Posterior Subcapsular Lens Opacities Research Articles

Lens opacity prevalence among the residents in high natural background radiation area in Yangjiang, China.

The aim of the study was to evaluate the risk and threshold doses of lens opacity among residents exposed to low-dose radiation. Residents aged ≥45 years were recruited from a high natural background radiation (HNBR) area in Yangjiang City and a control area selected from nearby Enping City. Lens opacities (LOPs) were classified according to the Lens Opacities Classification System (LOCS) III system. Face-to-face interviews were conducted to collect information on lifestyles, migration and medical history. Life-time cumulative doses were estimated using gender, age, occupancy factors and environmental radiation doses received indoors and outdoors. Logistic regression analyses were conducted to estimate the dose response and determine thresholds. In the HNBR area, among 479 study participants, 101 (21.1%), 245(51.1%) and 23 cases (4.8%), respectively, of cortical, nuclear and posterior subcapsular (PSC) LOPs were found. In the control area, those types of LOPs were identified among 58 cases (12.6%), 206 cases (51.2%) and 6 cases (1.3%) of 462 examinees, respectively. Cumulative eye lens dose was estimated to be 189.5 ± 36.5 mGy in the HNBR area. Logistic analyses gave odds ratios at 100 mGy of 1.26 [95% confidence interval (CI) 1.00–1.60], 0.81 (95% CI 0.64–1.01) and 1.73 (95% CI 1.05–2.85) for cortical, nuclear and PSC LOPs, respectively. For cortical LOPs, a logistic analysis with a threshold dose gave a threshold estimate of 140 mGy (90% CI 110–160 mGy). The results indicated that population exposed to life-time, low-dose-rate environmental radiation was at an elevated risk of cortical and PSC LOPs. A statistically significant threshold dose was obtained for cortical LOPs and no threshold dose for PSC LOPs.

Crystalline lens changes after selective laser trabeculoplasty in Afro-Caribbean patients with open-angle glaucoma; report 4 of the West Indies Glaucoma Laser Study (WIGLS)

To characterize changes in nuclear, cortical, and posterior subcapsular lens opacities after selective laser trabeculoplasty (SLT) in Afro-Caribbean eyes with primary open-angle glaucoma (POAG). Three clinical practices, Saint Lucia and Dominica. Prospective case series. Patients with POAG in the West Indies Glaucoma Laser Study (WIGLS) had 360-degree SLT after medication washout. No antiinflammatory therapy was used after SLT. Nuclear, cortical, and posterior subcapsular lens opacities were graded through dilated pupils using the Lens Opacification Classification System III (LOCS III) at baseline and 12, 24, and 36months after SLT, with the grader masked to all previous values after baseline assessment. Changes in opacity scores from baseline were evaluated using paired t tests. Seventy-two patients (142 phakic eyes) were evaluated. The mean (±SD) baseline LOCS III opacity scores in right eyes and left eyes, respectively, were 2.44±1.23 and 2.40±1.16 (nuclear), 0.39±1.08 and 0.30±0.85 (cortical), and 0.22±0.59 and 0.15±0.36 (posterior subcapsular). Other than a small improvement in bilateral nuclear opacity scores at 12months, no statistically or clinically significant changes in any opacity score occurred in either eye up to 36months postoperatively. Three eyes (2.1%) with preexisting lens opacities had cataract surgery for progressive lens changes at 3months, 21months, and 26months, respectively, after SLT. Selective laser trabeculoplasty was not associated with clinically significant changes in nuclear, cortical, or posterior subcapsular lens opacities in glaucomatous Afro-Caribbean eyes. The rate of cataract surgery is consistent with reported rates from longitudinal natural history studies in Caribbean and non-Caribbean populations.

Prevalence of Lens Opacities in Adult Chinese Americans: The Chinese American Eye Study (CHES).

