Burden Of Cataract Research Articles

Global Burden of Cataract and its Association with Socioeconomic Development Status, 1990-2019

Global Burden of Cataract and its Association with Socioeconomic Development Status, 1990-2019

Burden of cataract in developing countries

Burden of cataract in developing countries

Vitamin C and the Lens: New Insights into Delaying the Onset of Cataract.

Cataracts or clouding of the lens is the leading cause of blindness in the world. Age and diabetes are major risk factors, and with an increasing aging and diabetic population, the burden of cataracts will grow. Cataract surgery is an effective way to restore vision; however, alternatives to cataract surgery are required to reduce the looming cataract epidemic. Since it is well established that oxidative damage plays a major role in the etiology of cataracts, antioxidants have been promoted as therapies to delay and/or prevent cataracts. However, many antioxidant interventions including vitamin C have produced mixed results as anti-cataract therapies. Progress has been made towards our understanding of lens physiology and the mechanisms involved in the delivery and uptake of antioxidants to the lens which may guide future studies aimed at addressing some of the inconsistencies seen in previous animal and human studies. Of interest is the potential for vitamin C based supplements in delaying the onset of cataracts post vitrectomy which occurs in up to 80% of patients within two years. These targeted approaches are required to reduce the burden of cataract on hospitals and improve the quality of life of our aging and diabetic population.

FACTORS ASSOCIATED WITH PREVALENT LENS OPACITIES IN CHINESE AMERICAN ADULTS: THE CHINESE AMERICAN EYE STUDY

ABSTRACT Purpose To identify risk factors associated with lens opacities in Chinese Americans. Methods A cross-sectional population-based study of 4,582 Chinese Americans ≥50 years residing in Monterey Park, California. Participants completed a comprehensive clinical examination with lens assessment using the Lens Opacities Classification System II, with lens opacities defined by a grade ≥2 in either eye. Participants were considered to have nuclear-only, cortical-only, or posterior subcapsular (PSC)-only if that was the only type of opacity present in both eyes. Results Cortical-only opacity was associated with older age, diabetes mellitus (OR 1.5, 95%CI 1.1–2.1), and family history of cataracts (OR 1.5, 95%CI 1.2–1.9). Nuclear-only opacity was associated with older age, diabetes mellitus (OR 1.4, 95%CI 1.1–1.9), greater waist-to-hip ratio (OR 1.2, 95%CI 1.1–1.4), and high-density lipoprotein (OR 1.1, 95%CI 1.02–1.2). Mixed-type opacities were associated with older age, greater waist-to-hip ratio (OR 1.3, 95%CI 1.1–1.6), and higher HbA1 c (OR 1.3, 95%CI 1.1–1.4). Taller height (OR 0.7, 95%CI 0.6–0.8), greater weight (OR 0.98, 95%CI 0.97–0.99), and higher diastolic pressure (OR 0.98, 95%CI 0.96–0.99) were protective. Conclusion CHES identified a strong, dose–response association between age and all types of prevalent lens opacities, which suggests an increasing cataract burden in Chinese Americans based on aging populations. CHES results demonstrate general consistency with previous population-based studies in regard to more sedentary lifestyle exposures (e.g., Westernized lifestyle) and prevalent cortical-only, nuclear-only, and mixed-type opacities, yet also identified further sedentary lifestyle exposures associated with prevalent lens opacities. Improved glycemic control and a more active lifestyle that minimizes factors contributing to metabolic syndrome may help reduce the burden of vision loss associated with lens opacities.

Manual small incision cataract surgery.

To review various techniques of manual small incision cataract surgery (MSICS), updates on training residents and fellows, and cost-effectiveness of the surgery. Recent population studies estimate that there are 53 million people blind worldwide from cataracts, up from previous figures. This is in part because of population growth and increased life expectancy worldwide. MSICS continues to play a significant role in addressing cataract burden and there is an increasing need to train surgeons in the technique. In response to this need, several modules and rubrics have been developed to assist in the training process. MSICS has been refined over recent decades with overall outcomes comparable to phacoemulsification (phaco) in certain settings. MSICS cost and efficiency advantages support its ongoing essential role in addressing global cataract blindness.

