Incidence Of Nuclear Cataract Research Articles

The Combination of Healthy Diet and Healthy Body Weight Is Associated with Lower Risk of Nuclear Cataract in the Blue Mountains Eye Study

Greater adherence to dietary guidelines has previously been found to be associated with decreased risk of visual impairment. However, whether or not this association extends to age-related cataract, 1 of the leading causes of visual impairment, is unknown. The aim of this study was to assess the association between adherence to dietary guidelines, using total diet score, and incidence of age-related cataract. Of 3654 baseline participants of the population-based Blue Mountains Eye Study cohort (1992-1994), 2334 (75.8% survivors) and 1952 (76.7% survivors) were examined after 5 and 10 y, respectively. Cataract was assessed from lens photographs using the Wisconsin Cataract Grading System. Baseline total diet score was calculated from FFQ data following a modified version of the Healthy Eating Index for Australians. OR with 95% CI were estimated using discrete logistic regression analyses, adjusting for age, sex, and other confounders. To test interaction, a cross-product term of 2 factors was included in regression models. Of 2173 participants (84.7% of those returned for 1 or both follow-ups) with total diet score estimated, 57% were women, mean baseline age was 63.9±8.4y, and mean baseline BMI was 26.3±4.3 kg/m2. After multivariable adjustment, baseline total diet score was not associated with incidence of any cataract. A multiplicative interaction was observed between total diet score and BMI for incident nuclear cataract (P-interaction=0.04): increasing baseline total diet score was associated with decreased risk of nuclear cataract among participants with BMI <25 (per unit increased total diet score, OR: 0.90; 95% CI: 0.81, 0.99; P=0.02), but not among participants with BMI ≥25 (OR: 1.00; 95% CI: 0.92, 1.10; P=0.95). Adherence to dietary guidelines had no appreciable influence on cataract development overall in this older Australian population. However, adherence to dietary guidelines combined with healthy BMI is associated with decreased risk of nuclear cataract, an aging marker.

Antioxidant nutrient intake and the long-term incidence of age-related cataract: the Blue Mountains Eye Study

BackgroundOxidative stress has been implicated in cataractogenesis. Long-term intake of antioxidants may offer protection against cataract. ObjectiveWe investigated relations between antioxidant nutrient intakes measured at baseline and the 10-y incidence of age-related cataract. DesignDuring 1992–1994, 3654 persons aged ≥49 y attended baseline examinations of the Blue Mountains Eye Study (82.4% response). Of these persons, 2464 (67.4%) participants were followed ≥1 time after the baseline examinations (at either 5 or 10 y). At each examination, lens photography was performed and questionnaires were administered, including a 145-item semiquantitative food-frequency questionnaire. Antioxidants, including β-carotene, zinc, and vitamins A, C, and E, were assessed. Cataract was assessed at each examination from lens photographs with the use of the Wisconsin Cataract Grading System. Nuclear cataract was defined for opacity greater than standard 3. Cortical cataract was defined as cortical opacity ≥ 5% of the total lens area, and posterior subcapsular (PSC) cataract was defined as the presence of any such opacity. ResultsParticipants with the highest quintile of total intake (diet + supplements) of vitamin C had a reduced risk of incident nuclear cataract [adjusted odds ratio (OR): 0.55; 95% CI: 0.36, 0.86]. An above-median intake of combined antioxidants (vitamins C and E, β-carotene, and zinc) was associated with a reduced risk of incident nuclear cataract (OR: 0.51; 95% CI: 0.34, 0.76). Antioxidant intake was not associated with incident cortical or PSC cataract. ConclusionHigher intakes of vitamin C or the combined intake of antioxidants had long-term protective associations against development of nuclear cataract in this older population.