PurposeWe determined the age- and sex-specific prevalence of posterior subcapsular (PSC), nuclear, cortical, and mixed lens opacities in a population-based sample of Chinese-American adults.MethodsA population-based sample of Chinese-Americans 50 years and older, from 10 census tracts in Monterey Park, CA, USA, underwent a detailed interview and a comprehensive clinical examination that included assessment of different types of lens opacities by the slit-lamp–based Lens Opacities Classification System II (LOCS II). All lens changes (including pseudophakia/aphakia), PSC, nuclear, and/or cortical opacities, were evaluated and graded.ResultsOf the 5782 eligible subjects, 4582 (79.2%) Chinese Americans aged 50 years and older completed a comprehensive eye examination. Of the participants with LOCS II grading (n = 4234/4582, 92%), 3.0% had PSC opacities, 38.1% had nuclear opacities, and 23.4% had cortical opacities. The prevalence of all lens changes was 48.0% for all age groups and was higher by 10-year increasing age groups (P < 0.0001). The prevalence of visual impairment in the better-seeing eye with cortical only, nuclear only, PSC only, and mixed opacities was 3.9%, 5.0%, 14.3%, and 9.4%, respectively. A total of 454 (9.9%) individuals had undergone cataract extraction in at least one eye.ConclusionsChinese Americans have a high prevalence of visual impairment associated with lens opacities, and a high prevalence of nuclear opacities. Public health policies and programs designed to improve cataract detection and treatment could help reduce the burden of visual impairment in Chinese Americans.

The Association of Dietary Lutein plus Zeaxanthin and B Vitamins with Cataracts in the Age-Related Eye Disease Study: AREDS Report No. 37

To evaluate whether dietary intake of luteiin/zeaxanthin and B vitamins is associated with cataract prevalence and incidence.Clinic-based, baseline cross-sectional and prospective cohort study designs.Three thousand one hundred fifteen patients (6129 eyes) enrolled in the Age-Related Eye Disease Study 55 to 80 years of age followed up for mean of 9.6 years.Participants completed baseline food frequency questionnaires. Baseline and annual lens photographs were graded centrally. Multivariate models controlling for previously identified risk factors for cataracts tested for the association of cataracts with reported dietary intake, using the lowest quintile as reference.Cataract surgery, cataract status (type and severity) at baseline, and development of cataracts.At baseline, increased dietary riboflavin and B12 were associated inversely with nuclear and cortical lens opacities. In comparisons of persons with and without cataract, persons with the highest riboflavin intake versus those with the lowest intake had the following associations: mild nuclear cataract: odds ratio (OR), 0.78; 95% confidence interval (CI), 0.63-0.97; moderate nuclear cataract: OR, 0.62; 95% CI, 0.43-0.90; and mild cortical cataract: OR, 0.80; 95% CI, 0.65-0.99. For B12, the results were: mild nuclear cataract: OR, 0.78; 95% CI, 0.63-0.96; moderate nuclear cataract: OR, 0.62; 95% CI, 0.43-0.88; and mild cortical cataract: OR, 0.77; 95% CI, 0.63-0.95. Highest dietary B6 intake was associated with a decreased risk of moderate nuclear lens opacity developing compared with the lowest quintile (OR, 0.67; 95% CI, 0.45-0.99). Highest dietary intake levels of niacin and B12 were associated with a decreased risk of development of mild nuclear or mild cortical cataracts in participants not taking Centrum (Pfizer, New York, NY) multivitamins. For participants taking multivitamins during the study, the highest intake of dietary folate was associated with an increased risk of mild posterior subcapsular lens opacity development. No statistically significant associations were found between lutein plus zeaxanthin intake and presence at baseline or development of nuclear or cortical lens opacity outcomes.These findings are consistent with earlier studies suggesting that dietary intake of B vitamins may affect the occurrence of age-related lens opacities. Further investigations are warranted.

