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PubMed1995

[Morphologic changes in the lens epithelium in patients with age-induced cataract, radiation and steroid cataract and cataract following eye contusion].

The lens epithelium of the human eye plays a crucial role in the pathogenesis of primary and secondary cataract. Sixty hematoxylin-eosinstained lens epithelia were examined using a light microscope. Cell parameters were compared to one another in the various age groups of patients, between patients with secondary cataract (radiation cataract, steroid cataract and traumatic cataract) and patients with senile cataract, and between male and female patients. The t-test was used for statistical comparison. The median cell density was 3116.5 cells/mm2. The median nucleus-plasma ratio was 1:2.74. Patients with secondary cataract had a larger medium cell and nucleus area as well as a higher nucleus-plasma ratio and a lower cell density than patients with senile cataract. A part from degenerative and proliferative cell changes we found various cell types. The age of patients and the cause of cataract correlate with morphometric changes of lens epithelium cells. However, there was no correlation between specific cytologic changes and causes of cataract.

Adolescent↗
PubMed1984

Classification of human senile cataractous change by the American Cooperative Cataract Research Group (CCRG) method: II. Staged simplification of cataract classification.

One thousand nine hundred and seventy-six cataracts extracted intracapsularly were classified according to the system adopted by the Cooperative Cataract Research Group (CCRG) Consortium. A nine-stage protocol for simplifying the classification data is presented. The method of simplifying the basic CCRG classification emphasizes anatomic similarities among lenses. Simplification is indicated when small numbers of cataracts in any class provide insufficient statistical power to allow detection of scientifically or clinically important differences in rates between comparison groups, if such differences exist; however, simplification unavoidably obscures the anatomic, biochemical, and biophysical features of individual cataracts. Age-specific characteristics of this population of 1976 cataracts are used to demonstrate the effects of the simplification process. The preponderance of mixed cataracts and the relative scarcity of pure cataracts are documented, and the implications of these numbers for cataract research are presented.

Age Factors↗
PubMed2001

Age-related utilisation of cataract surgery in Sweden during 1992-1999. A retrospective study of cataract surgery rate in one-year age groups based on the Swedish National Cataract Register.

PURPOSE: To study the utilisation and increase of first eye cataract surgery in one-year age groups between 60 and 90 years of age during 1992-1999. METHODS: Data was extracted from the National Swedish Cataract Register (NCR) that covers about 93.2% of all cataract extractions performed in Sweden during 1992-1999. The total number of living persons in each one-year age group was collected from the Year Book of Statistics in Sweden (1993-2000). RESULTS: The number of cataract extractions in Sweden increased by 54.8% from 1992 to 1999. The rates of first eye cataract surgery in one-year age groups between 60 and 90 years of age were different for females and males and this difference did not change during a 37% increase of the surgery volume from 1992 to 1999. The rate of first eye cataract surgery increased significantly both for females (+29.4%) and males (+27.2%) during 1992 to 1999 in Sweden. CONCLUSION: The rate of first eye cataract surgery increased significantly from 1992 to 1999 but the gender difference in age-related utilisation of surgery remained unchanged. The increase in rate was about the same in all age groups.

Age Distribution↗
PubMed1994

National outcomes of cataract extraction. Retinal detachment and endophthalmitis after outpatient cataract surgery. Cataract Patient Outcomes Research Team.

BACKGROUND: A near-total shift to cataract extraction on an outpatient basis occurred as a result of an administrative ruling by the Health Care Financing Administration. No national study has been conducted to assess the possible effects of that decision on clinical outcomes of surgery. The authors compared the rates of retinal detachment (RD) repair and hospitalization for endophthalmitis after extracapsular cataract extraction (ECCE) (including phacoemulsification) in 1986 and 1987 with those following inpatient cataract extraction in 1984. METHODS: Using the 5% random sample of Medicare beneficiaries, we analyzed the claims of all individuals 66 years of age or older who underwent ECCE by nuclear expression or phacoemulsification in 1986 and 1987. A total of 57,103 patients were identified and followed to the end of 1988. Cumulative probability of RD repair and hospitalization for endophthalmitis was calculated by standard lifetable methods. These findings were compared with the cumulative probability of the same complications in a cohort of 330,000 patients who underwent cataract extraction on an inpatient basis in 1984. RESULTS: In the 1986-to-1987 cohort, the cumulative probability of RD within 3 years after cataract surgery was 0.81% and the cumulative probability of endophthalmitis within 1 year was 0.08%. The rate of RD is similar to that which we previously reported for 330,000 patients who underwent inpatient surgery in 1984, but the rate of endophthalmitis is significantly lower in the 1986-to-1987 outpatient cohort (0.08% versus 0.12%; z = 2.42; P = 0.01). CONCLUSIONS: The shift to outpatient cataract surgery was accompanied by no significant increase in the probability of RD repair and possibly a significant decrease in the rate of hospitalization for endophthalmitis.

