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PubMed2001

Visual impairment, age-related cataract, and mortality.

OBJECTIVE: To explore associations between visual impairment, cataract, and mortality in older persons after adjusting for other factors associated with mortality. METHODS: A population cohort of 3654 persons aged 49 years or older (82.4% of eligible residents in the Blue Mountains region, west of Sydney, Australia), were examined at the Blue Mountains Eye Study baseline period (1992-1994) and followed up 5 years later (1997-1999). Australian National Death Index data were used to confirm persons who had died since baseline. Associations between mortality and presence of visual impairment and cataract at baseline were assessed using the Cox proportional hazards regression model, controlling for age, sex, demographic and socioeconomic status, medical history, and health risk behaviors. RESULTS: By June 30, 1999, 604 participants (16.5%) had died. The age- and sex-standardized 7-year cumulative mortality rate was 26% among persons with any visual impairment and 16% in persons without visual impairment. After adjusting for factors found significantly associated with mortality, including age, male sex, low self-rated health, low socioeconomic status, systemic medical conditions, and negative health risk behaviors, the presence at baseline of any visual impairment was independently associated with increased mortality risk (risk ratio [RR], 1.7; 95% confidence interval, 1.2-2.3). The presence of age-related cataract, either nuclear (RR, 1.5), cortical (RR, 1.3), or posterior subcapsular cataract (RR, 1.5), was also significantly associated with increased mortality risk. These associations remained statistically significant when visual impairment and each type of cataract were included simultaneously in the multivariate Cox model. CONCLUSION: Visual impairment and age-related cataract may be independent risk factors for increased mortality in older persons.

Aged↗
PubMed2005

Acute endophthalmitis following cataract surgery: a systematic review of the literature.

OBJECTIVES: To determine the reported incidence of acute endophthalmitis following cataract extraction over time and to explore possible contributing factors, such as type of cataract incision. METHODS: A systematic review of English-language articles was conducted by performing a broad search of PubMed from 1963 through March 2003 using such terms as cataract extraction, endophthalmitis, and postoperative complication. Additional studies were identified from bibliographies of relevant articles and published proceedings. Surgical approach was recorded, when available. Pooled incidence rates and relative risks of developing endophthalmitis using different incision techniques were assessed. RESULTS: From 4916 unique, potentially relevant citations, 215 studies that addressed endophthalmitis and met the selection criteria were analyzed. A total of 3 140 650 cataract extractions were pooled resulting in an overall rate of 0.128% of postcataract endophthalmitis. However, the incidence of acute endophthalmitis changed over time, with a significant increase since 2000 compared with previous decades (relative risk, 2.44 [95% confidence interval, 2.27-2.61]). The rate of endophthalmitis was 0.265% in the 2000-2003 period, 0.087% in the 1990s, 0.158% in the 1980s, and 0.327% during the 1970s. Furthermore, an upward trend in rates after 1992 was noted, compared with 1991 and prior. Incision type appeared to significantly influence risk, as endophthalmitis following clear corneal cataract extraction during the 1992-2003 period was 0.189% compared with 0.074% (relative risk, 2.55 [95% confidence interval, 1.75-3.71]) for scleral incision and 0.062% (relative risk, 3.06 [95% confidence interval, 2.48-3.76]) for limbal incision. CONCLUSIONS: This systematic review indicates that the incidence of endophthalmitis associated with cataract extraction has increased over the last decade. This upward trend in endophthalmitis frequency coincides temporally with the development of sutureless clear corneal incisions.

Acute Disease↗
PubMed1986

Response of the corneal endothelium to cataract surgery.

Regional changes in endothelial cell density, morphology, and corneal thickness were serially examined with a specular microscope after intracapsular cataract extraction (four eyes), extracapsular cataract extraction (five eyes), and extracapsular cataract extraction with posterior chamber lens implantation (13 eyes). Regardless of the type of cataract surgery, cell loss and morphologic changes (decreased percentage of hexagonal cells, increased cellular elongation, and increased coefficient of variation) were greatest and occurred within one week in the superior cornea. Similar changes occurred after one month centrally but were minimal inferiorly. Endothelial cell density stabilized, and the morphologic changes resolved within three months in all regions of the cornea. Corneal swelling resolved within one month. Differences between the procedures were noted only in the superior portion of endothelium, where cell loss and morphologic changes were greatest following intracapsular cataract extraction. Also, endothelial wound healing was complete and stable three months after cataract surgery, with or without posterior chamber lens implantation.

