Cortical Cataract Research Articles

Bilateral Pterygium in a Paediatric Cancer Patient taking Vemurafenib: A Case Report

Introduction: Anticancer drugs with reactive oxygen species (ROS) inducing mechanisms, such as vemurafenib, have been shown to be effective against various types of cancer. However, the adverse effects of increased oxidative stress have the potential to damage not only cancer cells, but also normal cells such as those in eyes and potentially leading to ocular diseases including pterygium and cataract. Presentations: A nine-year-old patient presented with bilateral nasal pterygium and early bilateral cortical cataracts, which are uncommon for his age group. Patient has a background of v-raf murine sarcoma viral oncogene homolog B1 (BRAF) V600E positive pilocytic astrocytoma with anaplastic features, diagnosed at age 2.5 years old. Vemurafenib was commenced at the time of diagnosis. Conclusion: We suspect that these ophthalmic findings are associated with his prolonged treatment with vemurafenib which may be of a pathophysiological significance.

The Association between Vitamin D3 Deficiency and Cataract Formation in Baghdad Al-Karkh

Background: Visual impairment is a global issue that is particularly problematic for poor nations. It is linked to diminished physical activity, social isolation, reliance on everyday tasks, and even death. The clouding of the lens inside the eye is called a cataract. It is one of the main causes of blindness and visual impairment in the world. Because of its anti-inflammatory and antioxidant properties, vitamin D, a prohormone in the blood, is crucial to the pathophysiology of many ocular illnesses. Given that oxidative stress and inflammation are significant contributors to the development of cataracts, a number of research have evaluated the relationship between vitamin D3 deficiency and cataract formation. Objective: Determine whether a vitamin D3 deficiency and cataracts are related. Patients and Methods: A cross-sectional study that was carried out included a total of 100 cataract patients who are 60 years of age or younger from September 2023 to March 2024 in the Ophthalmology Department of Imamein Kadhimein Medical City, Baghdad, Iraq. Questionnaire form was used which consist of sociodemographic information, socioeconomic status, dietary sources of vitamin D3, sun exposure, anthropometric measures and ophthalmic examination. Vitamin D3 level had been investigated in laboratory of the hospital. Results: Thirty percent of patients had cortical cataracts, 57% had nuclear cataracts, and 13% had posterior subcapsular cataracts. Sixty-nine percent of patients had a vitamin D3 level that is less than 20 ng/ml. Of the patients, 13% had a vitamin D3 level between 20 and 30 ng/ml, while 18% had a level greater than 30 ng/ml. There is a significant association between the level of vitamin D3 and the type of cataract (p-value = 0.013). Sixty-nine percent of patients with deficient vitamin D3 levels had 9% posterior subcapsular cataracts, 36% cortical cataracts, and 55% nuclear cataracts. Patients with insufficient vitamin D3 levels had 8% posterior subcapsular cataracts, 8% cortical cataracts, and 84% nuclear cataracts. While patients with sufficient vitamin D3 levels had 33% posterior subcapsular cataracts, 22% cortical cataracts, and 45% nuclear cataracts. The body mass index and vitamin D3 level were significantly associated (p-value = 0.003). Patients with a vitamin D3 level less than 20 ng/ml comprised 31% overweight patients, 26% class I obese patients, 26% class II obese patients, and 4% class III obese patients. Thirteen percent of these patients had normal weights. Patients with a vitamin D3 level 20-30 ng/ml comprised 46% overweight patients, 23% class II obese patients, and 31% with normal weight. While patients with a vitamin D3 level more than 30 ng/ml comprised 33% normal weight patients and 67% overweight. Conclusion: Vitamin D3 deficiency has a significant association with cataract formation, especially nuclear and cortical types, sun exposure, educational level, socioeconomic status, and obesity.

