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PubMed2002

Change of subjective visual function in first-eye cataract patients when the rate of surgery increases in a population.

BACKGROUND: The increasing demand for cataract surgery has stimulated interest in outcome research and the potential public health impact of the intervention. OBJECTIVE: To determine the impact of an increased rate of first-eye cataract surgery on visual acuity (VA) and subjective visual ability/disability, before and after surgery, in a geographically defined population. RESEARCH DESIGN: A prospective, observational study. SUBJECTS: All patients who had first-eye cataract extraction at one clinic during two separate 1-year periods. Five hundred seventy-six patients had surgery in 1997, and 353 had surgery in 1992 (17.2 and 10.6 per 1000 population 65 and older, respectively). MEASURES: Best-corrected VAs were measured, and the patients answered self-administered questionnaires, before and after surgery. The questionnaires focused on the patients' subjective difficulties performing some common vision-dependent activities, such as reading, television-viewing, orientation, etc. RESULTS: In 1997 compared with 1992 the VA of the eye to be operated was on average better (chi2 for trend; P<0.0001), and the subjective visual disability was less before surgery (mean disability index 6.9 vs. 7.5; P<0.0001). There was also a smaller percentage of mature cataracts (15% vs. 23%; P<0.0001). After surgery the VA of the operated eye was better in 1997 (chi2 for trend; P<0.001), but there was no difference in improvement of subjective visual ability, nor change in subjective visual disability, compared with 1992. The patients' expectations and actual postoperative improvement of their ability to cope with daily life were higher in 1997 (chi2 for trend; P<0.0001 and P<0.001). CONCLUSIONS: A higher frequency of first-eye cataract surgery in a population was before surgery associated with an on average better VA of the eye to be operated, a less perceived visual disability regarding some common vision-dependent activities, a lower percentage of mature cataracts and thus earlier surgery. Consequently, a higher rate of surgery would likely be associated with a lesser amount of visual impairment because of cataract in the population.

Aged↗
PubMed2004

Genetics of childhood cataract.

PURPOSE OF REVIEW: Congenital cataracts, although much less common than their age-related counterparts, account for one-tenth of cases of childhood blindness. Approximately half are inherited, either in isolation or as part of a syndrome of ocular or systemic anomalies. This article reviews recent advances made in understanding the molecular genetic basis of isolated, nonsyndromic inherited cataract. RECENT FINDINGS: New disease-causing mutations continue to be identified and now encompass genes encoding a wide variety of different lens proteins. More detailed investigations of the functional consequences of each mutation are being reported and suggest that lens opacification results not only from precipitation and amyloid-like accumulation of proteins essential for lens transparency but also from interference with their secondary functions. SUMMARY: Improved functional characterization of mutations causing childhood cataract will improve understanding of lens development and physiology but will also have implications for the more common age-related cataract. This too has a significant genetic component to its etiology, and genes causing monogenic forms of childhood inherited cataract represent excellent candidate genes for age-related cataract. The identification of the genes conferring increased risk of developing age-related cataract will bring closer the development of a medical treatment to delay the onset of lens opacification and need for surgery.

Cataract↗
PubMed2004

Surgical strategies in patients with combined cataract and glaucoma.

PURPOSE OF REVIEW: In the elderly population, the combined presence of cataract and glaucoma is a frequent condition. In this situation, several surgical options are possible: cataract surgery only and later maybe trabeculectomy, trabeculectomy only and later maybe cataract surgery, or combined cataract and glaucoma surgery. This review compares the different surgical options on the basis of their achievable postoperative intraocular pressure (IOP) level and success and complication rates. RECENT FINDINGS: The impression of better IOP regulation with trabeculectomy than with phacotrabeculectomy has been recently confirmed by an evidence-based review. Contrary to this finding, the success of deep sclerectomy or trabeculotomy does not seem to be compromised by simultaneous phacoemulsification. In eyes with previous glaucoma-filtering surgery, cataract surgery with clear corneal incision has no effect on mean IOP but increases the 3-year failure probability. For phacotrabeculectomy, moderate evidence of a beneficial effect of MMC on IOP regulation and only weak evidence for separating the incisions has been recently reported by another evidence-based review. SUMMARY: The choice of the preferred surgical method depends on the target pressure, the amount of glaucomatous damage, and the grade of visual disturbance caused by the cataract. Phacotrabeculectomy combined with mitomycin C achieves the best IOP lowering of all types of combined cataract and glaucoma surgery currently possible but is associated with potentially sight-threatening complications. In the absence of a low target pressure, phacotrabeculotomy or the combination of phacoemulsification with viscocanalostomy or deep sclerectomy may be the therapy of choice.