Adult↗
PubMed1988

Congenital and traumatic cataract. The effect on ocular axial length.

Elongation of the eye is one of the drawbacks of implanting intraocular lenses in children. To evaluate possible effects of cataract and aphakia on eye elongation, we measured the axial length in children with unilateral aphakia (15 children with congenital cataract and 27 with traumatic cataract) and in children with bilateral congenital cataract (operated on in 14 cases and not operated on in eight cases). In all cases of unilateral aphakia, the aphakic eye was consistently longer than the normal fellow eye. Excessive eye elongation was related to corresponding reduction in visual acuity. The presumed rate of elongation was quantitatively expressed using the time elapsed since surgery and the age of the child. In bilateral congenital cataract, the axial length measured in aphakic eyes that were operated on was similar to that in eyes that were not operated on. We suggest that unilateral cataract or aphakia is associated with excessive eye elongation of affected eyes. Eye elongation seems to be related to amblyopia and poor vision rather than to aphakia.

Adolescent↗
PubMed1989

India-US case-control study of age-related cataracts. India-US Case-Control Study Group.

In a hospital-based case-control study of 1441 patients with age-related cataracts and 549 controls, we studied associations between types of cataract--nuclear, cortical, posterior subcapsular, and mixed--and a number of physiologic, behavioral, environmental, and biochemical variables. Using polychotomous logistic regression analysis, we found an increased risk of cataract with lower educational achievement (all types of cataract), decreased cloud cover at place of residence (all types), use of aspirin less than once a month (posterior subcapsular and mixed), diets low in selected nutrients (posterior subcapsular, nuclear, and mixed), higher blood pressure (nuclear and mixed), lower body mass index (nuclear and mixed), use of cheaper cooking fuels (cortical, nuclear, and mixed), and lower levels of an antioxidant index based on red blood cell levels of glutathione peroxidase and glucose-6-phosphate dehydrogenase and plasma levels of ascorbic acid and vitamin E (posterior subcapsular and mixed). All risks cited were significantly different from those for the other cataract types, a finding that emphasizes the need to investigate the epidemiology of specific types of cataract.

Adult↗
PubMed1993

Axial dimension of the human cataractous lens.

OBJECTIVE: To determine the axial thickness of the human cataractous lens and analyze the effect of age and axial length on its thickness. METHOD: The axial thickness of the human lens was measured ultrasonically with immersion technique A-scan at 1641 m/s in 600 cataractous eyes immediately before cataract surgery for visual rehabilitation. The axial length was similarly measured but at 1555 m/s. RESULTS: The mean (+/- SD) thickness for all eyes in patients aged from 19 to 97 years was 4.63 (+/- 0.68) mm, with a mean age of 69 (+/- 12) years and a mean axial length of 23.65 (+/- 1.28) mm. The thickness of the cataractous lens was directly proportional to age, with a mean of 3.78 (+/- 0.21) mm in the third decade and a mean of 5.03 (+/- 0.46) mm in the 10th decade. Using one-way analysis of variance, the differences were statistically significant (P = .0002). The thickness of the lens was inversely proportional to the axial length of the eye (P < .003). The mean thickness was 5.03 (+/- 0.63) mm in eyes with axial length of less than 22 mm and 4.24 (+/- 0.58) mm in eyes with axial length of 27 mm or more. Eyes in patients younger than age 65 years (158 eyes) had a mean axial length of 24.08 (+/- 1.53) mm, eyes in patients aged from 65 to 75 years (252 eyes) had a mean axial length of 23.67 (+/- 1.19) mm, and eyes in patients older than age 75 years (190 eyes) had a mean axial length of 23.26 (+/- 1.03) mm. The differences were statistically significant using analysis of variance (P < .0001). CONCLUSIONS: The data confirm the fact that the lens thickens with age, at least in cataractous eyes. Axial length was shown to have an emmetropizing effect on lens thickness, being more optically powerful (thicker) in hyperopic eyes. These values are useful in determining average sound velocities for use with ultrasound A-scan instruments for measuring the axial length of the eye. Patients with axial myopia are more likely to develop cataracts at an earlier age than those with shorter axial lengths.