Visual Acuity after Cataract Surgery in Patients with Age-Related Macular Degeneration: Age-Related Eye Disease Study 2 Report Number 5

To evaluate visual acuity outcomes after cataract surgery in persons with varying degrees of severity of age-related macular degeneration (AMD).Cohort study.A total of 1232 eyes of 793 participants who underwent cataract surgery during the Age-Related Eye Disease Study 2, a prospective, multicenter, randomized controlled trial of nutritional supplements for treatment of AMD.Preoperative and postoperative characteristics of participants who underwent cataract extraction during the 5-year trial were analyzed. Both clinical data and standardized red-reflex lens and fundus photographs were obtained at baseline and annually. Photographs were graded by a centralized reading center for cortical and posterior subcapsular lens opacities and for AMD severity. Cataract surgery was documented at annual study visits or by history during the 6-month telephone calls. Analyses were conducted using multivariate repeated-measures regression.Change in best-corrected visual acuity (BCVA) after cataract surgery compared with preoperative BCVA.Adjusting for age at time of surgery, gender, interval between preoperative and postoperative visits, and type and severity of cataract, the mean changes in visual acuity were as follows: eyes with mild AMD (n = 30) gained 11.2 letters (95% confidence interval [CI], 6.9-15.5), eyes with moderate AMD (n = 346) gained 11.1 letters (95% CI, 9.1-13.2), eyes with severe AMD (n = 462) gained 8.7 letters (95% CI, 6.7-10.7), eyes with noncentral geographic atrophy (n = 70) gained 8.9 letters (95% CI, 5.8-12.1), and eyes with advanced AMD (central geographic atrophy, neovascular disease, or both; n = 324) gained 6.8 letters (95% CI, 4.9-8.8). The visual acuity gain across all AMD severity groups was statistically significant from preoperative values (P < 0.0001).Mean visual acuities improved significantly after cataract surgery across varying degrees of AMD severity.

Health hazards and mitigation of chronic poisoning from arsenic in drinking water: Taiwan experiences

There are two endemic areas of long-term exposure to arsenic from drinking water in Taiwan. Residents in the southwestern and northeastern endemic areas started using high-arsenic artesian well water in the early 1910s and late 1940s, respectively. Public water supply system using surface water was implemented in southwestern and northeastern endemic areas in the 1970s and 1990s, respectively. Systemic health hazards of long-term exposure to arsenic in drinking water have been intensively investigated since the 1960s, especially after 1985 in Taiwan. Several diseases have been well documented to be associated with chronic arsenic poisoning from drinking water showing a dose-response relation. They include characteristic skin lesions like hyperpigmentation or depigmentation, hyperkeratosis in palms and soles, and Bowen disease, peripheral vascular disease (specifically blackfoot disease), ischemic heart disease, cerebral infarction, microvascular diseases, abnormal peripheral microcirculation, carotid atherosclerosis, QT prolongation and increased dispersion in electrocardiography, hypertension, goiter, diabetes mellitus, cataract (specifically posterior subcapsular lens opacity), pterygium, slow neural conduction, retarded neurobehavioral development, erectile dysfunction, and cancers of the skin, lung, urinary bladder, kidney, and liver. The method of choice to mitigate arsenic poisoning through drinking water is to use safe drinking water from uncontaminated sources.

Evaluation of Optimized Digital Fundus Reflex Photographs for Lens Opacities in the Age-Related Eye Disease Study 2: AREDS2 Report 7

We described the system for grading lens opacities using stereoscopic digital fundus reflex photographs in the Age-Related Eye Disease Study 2 (AREDS2) and compared reproducibility with the AREDS lens grading system, which used retroillumination film images. Stereoscopic fundus reflex photographs were acquired in a standardized fashion at baseline and annually. Images were enhanced and evaluated in the red channel at a central reading center. Percentage involvement of cortical and posterior subcapsular (PSC) lens opacities within the central 5 mm diameter zone of a modified AREDS lens grid was estimated. Reproducibility was assessed for contemporaneous variability (ongoing, monthly regrade on 5% of submissions, n = 777 eyes) and temporal drift (regrading a subset of baseline photographs annually, n = 88). In the contemporaneous exercise, the agreement for presence of cortical opacities was 93% (κ = 0.86) and for PSC opacities it was 97% (κ = 0.83). Intraclass correlation (ICC) for area of central zone involvement was 0.95 for cortical and 0.99 for PSC opacities. Historic data for contemporaneous regrading of film-based images in AREDS showed an ICC of 0.94 for cortical and 0.82 for PSC. The final annual temporal drift exercise had a reproducibility of 95% for cortical and PSC opacities. Digital grading using fundus reflex images with image enhancing tools has reproducibility comparable to film-based retroillumination images, and may be useful for centralized objective lens opacity assessment in clinical trials using widely available fundus cameras. Red reflex images limit evaluation to cortical and PSC opacities, and do not permit assessment of nuclear opacities. (ClinicalTrials.gov number, NCT00345176.).