Nuclear Cataract

JAMA Statin Use and Incident Nuclear Cataract Context: Statins are widely prescribed for their lipid-lowering effects but also have putative antioxidant properties. Oxidative stress is believed to play a role in the development of nuclear cataract, but little is known regarding the relationship of statin use and cataract incidence. Objective: To evaluate the relationship of use of statins and incident cataract in adults in a midwestern community in the United States. Design, Setting, and Participants: The Beaver Dam Eye Study, an observational, longitudinal, population-based study of age-related eye disease in Beaver Dam, Wis. There were 1299 persons who were seen at the third examination in 1998-2000, had gradable photographs in both eyes, and were deemed to be at risk of developing nuclear cataract within 5 years. Main Outcome Measure: Five-year incidence of cataract with respect to statin use. Cataracts were graded from photographs taken through the participant's dilated pupil. Results: A total of 210 persons developed incident nuclear cataract in the interval from 1998-2000 to 2003-2005. Five-year incidence of nuclear cataract was 12.2% in statin users compared with 17.2% in nonusers (odds ratio [OR], 0.55; 95% confidence interval [CI], 0.36-0.84), controlling for age. When only never smokers without diabetes were assessed, the age-, lipid level–, and sex-adjusted OR was 0.40 (95% CI, 0.18-0.90). Five-year incidence of cortical cataract was 9.9% in statin users and 7.5% in nonusers (OR, 1.28; 95% CI, 0.79-2.08); posterior subcapsular cataract occurred in 3.0% of statin users and 3.4% of nonusers (OR, 0.82; 95% CI, 0.39-1.71). Conclusion: Statin use in a general population appears to be associated with lower risk of nuclear cataract, the most common type of age-related cataract.

Statin Use and Incident Nuclear Cataract

Statins are widely prescribed for their lipid-lowering effects but also have putative antioxidant properties. Oxidative stress is believed to play a role in the development of nuclear cataract, but little is known regarding the relationship of statin use and cataract incidence. To evaluate the relationship of use of statins and incident cataract in adults in a midwestern community in the United States. The Beaver Dam Eye Study, an observational, longitudinal, population-based study of age-related eye disease in Beaver Dam, Wis. There were 1299 persons who were seen at the third examination in 1998-2000, had gradable photographs in both eyes, and were deemed to be at risk of developing nuclear cataract within 5 years. Five-year incidence of cataract with respect to statin use. Cataracts were graded from photographs taken through the participant's dilated pupil. A total of 210 persons developed incident nuclear cataract in the interval from 1998-2000 to 2003-2005. Five-year incidence of nuclear cataract was 12.2% in statin users compared with 17.2% in nonusers (odds ratio [OR], 0.55; 95% confidence interval [CI], 0.36-0.84), controlling for age. When only never smokers without diabetes were assessed, the age-, lipid level-, and sex-adjusted OR was 0.40 (95% CI, 0.18-0.90). Five-year incidence of cortical cataract was 9.9% in statin users and 7.5% in nonusers (OR, 1.28; 95% CI, 0.79-2.08); posterior subcapsular cataract occurred in 3.0% of statin users and 3.4% of nonusers (OR, 0.82; 95% CI, 0.39-1.71). Statin use in a general population appears to be associated with lower risk of nuclear cataract, the most common type of age-related cataract.

Associations between Elevated Intraocular Pressure and Glaucoma, Use of Glaucoma Medications, and 5-Year Incident Cataract: The Blue Mountains Eye Study

To examine incident relationships between elevated intraocular pressure (IOP), open-angle glaucoma (OAG), and use of glaucoma medications with 5-year incident cataract. Population-based cohort study. The Australian Blue Mountains Eye Study examined 3654 participants > or =50 years old at baseline (82.4% response; 1992-1994); 2335 eligible participants were reexamined after 5 years (75.1% response; 1997-1999). A detailed medical and ocular history, including current medications, was taken, and a comprehensive eye examination, including applanation tonometry, automated perimetry, and lens photography, was performed at each examination. The Wisconsin system was used to grade lens photographs in assessing incident nuclear, cortical, and posterior subcapsular cataract (PSC). Data from both eyes were assessed using generalized estimating equation analyses. Elevated IOP was defined as > or =21 mmHg. Open-angle glaucoma was diagnosed from typical glaucomatous field loss with matching optic disc cupping, without reference to IOP. Subjects without OAG or secondary or angle-closure glaucoma with IOP > 21 mmHg in either eye were classified as having ocular hypertension (OH), as were non-OAG subjects with IOP < 22 mmHg using glaucoma medications. Wisconsin levels 4 to 5 were graded as nuclear cataract, at least 5% lens involvement was graded as cortical cataract, and any PSC defined its presence. The 5-year incidence of nuclear cataract was 23.4% (592/2532), or 23.1% (574/2486) after excluding subjects using glaucoma medication. A marginally significant association was found for elevated IOP or OH at baseline and incident nuclear cataract (odds ratio [OR], 1.93 [95% confidence interval (CI), 0.97-3.89], and OR, 1.83 [95% CI, 0.96-3.48], respectively) in subjects not using glaucoma medications, after multivariate adjustment. Age- and gender-adjusted analyses showed similar but statistically significant associations. The association between elevated IOP or OH and nuclear cataract was significant in multivariate analyses (OR, 2.07 [95% CI, 1.04-3.12], and OR, 1.78 [95% CI, 1.05-3.01], respectively). Use of glaucoma medications was associated with nonsignificantly increased adjusted odds for incident nuclear cataract (OR, 1.90 [95% CI, 0.92-3.92]). No associations, however, were found with incident cortical cataract or PSC. Elevated IOP may increase the risk of nuclear cataract, but not that of other types. The use of glaucoma medications could magnify this risk.