Adult↗
PubMed1993

The content and cost of cataract surgery.

Although more than 1 million cataract surgeries are performed annually in the United States, little is known about the frequency of use or cost of various services provided in connection with this procedure. To assess the frequency with which various ophthalmic, optometric, anesthesia, and medical services are provided in conjunction with cataract surgery and to estimate the cost to Medicare associated with those services, we analyzed 1985 through 1988 Medicare claims records of a nationally representative 5% sample of Medicare beneficiaries. The experience of 57,103 Medicare beneficiaries who underwent extracapsular cataract surgery in 1986 or 1987 that was not combined with another ophthalmologic procedure formed the basis of our analysis. Projections for current costs were performed using 1991 charges allowed by Medicare for physician services. We estimate that the median charge allowed by Medicare for a "typical" episode of cataract surgery in 1991 was approximately $2500. In addition to the $3.4 billion that Medicare spent in 1991 on such "typical" episodes, Medicare spent more than $39 million on miscellaneous "atypical" preoperative ophthalmologic tests, such as specular microscopy (14% of cases) and potential acuity testing (8% of cases), more than $7 million on postoperative ophthalmologic diagnostic tests, such as fluorescein angiography (3% of cases), and more than $18 million on perioperative medical services (most commonly electrocardiography and chest roentgenography). The major determinants of the cost to Medicare associated with cataract surgery are the rate of performance of cataract surgery and neodymium-YAG laser capsulotomy and the charges allowed for these procedures.(ABSTRACT TRUNCATED AT 250 WORDS)

Cataract Extraction↗
PubMed1997

Effect of cataract extraction on the results of automated perimetry in glaucoma.

OBJECTIVE: To investigate the effect of cataract extraction on the results of automated perimetry in persons with glaucomatous visual field loss. SUBJECTS: Subjects from a retrospective study of visual field progression who underwent cataract extraction during follow-up were identified. Subjects came from the glaucoma service of a hospital-based tertiary referral center. METHODS: Subjects had at least 7 Humphrey 24-2 or 30-2 visual fields over 5 years or more, with an abnormal glaucoma hemifield test result on the first 2 examinations. Visual field data were transferred to a microcomputer and comparison of the visual fields immediately before and after cataract extraction was performed. RESULTS: Sixty-five eyes of 50 subjects (mean age, 71.8 years) were included in the analysis. A mean improvement in mean deviation (MD) of 1.68 dB (P<.001), and a mean worsening in corrected pattern SD (CPSD) of 0.54 dB (P=.09) was observed. The mean unweighted change in threshold in the 52 points of program 24-2 was 1.58 dB, corresponding to a 43.9% increase in sensitivity. A significant correlation between improvement in visual acuity and improvement in MD was also found. A mean increase in CPSD of 1.61 dB (P=.005) occurred in subjects with dense scotomas (minimum threshold value < or = 5 dB) and preoperative CPSD of 8 dB or less. CONCLUSIONS: In persons with glaucomatous visual field defects, cataract extraction produces only a modest improvement in MD. After cataract surgery, the CPSD index worsened in many subjects with dense scotomas. This suggests that the development of cataract can mask progressive glaucomatous visual field loss in such persons.

Aged↗
PubMed1999

Genetic factors influence cataract formation in alpha 3 connexin knockout mice.

Connexin alpha 3 (Cx46 or Gja3) gene targeted null mice developed lens nuclear cataracts shortly after birth. A large variance in the cataracts was observed in alpha 3 null sibs on a mixed 129SvJae X C57BL/6J F3 background. This suggested that the genetic background might influence the cataract phenotype. Therefore, we placed the alpha 3 null mutation into a 129SvJae background, and also backcrossed the mutation for six generations into 129SvJ and C57BL/6J backgrounds. While alpha 3 nulls on the two 129 backgrounds contained severe cataracts associated with gamma crystallin cleavage, alpha 3 nulls on the C57B16 background had far milder cataracts with no detectable gamma crystallin cleavage. These findings suggest that a genetic modifier exists that influences gamma crystallin stability, and that gamma crystallin breakdown is associated with severe nuclear cataracts.

