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PubMed2003

A population based case-control study of cataract and inhaled corticosteroids.

BACKGROUND/AIMS: Exposure to systemic corticosteroid use is known to be associated with a risk of cataract. Whether low doses of inhaled corticosteroids are associated with an increased risk of cataract is not known. This study was undertaken to quantify the risk of cataract associated with the use of inhaled corticosteroids and assess whether there is a dose-response relation. METHODS: A population based case-control study based on the General Practice Research Database in the United Kingdom. 15 479 people with cataract and 15 479 controls were matched for age, sex, practice, and observation period. RESULTS: The crude odds ratio for the association between any recorded exposure to inhaled corticosteroids and cataract was 1.58 (95% CI 1.46 to 1.71), reduced to 1.10 (95% CI 1.00 to 1.20) after adjustment for systemic corticosteroid exposure and consultation rate. There was a dose-response relation, the adjusted odds ratio rising from 0.99 (95% CI 0.87 to 1.13) at daily doses up to 400 micro g to 1.69 (95% CI 1.17 to 2.43) for daily doses greater than 1600 micro g. The association was also stronger with increasing duration of use. CONCLUSION: Higher doses and longer duration of exposure to inhaled corticosteroids are associated with an increased risk of cataract. The lowest doses compatible with good control of airways disease should be used. The risk of cataract associated with high doses of inhaled corticosteroids needs to be more widely appreciated.

Administration, Inhalation↗
PubMed2003

Refractive error changes in cortical, nuclear, and posterior subcapsular cataracts.

AIMS: To determine the effect of the three main morphological types of cataract on refractive error. METHODS: Data were prospectively collected from 77 subjects (age 67 (SD 8) years) with one morphological type of cataract. 34 had cortical, 21 had nuclear, and 21 had posterior subcapsular cataract. 22 subjects with clear lenses (60 (7) years) were recruited as controls. The spherical equivalent and astigmatic vector change between spectacle correction and optimal refraction were calculated. RESULTS: The cortical cataract group showed a significant astigmatic change of 0.71 (0.67) D (mean (1 SD)) compared to the control group (0.24 (0.20) D), with 24% outside the 95% confidence limit (0.63 D). The nuclear cataract group showed a significant myopic shift of -0.38 (0.60) D compared to the control group (+0.02 (0.21) D), with 52% beyond the minus 95% confidence limit (-0.39 D). CONCLUSION: A quarter of subjects with cortical cataract showed larger changes in astigmatism than subjects with clear lenses. This is probably because of the localised refractive index changes along cortical spoke opacities within the pupillary area. The well known myopic shift of nuclear cataract was also demonstrated.

Aged↗
PubMed2000

The genetics of childhood cataract.

Human congenital cataract has a diverse aetiology. In the proportion of cases where the cause is genetic, the disease shows wide phenotypic and genetic heterogeneity. Over the past few years, much research has been devoted to mapping the genes that underlie the disorder. This has been helped by the extensive array of naturally occurring and genetically engineered mouse cataract models and the abundance of human candidate genes. Most progress to date has been in the identification of genetic mutations causing autosomal dominant congenital cataract where eight genes have been implicated in cataractogenesis. Overall there is good correlation between the genetic mutations so far identified and the resulting lens phenotype but it is clear that mutations at more that one locus may give rise to similar forms of cataract. The identification of genes causing inherited forms of cataract will improve our understanding of the mechanisms underlying cataractogenesis in childhood and provide further insights into normal lens development and physiology. Perhaps more importantly, it is likely that some of the genes causing early onset cataract will be implicated in age related cataract which remains the commonest cause of blindness in the world.

Animals↗
PubMedDate not supplied

Pattern visual evoked cortical potentials predict postoperative visual acuity after cataract surgery in patients with glaucoma.

Visual acuity after cataract surgery in patients with glaucoma cannot be predicted accurately. We studied preoperative recordings of pattern visual evoked cortical potentials (PVECPs) to evaluate postoperative vision in patients with glaucoma and cataract. Fifty patients with glaucoma and no cataract and 31 patients with glaucoma and cataract who underwent phacoemulsification were included in this study. Age and P100 component significantly correlated with postoperative visual acuity with multiple linear regression analysis. A significantly greater number of patients with glaucoma, cataract, and a P100 component preoperatively showed a visual acuity of 0.7 or better postoperatively, as compared to those without a P100 component. PVECP before cataract surgery was able to predict postoperative good visual acuity in patients with glaucoma and cataract.