Smoking and cataract: Review of causal association

Several risk factors for the development of cataract have been identified. This review evaluates epidemiologic literature that has examined tobacco smoking as a risk factor for cataract formation using established causality criteria. Twenty-seven studies were included in this review. Evidence suggests that smoking has a 3-fold increase on the risk for incident nuclear cataract development. There was also evidence of dose response, temporal relationship, and reversibility of effect. There was limited evidence of an association between smoking and posterior subcapsular cataract, but little or no association with cortical cataract. Thus, the literature review indicated a strong association between smoking and the development of cataract, particularly nuclear cataract. The association fulfills the established criteria for causality. The association between smoking and other types of cataract is less distinct and requires further evaluation.

The relation of retinal microvascular characteristics to age-related eye disease: the Beaver Dam eye study

PurposeTo examine the relationship between microvascular characteristics (central retinal artery equivalent [CRAE], central retinal vein equivalent [CRVE], arteriole-to-venule ratio [AVR], focal retinal arteriolar narrowing, arteriovenous [A/V] nicking, and retinopathy) associated with systemic hypertension and ocular disease (age-related maculopathy [ARM], three types of cataract, and open-angle glaucoma). DesignPopulation-based cohort study. MethodsStandardized grading of microvascular characteristics was performed at baseline on fundus photographs taken on 4,926 persons aged 43 to 86 years who participated in the Beaver Dam Eye study at the baseline examination. Age-related maculopathy, cataract, and glaucoma status were determined at baseline; ARM and cataract were again determined at 5-year and 10-year follow-up examinations using standard protocols. ResultsWhile controlling for age and sex, generalized retinal arteriolar narrowing (lowest quintile of CRAE) was associated with the 10-year cumulative incidence of retinal pigment epithelial (RPE) depigmentation (risk ratio [RR] 1st vs 5th quintile, 1.93; 95% confidence interval [CI], 1.11, 3.34) and, inversely, with incident nuclear cataract (RR, 0.71; 95% CI, 0.50, 0.99). Arteriovenous nicking was associated with the incidence of early ARM (RR, 2.39; 95% CI, 1.02, 5.57). Otherwise, there were no statistically significant associations of focal arteriolar narrowing or retinopathy with incident ARM or any type of age-related cataract and no relation of CRAE, focal arteriolar narrowing, A/V nicking, or retinopathy with the prevalence of glaucoma. ConclusionThese data show that retinal vascular characteristics associated with hypertension are related to the incidence of ARM and nuclear cataract but not to prevalent glaucoma. Relationships, however, were weak and inconsistent.