Animals↗
PubMed2002

Surgical interventions for age-related cataract.

BACKGROUND: Cataract is the major cause of global blindness, accounting for 40 to 80% of all blindness in developing countries. The number of people blind from cataract is expected to rise due to the changing age distribution and increasing life expectancy. There is currently no proven intervention to prevent cataract and surgery is the only form of treatment. OBJECTIVES: The objective of this review is to compare the effects of different surgical interventions for age-related cataract. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register - CENTRAL/CCTR, which contains the Cochrane Eyes and Vision Group specialised register (Cochrane Library Issue 3 2001), MEDLINE (1966 to August 2001), EMBASE (1980 to September 2001), the reference lists of identified trials, and we contacted investigators and experts in the field for details of published and unpublished trials. SELECTION CRITERIA: We included randomised controlled trials evaluating surgical treatment for people with age-related cataract. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and discrepancies were resolved by discussion. Where appropriate, relative risks, odds ratios and weighted mean differences were summarised after assessing heterogeneity between the studies. We used a fixed effect model due to the low number of trials in each comparison. MAIN RESULTS: We identified six trials that randomised a total of 7828 people. Phacoemulsification gave a better visual outcome than extracapsular surgery and gave a similar average cost per procedure in one trial conducted in the UK. Extracapsular surgery with posterior chamber lens implant and intracapsular surgery with or without an anterior chamber intraocular lens implant gave acceptable visual outcomes at 12 to 24 months after surgery. In three large trials in south Asia, best-corrected visual acuity of less than 6/60 ranged from 0.5 to 4%. Higher rates of poor outcome were observed in a multicentre study with 19 surgeons compared to a single-centre study with two surgeons. REVIEWER'S CONCLUSIONS: This review provides evidence from one randomised controlled trial that phacoemulsification gives a better visual outcome than extracapsular extraction with sutures. However, this trial was conducted in a developed country specialised hospital setting and extrapolation to other settings must be made with caution. This review also found evidence that extracapsular cataract extraction with a posterior chamber lens implant provides better visual outcome than intracapsular extraction with aphakic glasses. This finding is also based on the results of a single trial. The long term effects of posterior capsular opacification need to be assessed in larger populations. The data in the review suggest that intracapsular extraction with an anterior chamber lens implant is an effective alternative to intracapsular extraction with aphakic glasses, with similar safety. Further data from developing regions are needed to compare all aspects of intraocular lens surgery with the three main surgical procedures - intracapsular extraction with an anterior chamber lens, extracapsular surgery with a posterior chamber lens with or without sutures.

Age Factors↗
PubMed1984

Non-invasive techniques in the study of cataract development at the metabolic and protein molecular level.

Metabolic changes may precede changes in lens protein structure and cataract opacification. Since many of the effects associated with cataract are oxidative in nature, changes in the redox state may be caused by alterations in the level of various metabolic intermediates such as ATP and NAD(P)H. Abnormal levels of H2O2 have been found in the aqueous fluid of cataract patients. Lenses have been treated with 1 mM-H2O2 in organ culture as a cataract model. H2O2 in this system uncouples Na+, K+-ATPase. This metabolic stress has been further evaluated non-invasively by 31P NMR to show that H2O2 can reduce ATP levels without any immediate effects on visual transparency. However, further treatment by this oxidant leads to definitive visual changes in lens clarity. These changes may be due to further changes in structural lens proteins caused by denaturation and aggregation induced by H2O2. The effects of H2O2 on isolated lens proteins is being examined in molecular detail by NMR to ascertain how the lens proteins become denatured in solution. The relevance of the H2O2 model to cataract formation can only be evaluated by using several non-invasive techniques beyond NMR, and then critically comparing the model systems with human cataract tissue samples.

Adenosine Triphosphate↗
PubMed1984

Oxidation and cataract.

