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Trends in health service delivery for cataract surgery at a large Australian ophthalmic hospital.

PURPOSE: To evaluate trends in health service delivery for cataract surgery at the Royal Victorian Eye and Ear Hospital, Melbourne, Australia. METHODS: A retrospective study was conducted of computerized hospital admissions for cataract surgery from July 1994 through June 1999. Main outcome measures included the annual number of cataract surgeries, waiting time, percentage of patients hospitalized overnight, length of overnight hospitalization, type of cataract surgery, surgery duration and total time in the operating theatre. RESULTS: Although the annual number of patients undergoing cataract surgery increased from 3395 to 4796 over the 5-year study interval, there was a 13-day reduction in mean waiting time for public patients, a 30% reduction in overnight hospitalizations and a half-day reduction in length of hospitalization for all patients. There was also an increasing trend in use of phacoemulsification cataract extraction. CONCLUSIONS: The health-care delivery for cataract surgery appears to have improved during the past 5 years at the Royal Victorian Eye and Ear Hospital.

Aged↗

[Block excision of epithelial ingrowth after cataract surgery--report on 15 patients].

BACKGROUND: Cystic or diffuse epithelial ingrowth into the anterior chamber after cataract surgery is a rare complication. It can lead to painful secondary glaucomas or in case of fistulation to persisting ocular hypotony or atrophy of the globe due to wrong or inadequate therapy. PATIENTS AND METHODS: The cause of epithelial ingrowth was a previous cataract surgery in 15 of 59 patients (25 %, Erlangen Block-Excision Registry for epithelial ingrowth). Eleven patients were females. Mean age was 65 +/- 13 years. RESULTS: Ten patients underwent block excision of epithelium, adjacent iris, ciliary body, sclera or cornea due to epithelial ingrowth following intracapsular cataract extraction between 1980 and 1987 and five patients since 1987 because of epithelial ingrowth following extracapsular cataract extraction (4 with and 1 without intraocular lens implantation); all primary cataract surgeries had been performed in external hospitals. We found a diffuse invasion in 3 eyes (all following icCE) and a cystic epithelial invasion in 12 eyes histologically. Mean time interval between cataract surgery and block excision was 7 +/- 8 years (range: 1 to 33 years). The excisional defect in the globes wall was covered using a tectonic corneoscleral graft (diameter: 8.0 +/- 1.8 mm). Postoperative astigmatism was 3.6 +/- 3.4 dpt. Six eyes had postoperatively a visual acuity of 20/200 or better. No recurrence of epithelial downgrowth was observed, nor was an enucleation needed. CONCLUSION: Surgical procedures with opening of the cyst (e.g. laser) are contraindicated and may lead to a transformation from cystic into diffuse epithelial invasion with potential blindness. The therapy of first choice in eyes with cystic epithelial ingrowth and an extension less than five clock hours is the curative block-excision technique combined with tectonic corneoscleral graft. Surgical results are excellent in order to regard a curative excision and the survival of the eye with acceptable achieved function in consideration of the difficult primary situation with intra- and postoperative complications due to previous cataract surgery.

Aged↗

Calcium ATPase activity and membrane structure in clear and cataractous human lenses.

PURPOSE: Maintenance of calcium homeostasis is imperative for the clarity of the lens. Ca(2+)-ATPase is essential for the removal of cytosolic calcium, either across the plasma membrane or through intracellular organelles such as the endoplasmic reticulum. In this study, membranes prepared from clear lens epithelium were compared to membranes prepared from cataractous lens epithelium. METHODS: Human lens membranes were prepared by a protocol utilizing homogenization and centrifugation. Ca(2+)-ATPase activity was measured biochemically using Gamma-32P labeled ATP. Lipid order was measured using infrared and Raman spectroscopy. RESULTS: Ca(2+)-ATPase activity was similar in membranes prepared from cataractous lenses that were classified as nuclear subcapsular, nuclear and brunescent cataracts. Ca(2+)-ATPase activity was approximately 50% less in membranes prepared from cataractous lenses in comparison to clear lenses. Because clear lenses from Indian donors was unavailable, clear human lenses were used as a qualitative control for the measurement for Ca(2+)-ATPase activity. Lipid order was measured in lens fibers from cataractous and clear lenses from the United States donors. Lipid order increased from 55% in the hydrocarbon chains from clear lens fibers to 84% in cataractous lens fibers. CONCLUSIONS: These findings support the hypothesis that membranes are deranged in cataractous tissue, which should lead to altered levels of calcium.