Surgical coverage of cataract in a rural area of north India: A cross-sectional study.

Background:India has the highest number of blind people globally, unoperated cataract being the most common cause of blindness and low vision. Although safe and effective cataract surgical techniques are available, the cataract burden continues to increase annually, due to the backlog of patients to be operated upon, and a growing number of cataract cases due to increased life expectancy.Aim:To assess cataract surgical coverage (CSC) in a rural area of north India.Methods:A population-based cross-sectional study of CSC among adults (40 years and above) was carried out in two villages of a block in north India using a predesigned questionnaire, visual acuity assessment, and distant direct ophthalmoscopy. Based on the data obtained, CSC (VA <6/60) for both “persons” as well as “eyes” was calculated.Results:Overall, CSC (persons) of 43.20% was observed, 29.31% coverage among persons with unilateral cataract and 50.45% among persons with bilateral cataract while CSC (eyes) was found to be 37.14%, being significantly higher (43.56%) among females compared to males (28.21%) (P = 0.012). Around 50% of cataract surgeries were performed in private facilities, 41.35% in government facilities, and rest 8.65% in eye camps. Nearly 90.38% were implanted intraocular lens and 9.62% were non-intraocular lens surgeries.Conclusions:Surgical needs for cataract are currently not being met effectively. Reasons for inadequate cataract surgical services need to be sought and addressed to improve the uptake of existing services. Further, reasons for underutilization of government hospitals for cataract surgeries need to be examined.

The Impact of Sociodemographic and Socioeconomic Factors on the Burden of Cataract in Small Island Developing States (SIDS) in the Caribbean from 1990 to 2016

ABSTRACTPurpose: To study the impact of sociodemographic and socioeconomic factors on the cataract burden in Caribbean small island developing states (SIDS) using disability-adjusted life-years (DALYs).Methods: National and regional age and sex specific cataract DALY numbers and rates from 1990 to 2016 for Caribbean SIDS, were extracted from the Global Burden of Disease Study 2016. The human development index (HDI), healthcare access and quality (HAQ) index, and the World Bank’s classification of economies were used as socioeconomic status indicators. The Gini coefficient, Atkinson, Theil and concentration indices were used to measure health inequality. Paired Wilcoxon signed rank test, Pearson correlation, and linear regression analyses were performed to evaluate the sociodemographic and socioeconomic factors associated with differences in cataract burden.Results: Men had higher age-standardized DALY rates than women (P < .001) with median rates of 90.72 (Interquartile range [IQR], 87.8–94.2) and 83.94(IQR, 80.9–86.5), respectively. The burden of cataract increased with age. Upper-middle income countries had higher age-standardized DALY rates than high income countries (P < .001), with median rates of 90.1 (IQR, 86.8–93.4) and 79.8 (IQR, 77.5–81.8), respectively. Age-standardized DALY rates were inversely correlated with HDI (r = – 0.61, β = – 51.56 [P < .05]) and HAQ (r = – 0.68, β = – 0.46 [P < .01). Between-country inequality was negligible, and the burden of cataract is greater among the poor.Conclusion: Global trends of socioeconomic factors were confirmed. Significantly, men had higher age-standardized DALY rates than women. This is an area for further research.

An Epidemiological Study of Cataract Patients:Findings From a Hospital-based Study

Background: Cataract, which refers to a clouding of the crystalline lens of the eye, stands out as the first priority amongst the major causes of blindness. Cataract is one of the important causes of low vision in both developed and developing countries. Cataract occurs more frequently with advancing age. Knowledge regarding magnitude and socio demographic factors will be helpful for healthcare managers. Therefore, the present study was conducted among the patients in ophthalmology department of a tertiary health center to study the epidemiological profile and causes of cataract. Method: A Hospital based Cross Sectional Study conducted from July 2017 to December 2017 in a tertiary health center in central India. Total 336 patients who availed services from ophthalmology department during study period were included in the study and relevant data was collected from them. Data analysis was done by percentages, proportions, and tests of significance (Chi-square test). Results: A total of 181 patients were investigated in the study with gender distribution of 67.7 % male. Most of the patients were above 60 years. Left eye was more commonly involved in cataract. Marital status, educational status and occupation of the patients were found to be statistically significant Conclusions: The present study concluded with the findings highlighting the huge burden of cataract in central India and the role of multiple factors in cataract genesis pointing towards a multi-factorial causation.