Cataract↗
PubMed2005

Cataracts among cancer survivors.

OBJECTIVES: To determine the frequency of cataracts in cancer survivors and their association with patients' demographic characteristics, treatment, and cancer type and the perceived effect cancer had had on their overall health. METHODS: This was a descriptive, cross-sectional review of the results of a survey of long-term cancer survivors who had been treated at the authors' institution. RESULTS: Of 3936 respondents to the survey, 168 (4%) reported having had cataracts. Cataracts were most frequent in survivors of hematologic diseases (chronic leukemia, 17%; myeloma, 13%; acute leukemia, 9%; and lymphoma, 7%). There were no notable associations between cataracts and gender, age, ethnicity, marital status, education completed, or work status. Cancer survivors with cataracts were more likely to report that cancer had affected their overall health (56% vs 39%). There was a trend of association between cataracts and prior treatment with bone marrow transplantation, but not corticosteroids. CONCLUSION: Cataracts affect a minority of long-term cancer survivors, but those who reported them were more likely to report that cancer had had a lasting effect on their overall health. Vision evaluation for all cancer survivors is recommended.

Adrenal Cortex Hormones↗
PubMed1996

Cataract surgery in Australia 1985-94.

BACKGROUND: Cataract surgery is the most common form of major ophthalmic surgery in Australia and a common surgical procedure among the elderly. The purpose of this report is to compile the numbers and rates of cataract extractions and implant of IOLs over the period 1985-94 for Australia. METHODS: Data were obtained for public and private cataract extractions and IOL implants from state and territory ministries of health and from the Health Insurance Commission. The data relating to cataract surgery were compared with the growth in the proportion of elderly people in the population. RESULTS: The number of cataract extractions has increased by 2.6 times over the ten-year period to 67,459 in 1994 and IOL implants have increased by 2.9 times over the same period to 70,084. The increase in the elderly population for the period was 1.3 times so that there is a relative doubling in the rate of surgery. The proportion of public patients has risen from 19% to 28% from 1985 to 1994. CONCLUSIONS: The numbers of cataract extractions and IOL implants was increased at double the rate expected from the growth in the elderly population. Advances in microsurgery and IOL technology have resulted improved outcomes and have created a greater patient demand. The improved outcomes have also lead to ophthalmologists recommending cataract surgery at better visual acuity levels than previously.

Aged↗
PubMed2005

Prioritization of cataract surgery: visual analogue scale versus scoring system.

BACKGROUND: The purpose of the present paper was to evaluate the variability of using a visual analogue scale (VAS) and to assess the feasibility of a priority-setting scoring system for prioritizing elective cataract surgery. METHODS: Consecutive cases listed for cataract surgery were prospectively recruited. Ophthalmologists listed patients to undergo early or normal surgery and were asked to rate the urgency of surgery using a VAS. Patients were then reassessed and a cataract surgery prioritization (CSP) score was calculated based on the New Zealand priority criteria for cataract surgery. Correlation coefficients between VAS and CSP scores were calculated to determine the variability among ophthalmologists in using the VAS in prioritizing surgery. Further analyses were performed to assess the potential impact of implementing the CSP system. RESULTS: A total of 326 patients were recruited. There was a positive correlation between VAS and CSP scores (Spearman rho= 0.407, P < 0.001). A high degree of variation among ophthalmologists in the use of VAS was found. Patients with poor binocular vision were not listed as early, whereas patients with poor vision in the eye listed for cataract surgery but good vision in the fellow eye were more likely to be prioritized to have early operation. These findings suggest that patients with severe impairment in binocular visual function were not adequately accounted for during cataract surgery listing. CONCLUSIONS: The use of a VAS for prioritizing cataract surgery may be suboptimal due to high subjectivity. Adoption of an objective criteria-validated priority-setting scoring system may allow better stratification of patients to ensure better service provision.