Five-year incidence of cataract in older persons with diabetes and pre-diabetes

PURPOSE To investigate longitudinal associations between diabetes and the 5-year incidence of cataract and cataract surgery. (A population-based, cohort study of 2335 persons with baseline ages 49 years or older resident in the Blue Mountains region, west of Sydney, Australia). METHODS Baseline information on diabetes history was collected during an interviewer-administered questionnaire. Impaired Fasting Glucose (IFG) was defined as venous plasma glucose between 6.0 and 7.0 mmol/L and newly diagnosed diabetes as plasma glucose >7.0 mmol/L, using fasting blood glucose measurements taken at baseline. Retroillumination lens photographs from the baseline and 5-year follow-up examinations were graded for presence of cortical, posterior subcapsular (PSC) and nuclear cataract. RESULTS We found a 2-fold higher 5-year incidence of cortical cataract in participants with IFG, multivariate adjusted odds ratio (OR) 2.2, 95% confidence interval (CI) 1.1-4.1. Incident PSC cataract was more frequent among persons with diabetes, but this association was statistically significant only for those with newly diagnosed diabetes, multivariate adjusted OR 4.5 (CI 1.5-13.0). There were no statistically significant associations found between incident nuclear cataract or cataract surgery and either diabetes or IFG. CONCLUSIONS These epidemiological data suggest that IFG, a pre-diabetic condition, may be a risk factor for the development of cortical cataract.

Socioeconomic and lifestyle factors and the 10-year incidence of age-related cataracts

Purpose To investigate the association of socioeconomic and lifestyle factors with incidence of age-related cataracts. Design Population-based longitudinal epidemiologic study. Methods Persons aged 43 to 86 years (n = 4,926) living in Beaver Dam, Wisconsin, were examined in 1988 to 1990, 1993 to 1995, and 1998 to 2000. Medical histories were obtained, and photographs of the lenses were taken at each visit. Photographs were graded according to standard protocols. Results Socioeconomic and lifestyle factors considered were income, education, occupation, smoking, alcohol, caffeine, and multivitamin use. After adjustment for age and sex, income (or education) was inversely and smoking was directly related to the 10-year cumulative incidence of nuclear cataract. None of the factors were significantly associated with incident cortical or posterior subcapsular cataract. We found no evidence in these analyses to suggest that history of multivitamin use altered the relationships of smoking to the incidence of cataracts. In models adjusting for all other significant risk factors, the individual significance values for each individual factor differed little from the models adjusting only for age and sex. Conclusions Incident nuclear cataract was associated with income and smoking 10 years earlier. There were no significant lifestyle exposures associated with incident cortical and posterior subcapsular cataract.

Myopic refractive shift caused by incident cataract: The Blue Mountains Eye Study

PURPOSE To assess the myopic shift in refraction caused by incident cataract in the Blue Mountains Eye Study (BMES) population. METHODS Five-year prospective follow-up of the BMES, initially performed in 1992. After 5 years, 2335 survivors (75.1%) of 3654 baseline BMES participants were re-examined. Refractive change was assessed by age, sex, incident cataract type and baseline refraction. Slit-lamp and retroillumination lens photographs were graded for presence of incident cataract and signs of previous cataract surgery. Objective and subjective refractions were performed. RESULTS In a multivariate model, age (p < 0.0001), incident nuclear cataract (p < 0.0003), hyperopia (p < 0.0009), incident posterior subcapsular cataract (p < 0.0027) and incident cortical cataract (p < 0.025) were factors associated with a relatively modest myopic refractive shift (0.34 diopters). Baseline myopia and gender were not associated with refractive change over the follow-up period. A myopic shift in refraction occurred most frequently in older (=70 years) than younger (<70 years) participants. CONCLUSIONS Older age, baseline hyperopia and all types of incident cataract were principal factors found associated with myopic refractive shift over 5 years in an older population.

Incidence of age-related cataract over a 10-year interval: the Beaver Dam Eye Study

Objective or purpose To describe the cumulative incidence of age-related cataracts and cataract surgery over a 10-year interval. Design Prospective epidemiologic study. Participants Persons 43 to 86 years of age participating in the Beaver Dam Eye Study (n = 4926 at baseline, 2764 for baseline, 5-year and 10-year follow-ups). Methods Questionnaires and examinations were performed according to standardized protocols in a clinic setting in the town of Beaver Dam, Wisconsin. Lens photographs were obtained with specially modified cameras and were graded according to codified rules by trained graders. Main outcome measures Nuclear, cortical, and posterior subcapsular cataracts and cataract surgery. Results In right eyes, incident nuclear cataract occurred in 19.4%, cortical cataract in 17.4%, posterior subcapsular cataract in 6.1%, and cataract surgery in 10.8%. Incidence increased for all end points with age. Women had significantly higher incidences of nuclear cataract and cataract surgery than men. Time trends seem to be influencing the incidence of cataract surgery. Conclusions Age-related cataracts are common events in aging. Age-specific cataract surgery incidence seems to be increasing.