Previous work has established that oxidation of the constituents of the human lens is an early event in the development of cataract. In old pre-cataractous lenses, oxidation of the fibre membrane polypeptides is observed. Non-disulphide-linked aggregates possibly generated by photo-oxidation are also found. With the development of cataract the oxidation becomes more extensive, affecting many of the proteins of the tissue. High molecular weight, disulphide-linked aggregates are formed, involving cytosol and membrane components. Membrane rupture accompanies the process. Hydrogen peroxide has been found in elevated levels in the aqueous fluid of some cataract patients. H2O2 will cause cataract and has been shown to affect Na+,K+-ATPase. Analyses of available data suggest that (1) oxidation of membrane components may be an initiating event in cataract, and (2) the oxidizing agent may come from the exterior environment of the tissue. The problems involved in proving this hypothesis are discussed and an approach to testing the hypothesis is suggested.

Aging↗
PubMed1985

Juvenile cataract in Hutterites.

Isolated juvenile or congenital cataract is a rare disorder. It occurs commonly as part of a more generalized or systemic condition or as a component of a syndrome. When encountered per se it may be genetically determined. The inheritance then often is autosomal dominant; autosomal recessive transmission of isolated juvenile cataract is rare. Here we present, four sibships from an extensive kindred including nine individuals affected with juvenile (or congenital) cataracts. The kindred belongs to the Lehrerleut Hutterite group from the provinces of Saskatchewan and Alberta in Canada and the state of Montana in the United States. Apart from the cataracts, all the patients were healthy and of normal growth and development. Specifically, no metabolic disorder could be identified. Intellect, hearing and behavior were all normal and the patients were neurologically intact. Furthermore, there were no other ocular lesions aside from the cataracts. In this kindred cataracts appear to be a recessive trait.

Alberta↗
PubMed2001

Probable genetic origin for a large number of cataracts among captive-bred vervet monkeys (Chlorocebus aethiops).

During a period of 6 years, uni- or bilateral cataracts occurred in 55 captive-bred vervet monkeys, representing 27.6% of all offspring produced in that time. Fifty-eight percent of all cases were detectable only by ophthalmoscopy. A total of 30% of cases were offspring of wild-caught parents, 40% from first-generation captive-bred parents, 4% from second-generation captive-bred parents, and 26% from parents of which one was wild caught. Cataracts that could be observed macroscopically appeared at about 6-8 mo of age. A sample of juvenile vervet monkeys with cataracts and their parents had no antibodies against rubella virus, herpes simplex virus, or toxoplasma gondi, and all except two wild-caught breeding females had no antibodies against cytomegalovirus. Plasma vitamin D3 (25 [OH] D), calcium, phosphorus, and glucose concentrations of six cataract cases were comparable to a control group of healthy individuals. The exclusion of these extraneous factors, as well as the fact that the majority of all cases were related, was considered evidence of hereditary etiology. Males and females that had either produced offspring with cataracts or were related to individuals with cataracts were replaced. To date, 35 babies have been born, and no new cases have since occurred.

Animals↗
PubMed1996

Role of lipid aldehydes in cataractogenesis: 4-hydroxynonenal-induced cataract.

Free radicals have extremely short half-lives and they readily oxidize lipids and initiate an autocatalytic chain reaction of lipid peroxidation, which leads to the formation of lipid peroxides. The lipid peroxides undergo degradation to form metastable lipid aldehydes such as 4-hydroxynonenal (HNE). We have shown earlier that under hyperglycemia, lipid peroxides increase; and aldose reductase, an enzyme that reduces glucose to sorbitol, efficiently reduces HNE. The purpose of the present studies was thus to investigate the role of HNE in hyperglycemic cataract and understand the mechanism(s) of its prevention by antioxidants and aldose reductase inhibitors. HNE and hyperglycemic cataract were developed by culturing rat lenses in TC-199 medium containing 50 microM HNE and 50 mM glucose, respectively. The effect of an anti-oxidant, trolox, and an aldose reductase inhibitor, sorbinil, on the progression of HNE and hyperglycemic cataract, evaluated by digital image analysis, was followed for 8 and 9 days, respectively. In lenses cultured with HNE, the decrease in transmitted light was 43, 65, and 87% on Days 3, 5, and 8, respectively. Trolox ameliorated the HNE cataract, whereas sorbinil accelerated the progression of HNE cataract and prevented the progression of hyperglycemic cataract. It is concluded that HNE formed under hyperglycemia may play a pivotal role in diabetic cataractogenesis.

Aldehyde Reductase↗
PubMed1993

Relationship between lens protein glycation and membrane structure in human cataract.