Ten-Year Incidence Rates of Age-Related Cataract in the Age-Related Eye Disease Study (AREDS): AREDS Report No. 33

Purpose: To investigate the long-term incidence of age-related cataract and cataract surgery in the Age-Related Eye Disease Study (AREDS) cohort.Methods: Baseline and annual lens photographs of participants, aged 55–80 years, were graded centrally for nuclear, cortical, and posterior subcapsular (PSC) lens opacities using the AREDS System for Classifying Cataracts. Progression from a baseline status of no or mild lens opacity to at least moderate severity was analyzed and cumulative incidence estimated rates were calculated for each lens opacity type and cataract surgery stratified by age, sex, race, age-related macular degeneration category, multivitamin (Centrum) use and history of diabetes.Results: The ten-year cumulative incidence was 43.6% for any cataract, 23.1% for nuclear cataract, 22.0% for cortical cataract, 13.1% for PSC cataract, and 26.8% for cataract surgery. The 5- and 10-year incidence rates of all cataract types and cataract surgery were significantly higher with increasing age. Females had a higher incidence of any, nuclear and cortical cataract and cataract surgery (p = 0.02–0.05). Incidence of cortical cataract was higher in non-white participants (p = 0.001).Conclusions: These results are largely consistent with the results of previous observational studies. Long-term incidence rates of type-specific cataract can be useful in designing clinical studies of age-related cataract.

Cataract surgery rationing in an age of austerity – Is a UK district general hospital compliant with regional cataract booking guidelines?

AbstractPurpose The rate of cataract surgery in Outer North East London (ONEL) is significantly higher than the standardised admission rate (SAR) for England. Financial pressures have forced cost savings by restricting cataract operations, aiming for 22% reduction through new clinical acceptance criteria for the region since April 2011. This involves: 1. Best corrected distance visual acuity 6/10 or worse in the better eye AND Impaired lifestyle due to cataract: OR 2. Severe glare, diplopia or anisometropia &gt;/= 1.5 D Exceptions include: • Significant posterior subcapsular lens opacity despite good vision • If surgery is needed to help co‐manage conditions such as glaucoma or for the view of the retina in patients with diabetic retinopathyMethods Retrospective audit of cataract surgery from Aug 2010 ‐ Dec 2011. Medisoft electronic database query identified patients with VA &gt; 6/9 for case‐note review to ascertain reasons for (non/)compliance with cataract booking criteria.Results 1084 cataract operations were performed. Median age was 73.5 years. n=34 eyes with pre‐op VA 6/9 or better; pre‐April 2011 (9 cases) vs post‐April 2011 (25 cases). Case‐note review revealed: • Glare (8) / Anisometropia (3): 11 • Posterior Subcapsular cataract: 4 • Co‐management of other pathology: 23 Glaucoma (15), Diabetic Retinopathy (7), ARMD (1) • Not valid: 2Conclusion Rationing must be balanced with individual clinical needs. 99.8% of cataract operations met the new restricted criteria. This sample is an underestimate as not all cataract operations are registered on the Medisoft database. A re‐audit in 6‐8 months would establish compliance and feasibility as policies are tightened.

Risk Factors for Incident Cortical, Nuclear, Posterior Subcapsular, and Mixed Lens Opacities: The Los Angeles Latino Eye Study

