints may suggest the shared etiologic role of oxidative stress. METHODS: To assess any role of oxidative stress in cognitive function and early cognitive decline, we investigated the relation between cognition and cataract extraction in 16,197 community-dwelling women age 70-79 years from the Nurses' Health Study. Six cognitive tests were administered by telephone from 1995 to 2000; second interviews are ongoing and have been completed for 12,995 women. In total, 3,597 women reported cataract extraction prior to their baseline cognitive assessment. We used logistic regression to calculate multivariate-adjusted relative risks of a low score and of substantial decline, comparing those with and without cataract extraction. RESULTS: Using a global score that combines the results of the cognitive tests, there was no relation between cataract and either low score (RR = 0.99; 95% CI = 0.87-1.13) or substantial decline from baseline to second interview (RR = 1.08; CI = 0.93-1.25). CONCLUSION: Cataract extraction does not appear to be related to cognitive function in these women.

Aged↗
PubMed2004

Prevalence of pseudoexfoliation syndrome in Ethiopian patients scheduled for cataract surgery.

PURPOSE: To evaluate the prevalence of pseudoexfoliation syndrome (PEX) among Ethiopian patients with age-related cataract scheduled for surgery. PATIENTS AND METHODS: In a prospective study, 229 consecutive eyes with age-related cataract scheduled for surgery were evaluated for the prevalence of PEX, type of cataract, intraocular pressure (IOP) and glaucoma. RESULTS: The mean age of the 229 patients was 62.1 +/- 10.5 years (range 47-91 years). The prevalence of PEX was 39.3% (90 of 229 eyes). Pseudoexfoliation syndrome was bilateral in 62.2% (56/90) of cases. The mean age of those with PEX (63.7 +/- 10.7 years) was significantly more than that of those without PEX (60.3 +/- 9.2 years) (p = 0.01). The prevalence of PEX significantly increased with age (p = 0.02). Patients with hypermature cataract had significantly more PEX (p < 0.001). Mean IOP was significantly higher in eyes with PEX (18.4 +/- 3.2 mmHg) than in those without PEX (15.8 +/- 3.6 mmHg) (p < 0.001). Significantly more eyes in the PEX group had IOP > 21 mmHg (p < 0.01) and established glaucoma (p < 0.05). An incidence of PEX was found in all major ethnic groups in Ethiopia. There was no significant difference in the prevalence of PEX between the different ethnic groups (p > 0.5). CONCLUSIONS: The prevalence of PEX among Ethiopian patients with cataract is high and occurs at a relatively younger age when compared to previous reports from Europe. Pseudoexfoliation syndrome has been found to be significantly associated with hypermature cataract, higher mean IOP, IOP > 21 mmHg and glaucoma. Population-based studies are recommended to evaluate the prevalence of PEX in the general population and its association with cataract and glaucoma.

Aged↗
PubMed1996

Ocular axial length in children with unilateral congenital cataract.

Ocular axial length and thickness were measured in 12 children (age 4 to 418 days, median 103 days) with unilateral congenital cataract who were referred to St. Erik's Eye Hospital during 1991-1994. The measurements were performed in both eyes with A-scan ultrasonography before cataract extraction. In 4 children measurement of the axial length was repeated 1 to 4 months after the unilateral cataract extraction. All eyes with congenital cataract were shorter than the normal fellow eye. The individual axial length differences showed a mean value +/- SEM of 1.03 +/- 0.16 mm. This difference was statistically significant (P < 0.01). In the 4 children where measurement of the axial length was repeated, the difference between the eyes after unilateral cataract extraction had become greater than before. In addition, the thickness of the cataractous lens was 0.63 +/- 0.17 mm (mean +/- SEM) less than the non-operated clear lens. This difference was statistically significant (p < 0.01). In conclusion, in children with unilateral congenital cataract the affected eye has a shorter axial length and a thinner lens.

Anthropometry↗
PubMed2006

NIKE: a new clinical tool for establishing levels of indications for cataract surgery.