Aged↗
PubMed1984

Classification of human senile cataractous change by the American Cooperative Cataract Research Group (CCRG) method: III. The association of nuclear color (sclerosis) with extent of cataract formation, age, and visual acuity.

Nineteen hundred and seventy-six immature human cataracts extracted intracapsularly were classified according to the Cooperative Cataract Research Group (CCRG) method of cataract classification. Data on cataract location and extent, nuclear color, preoperative visual acuity, age, and sex were organized and stored in the PROPHET system. The data were examined for relationships between nuclear color (sclerosis) and the age of the cataractous lens, the extent of opacification in seven anatomical regions including the degree of nuclear opacification and the preoperative visual acuity. Nuclear color correlates with age in a curvilinear manner. Nuclear yellowing increases gradually with increasing nuclear opacification, but the color change is so slight as to be useless for the purposes of inferring the intensity of nuclear opacification from the color of the nucleus. There is no association between the extent of anterior cortical, equatorial cortical, posterior cortical, subcapsular or supranuclear opacification, and nuclear color. Nuclear color impairs vision only for the range dark yellow through black. These data justify the recommendation that nuclear color be abandoned as the single index of the severity of any type of senile cataractous change.

Age Factors↗
PubMed2001

[Complicated cataract: Part II: complicated cataract in glaucoma. Part II: Complicated cataract in retinal degenerative disorders].

The paper shows pathognomonique cases of complicated cataracts concerning the prognostic aspects of surgical treatment. The article presents surgical methods of treating patients with secondary cataract in high myopia and glaucoma. Modern diagnostic methods are discussed, how to choose the safest surgical technique and to reach the desired postoperative refraction. More effective ways of cataract surgery in patients with glaucoma and in high myopia are suggested.

Cataract↗
PubMed2000

Cataract-free interval and severity of cataract after total body irradiation and bone marrow transplantation: influence of treatment parameters.

PURPOSE: To determine prospectively the cataract-free interval (latency time) after total body irradiation (TBI) and bone marrow transplantation (BMT) and to assess accurately the final severity of the cataract. METHODS AND MATERIALS: Ninety-three of the patients who received TBI as a part of their conditioning regimen for BMT between 1982 and 1995 were followed with respect to cataract formation. Included were only patients who had a follow-up period of at least 23 months. TBI was applied in one fraction of 8 Gy or two fractions of 5 or 6 Gy. Cataract-free period was assessed and in 56 patients, who could be followed until stabilization of the cataract had occurred, final severity of the cataract was determined using a classification system. With respect to final severity, two groups were analyzed: subclinical low-grade cataract and high-grade cataract. Cataract-free period and final severity were determined with respect to type of transplantation, TBI dose, and posttransplant variables such as graft versus host disease (GVHD) and steroid treatment. RESULTS: Cataract incidence of the analyzed patients was 89%. Median time to develop a cataract was 58 months for autologous transplanted patients. For allogeneic transplanted patients treated or not treated with steroids, median times were 33 and 46 months, respectively. Final severity was not significantly different for autologous or allogeneic patients. In allogeneic patients, however, final severity was significantly different for patients who had or had not been treated with steroids for GVHD: 93% versus 35% high-grade cataract, respectively. Final severity was also different for patients receiving 1 x 8 or 2 x 5 Gy TBI, from patients receiving 2 x 6 Gy as conditioning therapy: 33% versus 79% high-grade cataract, respectively. The group of patients receiving 2 x 6 Gy comprised, however, more patients with steroid treatment for GVHD. So the high percentage of high-grade cataract in the 2 x 6 Gy group might also have been caused to a significant extent by steroid treatment. The percentage of patients with high-grade cataract was lower in allogeneic transplanted patients without steroid treatment for GVHD than in autologous transplanted patients: 35% versus 48%. An explanation for this could be pretransplant therapy containing high-dose steroids. CONCLUSIONS: After high-dose-rate TBI in one or two fractions, steroids for GVHD influence latency time of a cataract and are of great importance for the severity the cataract finally attains. Although a cataract will develop in all patients, a clinically important high-grade cataract is relatively infrequent in patients not treated with steroids. Pretransplant therapy might also influence final severity of cataract.