Purpose: To identify sociodemographic and biological risk factors associated with the 4-year incidence of nuclear, cortical, posterior subcapsular (PSC), and mixed lens opacities. Design: Population-based, longitudinal study. Participants: We included 4658 Latinos 40 years from 6 census tracts in Los Angeles, California. Methods: Participants underwent an interview and detailed eye examination, including best-corrected visual acuity and slit-lamp assessment of lens opacities using the Lens Opacities Classification System II (LOCS II) at baseline and again 4 years later. Each opacity type was defined in persons with a LOCS II score of 2. Univariate and forward stepwise logistic regression analyses were used to identify independent baseline risk factors associated with 4-year incidence of nuclear only, cortical only, PSC only, and mixed (when 1 opacity type developed in a person) lens opacities. These comprised 4 mutually exclusive groups, and were based on person rather than eye. Main Outcome Measures: Odds ratios for independent risk factors associated with 4-year incidence of nuclear-only, cortical-only, PSC-only, and mixed lens opacities. Results: Of the 3471 participants with gradable lenses in the same eye at baseline and 4-year follow-up, 200 (5.8%) had incident nuclear-only opacities, 151 (4.1%) had incident cortical-only opacities, 16 (0.5%) had incident PSC-only lens opacities, and 88 (2.5%) had mixed lens opacities. Independent baseline risk factors for incident nuclear-only lens opacities included older age, current smoking, and presence of diabetes. Independent risk factors for incident cortical-only lens opacities included older age and having diabetes at baseline. Female gender was an independent risk factor for incident PSC-only lens opacities. Older age and presence of diabetes at baseline examination were independent risk factors for incident mixed lens opacities. Specifically, in diabetics, higher levels of hemoglobin A1c was associated with greater risk for 4-year incident nuclear-only, cortical-only and mixed lens opacities. Conclusions: Improved diabetic control and smoking prevention may reduce the risk of developing lens opacities. Understanding both modifiable and nonmodifiable risk factors provides insight into the development of lens opacification. Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article. Ophthalmology 2012;119:2040–2047 © 2012 by the American Academy of Ophthalmology.

Interventional cardiologists and risk of radiation-induced cataract: Results of a French multicenter observational study

BackgroundInterventional cardiologists (ICs) are exposed to X-rays and may be at risk to develop cataract earlier than common senile cataract. Excess risk of posterior subcapsular cataract, known as radiation-induced, was previously observed in samples of ICs from Malaysia, and Latin America. The O'CLOC study (Occupational Cataracts and Lens Opacities in interventional Cardiology) was performed to quantify the risk at the scale of France. MethodsThis cross-sectional multicenter study included an exposed group of ICs from different French centers and an unexposed control group of non-medical workers. Individual information was collected about cataract risk factors and past and present workload in catheterization laboratory. All participants had a clinical eye examination to classify the lens opacities (nuclear, cortical, or posterior subcapsular) with the international standard classification LOCS III. ResultsThe study included 106 ICs (mean age=51±7years) and 99 unexposed control subjects (mean age=50±7years). The groups did not differ significantly in the prevalence of either nuclear or cortical lens opacities (61% vs. 69% and 23% vs. 29%, respectively). However, posterior subcapsular lens opacities, were significantly more frequent among ICs (17% vs. 5%, p=0.006), for an OR=3.9 [1.3–11.4]. The risk increased with duration of activity but no clear relationship with workload was observed. However, the risk appeared lower for regular users of protective lead glasses (OR=2.2 [0.4–12.8]). ConclusionsICs, in France as elsewhere, are at high risk of posterior subcapsular cataracts. Use of protective equipment against X-rays, in particular lead glasses, is strongly recommended to limit this risk.

Prevalence and associations of cataract in a rural Chinese adult population: the Handan Eye Study

Cataract remains the leading cause of blindness and visual impairment in the world and in China. However, data on the prevalence of cataract based on standardized lens grading protocols from mainland China are limited. This paper estimated the age- and gender-specific prevalence and risk factor for cataract In a population-based Chinese sample, participants underwent a comprehensive ophthalmic examination, including assessment of cortical, nuclear, posterior subcapsular (PSC) and mixed lens opacities from slit-lamp grading using the Lens Opacities Classification System III. Of the 7,557 eligible subjects, 6,830 took part in the study (90.4% response rate), and 6,544 participants (95.8%, mean age 52.0 ± 11.8 years) had lens data for analyses. The prevalence of any cataract surgery in at least one eye was 0.8% (95% confidence interval [CI], 0.62, 1.06), with similar rates between men and women. The overall prevalence of any cataract or cataract surgery was 20.8% (95% CI, 19.8, 21.8), higher in women than in men after adjusting for age (23.6% vs 17.6%; OR: 1.78; 95% CI: 1.54-2.07). When distinct lens opacity was categorized in each eye as cortical, nuclear, PSC or mixed, based on one randomly selected eye, cortical cataract was the most common distinct subtype (12.3%), followed by mixed (3.2%), nuclear (1.7%), and PSC (0.2%) cataract. The prevalence of all lens opacities increased with age (P < 0.001). After excluding other causes for visual impairment, the proportion of people with best corrected visual acuity <20/60 was 21% among those with PSC, and 12% among those with mixed opacities in the better-seeing eye. In multivariable logistic regression models, myopia was associated with all cataract types, while higher fasting plasma glucose and diabetes were only associated with PSC cataract. Cataract affects 20% of the population aged 30 years and older living in rural China, with cortical cataract the most common subtype. Risk factors for cataract include myopia and diabetes.