Adult↗
PubMed1994

Inhibitory effect of melatonin on cataract formation in newborn rats: evidence for an antioxidative role for melatonin.

We evaluated the inhibitory effect of melatonin, a recently discovered scavenger of free radicals, on cataract formation in the newborn rat. The glutathione synthesis inhibitor, buthionine sulfoximine (BSO) (3 mmol/kg), was intraperitoneally injected into newborn rats for 3 consecutive days starting on day 2 after birth. These glutathione depleted rats develop cataracts. Melatonin (4 mg/kg) was injected intraperitoneally into half of the rats once a day beginning at day 2 after birth; the other half of the animals received solvent daily. The incidence of cataract was observed on day 16, after the eyes of the newborn animals had opened. Both reduced glutathione (GSH) and oxidized glutathione (GSSG) levels were measured. Cataracts were observed in all animals (18/18) treated with BSO plus solvent. The incidence of the cataract in the animals cotreated with melatonin was only 6.2% (1/15). Total lenticular glutathione (GSH + GSSG) levels in BSO only treated rats were reduced by 97%. The total glutathione in the lens of the BSO plus melatonin group was significantly higher (by 3%) than that of the BSO only group. The percentage of the total glutathione as GSSG for the BSO plus solvent group was higher than the control value. Cotreatment of BSO injected rats with melatonin (4 mg/kg/day) clearly reduced cataract formation proving that it is directly or indirectly protective against oxidative stress which accompanies glutathione deficiency. The inhibitory effects of melatonin on cataract formation in this study could be due to melatonin's free radical scavenging activity or due to its stimulatory effect on glutathione production.

Animals↗
PubMed1979

Variations of lens thickness in relation to biomicroscopic types of human senile cataract.

The results are reported of 38 ultrasonographic in vivo mensurations of intraindividual differences in axial thickness between a cataractous lens in one eye and a biomicroscopically clear or slightly cataractous lens (incipient deep cortical opacity) in the other. Obviously intumescent cataractous lenses were excluded. In general, the cataractous lens was thinner than the contralateral clear or slightly cataractous lens. Large decreases in lens thickness appeared in lenses with the capsule-near opacities of posterior subcapsular cataract (PSC) + anterior capsular/subcapsular opacity (ACSCO). PSC was more closely correlated to lens thinning than was ACSCO. Nuclear cataract very often occurred in thin lenses, but did not appear to cause lens thinning per se. Deep cortical opacity was not associated with lens thinning. The present results contributed to our argumentation that the decrease in lens thickness is due to a leak of lens material through the "lens membrane" beside a possible cessation of growth of the lens fibres.

Age Factors↗
PubMed2005

The telomere of human chromosome 1p contains at least two independent autosomal dominant congenital cataract genes.

AIMS: Multiple genetic causes of congenital cataract have been identified, both as a component of syndromes and in families that present with isolated congenital cataract. Linkage analysis was used to map the genetic locus in a six generation Australian family presenting with total congenital cataract. METHODS: Microsatellite markers located across all known autosomal dominant congenital cataract loci were genotyped in all recruited family members of the Tasmanian family. Both two point and multipoint linkage analysis were used to assess each locus under an autosomal dominant model. RESULTS: Significant linkage was detected at the telomere of the p arm of chromosome 1, with a maximum two point LOD of 4.21 at marker D1S507, a maximum multipoint exact LOD of 5.44, and an estimated location score of 5.61 at marker D1S507. Haplotype analysis places the gene inside a critical region between D1S228 and D1S199, a distance of approximately 6 megabases. The candidate gene PAX7 residing within the critical interval was excluded by direct sequencing in affected individuals. CONCLUSION: This is the third report of congenital cataract linkage to 1ptel. The critical region as defined by the shared haplotype in this family is clearly centromeric from the Volkmann cataract locus identified through study of a Danish family, indicating that two genes causing autosomal dominant congenital cataract map to the telomeric region of chromosome 1p.