Adolescent↗
PubMed2002

A review of the epidemiologic evidence linking ultraviolet radiation and cataracts.

BACKGROUND/AIMS: Cataract is the most common cause of blindness in the world and there are currently no strategies to prevent it. The aim of this paper is to review the epidemiologic evidence linking ultraviolet (UV) radiation and cataract. METHODS: Published epidemiologic research articles on UV and cataract were reviewed against the epidemiologic criteria for causality: biological plausibility, strength of the association, specificity, experimental evidence, temporal sequence of events, dose-response relationship, and consistency. RESULTS: The majority of the 22 epidemiologic studies reviewed met most of the epidemiologic criteria for causality and support an association between UV-B and the development of cortical cataract and perhaps posterior subcapsular cataract. CONCLUSIONS: The epidemiologic data justify the implementation of public health campaigns to raise public awareness of the risk of cortical cataract due to ocular UV-B exposure. Future researchers should be careful to avoid potential bias by measuring personal ocular UV exposure and by quantifying cataract carefully.

Cataract↗
PubMed2005

Nutritional supplementation to prevent cataract formation.

Age-related cataract (ARC) is the leading cause of blindness in the world, particularly in developing countries. In contrast, cataract surgery has become the most frequent surgical procedure in people aged 65 years or older in the Western world, causing a considerable financial burden to the health care system. The development of cataracts is mainly an age-related phenomenon, although socioeconomic and lifestyle factors appear to influence their development, e.g. smoking has been found to directly influence ARC. A key role in the pathomechanism of the crystalline lens alteration is played by glucose metabolism and associated effected redox potential, which may induce oxidative damages. Aldose reductase blockers were able to prevent the development of diabetic cataracts in experimental studies, however clinical trials were interrupted due to unclear side effects. Other drugs with radical scavenging properties were effective in in vitro and in vivo experiments, but could not be proven to be efficient and safe in preclinical human trials. A number of epidemiological studies showed an increased risk of nuclear or cortical cataract in people with low blood levels of vitamin E. It is also known that the measured levels of ascorbic acid decline with increasing age in the lens. Beta-Carotin and other non-polar carotenoids seem to be missing and may therefore only play a minor role. Polarized carotenoid lutein and zeaxanthin are available in low concentrations and may therefore have some direct effects. The results of the present interventional studies are still controversial. While the Linxian studies indicated that the prevalence for nuclear cataract was reduced by the supplementation with retinol/zinc or vitamin C/molybdenum, the AREDS trial showed no effect of the antioxidant formulation on the development or progression of ARC. Again, while the REACT study demonstrated a statistically significant positive treatment effect 2 years after treatment for the US patients and for both subgroups (US & UK) after 3 years, no effect was observed in UK patients alone. In another US study, the Physician Health Study, no positive or negative effect of Beta-carotin was observed. Taken together, these studies suggest that any effect of antioxidants on cataract development is likely to be very small and probably is of no clinical or public health significance, thus removing a major rationale for 'anticataract' vitamin supplementation among health-conscious individuals.

Antioxidants↗
PubMed2005

Connexin 46 and connexin 50 in selenite cataract.

The purpose of this work was to determine if the lens gap junction proteins connexin 46 (Cx46) and connexin 50 (Cx50) were altered with the development of selenite-induced cataract. Cataracts were induced in young Sprague-Dawley rats with a single subcutaneous injection of sodium selenite; age-matched uninjected rats served as controls. Membrane fractions were isolated from homogenates of cortex and nucleus of normal and cataractous lenses by differential and discontinuous sucrose gradient centrifugation. Aliquots of urea-insoluble protein from membrane fractions were analyzed by quantitative densitometry of Western blots probed with antibodies to Cx46 and Cx50. A significant decrease in the more slowly migrating Cx46-reactive band, which represents phosphorylated Cx46, was found in the major membrane fraction of the cortex of cataractous lenses. There was no significant difference in the amounts of either Cx46 or Cx50 associated with selenite cataract in any of the membrane fractions examined. These results suggest that alteration of gap junction function (as evidenced by the change in phosphorylation of Cx46) may be associated with the development of the selenite cataract, but that neither Cx46 nor Cx50 is subject to the well-characterized proteolysis associated with the selenite cataract model.