Changes in Lens Structure in Pathological Myopia, Cataract Surgery and Special Situations

Pathological myopia is a major cause of low vision and blindness worldwide. In patients with pathological myopia, there are changes such as thinning of the lens and increase in equatorial diameter. In various population and clinic-based cohort, case-control and cross-sectional studies, it has been reported that myopic patients have a higher risk of posterior subcapsular cataract, cortical and nuclear cataract. It is known that the modern technique of phacoemulsification and intraocular lens implantation is effective in highly myopic eyes and provides significant improvement in visual acuity. However, complications related to phacoemulsification such as posterior capsule rupture, retinal detachment, progression of existing maculopathy, capsular phimosis, late lens dislocation and transient intraocular pressure elevation occur more frequently in highly myopic patients. As a result, it is extremely important that cataract surgeries of these patients are performed by experienced surgeons and that attention is paid to perioperative and postoperative complications.

Evaluation of antioxidant status of lens epithelial cells in cataract patients.

The main factor that causes cataracts is the increased oxidative stress and imbalance of an antioxidant defense mechanism, which leads to significant changes in the lens microarchitecture. Senile cataract is the most common type of acquired cataracts due to aging. We carried out a case-control study in the biochemistry department to examine the antioxidant status (catalase and total antioxidant capacity [TAC]) and lipid peroxidation marker, that is, malondialdehyde (MDA) in human lens epithelial cells (HLECs) of different grades of senile cortical, nuclear, and posterior subcapsular cataracts. We collected 150 samples from patients aged 50-90 years. These included 50 samples of cortical cataracts, 50 of nuclear cataracts, and 50 samples of posterior subcapsular cataracts. We measured catalase activity by the Beer method, TAC by the Benzie and Strain method, and protein by the Bradford method. We also estimated TAC in the aqueous extract of HLECs by the ferric reducing ability of plasma (FRAP) method and MDA by the thiobarbituric acid assay method. The results of this study showed that the level of catalase enzyme was higher in the first grade of nuclear, posterior subcapsular, and cortical cataracts than in other grades. This suggests that the catalase enzyme activity drops sharply in the second and third grades of these types of cataracts. The same pattern was observed for TAC, which was higher in the first grade of nuclear, posterior subcapsular, and cortical cataracts than in other grades. There were significant differences between catalase and TAC in different grades of cataracts, indicating that as the grading increases, both catalase and TAC decrease. The results of this study showed that the levels of MDA were higher and the levels of catalase and TAC were lower in patients with more severe cataracts compared to the healthy controls.

Delayed-onset spontaneous bilateral Descemet’s membrane detachment after uneventful phacoemulsification

A 69-year-old male presented with defective vision in both eyes. Best corrected visual acuity (BCVA) was 6/6 p with anterior cortical and posterior subcapsular cataracts in both eyes. Fundus examination was normal. He underwent successful phacoemulsification with intraocular lens implantation in the left eye, improving BCVA to 6/6. Two months later, BCVA in the right eye decreased to 6/12p; cataract progression was noted. Phacoemulsification in the right eye restored BCVA to 6/6. Four months post-left eye surgery, he developed corneal edema with descemet membrane detachment (DMD). Multiple descemetopexies with SF6 led to reattachment. Right eye also developed DMD which reattached with SF6 descemetopexy. Final visual acuity was 6/6 in the right eye and 6/6 partial in the left eye.

Minimizing Oxidative Stress in the Lens: Alternative Measures for Elevating Glutathione in the Lens to Protect against Cataract.

