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Clinical & Experimental Ophthalmology Mar 2021We review the current literature regarding the risk factors for cataract and the association between cataract and systemic disease. Numerous epidemiologic studies have... (Review)
Review
We review the current literature regarding the risk factors for cataract and the association between cataract and systemic disease. Numerous epidemiologic studies have found that the risk factors for age-related cataract formation include age, sex, race and myopia. Modifiable risk factors include smoking, socioeconomic status and ultra-violet light exposure. Alcohol intake and nutritional status may play a role in cataract formation. Cataract has been associated with many systemic diseases mainly diabetes mellitus, hypertension, obesity, chronic kidney disease and autoimmune disease. Cataract is also a hallmark of many metabolic disorders and syndromes. These findings are important to help implement risk factor and lifestyle-modification strategies that can hopefully decrease the burden of global cataract blindness.
Topics: Cataract; Diabetes Mellitus; Humans; Hypertension; Life Style; Risk Factors
PubMed: 33426783
DOI: 10.1111/ceo.13892 -
Klinische Monatsblatter Fur... Apr 2022The purpose of this article is a condensed overview of contemporaneous "state of art and knowledge" of age-related cataract. As an introduction, some aspects of... (Review)
Review
The purpose of this article is a condensed overview of contemporaneous "state of art and knowledge" of age-related cataract. As an introduction, some aspects of terminology, epidemiology, lens anatomy and pathophysiology of age-related cataract, selected for clinical interest and relevance, are outlined. Clinical aspects include signs and symptoms: Objective criteria for cortical, nuclear and posterior subcapsular cataract are described, followed by typical symptoms such as decreased visual acuity, contrast sensitivity and foggy vision, altered colour perception, decreased mesopic and scotopic vision, glare, myopization and monocular diplopia. Diagnostic evaluation consists of a general ophthalmic examination, including history, refraction and vision testing, tonometry and morphologic examination of anterior and posterior segment, and is supplemented by special tests and examinations, such as interference vision (retinometer), keratometry including corneal topo-/tomography, biometry (ultrasound and optical), specular microscopy of the corneal endothelium and OCT of the central retina. Treatment is exclusively surgical: Evaluating the indication for surgery individually, weighing chances and risks, determining individual decisions such as anesthesia, surgical technical options, target refraction and intraocular lens options is discussed in detail. Finally, some perioperative considerations for medical treatment and infection prophylaxis are outlined. The last section deals with short- and long-term complications and their management - including early pressure rises, corneal edema, inflammatory response and endophthalmitis, and, in the longer term, secondary cataract, refractive problems, cystoid macular edema and retinal detachment.
Topics: Cataract; Cataract Extraction; Humans; Lens, Crystalline; Lenses, Intraocular; Refraction, Ocular; Visual Acuity
PubMed: 35253130
DOI: 10.1055/a-1758-3451 -
Primary Care Sep 2015Cataract surgery with an intraocular lens implant is one of the most common and thought to be the most effective surgical procedure in any field of medicine. Although... (Review)
Review
Cataract surgery with an intraocular lens implant is one of the most common and thought to be the most effective surgical procedure in any field of medicine. Although aging is the most common cause, other factors are also known to be associated with cataract formation. Although cataracts are the domain of ophthalmology, primary care physicians are frequently the ones to whom patients present with vision complaints. Knowledge of cataract symptoms, how to evaluate them, and a basic understanding of the surgery to correct cataracts make primary care physicians an integral part of treating this leading cause of preventable blindness.
Topics: Aging; Cataract; Cataract Extraction; Cost-Benefit Analysis; Diagnosis, Differential; Eye; Humans; Lenses, Intraocular; Prevalence; Primary Health Care; Referral and Consultation; Risk Factors
PubMed: 26319346
DOI: 10.1016/j.pop.2015.05.012 -
Current Opinion in Ophthalmology Jan 2017Cataracts are a significant cause of blindness and visual impairment worldwide. The present article reviews the literature and describes the current extent of cataracts... (Review)
Review
PURPOSE OF REVIEW
Cataracts are a significant cause of blindness and visual impairment worldwide. The present article reviews the literature and describes the current extent of cataracts globally, barriers to treatment, and recommendations for improving the treatment of cataracts.
RECENT FINDINGS
Prevalence and absolute number of blind because of cataracts remain high, although rates are declining in many areas globally. The age-standardized prevalence of blindness in adults older than 50 remains highest in western sub-Saharan Africa, with a rate of 6.0%. The greatest declines in age-standardized blindness because of cataracts in adults older than 50 between 1990 and 2010 were in East Asia, tropical Latin America, and western Europe. Recent studies have largely found higher rates of cataracts in women than in men. A new simulator for training ophthalmologists in manual small-incision cataract surgery holds promise for the future.