Adolescent↗
PubMed2004

Lipid peroxidation and cataracts: N-acetylcarnosine as a therapeutic tool to manage age-related cataracts in human and in canine eyes.

Cataract formation represents a serious problem in the elderly, with approximately 25% of the population aged >65 years and about 50% aged >80 years experiencing a serious loss of vision as a result of this condition. Not only do cataracts diminish quality of life, they also impose a severe strain on global healthcare budgets. In the US, 43% of all visits to ophthalmologists by Medicare patients are associated with cataract. Surgery represents the standard treatment of this condition, and 1.35 million cataract operations are performed annually in the US, costing 3.5 billion US dollars (year of costing, 1998). Unfortunately, the costs of surgical treatment and the fact that the number of patients exceeds surgical capacities result in many patients being blinded by cataracts worldwide. This situation is particularly serious in developing countries; worldwide 17 million people are blind because of cataract formation, and the problem will grow in parallel with aging of the population. In any event, surgical removal of cataracts may not represent the optimal solution. Although generally recognised as being one of the safest operations, there is a significant complication rate associated with this surgical procedure. Opacification of the posterior lens capsule occurs in 30-50% of patients within 2 years of cataract removal and requires laser treatment, a further 0.8% experience retinal detachments, approximately 1% are rehospitalised for corneal problems, and about 0.1% develop endophthalmitis. Although the risks are small, the large number of procedures performed means that 26,000 individuals develop serious complications as a result of cataract surgery annually in the US alone. Thus, risk and cost factors drive the investigation of pharmaceutical approaches to the maintenance of lens transparency. The role of free radical-induced lipid oxidation in the development of cataracts has been identified. Initial stages of cataract are characterised by the accumulation of primary (diene conjugates, cetodienes) lipid peroxidation (LPO) products, while in later stages there is a prevalence of LPO fluorescent end-products. A reliable increase in oxiproducts of fatty acyl content of lenticular lipids was shown by a direct gas chromatography technique producing fatty acid fluorine-substituted derivatives. The lens opacity degree correlates with the level of the LPO fluorescent end-product accumulation in its tissue, accompanied by sulfhydryl group oxidation of lens proteins due to a decrease of reduced glutathione concentration in the lens. The injection of LPO products into the vitreous has been shown to induce cataract. It is concluded that peroxide damage of the lens fibre membranes may be the initial cause of cataract development. N-acetylcarnosine (as the ophthalmic drug Can-C), has been found to be suitable for the nonsurgical prevention and treatment of age-related cataracts. This molecule protects the crystalline lens from oxidative stress-induced damage, and in a recent clinical trial it was shown to produce an effective, safe and long-term improvement in sight. When administered topically to the eye in the form of Can-C, N-acetylcarnosine functions as a time-release prodrug form of L-carnosine resistant to hydrolysis with carnosinase. N-acetylcarnosine has potential as an in vivo universal antioxidant because of its ability to protect against oxidative stress in the lipid phase of biological cellular membranes and in the aqueous environment by a gradual intraocular turnover into L-carnosine. In our study the clinical effects of a topical solution of N-acetylcarnosine (Can-C) on lens opacities were examined in patients with cataracts and in canines with age-related cataracts. These data showed that N-acetylcarnosine is effective in the management of age-related cataract reversal and prevention both in human and in canine eyes.