Risk Factors for Cortical, Nuclear, Posterior Subcapsular, and Mixed Lens Opacities: The Los Angeles Latino Eye Study

To identify sociodemographic and biological risk factors associated with having cortical, nuclear, posterior subcapsular (PSC), and mixed lens opacities. Population-based, cross-sectional study. A total of 5945 Latinos aged ≥ 40 years from 6 census tracts in Los Angeles, California. Participants underwent an interview and detailed eye examination, including best-corrected visual acuity and slit-lamp assessment of lens opacities using the Lens Opacities Classification System II. Univariate and stepwise logistic regression analyses were used to identify independent risk factors associated with each type of lens opacity. Odds ratios for sociodemographic and biological risk factors associated with cortical only, nuclear only, PSC only, and mixed lens opacities. Of the 5945 participants with gradable lenses, 468 had cortical only lens opacities, 217 had nuclear only lens opacities, 27 had PSC only opacities, and 364 had mixed lens opacities. Older age, higher hemoglobin A(1c), and history of diabetes mellitus were independent risk factors for cortical only lens opacities. Older age, smoking, and myopic refractive error were independent risk factors for nuclear only lens opacities. Higher systolic blood pressure and history of diabetes were independent risk factors for PSC lens opacities. Older age, myopic refractive error, history of diabetes, higher systolic blood pressure, female gender, and presence of large drusen were independent risk factors for mixed lens opacities. The modifiable and non-modifiable risk factors identified in this study provide insight into the mechanisms related to the development of lens opacification. Improved glycemic control, smoking cessation and prevention, and blood pressure control may help to reduce the risk of having lens opacities and their associated vision loss.

The prevalence of cataract in a population with and without type 2 diabetes mellitus

To evaluate the prevalence and risk factors of lens opacities in a geographically defined population of subjects with type 2 diabetes mellitus compared with a control population. Subjects in the community of Laxå with a diagnosis of type 2 diabetes mellitus (n = 275) and a control group (n = 256) participated in the study. Lens opacities were graded with Lens Opacities Classification System II in all participants. Lens Opacities Classification System score ≥ 2 was considered as significant lens opacity. Anthropometric and blood chemistry data were collected for all participants in connection with the eye examination. For the diabetic population, yearly updated information on glucose control, blood pressure and body mass index was available through medical records from diabetes diagnosis until the time of the eye examination. The prevalence of significant cortical, posterior subcapsular and nuclear cataract was 65.5%, 42.5% and 48.0%, respectively, in the type 2 diabetes population in Laxå. In logistic regression analyses, all types of lens opacities were strongly associated with age (p < 0.0001). Cortical lens opacity was also associated with a diagnosis of diabetes (p < 0.0001), posterior subcapsular lens opacity with HbA1c (p < 0.0001) and nuclear lens opacity with female gender and higher heart rate (both p = 0.0004). In the diabetic population, all types of cataract were likewise strongly associated with age (p < 0.0001), posterior subcapsular cataract with HbA1c (p = 0.0032), nuclear cataract with female gender (p = 0.0002) and higher heart rate (p = 0.0008). Our study shows that cortical cataract is associated with diabetes mellitus, not necessarily defined by glucose control, whereas posterior subcapsular cataract is associated with glucose levels. Nuclear cataract is not associated with diabetes mellitus, but is more frequent in women and is also associated with higher heart rate.