Aphakia, Postcataract↗
PubMed2005

Effect of cataract extraction on frequency doubling technology perimetry in patients with glaucoma.

AIM: To evaluate the effect of cataract surgery on frequency doubling technology (FDT) perimetry in patients with co-existing cataract and glaucoma. METHODS: In this consecutive prospective cohort study 27 patients with open angle glaucoma scheduled for cataract extraction alone or combined with trabeculectomy were enrolled. All patients underwent FDT threshold C-20 visual fields within 3 months before and 3 months after surgery. Changes in mean deviation (MD) and pattern standard deviation (PSD) were evaluated. Additionally, changes in best corrected logMAR visual acuity (VA), intraocular pressure (IOP), and number of glaucoma medications were also studied. RESULTS: 22 patients completed the study. VA improved after surgery, from 0.47 (SD 0.19) to 0.12 (0.17) (p<0.001). The visual indexes changed after cataract extraction: MD improved (from -10.9 (SD 4.6) dB to -7.0 (4.6) dB; p<0.001) while PSD worsened (from 7.1 (SD 3.5) dB to 8.5 (3.8) dB; p = 0.001). CONCLUSION: In patients with co-existing cataract and glaucoma, examined with FDT, MD improved and PSD worsened after cataract surgery. Global indexes of FDT should be interpreted with caution in patients with glaucoma and cataracts.

Aged↗
PubMed2006

Influence of tobacco use on cataract development.

AIM: To study the influence of tobacco use on cataract formation in a rural South Indian population. METHODS: 3924 subjects from the Chennai Glaucoma Study conducted in rural south India underwent a comprehensive eye examination, including Lens Opacities Classification System II grading. Information on tobacco use, type of tobacco (smoking and smokeless), duration and quantity of use was collected. RESULTS: 1705 (male:female (M:F) 1106:599) people used tobacco and were significantly older (mean (standard deviation (SD)) age 55.80 (10.64) years) than non-users (52.23 (10.51); p<0.001). 731 (M:F 730:1) people smoked, 900 (M:F 302:598) used smokeless tobacco, and 74 (M:F, 74:0) used tobacco in both forms. The unadjusted and adjusted (age and sex) odds ratio (OR) for a positive history of tobacco use and cataract was 1.72 (95% confidence interval (CI) 1.51 to 1.96) and 1.39 (95% CI 1.15 to 1.68), respectively. The unadjusted OR for smokers and smokeless tobacco users was 1.04 (95% CI 0.88 to 1.23) and 2.74 (95% CI 2.31 to 3.26), respectively. The adjusted OR was 1.19 (95% CI 0.89 to 1.59) and 1.54 (95% CI 1.22 to 1.95), respectively. No significant association was noted between smoking and any particular type of cataract. Smokeless tobacco use was found to be significantly associated with nuclear cataract even after adjusting for age and sex (OR 1.67, p = 0.067, 95% CI 1.16 to 2.39). CONCLUSION: Tobacco use was significantly associated with cataract. Smoking was not found to be significantly associated with cataract formation; however, smokeless tobacco use was more strongly associated with cataract.

Age Distribution↗
PubMed1993

Loss of contrast sensitivity in diabetic patients with LOCS II classified cataracts.

Contrast sensitivity function (CSF) was assessed in a population of diabetics with moderate cataracts to determine if CSF testing provides more information about visual dysfunction than Snellen or Lotmar interferometric visual acuity. With the Lens Opacities Classification Systems Version II (LOCS II) of cataract classification it was possible to grade accurately the type and severity of cataract and nuclear brunescence. The presence of statistically significant relationships between increasing LOCS II classification (worsening cataract) and diminished function, even when the regression model was controlled for Snellen visual acuity, supports the thesis that CSF measurements do provide more information about cataract related visual loss than Snellen acuity alone. Statistically significant (p < or = 0.05) relationships existed between different morphological types of cataract, nuclear colour, and CSF at specific frequencies. The frequencies affected differed with cataract type or nuclear colour, and with distance and near CSF.

Adult↗
PubMed1995

Study of nuclear cataract progression using the National Eye Institute Scheimpflug system.