SUMMARY
The rates of cataract surgery are increasing and postoperative outcomes are improving worldwide, yet challenges to reducing the cataract burden further remain. Cost, an insufficient number of ophthalmologists, and low government funding remain significant barriers but investment in further eye care infrastructure and training of additional ophthalmologists would improve the current situation.
Topics: Blindness; Cataract; Cataract Extraction; Global Health; Health Services Accessibility; Healthcare Disparities; Humans
PubMed: 27820750
DOI: 10.1097/ICU.0000000000000340 -
Experimental Eye Research Mar 2017The crystalline lens plays an important role in the refractive vision of vertebrates by facilitating variable fine focusing of light onto the retina. Loss of lens... (Review)
Review
The crystalline lens plays an important role in the refractive vision of vertebrates by facilitating variable fine focusing of light onto the retina. Loss of lens transparency, or cataract, is a frequently acquired cause of visual impairment in adults and may also present during childhood. Genetic studies have identified mutations in over 30 causative genes for congenital or other early-onset forms of cataract as well as several gene variants associated with age-related cataract. However, the pathogenic mechanisms resulting from genetic determinants of cataract are only just beginning to be understood. Here, we briefly summarize current concepts pointing to differences in the molecular mechanisms underlying congenital and age-related forms of cataract.
Topics: Aging; Animals; Cataract; Crystallins; Humans; Lens, Crystalline; Mutation
PubMed: 27334249
DOI: 10.1016/j.exer.2016.06.011 -
Annual Review of Vision Science Sep 2019Cataract, the clinical correlate of opacity or light scattering in the eye lens, is usually caused by the presence of high-molecular-weight (HMW) protein aggregates or... (Review)
Review
Cataract, the clinical correlate of opacity or light scattering in the eye lens, is usually caused by the presence of high-molecular-weight (HMW) protein aggregates or disruption of the lens microarchitecture. In general, genes involved in inherited cataracts reflect important processes and pathways in the lens including lens crystallins, connexins, growth factors, membrane proteins, intermediate filament proteins, and chaperones. Usually, mutations causing severe damage to proteins cause congenital cataracts, while milder variants increasing susceptibility to environmental insults are associated with age-related cataracts. These may have different pathogenic mechanisms: Congenital cataracts induce the unfolded protein response and apoptosis. By contrast, denatured crystallins in age-related cataracts are bound by α-crystallin and form light-scattering HMW aggregates. New therapeutic approaches to age-related cataracts use chemical chaperones to solubilize HMW aggregates, while attempts are being made to regenerate lenses using endogenous stem cells to treat congenital cataracts.
Topics: Apoptosis; Cataract; Crystallins; Eye Diseases, Hereditary; Humans; Stem Cell Transplantation
PubMed: 31525139
DOI: 10.1146/annurev-vision-091517-034346 -
Journal Francais D'ophtalmologie Sep 2020Cataract is a partial or total opacification of the crystalline lens. In adults, cataract is acquired; the most common form is the age-related cataract. Assessment of... (Review)
Review
Cataract is a partial or total opacification of the crystalline lens. In adults, cataract is acquired; the most common form is the age-related cataract. Assessment of the functional impact of a cataract is clinical. The common symptom is loss of visual acuity, but other symptoms (photophobia, monocular diplopia, myopic shift, change in color vision, etc.) may be found depending on the anatomical distribution of the opacities (nuclear, posterior subcapsular, cortical). Diagnosis is based on slit-lamp examination after pupillary dilation. This allows classification of the opacities according to their anatomical distribution and can help direct any etiologic work-up. A number of potential causes should be ruled out before concluding that a cataract is age-related. Cataracts may be iatrogenic, associated with other ocular or systemic disease, or induced by ocular trauma. Knowledge of the signs, symptoms, and clinical forms of cataract helps to establish proper indications for cataract surgery in accordance with preferred practice patterns in ophthalmology.
Topics: Adult; Age of Onset; Cataract; Humans; Prevalence; Visual Acuity
PubMed: 32586638
DOI: 10.1016/j.jfo.2019.11.009 -
JAMA Internal Medicine Feb 2022Visual function is important for older adults. Interventions to preserve vision, such as cataract extraction, may modify dementia risk.
IMPORTANCE
Visual function is important for older adults. Interventions to preserve vision, such as cataract extraction, may modify dementia risk.
OBJECTIVE
To determine whether cataract extraction is associated with reduced risk of dementia among older adults.