Animals↗
PubMed1986

Superoxide dismutase molecules in human cataractous lenses.

Specific activity of superoxide dismutase (SOD) in cataractous lenses was examined. Immunoprecipitation with monospecific antibodies showed an accumulation of catalytically inactive, but antigenically reactive enzyme molecules in lenses with various types of cataracts. The inactive enzyme molecules can be demonstrated in all kinds of cataracts, including dense, mature cataracts with very low or nondetectable enzyme activity. In cataracts from diabetic patients, the mean enzyme activity was higher than in nondiabetic patients. This was especially marked in nuclear cataracts, in which the specific activity of SOD was higher than in similar cataracts from nondiabetics.

Cataract↗
PubMed1997

Some plasma constituents correlate with human cataract location and nuclear colour.

AIMS: To look for differences in levels of various plasma constituents between pair-matched controls and patients who had cataracts classified by location and appearance of lens opacity and nuclear colour in order to identify systemic risk factors. METHODS: One thousand patients were taken from the cataract waiting list of a specialist eye hospital. For each patient, a matched control of the same sex and half-decade of age but without cataract was taken from the patient-list of the family doctor of the patient; the control was the next alphabetically after the patient on the doctor's list. At an early morning visit to the homes of both patients and controls, fasting, a team of nurses performed venepunctures and collected information for a questionnaire. Eye examinations were performed by a team of ophthalmologists. RESULTS: Predominantly nuclear cataract was significantly associated with raised plasma alanine aminotransferase and bilirubin, posterior subcapsular cataract with increased calcium and urea, cuneiform with reduced potassium, mature/hypermature with raised potassium and reduced total carbon dioxide. The following were consistently significantly associated with all forms of cataract; diabetes and raised plasma glucose (not in non-diabetics), use of steroid medication, raised levels of cortisol (steroid users excluded), albumin, alkaline phosphatase, gamma-glutamyl transpeptidase, sodium and total protein and reduced levels of cholesterol and albumin/(total protein-albumin) ratio (an approximation for the albumin/globulin ratio). The multivariate analysis indicated that the most important non-specific cataractogenic effects were those of increased total protein, diabetes and use of steroid medication. CONCLUSION: This and other studies support, broadly, the conclusions that senile or age-related cataract is not merely caused by increasing age and also that various morphological types have different risk factors. The mechanisms underlying the biochemical associations with different patterns of lens opacification and the identification of the ultimate risk factors remain to be elucidated.

Aged↗
PubMed1987

On the epidemiology of cataract in Bulgaria.

Cataract prevalence in Bulgaria is a subject of current registration and of research studies. Our report deals with three basic sources: national statistics data, epidemiological study on cataract incidence, and clinical observation on risk factors. In 1985, 7.9 cataract cases per 1,000 population (over 15 years) have been registered. Cataract extractions increased from 6,972 (1980) to 8,050 (1984). Cataract prevalence study on 2.5 representative samples during the 1970 census in Bulgaria demonstrated 3.6% for urban and 2.5% for rural populations for 1 year of observation. The data showed a 10-fold increase when additional ophthalmologic examination of a given sample had been performed. The clinically based study of cataract characteristics and risk factors includes about 600 patients for a 1-year period. In this report the data according to sex and age distribution, type of cataract and the presence of systemic disease have been presented.

Adult↗
PubMed2005

Human lens phospholipid changes with age and cataract.