AIMS: A study was conducted to determine the capability of the recently developed National Eye Institute (NEI) Scheimpflug cataract imaging system in detecting changes in the nuclear region of the lens over a 1 year period. METHODS: Twenty five eyes with pure nuclear cataracts with mean nuclear densities < or = 0.30 optical density units (ODU) as well as 30 normal control eyes were each examined at baseline and 12 months later. Computerised densitometry using the NEI Scheimpflug cataract imaging system was performed. Clinical grading of the lenses was also done using the Lens Opacities Classification System II (LOCS II). For densitometry, a change of plus or minus 0.023 ODU (the 99% range) in mean density in the nuclear area was considered a progression or regression at 1 year. RESULTS: Using the Scheimpflug densitometry, 14 of the 25 cataractous eyes showed significant progression at 1 year. In the normal control group, only three of the 30 eyes showed significant progression. In contrast, using the LOCS II clinical grading, only two of the 25 cataractous eyes showed a one step increase, two of the 30 controls progressed at 1 year, and none regressed. There was no significant difference in visual acuity. CONCLUSION: This study suggests the value of the NEI Scheimpflug cataract imaging system in detecting nuclear change within 1 year. However, clinically significant changes may require longer follow up periods. These data will be useful in planning future longitudinal studies of nuclear cataracts, such as for clinical trials of anticataract drugs.

Adult↗
PubMed1996

Aetiology of childhood cataract in south India.

AIM: To identify the causes of childhood cataract in south India with emphasis on factors that might be potentially preventable. METHODS: A total of 514 consecutive children with cataract attending an eye hospital outpatient clinic were examined and their parents interviewed by a trained interviewer using a standardised questionnaire in the local language. Serology was performed on children under 1 year of age to detect congenital rubella syndrome (CRS). Other investigations were performed as clinically indicated. RESULTS: Of the 366 children with non-traumatic cataract 25% were hereditary, 15% were due to congenital rubella syndrome, and 51% were undetermined. In children under 1 year of age 25% were due to rubella and cataract of nuclear morphology had a 75% positive predictive value for CRS. Mothers of children in the undetermined group were more likely to have taken abortifacients than a group of age matched controls (p = 0.1) but use of other medications in pregnancy was similar in both groups. Of the 148 (29%) children with traumatic cataracts three quarters were over the age of 6 years. Stick injuries were responsible for 28%, thorn injuries for 21%, and firecrackers for 5%. CONCLUSION: Nearly half of non-traumatic cataract in south India is due to potentially preventable causes (CRS and autosomal dominant disease). There is need for further work to identify the factors leading to childhood cataract in at least half of the cases for which no definite cause can as yet be determined.

Abortifacient Agents↗
PubMed1996

Effect of a cataract simulation on clinical and real world vision.

AIMS/BACKGROUND: Many reports have indicated that some patients with cataract can retain good visual acuity but complain of significant visual problems. This is the first in a series of papers trying to determine what causes these symptoms and whether other clinical tests can predict the real world vision loss. METHODS: The effect of a cataract simulation with a similar angular distribution of light scatter as real cataract on clinical (visual acuity, contrast sensitivity, and disability glare) and real world vision (face recognition, reading speed, and mobility orientation) was investigated. RESULTS: The simulation had a relatively small effect on visual acuity (6/6 with the simulation), but much larger effects on contrast sensitivity and low contrast acuity with and without glare. The simulation had no effect on high luminance and high contrast real world tasks, such as mobility orientation in room light and optimal reading speed. A small, but significant deterioration was found for the slightly lower contrast task of face and expression recognition. However, under low luminance conditions, substantial defects in mobility orientation were obtained (despite 6/6 acuity). CONCLUSIONS: Although the relative effect of the cataract simulation on acuity and contrast tasks is not typical of the average cataract, it can be found in those cataract patients with visual problems despite good visual acuity. This corroborates the suggestion that it is large amounts of wide angle light scatter (forward and/or backward) which are at least partly responsible for visual disability in cataract patients with good visual acuity. A patient's reported visual disability may depend on the percentage of time he or she spends under low contrast and/or low luminance conditions, such as walking or reading in dim illumination, and walking or driving at night, in fog, or heavy rain.