Oxidative stress plays a major role in the formation of the cataract that is the result of advancing age, diabetes or which follows vitrectomy surgery. Glutathione (GSH) is the principal antioxidant in the lens, and so supplementation with GSH would seem like an intuitive strategy to counteract oxidative stress there. However, the delivery of glutathione to the lens is fraught with difficulties, including the limited bioavailability of GSH caused by its rapid degradation, anatomical barriers of the anterior eye that result in insufficient delivery of GSH to the lens, and intracellular barriers within the lens that limit delivery of GSH to its different regions. Hence, more attention should be focused on alternative methods by which to enhance GSH levels in the lens. In this review, we focus on the following three strategies, which utilize the natural molecular machinery of the lens to enhance GSH and/or antioxidant potential in its different regions: the NRF2 pathway, which regulates the transcription of genes involved in GSH homeostasis; the use of lipid permeable cysteine-based analogues to increase the availability of cysteine for GSH synthesis; and the upregulation of the lens's internal microcirculation system, which is a circulating current of Na+ ions that drives water transport in the lens and with it the potential delivery of cysteine or GSH. The first two strategies have the potential to restore GSH levels in the epithelium and cortex, while the ability to harness the lens's internal microcirculation system offers the exciting potential to deliver and elevate antioxidant levels in its nucleus. This is an important distinction, as the damage phenotypes for age-related (nuclear) and diabetic (cortical) cataract indicate that antioxidant delivery must be targeted to different regions of the lens in order to alleviate oxidative stress. Given our increasing aging and diabetic populations it has become increasingly important to consider how the natural machinery of the lens can be utilized to restore GSH levels in its different regions and to afford protection from cataract.

Missed intralenticular foreign body – A cause of ocular inflammation

A 36-year-old male presented with a complaint of glare since 2 months. He had a history of trauma to the left eye with copper wire 2 years back. At presentation, the visual acuity was 20/20 in both eyes. Anterior-segment evaluation of the left eye revealed peripheral corneal scar, anterior uveitis, and iris hole. Dilated evaluation revealed sunflower cataract, focal cortical cataract, and an intralenticular foreign body (ILFB). The posterior segment was normal. Inflammation was controlled with topical steroids, followed by ILFB removal, phacoaspiration, and intraocular lens implantation. A thorough dilated ocular examination is essential to rule out an intraocular foreign body in all the cases of penetrating ocular trauma.

Prospective Cytokine Profiling in Aqueous Humor Reveals a Proinflammatory Microenvironment in Highly Dense Nuclear Cataracts.

To investigate if the cytokine profile in the aqueous humor (AH) of cataract patients varies according to cataract type and severity. This prospective study included 397 eyes of 397 patients (median age, 76 years; range, 30-94 years) who underwent standard small-incision phacoemulsification surgery. Cataracts were graded using the LOCS III system: mild (≤3), moderate (3.5-5), and severe (≥5). Biometric measurements from the IOL master 700 (Zeiss, Oberkochen, Germany) were used to differentiate between thick (>4.5 mm) and thin lenses. Information about age, gender, and self-reported diseases was obtained from patient records. Eleven different proteins were measured in AH using a multiplex cytokine assay (AYOXXA Biosystems, Cologne, Germany), including IL- 6, IL-8, angiopoietin 2, C-reactive protein (CRP), vascular endothelial growth factor A (VEGF-A), platelet-derived growth factor BB, placental growth factor, CXCL12, CXCL13, and CXCL10. Statistical analysis was performed using R and included nonparametrical testing, linear regression, and k-means clustering. Higher nuclear LOCS grades correlated with increased levels of CCL2 (360 vs. 387 vs. 517 pg/mL, P < 0.001), VEGF-A (270 vs. 292 vs. 390 pg/mL, P = 0.012), IL-8 (3.1 vs. 4.2 vs. 5.7 pg/mL, P = 0.018), and CXCL10 (52 vs. 61 vs. 90 pg/mL, P = 0.003). No associations were observed for cortical and subcapsular cataracts. Thicker lenses were associated with significantly increased levels of CRP, CXCL10, CXCL12, IL-6, IL-8, and VEGF-A. The cytokine profile of AH varies based on cataract grading and lens thickness. In highly dense nuclear cataracts, CCL2, VEGF-A, IL-8, and CXCL10 were elevated.

Association between vitamin D level and cataract: A systematic review and meta-analysis.