PURPOSE: To determine the phospholipid changes responsible for the increase in membrane lipid hydrocarbon chain order, or stiffness, with age and cataract in the human lens. METHODS: Clear human lenses were pooled into four groups, with donors ranging in age from 15 to 29, 30 to 49, 50 to 64, and 65 to 74 years. Whole human cataractous lenses were obtained from donors after extracapsular cataract extraction. Cataractous lenses were grouped into four classifications: mature, mixed cortical and nuclear, immature nuclear sclerotic, mature posterior subcapsular, and mature nuclear. Lipids were extracted and quantified gravimetrically. The relative phospholipid composition was determined by (31)P-nuclear magnetic resonance spectroscopy. RESULTS: The relative and absolute amount of sphingolipids, including dihydrosphingomyelin and sphingomyelin, increased with age, whereas glycerolipids, including phosphatidylcholine and two phosphatidylethanolamine-related phospholipids, decreased. These changes were exacerbated by the presence of cataract and were substantial, greater than the changes in lipid levels reported in any organ in association with any disease. CONCLUSIONS: The changes in the amount of lipids with age and cataract support the idea that glycerolipids are selectively oxidized over lipids with fewer double bonds, such as sphingolipids. As a result of the elevation of sphingolipid levels with species, age, and cataract, lipid hydrocarbon chain order, or stiffness, increases. Increased membrane stiffness may increase light-scattering, reduce calcium pump activity, alter protein-lipid interactions, and perhaps slow fiber cell elongation.

Adolescent↗
PubMed2006

Plasma lutein and zeaxanthin and other carotenoids as modifiable risk factors for age-related maculopathy and cataract: the POLA Study.

PURPOSE: To assess the associations of plasma lutein and zeaxanthin and other carotenoids with the risk of age-related maculopathy (ARM) and cataract in the population-based Pathologies Oculaires Liées à l'Age (POLA) Study. METHODS: Retinal photographs were graded according to the international classification. ARM was defined by the presence of late ARM (neovascular ARM, geographic atrophy) and/or soft indistinct drusen (>125 microm) and/or soft distinct drusen (>125 microm) associated with pigmentary abnormalities. Cataract classification was based on a direct standardized lens examination at the slit lamp, according to Lens Opacities Classification System III. Plasma carotenoids were measured by high-performance liquid chromatography (HPLC), in 899 subjects of the cohort. RESULTS: After multivariate adjustment, the highest quintile of plasma zeaxanthin was significantly associated with reduced risk of ARM (OR=0.07; 95% CI: 0.01-0.58; P for trend=0.005), nuclear cataract (OR=0.23; 95% CI: 0.08-0.68; P for trend=0.003) and any cataract (OR=0.53; 95% CI: 0.31-0.89; P for trend=0.01). ARM was significantly associated with combined plasma lutein and zeaxanthin (OR=0.21; 95% CI: 0.05-0.79; P for trend=0.01), and tended to be associated with plasma lutein (OR=0.31; 95% CI: 0.09-1.07; P for trend=0.04), whereas cataract showed no such associations. Among other carotenoids, only beta-carotene showed a significant negative association with nuclear cataract, but not ARM. CONCLUSIONS: These results are strongly suggestive of a protective role of the xanthophylls, in particular zeaxanthin, for the protection against ARM and cataract.

Cataract↗
PubMed2006

Identification of a CRYAB mutation associated with autosomal dominant posterior polar cataract in a Chinese family.

PURPOSE: A four-generation Chinese family with 13 members affected with autosomal dominant congenital posterior polar cataract was studied. The purpose of this study was to identify the disease-causing gene in the family and to validate that mutations in CRYAB, the alphaB-crystallin gene, cause the congenital cataract. METHODS: Linkage analysis was performed with a panel of microsatellite markers flanking candidate genetic loci for cataracts, including 14 known autosomal dominant congenital cataract (ADCC) genes. For mutation analysis, the complete coding region and exon-intron boundaries of CRYAB were sequenced with DNA from the proband. Single-strand conformation polymorphism (SSCP) analysis for exon 1 of CRYAB was performed in all family members and 200 normal control subjects. RESULTS: The disease gene in the Chinese family was mapped to chromosome 11 in region q22-22.3 with a maximum lod score of 4.52. Direct DNA sequence of CRYAB revealed a heterozygous C-->T transition at nucleotide 58, resulting in a novel 58 C-->T (Pro20Ser) mutation. The Pro20Ser mutation cosegregated with all affected individuals and was not present in unaffected members in the family or in 200 normal control subjects. The mutation occurs at the evolutionarily conserved residue Pro20 in the N-terminal region of alphaB-crystallin. CONCLUSIONS: To date, only one CRYAB mutation has been associated with congenital isolated cataract. This study identified a second novel mutation in CRYAB in a large Chinese cataract family. Together, these results provide strong evidence that CRYAB is a pathogenic gene for congenital cataract.