Aging↗
PubMed2004

Cataract prevalence, cataract surgical coverage and its contribution to the reduction of visual disability in Oman.

AIM: To estimate the magnitude and determinants of cataract prevalence and cataract surgical coverage and to evaluate their role in visual disability in Oman. METHODS: A cross-sectional study was conducted on 11,413 subjects in Oman in 1997. The presence and stage of cataract was noted on the basis of the history and an examination. The patient's phakic, pseudophakic or aphakic status and visual status were determined. The prevalence of cataract and the cataract surgical coverage were estimated. A causal relation was assumed between a backlog of cataract and age, gender and area of residence. The Attributable Risk (AR) and Population Attributable Risk (PAR) for these factors were estimated. RESULTS: The prevalence of cataract was 29.3/1000 (95% CI: 27.76 to 30.84). This was 4.97/1000 (95% CI: 3.68 to 6.26) for blinding cataract (vision < 3/60). The cataract surgery services covered 70.18% (95% CI: 69.52 to 70.84) of the blinding cataracts and 28.76% (95% CI: 28.11 to 29.41) of all cataracts. The AR and PAR of female gender in the cataract backlog were 35.5% and 1.06%, respectively. The AR and PAR of the residents of 'Group B' regions were 40.5% and 1.26%, respectively. The AR and PAR of subjects "less than 60 years old' were 55.6% and 1.66%, respectively. If the gaps in cataract surgery due to gender, regions and age groups were to be filled, the prevalence of cataract could be reduced by 1.06%, 1.21% and 1.66%, respectively. CONCLUSION: The health program should identify and address the barriers to cataract surgery among identified high-risk groups.

Adult↗
PubMed2005

Is renal impairment a predictor of the incidence of cataract or cataract surgery? Findings from a population-based study.

PURPOSE: To explore the relationship between creatinine clearance, an estimate of glomerular filtration rate, and 5-year incidence of cataract and cataract surgery. DESIGN: Population-based cohort study. PARTICIPANTS: Of the 3654 participants (aged 49 years or older) of the Blue Mountains Eye Study (BMES I) baseline examination (during 1992 to 1994), 2334 (75%) were reexamined after 5 years from 1997 to 1999 (BMES II). METHOD: Risk factor data were collected for all participants at baseline (BMES I). Assessment of renal function was based on estimated creatinine clearance (C(Cr)) calculated with the Cockcroft-Gault formula, adjusted for body surface area, and expressed in ml/minute/1.73 m2. Cataract incidence was determined from graded photographs. The association between renal function and incidence of cataract and cataract surgery was analyzed by logistic regression. MAIN OUTCOME MEASURES: Incidence of nuclear, cortical, and posterior subcapsular cataract, and cataract surgery. RESULTS: Mean C(Cr) +/- standard deviation was 60+/-13 ml/minute/1.73 m2. The overall 5-year incidence of nuclear, cortical, and posterior subcapsular cataract was 35.7% (417 of 1167 participants at risk), 16.7% (274 of 1641), and 4.3% (77 of 1790), respectively. Cataract surgery was performed in 6.8% (144 of 2123) of participants. There were no significant associations of renal function with incident nuclear (odds ratio [OR], 1.0; 95% confidence interval [CI], 0.99-1.02), cortical (OR, 1.0; CI, 0.98-1.01), and posterior subcapsular cataract (OR, 1.0; CI, 0.99-1.04) after adjusting for multiple risk factors. After adjusting for age, gender, and dark brown iris color, moderate or worse renal impairment (C(Cr) <60 ml/minute/1.73 m2) compared with normal or mildly impaired function (C(Cr) > or =60 ml/minute/1.73 m2) was significantly associated with incident cataract surgery (P<0.05), but the effect depended on age. Participants younger than 60 years of age with moderate to severe renal impairment had increased odds of incident cataract surgery (OR, 2.75; CI, 1.06-7.14), but this OR decreased with age. In participants 80 years old or older, the OR was 0.34 (CI, 0.11-1.10). CONCLUSIONS: There were no significant effects of renal function on the incidence of cataract of any type. The effect of moderate or worse renal impairment on incident cataract surgery depended on age. However, the interpretation of this effect is uncertain because of additional factors that may be involved in patients having surgery.