The association between serum vitamin D level and cataract remains controversial. This study aims to evaluate the association between vitamin D level and cataract. In this study, articles in the PubMed, Web of Science, and EMBASE databases were searched up to 30 August 2023 and 626 articles were screened. Four studies involving a total of 10,928 subjects with cataract and 10,117 control subjects met the inclusion criteria. Decreased serum vitamin D level was associated with higher incidence of cataract (P = 0.047; MD: -4.87; 95%CI: [-9.67, -0.07]). In the subgroup analysis by sex, a significant association was found between serum vitamin D level and cataract in both male (P = 0.01, MD: -2.15,95%CI: [-3.83, -0.46]) and female (P < 0.01; MD: -6.67,95%CI: [-8.20, -5.14]).In the subgroup analysis by the types of cataract, significant association was found between serum vitamin D level and nuclear (P < 0.01; MD: -10.48; 95%CI: [-12.72, -8.24]) and posterior subcapsular cataract (P = 0.02; MD: -6.05; 95%CI: [-11.30, -0.80]) but not in cortical cataract (P = 0.14; MD: -6.74; 95%CI: [-15.70, 2.22]). This meta-analysis revealed potential association between serum vitamin D level and cataract, more significant in female, and the subtypes of nuclear and posterior subcapsular cataract.

The Synergistic Effects of Polyol Pathway-Induced Oxidative and Osmotic Stress in the Aetiology of Diabetic Cataracts.

Cataracts are the world's leading cause of blindness, and diabetes is the second leading risk factor for cataracts after old age. Despite this, no preventative treatment exists for cataracts. The altered metabolism of excess glucose during hyperglycaemia is known to be the underlying cause of diabetic cataractogenesis, resulting in localised disruptions to fibre cell morphology and cell swelling in the outer cortex of the lens. In rat models of diabetic cataracts, this damage has been shown to result from osmotic stress and oxidative stress due to the accumulation of intracellular sorbitol, the depletion of NADPH which is used to regenerate glutathione, and the generation of fructose metabolites via the polyol pathway. However, differences in lens physiology and the metabolism of glucose in the lenses of different species have prevented the translation of successful treatments in animal models into effective treatments in humans. Here, we review the stresses that arise from hyperglycaemic glucose metabolism and link these to the regionally distinct metabolic and physiological adaptations in the lens that are vulnerable to these stressors, highlighting the evidence that chronic oxidative stress together with osmotic stress underlies the aetiology of human diabetic cortical cataracts. With this information, we also highlight fundamental gaps in the knowledge that could help to inform new avenues of research if effective anti-diabetic cataract therapies are to be developed in the future.

STUDY OF CLINICAL PROFILE OF PSEUDO-EXFOLIATION SYNDROME AND PSEUDO-EXFOLIATION CATARACT IN A TERTIARY HEALTH CARE HOSPITAL IN WESTERN ODISHA

Objective: The pseudo-exfoliation (PEX) syndrome is a complex disorder characterized by the deposition of fibrillary materials around the blood vessels of organs. This study was conducted with the aim of knowing the actual prevalence of PEX in Western Odisha and the characteristics of cataracts in those PEX patients. Methods: This cross-sectional study included 340 OPD patients and was conducted between January 1, 2021, and December 31, 2022, at Hitech Medical College and Hospital. The prevalence of PEX and cataracts was studied. The data was analyzed using basic descriptive statistics and reported in frequencies and percentages. Results: The study showed 74 patients out of 340 were diagnosed with pseudoexfoliation syndrome, with a prevalence of 23%. 42 patients (58%) were male and 32 (42%) were female, with a M: F ratio of 1.3:1. The mean age of presentation was 67 y (range 51–84 y), and the majority of patients (41%) were in the age group of 61–70 y. The increased intraocular pressure was noticed in 11 cases (15%) in our study. Two patients each had open-angle glaucoma and lens-induced glaucoma. Nuclear cataract was the most common type of cataract observed in 27% of the study group, followed by cortical cataract with nuclear sclerosis in 19% of cases. Conclusion: It is concluded that pseudo-exfoliation syndrome is more common in males than in females, with a higher number of patients in the age group of 81 y and older. Therefore, it can be assumed that it is associated with the age factor. Nuclear cataract was the most common type of cataract observed in our study population.