Aged↗
PubMedDate not supplied

Hereditary hyperferritinemia cataract syndrome: ocular, genetic, and biochemical findings.

PURPOSE: To describe the cataract morphology and genetic and biochemical findings in a four-generation family with hereditary hyperferritinemia cataract syndrome (HHCS). METHODS: Family members of the proband with HHCS were investigated. DNA sequencing was carried out to identify the iron responsive element (IRE) of the L-ferritin gene in affected and non-affected family members. Molecular modeling allowed prediction of the structure of the mutant IRE in affected cases. Serum ferritin and transferrin saturation were determined using standard methods. All family members underwent slit lamp examination by an ophthalmologist to document presence of cataract or lens status. Cataract morphology was documented where present. RESULTS: This family with HHCS had the genetic heterozygous mutation G32C in the IRE of the L-ferritin mRNA. Lens opacities were detectable in young members of the family, and morphology of cataracts was consistent with previous reports. Biochemical testing demonstrated high serum ferritin levels in affected individuals. CONCLUSIONS: The morphology of cataracts in HHCS seems to be similar in all cases. In the heterozygous G32C mutation, the age at onset of cataracts is very early. Greater awareness of this condition among ophthalmologists will lead to effective family counseling of those affected, by genetic testing or simple biochemical tests. Serum ferritin levels can be effectively used to screen for this condition in suspected families.

Adolescent↗
PubMed2006

Low-dose inhaled and nasal corticosteroid use and the risk of cataracts.

Orally inhaled corticosteroid use has been convincingly linked to an increase in the risk of cataracts, although the risk at lower doses in common use remains uncertain. The potential risk of cataracts with the use of nasal corticosteroids is unknown. A matched nested case-control analysis was performed in a population-based cohort of elderly people who had been dispensed medications for airway disease, as identified through a universal drug benefit plan. Inhaled corticosteroid use was associated with a dose-related increase in both the risk of all cataracts and severe cataracts requiring extraction, and the increase in risk of severe cataracts was apparent even at daily doses of </=500 microg. An excess risk with nasal corticosteroids was not apparent for severe cataracts. It is concluded that, among the elderly, even low doses of inhaled corticosteroids are associated with a small but significant excess risk of cataracts requiring extraction. Such an excess risk was not observed with nasal corticosteroids.

Administration, Inhalation↗
PubMed2006

Cataract surgery by appointment--a pilot study.

BACKGROUND: "Cataract Surgery by Appointment" is a new method of delivery of cataract surgery that reduces the time a patient spends in hospital by their direct arrival at the operating theatre, having self-prepared for surgery, thus avoiding admission to the ward or time spent in the Day Case Unit. The patient can stay as little as 20 minutes from their arrival to going home. We describe the process in detail, and seek to evaluate the visual outcome, safety and patient satisfaction of same. METHODS: Visual outcome and safety data were obtained from patients' medical records, prospectively. Patients were also surveyed by a questionnaire to determine their satisfaction with the service and viability as a prospect for providing a more efficient cataract surgery service. RESULTS: In 2002, fifty-one eyes of 39 consecutive patients underwent "Cataract Surgery by Appointment". There were 16 male and 23 female. The pre-operative best-corrected visual acuity was 6/9 or better in 17 (33%) eyes. The post-operative best-corrected visual acuity was 6/9 or better in 44 (86%) eyes. There were no per-operative complications. Post-operative complications occurred in 3 (6%) eyes. The average number of days from surgery to final discharge was 14.5 days. Twenty-eight (72%) completed questionnaires were returned. The results show that the majority of patients were satisfied with their overall experience of this mode of delivery for cataract surgery. CONCLUSION: "Cataract Surgery by Appointment" performed under local anaesthesia by a skilled ophthalmic surgeon appears to be safe and effective for highly selected cases. This method of delivery gave a high level of patient satisfaction, and is the ultimate form of day case cataract surgery. The method may gain widespread use should per-operative intracameral pupil dilatation prove to be effective and acceptable. Attention should be paid to risk-stratification, so complex cases are allocated more time on the operating list.