Cataract Burden in a Peri-Urban Local Government in a Low Income Country: The Need for Government Intervention

Cataract Burden in a Peri-Urban Local Government in a Low Income Country: The Need for Government Intervention

Association of Sex With the Global Burden of Cataract

Eye disease burden could help guide health policy making. Differences in cataract burden by sex is a major concern of reducing avoidable blindness caused by cataract. To investigate the association of sex with the global burden of cataract by year, age, and socioeconomic status using disability-adjusted life-years (DALYs). This international, comparative burden-of-disease study extracted the global, regional, and national sex-specific DALY numbers, crude DALY rates, and age-standardized DALY rates caused by cataract by year and age from the Global Burden of Disease Study 2015. The DALY data were collected from January 1, 1990, through December 31, 2015, for ever 5 years. The human development index (HDI) in 2015 was extracted as an indicator of national socioeconomic status from the Human Development Report. Comparisons of sex-specific DALY estimates due to cataract by year, age, and socioeconomic status at the global level. Paired Wilcoxon signed rank test, Pearson correlation, and linear regression analyses were performed to evaluate the socioeconomic-associated sex differences in cataract burden. Differences in rates of cataract by sex were similar between 1990 and 2015, with age-standardized DALY rates of 54.5 among men vs 65.0 among women in 1990 and 52.3 among men vs 67.0 among women in 2015. Women had higher rates than men of the same age, and sexual differences increased with age. Paired Wilcoxon signed rank test revealed that age-standardized DALY rates among women were higher than those among men for each HDI-based country group (z range, -4.236 to -6.093; P < .001). The difference (female minus male) in age-standardized DALY rates (r = -0.610 [P < .001]; standardized β = -0.610 [P < .001]) and the female to male age-standardized DALY rate ratios (r = -0.180 [P = .02]; standardized β = -0.180 [P = .02]) were inversely correlated with HDI. Although global cataract health care is progressing, sexual differences in cataract burden showed little improvement in the past few decades. Worldwide, women have a higher cataract burden than men. Older age and lower socioeconomic status are associated with greater differences in rates of cataract by sex. Our findings may enhance public awareness of sexual differences in global cataract burden and emphasize the importance of making sex-sensitive health policy to manage global vision loss caused by cataract.

Socioeconomic Disparity in Global Burden of Cataract: An Analysis for 2013 With Time Trends Since 1990

To assess socioeconomic disparity in global burden of cataract, by using disability-adjusted life years (DALYs). International, comparative burden-of-disease study. Published data on national age-standardized DALY rates caused by cataract and human development index (HDI) between 1990 and 2013 were obtained. The association between age-standardized DALY rates and HDI in 2013 was analyzed. The health-related Gini coefficients and the concentration indexes were calculated to explore the trends in between-country inequality in cataract burden from 1990 to 2013. Multiple comparison revealed that lower-HDI countries had higher age-standardized DALY rates caused by cataract. Age-standardized DALY rates were inversely associated with HDI (β=-0.522, P<.01). From 1990 to 2013, global age-standardized DALY rates showed a trend of decline, whereas the Gini coefficients increased from 0.409 to 0.439. The concentration indexes indicated that socioeconomic-associated inequality declined in the 1990s and subsequently increased since 2000, with values of-0.259 in 1990,-0.244 in 2000, and-0.273 in 2013. Global health progress in cataract was accompanied by widening inequality, with cataract burden being more concentrated in countries with lower socioeconomic status. The findings highlight the need to provide more cataract services for developing countries, to combat global vision loss caused by cataract.

The global state of cataract blindness.