PURPOSE: The purpose of this study was to construct a new clinical tool for establishing levels of indications for cataract surgery, and to validate this tool. METHODS: Teams from nine eye clinics reached an agreement about the need to develop a clinical tool for setting levels of indications for cataract surgery and about the items that should be included in the tool. The tool was to be called 'NIKE' (Nationell Indikationsmodell för Kataraktextraktion). The Canadian Cataract Priority Criteria Tool served as a model for the NIKE tool, which was modified for Swedish conditions. Items included in the tool were visual acuity of both eyes, patients' perceived difficulties in day-to-day life, cataract symptoms, the ability to live independently, and medical/ophthalmic reasons for surgery. The tool was validated and tested in 343 cataract surgery patients. Validity, stability and reliability were tested and the outcome of surgery was studied in relation to the indication setting. RESULTS: Four indication groups (IGs) were suggested. The group with the greatest indications for surgery was named group 1 and that with the lowest, group 4. Validity was proved to be good. Surgery had the greatest impact on the group with the highest indications for surgery. Test-retest reliability test and interexaminer tests of indication settings showed statistically significant intraclass correlations (intraclass correlation coefficients [ICCs] 0.526 and 0.923, respectively). CONCLUSIONS: A new clinical tool for indication setting in cataract surgery is presented. This tool, the NIKE, takes into account both visual acuity and the patient's perceived problems in day-to-day life because of cataract. The tool seems to be stable and reliable and neutral towards different examiners.

Activities of Daily Living↗
PubMed2006

Rapid assessment of avoidable blindness and needs assessment of cataract surgical services in Satkhira District, Bangladesh.

AIMS: To estimate the magnitude and causes of blindness in people aged > or =50 years in Satkhira district, Bangladesh, and to assess the availability of cataract surgical services. METHODS: 106 clusters of 50 people aged > or =50 years were selected by probability-proportionate to size sampling. Households were selected by compact segment sampling. Eligible participants had their visual acuity measured. Those with visual acuity <6/18 were examined by an ophthalmologist. A needs assessment of surgical services was conducted by interviewing service providers. RESULTS: 4868 people were examined (response rate 91.9%). The prevalence of bilateral blindness was 2.9% (95% confidence interval (CI) 2.4% to 3.5%), that of severe visual impairment was 1.6% (95% CI 1.2% to 2.0%) and that of visual impairment was 8.4% (95% CI 7.5% to 9.3%). 79% of bilateral blindness was due to cataract. The cataract surgical coverage was moderate; 61% of people with bilateral cataract blindness (visual acuity <3/60) had undergone surgery. 20% of the 213 eyes that had undergone cataract surgery had a best-corrected poor outcome (visual acuity <6/60). The cataract surgical rate (CSR) in Satkhira was 547 cataract surgeries per million people per year. CONCLUSIONS: Although the prevalence of blindness and visual impairment was lower than expected, the CSR is inadequate to meet the existing need, and the quality of surgery needs to be improved.

Aged↗
PubMed1997

Pulfrich's phenomenon in unilateral cataract.

AIMS: To determine whether unilateral cataract causes a pathological Pulfrich's phenomenon. METHODS: 29 subjects with unilateral cataract and contralateral pseudophakia were assessed on their ability to perceive the Pulfrich phenomenon. Using a computer generated pendulum image, and graded neutral density filters, a series of forced choice trials were performed in which the subject was required to describe the direction of any apparent pendulum rotation. A pathological Pulfrich effect was said to occur when apparent rotation was perceived in the presence of a zero strength neutral density filter. The size of any pathological Pulfrich effect which was present was quantified by neutralising the perceived pendulum rotation with neutral density filters of varying strength placed before the better seeing eye. RESULTS: 20 out of 29 subjects were able to perceive apparent pendulum rotation when uniocular filtering was performed. In the group (n = 12) which was tested both before and after cataract extraction with intraocular lens implantation, a statistically significant pathological Pulfrich effect was demonstrated preoperatively, compared with a group of normal control subjects. This effect was abolished after cataract extraction (p = 0.009). The median size of the effect was equivalent to a 0.25 log unit neutral density filter over the non-cataractous eye. The subjects who were unable to perceive the Pulfrich phenomenon at all had a significantly greater difference in the visual acuity of each eye (p = 0.045) and significantly worse stereoacuity than those who were able to perceive the effect (p = 0.002). CONCLUSIONS: Unilateral cataract can cause a pathological Pulfrich phenomenon. This finding may explain why some patients with unilateral cataract complain of visual symptoms that are not easily accounted for in terms of visual acuity, contrast sensitivity, or stereoacuity.

Adult↗
PubMed2002

Cataract blindness in Turkmenistan: results of a national survey.