Adult↗

Menadione-induced oxidative stress accelerates onset of Emory mouse cataract in vivo.

PURPOSE: We evaluated the effect of the free-radical generator, menadione, on the time of occurrence of cataract in the Emory mouse, a model for human cataract. Concomitant experiments were done to compare production and level of reactive metabolites of oxygen in the Emory mouse and its cataract resistant (CR) genetic control. METHODS: Test and control mice were fed both a normal diet and a diet supplemented with menadione, and the lenses were evaluated for the time of occurrence of cataract and the level of membrane ATPases. Effects of menadione were determined on incubated lenses of Emory and CR mice, assaying reactive species of oxygen, levels of antioxidant enzymes, and formation of the lipid peroxidation product, malondialdehyde. RESULTS: Systemic administration of menadione markedly accelerated the onset of Emory mouse cataract, and decreased ATPase activities suggested oxidative damage to membrane proteins. Cumulative levels of O2.-, H2O2, .OH and malondialdehyde were significantly higher than controls in the lenses incubated in the presence of menadione, showing that it generates oxidative stress. However, [GSH] in lenses decreased equally in test and control mice. The observed increases in catalase and glutathione peroxidase activities in the test lenses indicated an early protective response to oxidative insult. CONCLUSIONS: Acceleration by menadione of the appearance of cataract in the Emory mouse demonstrates that oxidative stress is a risk factor in late-onset cataract. This quinone caused a greater increase in the production and levels of reactive metabolites of oxygen in Emory mice than in CR mice, indicative of a higher susceptibility of the former to oxidative insult.

Animals↗

Correlation between prevention of cataract development by disulfiram and fates of selenium in selenite-treated rats.

PURPOSE: We found a new pharmacological effect of disulfiram (DSF) against rat pups with cataract induced by selenite injection. The possible reactive mechanism is discussed in this present paper. METHODS: Wistar male and female rats aged 13 and 30 days, and male rats aged 7 weeks were used this present study. Cataract was induced by injection of selenite (19 micromol/kg, s.c.) to 13-day old rats. The lens opacification was monitored by using the slit lamp equipped with an anterior eye segment analysis system (EAS-1000, Nidek). The selenium contents in rat organs were detected fluorimetrically. Liposomes containing DSF (DSF-liposomes) were prepared by the reverse-phase evaporation method. Rat pups were instilled 5 microl of DSF-liposomes into both eyes 4 times per day. Adult rats were administered with DSF suspensions (100 mg/kg) by nasal cannulation. The changes of plasma concentration of diethyldithiocarbamate (DDC), which was a metabolite of disulfiram, were determined by HPLC method. RESULTS: Intraocular treatment with DSF-liposomes prevented the onset of cataract development in rat pups injected with sodium selenite. Treatment with DSF also significantly reduced the selenium contents in plasma at 1 h post-treatment and in the eye at 96 h post-treatment. No significant differences of selenium content in liver and kidney were observed in 13-day old rats instilled with DSF-liposomes or DSF free liposomes. Cataract could not be induced in the 30-days-old rats with the same dose of selenite (19 micromol/kg) and the liver, kidney, and especially eye of the older rats had lower levels of selenium than 13-day old rats. Diethyldithiocarbamate (DDC), an active metabolite of DSF, was decreased in the plasma following a subcutaneous injection of sodium selenite. The selenium concentration in the plasma was decreased by the intranasal administration of DSF suspensions. CONCLUSIONS: Instillation of DSF-liposomes into the eyes of rat pups given a subcutaneous injection of sodium selenite to induce cataracts prevented the formation of cataracts. The mechanism of inhibition may have resulted from a decreased level of selenium in the eyes following the treatment with DSF. On the other hand, as it is known that the cataracts may result from selenite-induced oxidative stress in the lens, DSF and DDC may react as anti-oxidants.

Administration, Intranasal↗

Comparison of various calpain inhibitors in reduction of light scattering, protein precipitation and nuclear cataract in vitro.