Cataracts are a significant cause of blindness and visual impairment worldwide. The present article reviews the literature and describes the current extent of cataracts globally, barriers to treatment, and recommendations for improving the treatment of cataracts. Prevalence and absolute number of blind because of cataracts remain high, although rates are declining in many areas globally. The age-standardized prevalence of blindness in adults older than 50 remains highest in western sub-Saharan Africa, with a rate of 6.0%. The greatest declines in age-standardized blindness because of cataracts in adults older than 50 between 1990 and 2010 were in East Asia, tropical Latin America, and western Europe. Recent studies have largely found higher rates of cataracts in women than in men. A new simulator for training ophthalmologists in manual small-incision cataract surgery holds promise for the future. The rates of cataract surgery are increasing and postoperative outcomes are improving worldwide, yet challenges to reducing the cataract burden further remain. Cost, an insufficient number of ophthalmologists, and low government funding remain significant barriers but investment in further eye care infrastructure and training of additional ophthalmologists would improve the current situation.

Global prevalence of childhood cataract: a systematic review.

Childhood cataract is an avoidable cause of visual disability worldwide and is a priority for VISION 2020: The Right to Sight. There is a paucity of information about the burden of cataract in children and the aim of this review is to assess the global prevalence of childhood cataract. The methodology for the review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We performed a literature search for studies reporting estimates of prevalence or incidence of cataract among children (aged<18 years) at any global location using the Cochrane Library, Medline and Embase up to January 2015. No restrictions were imposed based on language or year of publication. Study quality was assessed using a critical appraisal tool designed for systematic reviews of prevalence. Twenty prevalence and four incidence studies of childhood cataract from five different geographical regions were included. The overall prevalence of childhood cataract and congenital cataract was in the range from 0.32 to 22.9/10000 children (median=1.03) and 0.63 to 9.74/10000 (median=1.71), respectively. The incidence ranged from 1.8 to 3.6/10000 per year. The prevalence of childhood cataract in low-income economies was found to be 0.42 to 2.05 compared with 0.63 to 13.6/10000 in high-income economies. There was no difference in the prevalence based on laterality or gender. This review highlights substantial gaps in the epidemiological knowledge of childhood cataract worldwide, particularly from low and lower middle-income economies. More studies are needed using standard definitions and case ascertainment methods with large enough sample sizes.

An epidemiological study of cataract among elderly population in Aligarh, Uttar Pradesh, India

Background: Cataract is one of the major causes of avoidable blindness in India. The burden of cataract among the elderly population needs to be assessed therefor, the study was planned to find the prevalence of cataract among the elderly population, and related socio-demographic factors. Methods: The study was a community-based cross-sectional study done at field practice area of rural health training centre and urban health training centre, J N Medical College, AMU, Aligarh, Uttar Pradesh, India. A sample of 550 was taken from the registered elderly population aged 60 years and above using systematic random sampling with PPS. Socio- demographic characteristics was obtained using pretested and predesigned questionnaire. Cataract was identified with the help of torch light examination of lens. Data was analysed using SPSS version 20. Tests of proportion (Wald’s method to calculate confidence interval) and chi-square test was used. P value <0.05 was considered as significant. Results: The prevalence of cataract in the study population was 72.1% (95% CI- 68.3%, 75.8%) which was significantly associated with age, marital status, type of family & working status. Conclusions: The study concluded that approx. three- fourth of elderly population had cataract which was significantly associated with various socio- demographic factors. Therefore, these factors need to be addressed to reduce the burden of cataract among elderly population.

National Burden of Eye Diseases in Iran, 1990-2010; Findings from the Global Burden of Diseases Study 2010.

Purpose:The disability-adjusted life-years (DALYs) lost due to eye diseases and trends in DALYs in Iran has not been previously reported. The object of this study is to report the burden of eye diseases in Iran and to compare changes from 1990 to 2010 based on age and gender.Methods:Data from the Global Burden of Disease Study 2010 (GBD 2010) are used to report DALYs for cataract, refraction/accommodation (functional) disorders, macular degeneration, and glaucoma.Results:Cataract, refraction/accommodation (functional) disorders, macular degeneration, and glaucoma were the 84th, 87th, 138th, and 151st causes of DALY in 1990 and the 89th, 72nd, 99th, and 137th in 2010, respectively. Cataract accounted for 0.085% of national DALY in 1990 and 0.09% in 2010, refraction/accommodation (functional) disorders accounted for 0.42% in 1990 and 0.47% in 2010, macular degeneration accounted for 0.017% in 1990 and 0.071% in 2010 and glaucoma accounted for 0.0099% in 1990 and 0.025% in 2010. There was a steady increase in DALY with age for each eye disease for both genders and dichotomized for males and females from 1990 to 2010.Conclusions:Epidemiologic transition is reflected in major ophthalmic and blinding diseases in the GBD data for Iran. The burden of macular degeneration is rising, followed by glaucoma. The burden of presbyopia affected individuals past their middle age. The burden of cataract manifested as a slower increase that could be attributable to better access to treatment.