AIM: To present results of a rapid assessment of cataract in Turkmenistan. METHODS: 6120 eligible people of 50 years and older were selected by systematic random sampling from the whole of Turkmenistan. A total of 6011 people were examined (coverage 98.2%). RESULTS: Cataract is the major cause of bilateral blindness (54%), followed by glaucoma (25%). The age and sex adjusted prevalence of bilateral cataract blindness (VA <3/60) in people of 50 years and older was 0.6% (95% CI: 0.4 to 0.9), with a cataract surgical coverage of 75% (people). For VA <6/60 the prevalence was 2.6% (95% CI: 2.1 to 3.2) in people aged 50 and above, approximately 0.26% of the total population. In this last group the surgical coverage was 44% (people) and 32% (eyes). Of the patients operated with IOL implantation 8.2% could not see 6/60, 44.8% of those operated without IOL could not see 6/60. The main barrier to cataract surgery was indifference ("old age, no need for surgery"), followed by "waiting for maturity." CONCLUSION: To increase the cataract surgical coverage in Turkmenistan the intake criteria should be lowered to VA <6/60 or less. At the same time the visual outcome of surgery can be improved by expanding the number of IOL surgeries and routine monitoring of cataract outcome. Additional investments will be required to provide all eye surgeons with appropriate equipment and skills for IOL surgery.

Blindness↗
PubMed2003

Sex inequalities in cataract blindness burden and surgical services in south India.

AIM: To determine sex inequalities in cataract blindness and surgical services in south India. METHODS: Details of lens status and cataract surgery were recorded for subjects aged 50 years and older identified through cluster sampling as part of population based cross sectional assessments of cataract blindness and surgical outcomes in three districts of south India. RESULTS: Females were less likely to be operated on for cataract (adjusted OR 0.71, 95% CI: 0.57 to 0.87) although the cataract blindness burden was higher for females (p<0.001). Literacy of the subject was a major predictor for being operated on for cataract. Achieving equal surgical coverage between sexes will have resulted in an additional 25.3% reduction of cataract blindness. CONCLUSIONS: Eye care programmes in this population need to be sensitised to the substantial reduction in blindness possible by achieving equal surgical coverage between sexes.

Age Distribution↗
PubMed1998

Incidence of cataract operations in Finnish male smokers unaffected by alpha tocopherol or beta carotene supplements.

OBJECTIVE: To examine the effect of alpha tocopherol and beta carotene supplementation on the incidence of age related cataract extraction. SETTING: The Alpha-tocopherol Beta-carotene (ATBC) Study was a randomised, double blind, placebo controlled, 2 x 2 factorial trial conducted in south western Finland. The cataract surgery study population of 28,934 male smokers 50-69 years of age at the start. INTERVENTION: Random assignment to one of four regimens: alpha tocopherol 50 mg per day, beta carotene 20 mg per day, both alpha tocopherol and beta carotene, or placebo. Follow up continued for five to eight years (median 5.7 years) with a total of 159,199 person years. OUTCOME MEASURE: Cataract extraction, ascertained from the National Hospital Discharge Registry. RESULTS: 425 men had cataract surgery because of senile or presenile cataract during the follow up. Of these, 112 men were in the alpha tocopherol alone group, 112 men in the beta carotene alone group, 96 men in the alpha tocopherol and beta carotene group, and 105 men in the placebo group. When supplementation with alpha tocopherol and with beta carotene were introduced to a Cox proportional hazards model with baseline characteristics (age, education, history of diabetes, body mass index, alcohol consumption, number of cigarettes smoked daily, smoking duration, visual acuity, and total cholesterol), neither alpha tocopherol (relative risk, RR, 0.91, 95% confidence intervals, CI, 0.74, 1.11) nor beta carotene (RR 0.97, 95% CI 0.79, 1.19) supplementation affected the incidence of cataract surgery. CONCLUSION: Supplementation with alpha tocopherol or beta carotene does not affect the incidence of cataract extractions among male smokers.

Aged↗
PubMed1986

Identification of metabolic risk factors for posterior subcapsular cataract.

To determine the possible role of glucose and lipid metabolism in the formation of cataract in elderly people we studied 463 patients undergoing cataract extraction. Of 188 males, 35 (19%) had posterior subcapsular cataract (group 1), 27 (14%) had cortical cataract (group 2), and 24 (13%) had nuclear cataract (group 3). Of 275 females, 27 (10%) belonged to group 1, 44 (16%) to group 2, and 33 (12%) to group 3. Patients in group 1 were significantly younger than those of group 2 and 3. In addition, patients in group 1 had higher concentrations of fasting serum triglycerides than patients of group 2 or 3. No difference in mean concentrations of serum cholesterol was observed between the different groups. However, fasting plasma glucose concentrations were higher in group 1 patients than in those of group 2 or 3. Patients in group 1 had a higher 'Broca index' than those in group 2 or 3, with the exception of males in group 3. These results suggest that the association of hypertriglyceridemia, hyperglycemia and obesity favors the formation of a specific morphologic type of lens opacity, posterior subcapsular cataract, occurring at an early age. They imply the possibility of effective modes of preventive therapy for a subgroup of patients with 'senile' cataract.