DESIGN, SETTING, AND PARTICIPANTS
This prospective, longitudinal cohort study analyzed data from the Adult Changes in Thought study, an ongoing, population-based cohort of randomly selected, cognitively normal members of Kaiser Permanente Washington. Study participants were 65 years of age or older and dementia free at enrollment and were followed up biennially until incident dementia (all-cause, Alzheimer disease, or Alzheimer disease and related dementia). Only participants who had a diagnosis of cataract or glaucoma before enrollment or during follow-up were included in the analyses (ie, a total of 3038 participants). Data used in the analyses were collected from 1994 through September 30, 2018, and all data were analyzed from April 6, 2019, to September 15, 2021.
EXPOSURES
The primary exposure of interest was cataract extraction. Data on diagnosis of cataract or glaucoma and exposure to surgery were extracted from electronic medical records. Extensive lists of dementia-related risk factors and health-related variables were obtained from study visit data and electronic medical records.
MAIN OUTCOMES AND MEASURES
The primary outcome was dementia as defined by Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria. Multivariate Cox proportional hazards regression analyses were conducted with the primary outcome. To address potential healthy patient bias, weighted marginal structural models incorporating the probability of surgery were used and the association of dementia with glaucoma surgery, which does not restore vision, was evaluated.
RESULTS
In total, 3038 participants were included (mean [SD] age at first cataract diagnosis, 74.4 (6.2) years; 1800 women (59%) and 1238 men (41%); and 2752 (91%) self-reported White race). Based on 23 554 person-years of follow-up, cataract extraction was associated with significantly reduced risk (hazard ratio, 0.71; 95% CI, 0.62-0.83; P < .001) of dementia compared with participants without surgery after controlling for years of education, self-reported White race, and smoking history and stratifying by apolipoprotein E genotype, sex, and age group at cataract diagnosis. Similar results were obtained in marginal structural models after adjusting for an extensive list of potential confounders. Glaucoma surgery did not have a significant association with dementia risk (hazard ratio, 1.08; 95% CI, 0.75-1.56; P = .68). Similar results were found with the development of Alzheimer disease dementia.
CONCLUSIONS AND RELEVANCE
This cohort study found that cataract extraction was significantly associated with lower risk of dementia development. If validated in future studies, cataract surgery may have clinical relevance in older adults at risk of developing dementia.
Topics: Aged; Alzheimer Disease; Cataract; Cataract Extraction; Cohort Studies; Female; Glaucoma; Humans; Longitudinal Studies; Male; Prospective Studies; Risk Factors
PubMed: 34870676
DOI: 10.1001/jamainternmed.2021.6990 -
Current Opinion in Ophthalmology Jan 2019To provide a comprehensive summary of past cataract grading systems, how they have shaped current grading systems, and the developing technologies that are being used to... (Review)
Review
PURPOSE OF REVIEW
To provide a comprehensive summary of past cataract grading systems, how they have shaped current grading systems, and the developing technologies that are being used to assess and grade cataracts.
RECENT FINDINGS
This summary of cataract grading systems examines the development and limitations that existed in past grading systems and how they have shaped the grading systems of present time. The Lens Opacities Classification System III (LOCS III) system is currently used both clinically and for research purposes. Recent advancements in imaging technologies have allowed researchers to create automatic systems that can locate lens landmarks and provide cataract grading scores that correlate well with LOCS III clinical grades. Utilizing existing technologies, researchers demonstrate that fundus photography and optical coherence tomography can be used as cataract grading tools. Lastly, deep learning has proved to be a powerful tool that can provide objective and reproducible cataract grading scores.
SUMMARY
Cataract grading schemes have provided ophthalmologists with a way to communicate clinical findings and to compare new developments in diagnostic technologies. As technologies advance, cataract grading can become more objective and standardized, allowing for improved patient care.
Topics: Cataract; Diagnostic Techniques, Ophthalmological; Humans; Lens, Crystalline; Photography; Tomography, Optical Coherence
PubMed: 30489359
DOI: 10.1097/ICU.0000000000000542 -
Klinische Monatsblatter Fur... May 2022Senile or age-related cataract is well known to ophthalmologists and also to colleagues in other medical specialties. Age-related cataract represents the most common...
Senile or age-related cataract is well known to ophthalmologists and also to colleagues in other medical specialties. Age-related cataract represents the most common cause of blindness worldwide but can be treated very successfully by a standard outpatient surgery. Far less common and therefore less known is the acquired cataract that can present a diagnostic and surgical challenge. The following article provides the reader with an overview of secondary acquired cataracts. The most common subtypes are mentioned first and then discussed in more detail so that the reader should have a structured knowledge after reading this article. This article focuses on acquired cataracts primarily in adults and highlights the surgical features including perioperative characteristics.
Topics: Adult; Aging; Blindness; Cataract; Cataract Extraction; Humans; Ophthalmologists
PubMed: 35253128
DOI: 10.1055/a-1758-3548