Appointments and Schedules↗
PubMed2004

An ocular drug delivery system containing zinc diethyldithiocarbamate and HPbetaCD inclusion complex--corneal permeability, anti-cataract effects and mechanism studies.

Our purpose was to study the formulation and anti-cataract effects of aqueous eye drops containing a high concentration of zinc diethyldithiocarbamate (Zn-DDC). A possible mechanism of the anti-cataract effect of Zn-DDC was also studied. Zn-DDC and hydroxypropyl-beta-cyclodextrin (HPbetaCD) inclusion complex (Zn-DDC/HPbetaCD) was studied using the saturation solution method and characterized by differential scanning calorimetry (DSC) and Fourier transform infrared spectroscopy (IR). Suitable formulations for Zn-DDC eye drops were established by means of in-vitro trans-corneal penetration experiments. The anti-cataract effect of the selected formulation was demonstrated by the delay in lens opacity development in hereditary shumuya cataract rats (SCRs). Semiquantitative reverse transcription polymerase chain reaction (RT-PCR) was performed to study the effect of diethyldithiocarbamate (DDC), a metabolite of Zn-DDC, on the transcription inducible nitric oxide synthase (iNOS) mRNA in human lens epithelial cells (HLEC). In the presence of 22% (w/v) HPbetaCD, the solubility of Zn-DDC in water (0.2 mM) was increased almost 850 fold (to 17 mM), by the formation of Zn-DDC/HPbetaCD. The stoichiometry of Zn-DDC inclusion was 1:1. The Zn-DDC/HPbetaCD stability constant, Ks (1:1) was estimated to be 3453 M(-1). The ophthalmic preparation containing 0.1% HPMC and 0.1% poloxamer 188 (P188) exhibited better permeability than the others in-vitro, and significantly delayed cataract formation in SCRs compared with non-treated SCRs. DDC inhibits the transcription of iNOS mRNA in HLEC. We concluded that this drug delivery system increases both the drug solubility in aqueous eye drops and the permeability of drug through the rabbit cornea, by the formation of a drug-cyclodextrin inclusion complex and the addition of polymers and penetration enhancers. The preparation effectively prevented the development of cataracts in SCRs. DDC, the metabolite of Zn-DDC, may be one of the factors in the prevention of cataract formation because it inhibits the transcription of iNOS mRNA.

2-Hydroxypropyl-beta-cyclodextrin↗
PubMed2005

[Barriers in the access to senile cataract treatment at Altino Ventura Foundation].

PURPOSE: To identify the barriers in the access to treatment of senile cataract and to evaluate the patient's costs in this process. METHODS: A survey of 101 patients who would undergo cataract surgery at Altino Ventura Foundation was performed using a questionnaire. The economical and social aspects of the whole process of treatment were evaluated. RESULTS: The principal barriers of cataract treatment were: fear of surgery, patient's low income, the need for preoperative examinations and the number of times the patient had to return to the service (3.2 +/- 1.5), as well as the waiting time between the first examination and the surgery (3.2 +/- 2.6 months - Mean +/- SEM). The examination costs varied from 5 to 170 reais (16.6 +/- 2.7 - Mean +/- SEM). DISCUSSION: The main reasons for not seeking for cataract treatment, as the fear to undergo surgery and the lack of financial resources had been similar to other Brazilian institutions. The number of times that the patient had to return to the service increased the expenses of the patient and the difficulties faced by him. Altino Ventura Foundation mainly takes care of the poorest population of the State, therefore, the expenses of the patients with transportation and examinations become obstacles to the treatment of cataract. CONCLUSIONS: The fear of surgery and the patient's low income and the social level of the institution's users were the principal barriers in the access to cataract treatment in this study. The need for preoperative examinations, sometimes unnecessary, contributes to a lower efficiency of the medical services offered to individuals of low income and social conditions. The surgery carried out at the same day of the cataract diagnosis makes the solution of the illness quickly possible, diminishing the number of times necessary for the patient's return to health service from three or more, to only one.

Activities of Daily Living↗