PURPOSE: To compare effects of calpain inhibitors on in vitro light-scattering in rat lens soluble protein and calcium-ionophore (A23187)-induced cataract formation in cultured rat lenses. METHODS: Rat lens soluble protein was hydrolyzed for 24 hours by activation of endogenous lens calpain. Ten calpain inhibitors were tested in this model at 10 and 25 microM concentration. As an index of protein precipitation, light scattering was measured daily at 405 nm for 8 days. Lens proteins were analyzed by isoelectric-focussing. Subsequently, rat lenses were cultured for 5 days with 10 microM A23187. Calpain inhibitors (SJA6017, MDL28170, AK295 and PD150606), which inhibited light-scattering were tested at 100 microM concentration in this model. Cataract evaluation, isoelectric-focussing and calcium determinations were performed. RESULTS: At 25 microM concentration AK295, SJA6017, E-64, PD-150606 and MDL28170 produced greater than 25% inhibition of light-scattering. Isoelectric-focussing revealed that addition of Ca(2+) produced characteristic crystallin proteolysis and aggregation patterns. AK295, SJA6017, MDL28170 and E64c prevented these changes. Lenses cultured in A23187 exhibited nuclear cataract, elevated calcium and proteolysis and aggregation of crystallins. Co-culture with SJA6017, MDL28170 and E64c reduced A23187-induced nuclear opacities, proteolysis and aggregation of crystallins without affecting increased total calcium. CONCLUSIONS: Endogenous calpain-activation model and A23187-induced cataract model can be used sequentially to screen calpain inhibitors for potential anti-cataract activity. Proteolytic changes in lens cortex after exposure to A23187 are also due to calpain activation. AK295, SJA6017 and MDL28170 possess efficacy against calcium-induced models of rodent cataracts. Use of calpain inhibitors represents a promising approach to cataract therapy.

Animals↗

Calpain inhibitor, SJA6017, reduces the rate of formation of selenite cataract in rats.

PURPOSE: 1) To measure the amount of calpain inhibitor SJA6017 taken up by lenses of young rats after administration; and 2) To test efficacy of SJA6017 against selenite cataract in regard to amelioration of proteolysis of lens protein and prevention of lens nuclear opacity. METHODS: Selenite nuclear cataracts were produced by subcutaneous injection of an overdose of sodium selenite to 16-day-old rats. SJA6017 was administered daily using intraperitoneal injections at 100 mg/kg body weight/day for 4 days. Lenses were observed and photographed by slit lamp biomicroscopy, and scored into one of three stages. Enucleated lenses were also scored into one of four stages and lens opacities in the nuclear region were quantified by image analysis. Proteolysis of crystallins was detected by SDS-PAGE. The amount of SJA6017 taken up by the lens was detected with a column switching HPLC system. RESULTS: Nuclear cataracts were visible in 31% of the animals receiving only selenite, while the frequency of nuclear cataract in the Se+SJA6017 group was reduced to only 16%. This effect of SJA6017 was confirmed by densitometric analysis as a reduction in the density of the nucleus. Similar proteolytic changes of crystallins occurred at all stages of selenite cataract formation. The amount of SJA6017 in the lens was detected at the level of 0.03 microM. CONCLUSIONS: Systemic SJA6017 was taken up by the lens, and SJA6017 ameliorated in vivo selenite cataract formation. These studies are important because they partially validate the biochemical rationale for developing non-surgical, drug treatments for cataract prevention in man.

Animals↗

N-acetyltransferase 2 phenotype may be associated with susceptibility to age-related cataract.

Free radicals and oxidative damage play roles in aging and age-related ocular diseases such as cataracts, so defensive mechanisms become important factors for protection. Because N-acetylation is involved in a wide variety of detoxification processes, this study was conducted to examine the relationship between the acetylator phenotypes and genotypes in a group of patients with age-related cataract. Sixty-one cases of age-related cataract and 104 controls were included in this study. Blood was collected in EDTA-containing tubes, and genomic DNA was extracted from the white blood cells by high pure PCR template preparation kit. Genotyping of NAT2 polymorphisms were detected by using a LightCycler-NAT2 mutation detection kit in real-time PCR. There was a significant difference in the distribution of the NAT2*6A acetylator phenotype between cases and the controls. The odds ratio of cataract for the NAT2*6A slow phenotype was 3.8 (95% CI = 1.08 to 13.11, p = 0.032) compared with the fast type. Our results suggest that slow acetylators are at higher risk of developing age-related cataracts than fast acetylators. As NAT2 is an important xenobiotic-metabolizing enzyme and theoretically xenobiotics such as ultraviolet B radiation, smoking, and alcohol use may induce cataract formation, NAT2 gene polymorphisms may be associated with genetic susceptibility of cataract.

Acetylation↗

Use of melatonin to prevent selenite-induced cataract formation in rat eyes.