Lens thickness and five-year cumulative incidence of cataracts: The Beaver Dam Eye Study

PURPOSE: To evaluate whether lens thickness is related to incidence of cataracts. METHODS: Lens thickness was measured from slit-lamp photographs of the lens at the time of the prevalence evaluation in the Beaver Dam Eye Study. Incident cataract was determined by grading standard slit-lamp and retroillumination photographs of the lens at the baseline and five-year follow-up examinations. Medical history was obtained and blood pressures, height and weight were measured according to protocol. RESULTS: Lens thickness was positively associated with incident nuclear cataract and inversely associated with incident cortical cataract after accounting for age, sex, diabetes status, hypertension, heavy drinking and cigarette smoking. CONCLUSIONS: Lens thickness is related to incidence of cataracts. Mechanisms to explain these relationships require further laboratory and epidemiologic investigation.

Incident cataract after a five-year interval and lifestyle factors: The Beaver Dam Eye Study

CONTEXT: A population-based study to investigate risk factors for age-related eye disease was begun in 1987 in a representative American community. Incidence of cataract was subsequently evaluated. SPECIFIC OBJECTIVES: To examine the relationships of cigarette smoking, alcohol, and caffeine intakes to incidence of age-related cataracts five years later. DESIGN: Observational epidemiologic incidence study of an adult population. PARTICIPANTS AND INTERVENTION: Adults 43-84 years of age were identified during a census in 1987-1988, and examined at baseline (1988-1990) and after a five-year interval (1993-1995). MAIN OUTCOME MEASURE: Standardized protocols were used at the baseline and follow-up evaluations for exposures and for objective identification of cataracts. RESULTS: Cumulative incidence of nuclear cataract in right eyes was about 12%, cortical cataract about 8%, and posterior subcapsular cataract about 3%. In multivariable analyses of the general estimating equations type, there were significant associations between nuclear cataract and: pack-years smoked (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.01, 1.09 per 10 pack-years); and current alcohol intake (OR 1.01, 95% CI 1.00, 1.02 per 10 grams ethanol/week). Cigarette smokers were more likely to have had cataract surgery in the interval between baseline and follow-up examinations. CONCLUSIONS: Cigarette smoking and alcohol consumption were associated with modestly increased risks of incident nuclear cataract over a five-year interval.

Incidence of age-related cataract: the Beaver Dam Eye Study.

To estimate the incidence of nuclear, cortical, and posterior subcapsular cataract in the Beaver Dam Eye Study cohort. A population-based study of the prevalence of age-related eye diseases was conducted between 1988 and 1990 (n=4926), and a follow-up study was conducted between 1993 and 1995 (n=3684). The evaluations included photographic documentation of the lens. Slitlamp photographs were taken to assess nuclear opacity, and retroillumination photographs were taken to assess cortical and posterior subcapsular cataract. The grading of photographs was done in a masked manner by trained graders using the same protocols for baseline and follow-up photographs. The graders were the same for both evaluations. Persons aged 43 to 86 years who were identified through a private census conducted from 1987 to 1988 of the population of Beaver Dam, Wis, were invited for a baseline examination held between 1988-1990 and again for a follow-up examination held between 1993-1995. Incident nuclear cataract occurred in 13.1%, cortical cataract in 8.0%, and posterior subcapsular cataract in 3.4% of right eyes. The cumulative incidence of nuclear cataract in right eyes increased from 2.9% in persons aged 43 to 54 years at baseline to 40.0% in those aged 75 years or older. For cortical and posterior subcapsular cataract, the corresponding values were 1.9% and 21.8% and 1.4% and 7.3%, respectively. Women were more likely than men to have nuclear cataract even after adjusting for age. Incident cataracts are common age-related problems, and incidence increases with increasing age at baseline. These data will help in planning for future care (eg, cataract surgery and change in spectacle correction) and in investigating the importance of risk factors.