Adult↗
PubMed1996

Role of lipid peroxidation in the pathogenesis of myopic and senile cataract.

AIMS/BACKGROUND: Increased production of free radicals, consumption of antioxidant, and oxidation of unsaturated lipids have been observed recently in cataractous lenses and active participation of the retina in human cataractogenesis has been proposed. To verify this hypothesis, the total (GSH) and oxidised (GSSG) glutathione concentrations were assayed in the lens and the malondialdehyde (MDA) levels assayed in the vitreous and in the lens of normal controls and patients with senile or myopic cataract. METHODS: The study was conducted on 34 lenses (nucleus and epinucleus) (nine clear lenses, 14 lenses with idiopathic senile cataract, and 11 lenses affected by severe myopic cataract) and vitreous of 19 (seven non-myopic, seven myopic, and five control) subjects. Glutathione determination was performed following the method of Reed, while malondialdehyde was assayed using a modification of the method of Dahle. RESULTS: Cataractous lenses showed a decreased content of GSH and increased concentration of GSSG compared with clear lenses. A higher oxidative consumption of GSH was found in myopic cataracts compared with senile ones. Also, increased levels of MDA were observed both in cataractous lenses and in the vitreous of myopic patients compared with the control and the senile ones. CONCLUSION: The observed alterations strongly suggest that retinal lipid peroxidation might play a key role in human cataractogenesis, especially in the myopic type.

Aged↗
PubMed1998

Visual outcome after paediatric cataract surgery: is age a major factor?

AIMS: To determine functional results after unilateral and bilateral cataract surgery in children with different aphakic optical correction. METHODS: In this retrospective study, we evaluated visual acuity and binocular vision in 107 children who underwent cataract surgery during the 10 year period from 1985 to 1995. Aphakia was corrected by an intracapsular intraocular lens (IOL), spectacles or contact lenses. RESULTS: Mean visual acuity was > 20/40 (< 0.3 log MAR) with normal binocular vision in 58 children over 7 months of age operated on for bilateral cataracts. Pseudophakic eyes regained visual acuity > 20/63 (< 0.5 log MAR) more often (90%) than aphakic eyes (46%) (p < 0.001). Binocular vision was also achieved more often after IOL implantation (p < 0.001). Visual outcome of early bilateral cataracts was less satisfactory in children with abnormal foveolar function. For 49 children who had surgery for unilateral cataracts, prognosis was poor when surgery was performed before the age of 7 months. For cataract surgery in older children (> or = 7 months) mean visual acuities were better with IOL implantation (p < 0.05). CONCLUSION: Cataract surgery with unilateral and bilateral IOL implantation can provide a beneficial effect on final visual outcome in children who are operated on before abnormal foveolar function develops.

Adolescent↗
PubMed2000

Spontaneous cataract absorption in patients with leptospiral uveitis.

AIMS: To describe the occurrence of spontaneous cataract absorption in patients with leptospiral uveitis. METHODS: The records of patients with seropositive leptospiral uveitis seen in the uveitis clinic at Aravind Eye Hospital between January 1994 and December 1997 were reviewed retrospectively. RESULTS: During the 4 years of the study, 394 eyes of 276 patients with seropositive leptospiral uveitis were identified. Of these, 54 eyes (13.7%) of 41 patients (14.9%) had a final visual acuity of 20/40 or worse attributable to cataract formation. Of these 54 eyes, 41 eyes (75.9%) had visually significant cataract on their first visit to the uveitis clinic, and 13 eyes (24.1%) were noted to have cataract 1-6 months after presentation. Spontaneous absorption was observed in 10 eyes (18.5%) of eight patients (19.5%), and occurred from 6 weeks to 18 months, with a median of 5 months, after the onset of cataract. Of 12 035 consecutive, non-leptospiral, non-traumatic, uveitic, control patients seen during the same 4 years of the study, none showed spontaneous cataract absorption. CONCLUSION: Spontaneous cataract absorption occurs in a significant number of patients with leptospiral uveitis, and appears to be unique to this form of non-traumatic uveitis.

Adolescent↗