Optical Biometry versus Ultrasound A-scan in Measuring Anterior Chamber Depth, Axial Length, and Lens Thickness in Patients Undergoing Cataract Surgery

Ocular biometry measurements use ultrasonography and optical biometry, offering high precision for noninvasive intraocular distance measurement in cataract surgery. This study aims to Compare agreement values between an optical biometry machine and an ocular ultrasound-based biometry device for axial length, anterior chamber depth, and lens thickness measurements. A study enrolled 64 eyes of 42 patients scheduled for cataract surgery at Benghazi Teaching Eye Hospital, Libya, from January 1st to February 1st, 2024. Patients' medical and ocular histories were taken, and slit lamp examinations were conducted. All eyes with visual impairment and good fixation were included. Axial length, anterior chamber depth, and lens thickness were measured using Aladdin optical biometer and an ellex eye-cubed ultrasonic contact biometer. The study involved 64 eyes with a mean age of 64.36 years, The most common type of cataract was posterior subcapsular cataract [46.9%], nuclear cataract [14.1%], and cortical cataract [14.1%]. Combined cataracts were also present in 31.3% of the participants. The ICC analysis showed a strong agreement [0.976] between the two measurement devices in assessing axial length. difference in measurements of the mean anterior chamber depth. ICC showed a high level of agreement between the two methods [0.545]. There was no significant difference in lens thickness as measured by optical biometry and A-scan ultrasound, with a medium positive correlation between lens thickness measurement by the two devices [P&lt;0.001]. The interclass correlation further supported these findings, with a strong correlation between lens thickness and cataract development [r = 0.753]. The study reveals consistency in the measurements between optical and ultrasound biometry, highlighting the need for future research, to address limitations like small sample size and potential biases.

A challenging case of scleral buckle-related restricted strabismus with unexpected good postoperative outcomes: A case report

Abstract Strabismus surgery in a scleral buckle patient is a challenging task that requires precise planning and meticulous surgical skills to accomplish a successful outcome. We report a case of a 32-year-old male who presented with complaints of diminution of vision in the right eye (RE) for 23 years and outward deviation of RE for 5 years after blunt trauma with a ball. The patient was diagnosed with RE total retinal detachment (RD) with traumatic retinal dialysis. He underwent scleral buckling as RD surgery in 2004 followed by silicon oil removal 6 months later elsewhere. On ocular examination of the RE, the best corrected visual acuity was perception of light with accurate projection of rays in all four quadrants, there was grade III relative afferent pupillary defect with an exotropia of 20° on Hirschberg test. The prism bar reflex test revealed an exotropia of 50 prism diopters (PD) [Figure 1]. An anterior segment examination revealed posterior subcapsular and cortical cataracts. After taking a retina clinic opinion, the patient underwent uneventful RE cataract surgery with in-bag implantation of a foldable implant cataract surgery first, followed by strabismus surgery under a guarded visual prognosis. Clinically significant adhesion and the presence of the scleral buckle posed a magnificent challenge during the strabismus surgery. The plan was improvised to 8 mm lateral rectus recession with 4 mm hang loose recession irrespective of a large deviation under local anesthesia. To our surprise, a satisfactory primary position alignment within 10 PD (orthophoria) was achieved, which was maintained on subsequent follow-up visits. We report an interesting and challenging case of restrictive strabismus due to scleral buckle which emphasizes that surgical procedures and their outcomes may not always align with expectations. Therefore, it is necessary to adopt a flexible and customized approach to effectively manage such instances.