Aged↗
PubMed2006

Cataract blindness and visual outcome of cataract surgery in a tribal area in Pakistan.

AIM: To estimate the rates of cataract blindness and cataract surgical coverage and to assess the visual outcome of cataract surgery among individuals aged > or =50 years in Orakzai Agency, Pakistan. METHODS: 1600 individuals aged > or =50 years were selected using probability proportional to size sampling. The main outcome measure was bilateral cataract blindness which was defined as visual acuity of <3/60 in the better eye with best available correction and with obvious central lens opacities/absence of red reflex in both eyes. RESULTS: A total of 1549 people were examined; the coverage rate was 96.8%. Of individuals who were examined, 958 (61.8%) were men. The overall prevalence of bilateral cataract blindness was 4.8% (95% CI: 3.8% to 5.9%). Women had a 2.1-fold greater prevalence of bilateral cataract blindness than men (7.1% (5.0% to 9.2%) v 3.4% (2.3% to 4.6%); p = <0.0001). However, cataract surgical coverage rates were lower for women than men. The overall quality of previous cataract surgery was poor: 43.1% eyes with cataract surgery had VA <6/60. 73.3% people with bilateral cataract blindness reported they could not undergo cataract surgery because they were too poor to afford its cost. CONCLUSION: The unacceptably high rates of cataract blindness and poor affordability and visual outcome of cataract surgery calls for the establishment, in the agency, of static cataract surgical services that are high quality, affordable, and gender sensitive.

Age Distribution↗
PubMed1993

Cataract development and cataract surgery in patients with juvenile rheumatoid arthritis-associated iridocyclitis.

PURPOSE: The authors used an aggressive stepladder, steroid-sparing, therapeutic algorithm in the care of patients with iridocyclitis associated with juvenile rheumatoid arthritis (JRA) to preserve vision, limit cataract formation, and improve probability of successful visual rehabilitation when cataract surgery became necessary. METHODS: The authors treated 60 patients with JRA-associated iridocyclitis with topical and regional corticosteroids, systemic nonsteroidal anti-inflammatory drugs, systemic steroids, and systemic immunosuppressive chemotherapy to achieve total quiescence of intraocular inflammation. Cataract surgery (phacoemulsification extracapsular cataract extraction) combined with pars plana vitrectomy was performed on those eyes with cataract sufficient to limit visual acuity to 20/200 or less, after maintenance of complete freedom from inflammation for at least 3 months. The incidence of cataract development and the visual outcome of cataract surgery were analyzed in those patients for whom a minimum follow-up of 1 year was available. RESULTS: Eventually, 10 of the 60 patients required systemic immunosuppressive chemotherapy in the stepladder therapeutic approach to achieve complete abolition of all active inflammation. Of 72 phakic eyes without cataract, significant cataract developed in 13 (18%) while under our care. The average postoperative stable visual acuity in this group was 20/40. Sixteen eyes of 12 additional patients had visually significant cataract at the time of our first evaluation of them. The average postoperative stable visual acuity in this group of patients after cataract surgery was 20/40. CONCLUSIONS: Iridocyclitis associated with JRA is an insidiously blinding disease, with 12% of individuals affected by this problem eventually blinded by the inflammatory consequences to the eye. A therapeutic philosophy of complete intolerance for active inflammation and limited tolerance for chronic steroid use may offer the most realistic hope for the next step in progress to prevent blindness in this patient population. The results of this study suggest that such a therapeutic attitude results in diminished cataract prevalence and decreased prevalence of vision-limiting retinal pathology, with resultant improved visual outcome of the cataract surgery which is eventually needed in a small proportion of the patients.

Adolescent↗
PubMed2003

Validity of a personal and family history of cataract and cataract surgery in genetic studies.