PURPOSE: To evaluate effects of melatonin on sodium selenite-induced cataract formation. METHODS: Twenty-three Sprague-Dawley rat pups were randomized into three groups. Group 1(n = 9), injected with selenite (s.c.) on postpartum day 10; group 2 (n = 7), injected with selenite (s.c.) on day 10 plus melatonin (i.p.) on days 8-15; group 3 (n = 7), saline-injected controls. Development of cataract was assessed weekly under a dissection microscope. Rat lenses and serums were analyzed for antioxidant enzymes superoxide dismutase (SOD) and catalase (CAT); oxidative stress indicators xanthine oxidase (XO) and malondialdehyde (MDA), a marker of lipid peroxidation; and protein carbonyl (PC), a marker of protein oxidation. RESULTS: Significant differences (p < 0.05) were seen in cataract development by the three groups. All rats developed dense nuclear cataract in group 1. Dense nuclear cataract was not observed in group 2: five of seven rats developed minor cataracts, while the other two had clear lenses. In control rats (group 3), all lenses remained clear. In selenite group (group 1), lens and serum levels of MDA, PC, and XO were significantly higher and levels of SOD and CAT were significantly lower than those in control group (p < 0.001). In selenite+melatonin group (group 2), lens and serum levels of MDA, PC, and XO significantly decreased and levels of SOD and CAT significantly increased when compared with selenite group. CONCLUSIONS: Studies with the rat selenite cataract model strongly support the activity of melatonin as an endogenous antioxidant and anticataract agent.

Animals↗

Antioxidants in prevention of cataracts in South India: methodology and baseline data*.

PURPOSE: To describe the methodology and baseline data for the Antioxidants in Prevention of Cataracts (APC) study in South India. METHODS: The APC study is a prospective, 5-year, randomized, triple-masked, placebo-controlled, field-based clinical trial to examine the effect of antioxidants (combination tablet of vitamins A, C, and E) on progression of cataract. The primary outcome variable is cataract progression (nuclear opalescence), evaluated with the slit-lamp biomicroscope by the Lens Opacification Classification System III method. Secondary outcome variables are progression in cortical and posterior subcapsular opacity and nuclear color, change in best corrected visual acuity, myopic shift, and treatment failure (progression to cataract surgery or best corrected vision worse than 20/400 in an eye). Inclusion criteria are age between 35 and 50 years and best-corrected visual acuity of 20/40 or better. Exclusion criteria are a diagnosis of diabetes mellitus or nonfasting blood glucose level>7.8 mmol/L, history or presence of various ocular conditions or treatment forms, or current use of vitamin supplements. Baseline ophthalmic, demographic, and potential cataract risk factor data (such as smoking, sunlight, or alcohol exposure) were compared between groups on an intent-to-treat basis. RESULTS: Of 954 people screened, 798 were enrolled, a sample size which exceeded the required estimate. More than 80% of subjects had 20/20 or better vision in at least one eye, and baseline prevalence of significant cataract according to the LOCS III grading scale was high. The two treatment groups were comparable for all baseline measures except alcohol intake. CONCLUSION: The sample size and group baseline characteristics will provide sufficient power to detect a change in cataract progression within 5 years.

Adult↗

Cataract in atomic bomb survivors.

PURPOSE: Ophthalmologic examinations were conducted on atomic bomb (A-bomb) survivors 55 years after exposure. MATERIALS AND METHODS: A-bomb survivors who had been exposed before 13 years of age at the time of the bombings in 1945 or who had been examined in a previous study between 1978 and 1980. The examinations, conducted between June 2000 and September 2002, included slit-lamp examination, digital photography and a cataract grading system for three parts of the lens (nucleus, cortex and posterior subcapsule) as an outcome variable. Proportional odds logistic regression analysis was conducted using the lowest grading class as a reference and included explanatory variables such as age, sex, city, dose and various cataract-related risk factors. When the grades in an individual differed, the worst grade was used. RESULTS: Results indicate that odds ratios (ORs) at 1 Sv were 1.07 (95% confidence intervals [CI] 0.90, 1.27) in nuclear colour, 1.12 (95% CI 0.94, 1.30) in nuclear cataract, 1.29 (95% CI 1.12, 1.49) in cortical cataract and 1.41 (95% CI 1.21, 1.64) in posterior subcapsular cataract. The same was true after excluding 13 people whose posterior subcapsular cataracts had been previously detected. CONCLUSION: Significant radiation effects were observed in two types of cataracts in A-bomb survivors.