B- Mode Ultrasonography of Ocular Abnormalities in Dogs

Background: Ultrasonography is a simple, safe and non-invasive method to examine the internal structures of eye in case of opacity of otherwise clear ocular medium like cornea, aqueous, lens, and vitreous. Methods: 123 dogs with ocular abnormalities from March 2021 to October 2022, presented to the Division of Veterinary Surgery and Radiology were included in this study. All of the animals underwent a thorough ophthalmic examination along with B-scan ultrasonography of both the eyes using a 7.5 MHz linear probe. Result: Ultrasonography revealed thin hyperechoic lines and a thin hyperechoic rim of the lens, indicating early cataract changes and cortical cataract, respectively. Sixty-two dogs were found to be affected by cataract; 20 dogs were affected by the disease Phthisis bulbi; 16 dogs had a complete retinal detachment showing a typical “morning glory” sign; 10 dogs had vitreous haemorrhage; 6 dogs had a damaged eye with lens dislocation; and 5 dogs had choroidal melanoma and intraocular tumours in 4 dogs out of 123 observed dogs. Further, out of 62 cataract cases, 16 dogs were affected by cortical cataracts, 41 had nuclear cataracts, and 5 dogs were affected by morgagnian cataracts. Therefore, B-scan ultrasonography of the eye was a quick, safe, and accurate way to examine the pathology, especially when opaque media inhibit direct examination or when exophthalmos is evident and the normal anatomy of the eye.

Prevalence and Associated Factors of Cataract, Cataract Surgery and Postoperative Outcome in an Old Population in Russia: The Ural Very Old Study

PurposeTo assess prevalence of cataract and cataract surgery in a very old population in Russia. DesignPopulation-based study. ParticipantsThe Ural Very Old Study included 1526 (81.1%) participants out of 1882 eligible individuals aged 85+ years. MethodsBased on anterior and posterior segment imaging, we assessed the prevalence of cataract, cataract surgery and other ocular disorders affecting best corrected visual acuity (BCVA). Main outcome measuresPrevalence of cataract and cataract surgery. ResultsThe study included 1163 (76.3%) individuals with lens information. Cataract surgery had been performed in 469 right eyes (41.0%;95%CI:38.1,43.9) (92.1% with posterior chamber IOL; 4.7% with multifocal IOL) and 479 left eyes (41.6%;95%CI:38.7,44.4) (92.7% with posterior chamber IOL; 4.2% with multifocal IOL). Among the 1163 study participants, 610 (52.5%) individuals had undergone cataract surgery in at least one eye. Higher prevalence of previous cataract surgery correlated (multivariable analysis) with lower IOP (OR:0.92;95%CI:0.88,0.95;P<0.001), glaucomatous optic nerve damage stage (OR:1.20;95%CI:1.05,1.36;P=0.006), and better visual acuity (OR:0.67;95%CI:0.51,0.89;P=0.005). Postoperative BCVA (mean:0.83±1.43logMAR) was reduced to moderate-to-severe vision impairment (MSVI) in 202 eyes (44.6%;95%CI:40.0,49.2) and to blindness in 53 eyes (11.7%;95%CI:8.7,14.7). Causes of postoperative MSVI were age-related macular degeneration (AMD) (34.2%), glaucoma (13.9%), and secondary cataract (5.4%). Causes for blindness were AMD (24.5%), glaucoma (18.9%), corneal opacifications (15.8%) and myopic macular degeneration (11.3%). YAG-laser capsulotomy had been performed in 6 (1.3%) out 469 right eyes after cataract surgery and in 12 (2.5%) out of 479 left eyes after cataract surgery. Prevalence of nuclear cataract and cortical cataract was 604/671 (90.0% in phakic eyes 51.9% in the whole study population) and 97.9% eyes (48.4% in total study population). Cataract caused bilateral MSVI and blindness in 28.2% (95%CI:25.6,30) and 2.9% (95%CI:1.9,3.9), respectively, of all study participants. ConclusionsDespite a relatively high prevalence of cataract surgery, this multiethnic cohort aged 85+ years from Russia showed a high prevalence of cataract-related MSVI and blindness, due to the old age of the participants. After cataract surgery, main causes for MSVI (prevalence:44.6%) and blindness (prevalence:11.7%) were AMD, glaucoma, corneal opacifications, and myopic macular degeneration. Almost all individuals aged 85+ years need cataract surgery, despite limited chance of postoperative good vision.