The Effect of Counseling on Cataract Patient Knowledge, Decisional Conflict, and Satisfaction

Purpose: Cataract is the leading cause of non-refractive preventable blindness, and comprehensive strategies to increase cataract surgery rates are imperative, including high-quality supportive patient education. We evaluated the effectiveness of non-physician pre-surgical counselors teaching patients about cataract and cataract surgery in improving patient knowledge, decisional conflict, and satisfaction.Methods: A survey was given before and after 61 newly-diagnosed cataract patients underwent pre-surgical counseling at the Aravind Eye Hospital, Madurai, India. The survey measured change in cataract knowledge and decisional conflict, a measure of anxiety surrounding the decision to undergo surgery, along with patient satisfaction. Multiple regression was used to identify factors that influenced change in knowledge.Results: Both patient knowledge scores and decisional conflict scores improved following counseling (mean difference +2.0, p = 0.004 and +8.4, p < 0.0001, respectively). Multiple regression analysis identified female sex (β = 2.5, p < 0.001) and being illiterate (β = 1.7, p = 0.04) as important predictors of increased knowledge post-counseling.Conclusion: Counseling both improved knowledge and reduced decisional conflict about cataract surgery, particularly among patients who had traditionally had more limited access to healthcare such as women and illiterate patients. Increased use of high quality counseling might help to further reduce the global burden of cataract and other forms of blindness.

Pattern of eye diseases presents at free outreach in rural community in the Northwestern Nigeria

Background: The lower socioeconomic status and long distance to eye care facility of the rural dwellers in many communities in developing countries accounts for the increase in the number of preventable and avoidable causes of blindness compare to developed countries of the world. It is widely believed that the best option to reduce blindness and visual impairment in these communities is to bring eye care services to their doorsteps in the form of outreach programs this has been practiced successfully in India and other Asian countries. Aims: To assess the pattern of eye diseases presenting at a free eye outreach in a rural community of Nigeria. Materials and Methods: A retrospective study was carried out on the findings of 3-day outreach programs at Zuru General Hospital, in Zuru Emirate of Kebbi State, Northwestern Nigeria. The following information was extracted from patient's folders: sociodemographics, diagnosis, treatment offered the patient, and distance of the patient house to the eye outreach center. The data were analyzed by SPSS version 18 (2006 Statistical Package for the Social Sciences, Chicago, Illinois, USA). Results: There were 458 patients seen at the outreach of which 197 (43%) were males and 261 (57%) were females. More than half of the patients 236 (52%) were 50 years and above, followed by age group of 34–50 years 99 (21.6%). The majority of the patients 128 (27.9%) were homemakers, followed by civil servants 125 (27.2%), and farmers 112 (24.5%). Most of the patients 188 (41%) covered a distance of 3–5 km before reaching the outreach center. The predominant ocular diseases seen were cataract 148 (32.3%), glaucoma 84 (18.3%), and refractive error 82 (17.9%). Conclusion: There were more females seen at our free eye outreach and majority of participants were 50 years and above. Cataract, glaucoma, and refractive error were the main reasons why patients presented at the outreach center. Efforts at improving the ocular health of this community should be focused on reducing the burden of cataract, glaucoma, and refractive error.