Aged↗
PubMed2006

Time series analysis of age related cataract hospitalizations and phacoemulsification.

BACKGROUND: Cataract surgery remains a commonly performed elective surgical procedure in the aging and the elderly. The purpose of this study was to utilize time series methodology to determine the temporal and seasonal variations and the strength of the seasonality in age-related (senile) cataract hospitalizations and phacoemulsification surgeries. METHODS: A retrospective, cross-sectional time series analysis was used to assess the presence and strength of seasonal and temporal patterns of age-related cataract hospitalizations and phacoemulsification surgeries from April 1, 1991 to March 31, 2002. Hospital admission rates for senile cataract (n = 70,281) and phacoemulsification (n = 556,431) were examined to determine monthly rates of hospitalization per 100,000 population. Time series methodology was then applied to the monthly aggregates. RESULTS: During the study period, age-related cataract hospitalizations in Ontario have declined from approximately 40 per 100,000 to only one per 100,000. Meanwhile, the use of phacoemulsification procedures has risen dramatically. The study found evidence of biannual peaks in both procedures during the spring and autumn months, and summer and winter troughs. Statistical analysis revealed significant overall seasonal patterns for both age-related cataract hospitalizations and phacoemulsifications (p < 0.01). CONCLUSION: This study illustrates the decline in age-related cataract hospitalizations in Ontario resulting from the shift to outpatient phacoemulsification surgery, and demonstrates the presence of biannual peaks (a characteristic indicative of seasonality), in hospitalization and phacoemulsification during the spring and autumn throughout the study period.

Aging↗
PubMedDate not supplied

Glaucoma following childhood cataract surgery.

Glaucoma has been recognized as an infrequent but serious complication following surgery for congenital and acquired cataracts in childhood. Little is known concerning the influence of factors on the risk of glaucoma such as age at surgery, type of cataract, associated ocular abnormalities, and type of surgery. We reviewed records of 240 eyes of 155 patients on whom cataract surgery had been performed between January 1965 and July 1990 at Children's Hospital, Boston. After excluding those patients who had been followed up less than 5 years after surgery, and those who had had surgery after the age of 10 years, 125 eyes of 82 patients were included in the study group. We identified 14 eyes of 9 patients that had developed open-angle glaucoma 5.3 to 13.1 years following surgery (average 7.4 years). An additional 4 eyes of 3 patients developed angle closure glaucoma, which was diagnosed at 146, 177, 2911, and 2939 days following surgery. A fifth patient developed acute angle closure 1.7 years following primary cataract surgery and 53 days following secondary discission. All but one of the patients who developed glaucoma had cataract surgery at less than 1 year of age. Age at surgery for the entire study group averaged 1.9 years, and ranged from 25 days to 9.6 years. We conclude that patients having cataract surgery before 1 year of age are at the greatest risk of developing postoperative open-angle glaucoma. Additional increased relative risk was found in eyes with microcornea, congenital rubella syndrome, and poor pupillary dilation with 1% cyclopentolate (Cyclogyl). No significant difference was seen among the various surgical methods of cataract removal.

Aphakia, Postcataract↗
PubMedDate not supplied

Update on the surgical management of pediatric cataracts.

The treatment of pediatric cataracts is rapidly evolving, and the visual prognosis for infants and children with cataracts is improving, due in part to earlier surgery, increased frequency of intraocular lens (IOL) implantation, more effective amblyopia therapy following surgery, and better forms of optical correction. A surgeon treating a child with a cataract is faced with An assortment of therapeutic dilemmas such as whether an IOL should be implanted, whether foldable lenses are appropriate, and whether the posterior capsule should be opened during surgery. Although the surgery can be technically difficult in small and unforgiving eyes, it is often the easy part as treatment decisions and results have lifelong implications. The visual system, which is immature at birth, has a latent period of approximately 6 weeks before it becomes sensitive to deprivation, and binocular vision first appears at approximately 3 months of age. It is therefore imperative that infants with visually significant congenital cataracts receive prompt treatment during the sensitive periods to decrease the risk of developing amblyopia or binocular abnormalities. An ideal time for early surgical intervention resulting in few complications and maximal visual outcome has not been identified with certainty. Perhaps the greatest overall change in the approach to the surgical treatment of pediatric cataracts has been the adaptation of techniques used in adult cataract surgery. This article focuses on the methods currently used in the management of pediatric cataracts.

Cataract↗