Syndromic myopia in marfan’s disease: about a case with review of the literature

Objective: To describe a case of myopic syndrome in Marfan disease. Results: The patient was 45 years old, with high myopia and wearing corrective lenses, with no previous history of any particular problem. She was seen for the management of a progressive bilateral decrease in visual acuity in a white, painless eye, with no history of trauma and no other associated signs. On the clinical examination, the corrected visual acuity was estimated at 02/10 in both eyes. The refraction revealed strong myopia at -11D. The examination of the lens after pupillary dilatation reveals a cortical cataract and upward crystalline ectopia in both eyes. At the posterior pole, there was a myopic cone, chorioretinal atrophy and poor macular reflex, with vessels of normal caliber. The retina was flat with no peripheral retinal tears

Correlation of Dysfunctional Lens Index with Lens Opacification System III in Age Related Cataract

Purpose: Age-Related changes in crystalline lens opacity and lens density contribute to formation of higher order aberrations resulting in reduced quality of vision. Precise quantification of cataract is important for predicting phacodynamics and educating patient. The iTrace(a ray-tracing aberrometer) provides Dysfunctional Lens Index (DLI). This study from Pakistan investigates the relationship between LOCS III and DLI in senile cataract. Study Design: Correlational study. Place and Duration of Study: Hashmanis Hospital, Karachi from March 2021 to May 2021. Methods: This study included 44 patients with age-related cataract. Demographic characteristics and complete ophthalmic examination of eyes including Best Corrected Visual Acuity (BCVA) and slit lamp biomicroscopy were performed. Age related cataracts were graded using the Standard technique of LOCS III. I-Trace was utilized for wave front analysis to calculate DLI. Results: BCVA and LOCS III nuclear opalescence score had strongest positive linear correlation (r=0.433, P&lt;0.01). DLI displayed a strong significant negative correlation to LOCS III Cortical Cataract (C) and LOCS III Posterior Sub-Capsular Cataract (P) score (r=-0.415 and r=-0.694; respectively). Conclusion: BCVA had insignificant and small to no correlation to LOCS III C score and P score. Whereas, DLI showed the strongest significant correlation to LOCS III C score and P score. Patient's optical quality determined by visual symptoms are more closely associated to DLI parameter as compared to LOCS III classification. DLI can provide a better objective way to elevate age related cataract, monitor the progression and determine phacodynamics.

Resilience of elderly patients with sarcopenic obesity and age-related visual impairment

BACKGROUND: The development of visual deficit due to glaucoma or cataracts significantly limits motor activity and reduces the independence of elderly patients from others in daily activities. However, resilience among older patients with primary open-angle glaucoma and cortical cataract remains largely unexplored.&#x0D; AIM: To analysis of the resilience of elderly patients with primary open-angle glaucoma and cortical cataract&#x0D; MATERIALS AND METHODS: For this study, two clinical groups were formed: patients aged 60–74 years with primary open-angle glaucoma without secondary cataracts in the amount of 135 people (64 men and 71 women) and patients with cortical cataracts without combination with glaucoma in the number of 128 people (59 men and 69 women). To study the viability of patients, the Connor-Davidson Resilience Scale-25, validated in the Russian Federation, was used.&#x0D; RESULTS: To the greatest extent, representatives of both study groups differed in the subdomain “security in relationships” and “positivity of accepted changes” with a representative difference. The compared groups of patients also had statistically significant differences in such an important subdomain as individual perseverance (p 0.05) and competence in mean scores for each cohort. At the same time, there was a deterioration in age-related vitality according to the final parameter of patients on the Connor-Davidson Resilience Scale-25. At the same time, the decrease in the average value of the integral parameter according to the age-related vitality scale used in the study was 16.3 points with a statistically significant difference (p 0.05) in the group with cortical cataracts.&#x0D; CONCLUSION: As a result of the study, it was found that cortical cataracts and primary open-angle glaucoma contributed to a decrease in the vitality of elderly patients, and this was more pronounced in patients with primary open-angle glaucoma, which should be taken into account when justifying medical and psychological support for such patients.

A Transformer-Based Knowledge Distillation Network for Cortical Cataract Grading.