Adolescent↗

Correlation between cataract and retinopathy due to lighting in F344 rats used in a long-term carcinogenicity study.

Correlations between light intensity of animal room lighting and both cataract and retinopathy of rats were examined, and relationships between the cataract and the retinopathy were further investigated. Seventy-nine male rats and 106 female rats surviving to the end of a 2-yr carcinogenicity study of monosodium succinate were used in this investigation. Animals were housed in polycarbonate cages, each containing 4 rats, with wire lids and hardwood chips for bedding and with a 12-h light/dark cycle. Individual groups comprising 13 cages were inserted into 3 by 5 cage hanging type racks. Light intensity was measured at the bottom (on the bedding) of individual cages. Statistically, both the incidence of cataracts and the severity of retinopathy were closely related to light intensity. The incidence of cataracts in males was significantly higher than that in females, while no sex difference was observed for the severity of retinopathy. Meanwhile, no differences in either the incidence of cataracts or the severity of retinopathy were observed between the monosodium succinate-treated and control groups and between the right and left eyes. While the occurrences of retinopathy and cataract were strongly associated, our results indicated that retinopathy occurs more frequently than cataracts, and thus the retina appeared to be more sensitive to the effects of lighting.

Animals↗

Lens epithelial cell apoptosis appears to be a common cellular basis for non-congenital cataract development in humans and animals.

Cataract is a major ocular disease that causes blindness in many developing countries of the world. It is well established that various factors such as oxidative stress, UV, and other toxic agents can induce both in vivo and in vitro cataract formation. However, a common cellular basis for this induction has not been previously recognized. The present study of lens epithelial cell viability suggests such a general mechanism. When lens epithelial cells from a group of 20 cataract patients 12 to 94 years old were analyzed by terminal deoxynucleotidyl transferase (TdT) labeling and DNA fragmentation assays, it was found that all of these patients had apoptotic epithelial cells ranging from 4.4 to 41.8%. By contrast, in eight normal human lenses of comparable age, very few apoptotic epithelial cells were observed. We suggest that cataract patients may have deficient defense systems against factors such as oxidative stress and UV at the onset of the disease. Such stress can trigger lens epithelial cell apoptosis that then may initiate cataract development. To test this hypothesis, it is also demonstrated here that hydrogen peroxide at concentrations previously found in some cataract patients induces both lens epithelial cell apoptosis and cortical opacity. Moreover, the temporal and spatial distribution of induced apoptotic lens epithelial cells precedes development of lens opacification. These results suggest that lens epithelial cell apoptosis may be a common cellular basis for initiation of noncongenital cataract formation.

Adult↗

Nonenzymatic glycosylation, sulfhydryl oxidation, and aggregation of lens proteins in experimental sugar cataracts.

The formation of sugar-cataracts has been hypothesized to involve the nonenzymatic glycosylation, sulfhydryl oxidation, and aggregation of lens proteins. Cataractous lenses of diabetic and galactosemic rats were analyzed for glycosylated lysine residues in crystallins. A five- and a ten-fold increase in glycosylated lysine residues was measured in galactose and diabetic cataracts, respectively. The modification was predominant in the insoluble fraction of the lens homogenate. The proteins were further examined for the presence of disulfide bonds and high molecular weight aggregates. After careful disruption of the lens in a nitrogen environment, a cloudy solution was obtained from cataractous lenses whereas a clear solution was obtained from normal lenses. The absorbance at 550 nm of the solution of both the galactosemic and the diabetic cataracts could be decreased by approximately 50% with the addition of dithioerythritol (50 mM). The presence of high molecular weight aggregates was ascertained by sucrose gradient centrifugation and gel filtration chromatography. The proteins were heterogenous in size and showed a mol wt range of 36 to greater than 176 million daltons. Treatment with dithioerythritol induced a marked decrease in the amount of high molecular weight proteins. These data suggest that sugar cataracts of experimental animals have, in common with human cataracts, the presence of high molecular weight aggregates which are in part linked by disulfide bonds.

Alloxan↗

A possible role for vitamins C and E in cataract prevention.