Socioeconomic disparities in cataract surgery

As the elderly population continues to grow in the USA, an understanding of the increasing burden of cataract is pivotal. This review seeks to iterate the presence of this burden and to understand it better in the context of race, sex, and socioeconomic factors. Although there have been multiple prevalence studies addressing the cataract burden in the USA, updated literature that directly elucidates the above issues has been sparse. Recent data support previous findings that the cataract burden among women is greater than that of men, likely predominantly due to greater longevity. With regard to race, there appears to be a slightly increased burden among Whites, although this increase may show regional variability and change over the next few decades, especially as the presently young Hispanic population continues to age and grow. It is likely that the significant divider responsible for unmet cataract surgery is socioeconomic, due to such factors as insurance coverage, income, and barriers to access such as transportation, service accessibility, and awareness. These latter barriers of income and access appear to be identical to those identified in developing countries. The cataract burden in the USA is significant and is expected to continue to grow. Further studies are warranted to help us better understand barriers to access, particularly with regard to race and socioeconomic factors. Local efforts to address education and logistical barriers as well as nationwide policy efforts to address insurance coverage appear to be a crucial factor in surmounting an ongoing but treatable chronic disease.

Effect of Aqueous Extract of Embelica officinalis on Selenite Induced Cataract in Rats.

Cataract is clouding of the eye lens that reduces the amount of incoming light and results in deteriorating vision. Blindness is thought to reach 75 million by 2020. Of these, unoperated cataract may be expected to account for at least 35 million. Thus, the burden of cataract is increasing remorselessly. Embelica officinalis is reported to have a very good antioxidant property and thus we hypothesized that it could be a good candidate in treatment of cataract. Hence, the aim of this study was to investigate the effect of aqueous extract of Embelica officinalis on selenite induced cataract in rats. For the purpose of this study, cataract was induced in young suckling (on the 10(th) day of life) albino wistar rats using sodium selenite (a single dose of sodium selenite; 20μM/kg; subcutaneously). After induction of cataract, the test drug (Embelica Officinalis) and the reference standard (ascorbic acid) were administered orally for 18 days. The progression or disappearance of cataract was observed with the help of an ophthalmoscope (OM-18, Takagi resolution 1.6). At the end of this study the alterations in the levels of total protein, soluble protein, reduced glutathione and malondialdehyde were estimated in the lens homogenate. Results showed that treatment with Embelica officinalis, as well as ascorbic acid, produced a significant decrease (p < 0.05) in malondialdehyde and a simultaneous increase in lens glutathione levels (p < 0.05). The malondialdehyde content was decreased by 48% in animals treated with Embelica officinalis. Similarly, lens glutathione was increased by 82.5% in animals treated with Embelica officinalis. There was also a significant (p < 0.05) increase in protein content (total protein = 59.36% and soluble protein = 105.78%) in animals treated with Embelica officinalis, indicating improvement in cataractogenic condition in the selenite induced cataract model. At the end of the treatment, disappearance of cataract was observed in test and standard treated animals. In conclusion, it could be said that aqueous extract of Embelica officinalis delayed the progression of cataract in sodium selenite induced cataractogenic rats.

The Prevalence and Causes of Visual Impairment in Central Sri Lanka: The Kandy Eye Study

To determine the prevalence and causes of uncorrectable visual impairment in the Kandy District of central Sri Lanka. Population-based, cross-sectional study. Inhabitants >or=40 years of age from villages in the Kandy District were selected by randomized cluster sampling; 1721 eligible participants were identified and 1375 participated in the study. The ophthalmic examination included best-corrected logarithm of the minimum angle of resolution visual acuity (VA), slit-lamp examination of the anterior segment, and dilated stereoscopic fundus examination. The principal cause of visual impairment after best correction was recorded. Visual impairment (better eye <6/18) and blindness (better eye <3/60) after best correction. Comprehensive examinations, including VA, were performed on 1375 subjects (79.9% participation rate). The prevalence of blindness was 1.1% (95% confidence interval [CI], 0.002-0.020; 15 participants). The prevalence of visual impairment was 5.9% (95% CI, 0.043-0.075; 81 subjects). Cataract and age-related macular degeneration were the main causes of visual impairment. Visual impairment remains a major public health problem in central Sri Lanka. Specific programs directed at reducing the cataract burden need to be implemented. The authors have no proprietary or commercial interest in any materials discussed in this article.