Radiation-induced cataract after occupational exposure in interventional cardiologists – the O'CLOC study

ObjectivesTo evaluate the risk of radiation-induced cataract among interventional cardiologists compared with unexposed workers.MethodsThe O'CLOC study (Occupational Cataracts and Lens Opacities in interventional Cardiology) includes an exposed group of interventional...

Occupational Cataracts and Lens Opacities in interventional Cardiology (O’CLOC Study)

AbstractPurpose Interventional cardiologists ‐ ICs, are exposed to ionizing radiations (X‐rays), which may induce early cataracts known as radiation‐induced cataracts. To test the existence of an increased risk of cataracts among ICs, the O'CLOC study was performed in France.Methods This study is a cross‐sectional study including an exposed group of ICs and a comparable unexposed group of non medical workers. Individual information on risk factors of cataracts (age, diabetes, myopia, etc. ...) and catheterization laboratory activity for ICs, were collected during a phone interview. Clinical eye examination including papillary dilatation and slit lamp examination was performed. LOCS III classification was used to detect lens opacities (nuclear, cortical or posterior subcapsular)Results The study included 106 ICs (mean age=51.1±7.3 yrs.) and 99 unexposed people (mean age =49.6±6.7 yrs.). There was no significant difference between both groups in terms of sex ratio, BMI, smoking status, diabetes, myopia, corticosteroids use. Regarding nuclear and cortical lens opacities, no significant difference was observed: 61% for ICs vs. 69% for unexposed group, p=0.23, and 23% for ICs vs. 29% for unexposed group, p=0.29, respectively. In contrast, posterior subcapsular lens opacities were significantly more frequent among ICs (17% vs. 5%, p = 0.006), corresponding to a crude OR=3.89 [1.39–10.93] which remained significant even after adjustment for age, sex, BMI, smoking status, diabetes, myopia and corticosteroids use (OR=3.85 [1.30–11.40], p=0.015).Conclusion In order to limit the exposure to the eyes and the risk of radiation‐induced cataract, we recommend ICs to wear lead glasses and use protective equipment against X‐rays.

Lens opacities among physicians occupationally exposed to ionizing radiation – a pilot study in Finland

The aim of this study was to estimate the prevalence of lens opacities among physicians occupationally exposed to radiation - overall and by occupational factors - and to assess the feasibility of a large-scale study for risk assessment. Based on a nationwide registry of 1312 physicians, mostly radiologists with occupational exposure to ionizing radiation, 120 subjects were invited to participate, of which 59 (49%) consented. The inclusion criteria included (i) age 45-70 years, (ii) cumulative recorded radiation dose >10 mSv, and (iii) duration of work with dose monitoring >15 years. The participants completed a questionnaire regarding occupational history and other risk factors for lens opacities. A full ophthalmological examination was performed. Lenticular changes were graded using the Lens Opacities Classification System, version II (LOCS II), and the Nidek EAS-1000 Scheimpflug slit-imaging videophotography system. Lens opacities were detected in 42% [95% confidence interval (95% CI) 29-55] of the 57 physicians without prior cataract surgery. Nuclear opacities were found in 14% (95% CI 6-26), cortical in 7% (95% CI 2-19), and posterior subcapsular in 5% (95% CI 1-15) of the subjects. The prevalence of lens opacities increased with age, smoking, and cumulative recorded radiation dose. After controlling for age, gender, and smoking, the excess odds ratio for any lens opacity was 0.13 (95% CI -0.02-0.28) per 10 mSv of cumulative radiation dose. Our preliminary results show cortical and posterior subcapsular lens opacities among physicians exposed to occupational radiation, consistent with recent studies on low dose radiation exposure. A full study with an unexposed reference group for risk estimation is warranted.