Biochemical evidence suggests that oxidative stress caused by accumulation of free radicals is involved in the pathogenesis of senile cataracts. If so, appropriate amounts of the antioxidant vitamins C and E might be expected to prevent or retard the process. Such activity has been observed in several in vitro and in vivo studies of experimentally-induced cataracts. A recent epidemiologic study found that cataract patients tended to have lower serum levels of vitamins C, E, or carotenoids than did control subjects. The present investigation, which compared the self-reported consumption of supplementary vitamins by 175 cataract patients with that of 175 individually matched, cataract-free subjects, revealed that the latter group used significantly more supplementary vitamins C and E (P = 0.01 and 0.004, respectively). Because the results suggested a reduction in the risk of cataracts of at least 50%, a randomized, controlled trial of vitamin supplementation in cataract prevention may be warranted.

Aged↗

Hormone replacement therapy, reproductive factors, and cataract. The Blue Mountains Eye Study.

The relation between estrogen (endogenous and exogenous) and cataract is unclear, with one large population-based study recently suggesting a protective effect of estrogen replacement therapy. The study reported in this paper, the Blue Mountains Eye Study, was conducted in Australia in 1992-1993 and involved 2,072 women aged 49-97 years. Subjects were recruited from a defined geographic area; the participation rate was 83 percent. Eye examination included photographs of the lens, which were graded for presence and severity of cortical, nuclear, and posterior subcapsular cataracts. Later age at menarche was associated with increased prevalence of all three types of cataract, but there were no associations with age at menopause, number of children, or use of the oral contraceptive pill. Among all women, there was no association between hormone replacement therapy and cataract. However, current users of hormone replacement therapy aged 65 years and over, among whom the duration of use was likely to have been longer than in younger current users, had lower prevalence of cortical cataract than did never users; the odds ratio adjusted for numerous potential confounders was 0.4 (95 percent confidence interval 0.2-0.8). The prevalence of posterior subcapsular cataract was increased in current users of hormone replacement therapy who had had a nonsurgical menopause; the adjusted odds ratio was 2.1 (95 percent confidence interval 1.1-4.1). The results of this study support the hypothesis that estrogen and/or progestin may be involved in cataract development. The effect of hormone replacement therapy on the lens needs to be evaluated in the laboratory and in further observational epidemiologic studies.

Aged↗

Antioxidant intake and risk of incident age-related nuclear cataracts in the Beaver Dam Eye Study.

The relation of antioxidant nutrients to the incidence of nuclear cataracts was investigated in a cohort of adults aged 43-84 years in the Beaver Dam Eye Study (Beaver Dam, Wisconsin). Nuclear opacity was assessed on a five-point ordinal scale using lens photographs taken at baseline (1988-1990) and at follow-up (1993-1995). Of the 1,354 persons eligible, 246 developed a nuclear cataract (level 4 or 5 opacity) in at least one eye. Antioxidant intakes were assessed using a food frequency questionnaire administered at baseline for time points corresponding to intake during the year preceding baseline and 10 years before baseline (the distant past). Lutein-zeaxanthin was the only carotenoid, out of five examined, that was associated with nuclear cataracts. Persons in the highest quintile of lutein intake in the distant past were half as likely to have an incident cataract as persons in the lowest quintile of intake (95% confidence interval 0.3-0.8). In the overall group, nuclear cataracts were not significantly related to intake of vitamin C or vitamin E. However, vitamins C and E were inversely associated with opacities in persons who had some other risk factors for cataracts. While results of this short term follow-up study are consistent with a possible protective influence of lutein and vitamins E and C on the development of nuclear cataracts, the evidence in the present study provides weak support for these associations.

Adult↗

Cataract and the use of statins: a case-control study.

BACKGROUND: In animal studies, statins have induced cataract formation. Because incident cataract is relatively uncommon, studies in humans have been unable to exclude a clinically important effect. AIMS: To assess the risk of cataract associated with the use of statins, and whether it is increased by concurrent use of drugs that inhibit the cytochrome P450 system. DESIGN: Population-based case-control study. METHODS: Patients were randomly sampled from the UK General Practice Research Database. The study included 15,479 people with cataract and 15,479 controls matched for age, sex, practice and observation period. RESULTS: The crude odds ratio (OR) for the association between any recorded exposure to statins and cataract was 1.41 (95%CI 1.21-1.65), but this reduced to 1.04 (95%CI 0.89-1.23, p=0.6) after adjustment for consultation rate. There was no evidence that the risk increased with higher doses or longer duration of statin use, or that the risk varied by individual statin. There was no evidence that the risk of cataract was increased by concurrent use of statins and drugs that inhibit the cytochrome P450 system. DISCUSSION: In the short- and medium-term, statins do not seem to be associated with an increased risk of cataract. The need to assess the effects of long-term statin exposure on the eye remains.

Aged↗