Glycation, which begins with the spontaneous reaction between sugar and proteins by the formation of Schiff bases, is known to especially damage long-lived proteins such as lens crystallins, and has been implicated in the ageing process and particularly in cataract formation. In this study of human senile cataract, a specific method is used to measure the formation of Amadori compounds in control postmortem and cataractous lenses, but no difference was found. However, the fluorescence of proteins at 430 nm (exc 350 nm), which has been attributed to advanced glycation, increased with normal ageing of the lens (cortex versus nucleus, and as a function of subject's age for each type of fibres) and was further enhanced in cataractous lenses. The precise molecular origin of this fluorescence remains to be elucidated. In parallel to the accumulation of non-tryptophan fluorophores, a decrease in the membrane fluidity was observed with lens ageing and more acutely with cataract. Both parameters are positively correlated (P < 1%). The modification of the membrane structure with glycation could explain the strong permeability changes occurring during cataract, measured here in terms of cation concentration and inositol leakage, as shown by the negative relationship between the fluorescence signal and the sodium to potassium ratio or the inositol level.

Aged↗
PubMed1993

Persistent hyaloid vascular system in age-related cataract in a SAM strain of mouse.

The cataractogenesis of age-related cataract in a strain of Senescence-Accelerated Mouse; SAM-P/9 was investigated. In the mature cataract, funnel-shaped tissue of the persistent hyaloid vascular system extended from the retinal papilla and covered the extremely protruding posterior pole of the cataractous lens, as seen using a stereomicroscope. Longitudinal examination of the eyes with transparent lenses using an ophthalmoscope revealed that the hyaloid vascular system persisted in about 90% of the 5-week-old mice, at least unilaterally. The eyes with transparent lenses in some old mice retained this tissue and a retrospective study revealed that cataract never occurred in eyes without this tissue. Microphthalmos was not observed. Histologically, in the eyes with transparent lenses, the posterior lens capsule covered with a hyaloid vascular system became very thin but only a few lens fibre cells just inside the capsule had swelled. In the lens of the mature cataract or even with initial changes, the lens capsules ruptured. Electron microscopic examination showed that the persistent hyaloid vascular system was tissue consisting of capillary and mesenchymal cells. These observations suggest that the persistent hyaloid vascular system is a necessary but not sole factor for age-related cataract formation in SAM-P/9, and that other age-related factors probably have a role.

Aging↗
PubMed1996

Prevention of naphthalene-induced cataract and hepatic glutathione loss by the L-cysteine prodrugs, MTCA and PTCA.

Rapid-onset cataracts were induced in SPF C57 bl/6 mice by intraperitoneal administration of naphthalene following cytochrome P-450 isozyme induction with phenobarbital. Several L-cysteine prodrugs with masked sulfhydryl groups in the form of thiazolidine-4-carboxylic acids, as well as N-acetyl-L-cysteine, N,S-bis-acetyl-L-cysteine and glutathione ethyl ester, were evaluated for their ability to maintain hepatic and lenticular glutathione at near-normal levels and to prevent naphthalene-induced cataract formation. Each prodrug was administered at three specified times to a cumulative total of 1.5 mole equivalents of the single dose of naphthalene. Three L-cysteine prodrugs delayed but did not prevent cataract formation in 40-60% of the mice over a 72-hr period, while eight of the 13 compounds produced cataract yields similar to the naphthalene control animals, i.e. 83% in 72 hr. However, two L-cysteine prodrugs, 2(R,S)-methylthiazolidine-4(R)-carboxylic acid (MTCA) and 2(R,S)-n-propylthiazolidine-4(R)-carboxylic acid (PTCA), prevented cataract formation in 20 of 21 and 12 of 12 mice, respectively, and maintained hepatic reduced glutathione levels at 82% and 51% of untreated controls. In contrast, glutathione was depressed to 3% of the normal value in those animals treated with naphthalene alone. Lenticular glutathione values were depressed, albeit minimally, in all naphthalene-treated mice regardless of administration of either MTCA or PTCA. The mice protected with either MTCA or PTCA showed no visible effects of naphthalene toxicity or lens opacities at any time. It can be concluded that these L-cysteine prodrugs were effective in preventing naphthalene-induced cataract and maintaining near-normal hepatic glutathione levels.

Animals↗