Five-Year Incidence of Age-Related Cataract and Cataract Surgery in the Adult Population of Greater Beijing: The Beijing Eye Study

To estimate the 5-year incidence of cataract and cataract surgery in an adult Chinese population. Population-based study. The Beijing Eye Study 2006 included 3251 (73.2%) subjects (≥45 years) of 4439 subjects who participated in the 2001 survey and returned for re-examination. Nuclear, cortical, and posterior subcapsular lens opacities were assessed based on standardized slit-lamp-based photographs and retroilluminated photographs of the lens using a modification of the grading score of the Age-Related Eye Disease Study. Incidence of any type of cataract and of cataract surgery. The 5-year incidence of nuclear cataract was 5.98% (95% confidence intervals [CI], 5.96%-6.00%), that of cortical cataract was 11.14% (95% CI, 11.12%-11.17%), that of posterior subcapsular cataract was 5.47% (95% CI, 5.45%-5.48%), and that of cataract surgery was 2.01% (95% CI, 2.00%-2.02%). The incidence of any cataract (16.82%; 95% CI, 16.79%-16.86%) was significantly associated with higher age (P<0.001) and female gender (P<0.001). It was not significantly associated with the area of habitation (P = 0.78), smoking (P = 0.95), or alcohol consumption (P = 0.12). Differentiation into the 3 cataract types revealed that the incidence of nuclear cataract additionally was associated with rural region (P<0.001) and smoking (P<0.001). The incidence of cortical cataract additionally was associated with nonsmoking (P = 0.02). The incidence of cataract surgery was significantly (P<0.001) associated with age only. As in white persons, the age-adjusted incidence of all types of cataract types increased with age and it was associated with female gender. When compared with data in the literature, the incidence rates of all cataract types did not vary markedly between Chinese in greater Beijing and white persons. In contrast, the incidence of cataract surgery was considerably lower in this Chinese population.

Straylight value depending on the location of lens opacity and utility of straylight measurement in deciding cataract surgery

Abstract Purpose To evaluate the difference of straylight value depending on the location of lens opacity and to study whether the straylight measurement is useful in deciding the surgery of early cataract. Methods 139 cataractous eyes were classified into posterior subcapsular opacity type, anterior subcapsular opacity type and diffuse nucleosclerosis type. Straylight values of each groups were measured. Straylight values of 28 patients(28 eyes) who complained visual disturbance despite good visual acuity were measured and compared with 28 control eyes. Postoperative straylight values and best corrected visual acuities of 28 patients were measured and compared with the preoperative values. Results Posterior subcapsular opacity group showed significantly high straylight values(p=0.000). Mean straylight values of 28 eyes(28 patients) and 28 control eyes were 2.04±0.91 and 1.56±0.29 respectively(p=0.002). This was well matched to the difference of self‐reported visual quality scores of each group(45.1 points and 29.8 points). Postoperative straylight values decreased significantly than preoperative straylight values(p=0.000) in 28 patients. Self‐reported visual quality was well related to the decrease of straylight values(from 45.1 points to 28.2 points). Conclusion Straylight value was significantly high in posterior subcapsular lens opacity. Straylight is found to have added value for visual quality assessment and it can be useful to determine the time of cataract surgery in early cataractous eyes.

Targeted mydriasis strategies for diabetic retinopathy screening clinics

To examine factors necessitating pupil dilation to achieve gradable diabetic screening photographs using a digital non-mydriatic camera and to establish techniques to predict the need for dilation and to validate them. Prospective clinic-based cross-sectional study with follow-up validation study. The participants' involved consecutive patients attending the diabetic retinopathy screening clinic at a University Hospital. Best corrected visual acuity, age, sex, pupil size, mean spherical equivalent, cataract grade and the requirement for dilation to achieve gradable photographs in 90 patients were recorded. Data analysis using principal component analysis and multivariate analysis of variance derived a set of equations to predict the requirement for dilation. The predictive powers of these equations were validated in an independent group of 51 patients. Smaller pupil size, denser nuclear colour, older age, poorer best-corrected visual acuity, cortical lens opacity and posterior subcapsular lens opacity were associated with the need for dilation (P<0.001 in all). Single variables used in isolation had a poorer predictive value than combining variables. Dilating patients with either a pupil size>3.75 mm or age>59 years correctly allocates 83 and 78% of patients, respectively to dilation or not. Combining pupil size with age produces a decision table that improves the predictive value to 84%. In the validation study this table had a predictive value of 80%. We have produced and validated criteria based on a range of clinical variables for application in a clinical setting that allows for the development of targeted mydriasis.