Cortical cataract, a common type of cataract, is particularly difficult to be diagnosed automatically due to the complex features of the lesions. Recently, many methods based on edge detection or deep learning were proposed for automatic cataract grading. However, these methods suffer a large performance drop in cortical cataract grading due to the more complex cortical opacities and uncertain data. In this paper, we propose a novel Transformer-based Knowledge Distillation Network, called TKD-Net, for cortical cataract grading. To tackle the complex opacity problem, we first devise a zone decomposition strategy to extract more refined features and introduce special sub-scores to consider critical factors of clinical cortical opacity assessment (location, area, density) for comprehensive quantification. Next, we develop a multi-modal mix-attention Transformer to efficiently fuse sub-scores and image modality for complex feature learning. However, obtaining the sub-score modality is a challenge in the clinic, which could cause the modality missing problem instead. To simultaneously alleviate the issues of modality missing and uncertain data, we further design a Transformer-based knowledge distillation method, which uses a teacher model with perfect data to guide a student model with modality-missing and uncertain data. We conduct extensive experiments on a dataset of commonly-used slit-lamp images annotated by the LOCS III grading system to demonstrate that our TKD-Net outperforms state-of-the-art methods, as well as the effectiveness of its key components. Codes are available at https://github.com/wjh892521292/Cataract_TKD-Net.

Association of Alpha-Crystallin with Human Cortical and Nuclear Lens Lipid Membrane Increases with the Grade of Cortical and Nuclear Cataract.

Eye lens α-crystallin has been shown to become increasingly membrane-bound with age and cataract formation; however, to our knowledge, no studies have investigated the membrane interactions of α-crystallin throughout the development of cataracts in separated cortical membrane (CM) and nuclear membrane (NM) from single human lenses. In this study, four pairs of human lenses from age-matched male and female donors and one pair of male lenses ranging in age from 64 to 73 years old (yo) were obtained to investigate the interactions of α-crystallin with the NM and CM throughout the progression of cortical cataract (CC) and nuclear cataract (NC) using the electron paramagnetic resonance spin-labeling method. Donor health history information (diabetes, smoker, hypertension, radiation treatment), sex, and race were included in the data analysis. The right eye lenses CM and NM investigated were 64 yo male (CC: 0), 68 yo male (CC: 3, NC: 2), 73 yo male (CC: 1, NC: 2), 68 yo female (CC: 3, NC: 2), and 73 yo female (CC: 1, NC: 3). Similarly, left eye lenses CM and NM investigated were 64 yo male (CC: 0), 68 yo male (CC: 3, NC: 2), 73 yo male (CC: 2, NC: 3), 68 yo female (CC: 3, NC: 2), and 73 yo female (CC: 1, NC: 3). Analysis of α-crystallin binding to male and female eye lens CM and NM revealed that the percentage of membrane surface occupied (MSO) by α-crystallin increases with increasing grade of CC and NC. The binding of α-crystallin resulted in decreased mobility, increased order, and increased hydrophobicity on the membrane surface in male and female eye lens CM and NM. CM mobility decreased with an increase in cataracts for both males and females, whereas the male lens NM mobility showed no significant change, while female lens NM showed increased mobility with an increase in cataract grade. Our data shows that a 68 yo female donor (long-term smoker, pre-diabetic, and hypertension; grade 3 CC) showed the largest MSO by α-crystallin in CM from both the left and right lens and had the most pronounced mobility changes relative to all other analyzed samples. The variation in cholesterol (Chol) content, size and amount of cholesterol bilayer domains (CBDs), and lipid composition in the CM and NM with age and cataract might result in a variation of membrane surface mobility, membrane surface hydrophobicity, and the interactions of α-crystallin at the surface of each CM and NM. These findings provide insight into the effect of decreased Chol content and the reduced size and amount of CBDs in the cataractous CM and NM with an increased binding of α-crystallin with increased CC and NC grade, which suggests that Chol and CBDs might be a key component in maintaining lens transparency.