PURPOSE: To determine the accuracy of a history of cataract and cataract surgery (self-report and for a sibling), and to determine which demographic, cognitive, and medical factors are predictive of an accurate history. METHODS: All participants in the Salisbury Eye Evaluation (SEE) project and their locally resident siblings were questioned about a personal and family history of cataract or cataract surgery. Lens grading at the slit lamp, using standardized photographs and a grading system, was performed for both SEE participants (probands) and their siblings. Cognitive testing and a history of systemic comorbidities were also obtained for all probands. RESULTS: Sensitivity of a history of cataract provided on behalf of a sibling was 32%, specificity 98%. The performance was better for a history of cataract surgery: sensitivity 90%, specificity 89%. For self-report of cataract, sensitivity was also low at 55%, with specificity at 77%. Self-report of cataract surgery gave a much better performance: sensitivity 94%, specificity 100%. Different cutoffs in the definition of cataract had little impact. Factors predicting a correct history of cataract included high school or greater education in the proband (odds ratio [OR] = 1.13, 95% confidence interval [CI]1.02-1.25) and younger sibling (but not proband) age (OR = 0.94 for each year of age, 95% CI 0.90-0.99). Gender, race and Mini-Mental Status Examination (MMSE) result were not predictive. CONCLUSIONS: Whereas accurate self and family histories for cataract surgery may be obtainable, it is difficult to ascertain cataract status accurately from history alone.

Aged↗
PubMed2001

Direct optometrist referral of cataract patients into a pilot 'one-stop' cataract surgery facility.

OBJECTIVES: To determine the feasibility of a) direct optometrist referral of patients with cataract, and b) combined assessment with same day cataract surgery ('one stop' cataract surgery). METHODS: Evaluation of 169 patients referred directly by optometrists into a pilot 'one stop' cataract surgery facility. RESULTS: Of 169 referrals, 160 patients (94.7%) were given confirmed appointments for the 'one stop' cataract service and 9 patients (5.3%) were appointed conventionally. Of 160 patients attending the 'one stop' cataract service, 154 patients (96.3%) underwent cataract surgery at the same visit, in 4 patients (2.5%) cataract surgery was indicated but deferred and in 2 patients (1.3%) cataract surgery was not indicated. The referral was supplemented with information regarding the patient's medical history forwarded by the general practitioner for 3 patients (1.8%). There were no systemic or sight-threatening complications. 151 patients (98.1%) achieved a visual acuity of 6/12 or better at a mean of 31 days post-operatively. CONCLUSION: Optometrists can accurately predict the need for cataract surgery and refer directly into a pilot 'one stop' cataract surgery facility, without the need for general practitioner involvement. 'One stop' cataract surgery is feasible; benefits to the patient include the abolition of the need to visit the general practitioner for consultation and referral, and the hospital for pre-assessment.

Ambulatory Surgical Procedures↗
PubMed1992

[Measuring scattered light with the Opacity Lensmeter 701 in normal eyes and eyes with cataracts. Correlation between scattered light and cataract-induced vision loss].

In 50 eyes with nuclear cataract, posterior subcapsular cataract and cortical cataract and 34 normal eyes, the amount of scattered light was determined using the Opacity Lensmeter 701 to determine its accuracy in distinguishing between clear and cataractous lenses. Taking as a basis the manufacturer's statement that normal lenses show Opacity Lensmeter readings of less than 25 and that cataractous lenses show Opacity Lensmeter readings of more than 30, 94% of the nuclear cataract cases, 62% of the posterior subcapsular cases and 66% of the cortical cataract cases were identified as being pathologically opaque. Of the normal eyes, 88% had an Opacity Lensmeter reading of less than 25. Among the types of cataract examined, a significant linear relationship (P < 0.05) between visual acuity loss due to cataract and scattered light measurements could be found only in eyes with nuclear cataract, with the individual results heavily scattered around the linear regression. In the case of nuclear cataracts, measuring scattered light with the Opacity Lensmeter is suitable for making general statements on visual loss due to cataract for a whole group of patients. However, in individual cases the results can only be used together with other clinical examinations.

Adult↗
PubMed1999

By the way, doctor... I am 83 and my vision is going. I gave up driving years ago, but it is getting so I can't see faces across the room and reading is a strain. Because I have a condition called Fuchs' corneal dystrophy, as well as cataracts, my doctor says I need to consider having both a cataract operation and corneal transplant. But I am worried about the long recovery period. Couldn't I just get by with the cataract operation, which I understand has a recovery period of only a few days?

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Aged↗