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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 -
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 -
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 -
The Pan African Medical Journal 2023
Topics: Humans; Cataract; Cataract Extraction
PubMed: 37426466
DOI: 10.11604/pamj.2023.45.16.39806 -
BMC Cell Biology Jan 2017The lens is an avascular organ composed of an anterior epithelial cell layer and fiber cells that form the bulk of the organ. The lens expresses connexin43 (Cx43),... (Review)
Review
The lens is an avascular organ composed of an anterior epithelial cell layer and fiber cells that form the bulk of the organ. The lens expresses connexin43 (Cx43), connexin46 (Cx46) and connexin50 (Cx50). Epithelial Cx50 has critical roles in cell proliferation and differentiation, likely involving growth factor-dependent signaling pathways. Both Cx46 and Cx50 are crucial for lens transparency; mutations in their genes have been linked to congenital and age-related cataracts. Congenital cataract-associated connexin mutants can affect protein trafficking, stability and/or function, and the functional effects may differ between gap junction channels and hemichannels. Dominantly inherited cataracts may result from effects of the connexin mutant on its wild type isotype, the other co-expressed wild type connexin and/or its interaction with other cellular components.
Topics: Animals; Cataract; Connexins; Humans; Intercellular Signaling Peptides and Proteins; Lens, Crystalline; Mutation; Signal Transduction
PubMed: 28124626
DOI: 10.1186/s12860-016-0116-6 -
Indian Journal of Ophthalmology Nov 2023
Topics: Humans; Infant, Newborn; Cataract; Eye; Iatrogenic Disease; Retinopathy of Prematurity; Gestational Age; Retrospective Studies; Laser Coagulation
PubMed: 37869997
DOI: 10.4103/IJO.IJO_2744_23 -
British Medical Journal Jul 1970
Topics: Aged; Aging; Cataract; Cataract Extraction; Humans; Methods; Surgical Instruments; Uveitis
PubMed: 5427488
DOI: 10.1136/bmj.3.5713.33 -
Tidsskrift For Den Norske Laegeforening... Nov 2020Elevated serum ferritin levels are common findings in clinical practice, usually caused by inflammation, liver disease, high alcohol consumption or malignancy, although...
BACKGROUND
Elevated serum ferritin levels are common findings in clinical practice, usually caused by inflammation, liver disease, high alcohol consumption or malignancy, although it can occur in association with rare genetic conditions.
CASE PRESENTATION
We describe a male in his sixties with persistent hyperferritinaemia without associated iron overload and subsequent development of cataract. The patient himself suggested hyperferritinaemia-cataract syndrome as a diagnosis, which was subsequently confirmed with mutation analysis of the light chain ferritin (FTL) gene. Such mutations are inherited in an autosomal dominant pattern.
INTERPRETATION
Mutations in FTL are known to interfere with the balance between iron levels and ferritin production. When common causes of hyperferritinaemia are excluded, rare conditions should be considered in order to avoid unnecessary procedures and treatment. Genetic analyses are available for all clinicians and should be requested upon the right indications.
Topics: Cataract; Ferritins; Genetic Testing; Humans; Iron Metabolism Disorders; Male; Mutation; Pedigree
PubMed: 33172243
DOI: 10.4045/tidsskr.20.0255 -
Eye (London, England) Jan 2022To determine the patient-related factors that contribute to intraoperative corticocapsular adhesions (CCA) during phacoemulsification cataract extraction (PCE).
OBJECTIVES
To determine the patient-related factors that contribute to intraoperative corticocapsular adhesions (CCA) during phacoemulsification cataract extraction (PCE).
METHODS
Prospective, single surgeon, multi-year study of consecutive patients undergoing PCE was performed. At the conclusion of each procedure, the surgeon recorded the CCA and perceived surgeon stress score. Patient variables included gender, age, diabetes mellitus, intake of oral alpha blockers, floppy iris, laterality, pseudo-exfoliation, and intraocular lens power.
RESULTS
During the 10-year study, 1097 eyes underwent surgery and CCA was diagnosed intraoperatively in 41 eyes. On multi-variable analysis, the following patient characteristics were associated with intraoperative CCA: diabetes mellitus (p = 0.002), age >80 years (p = 0.002), presence of posterior capsular cataract (p = 0.046), severe nuclear sclerosis (p = 0.004), and absence of pseudo-exfoliation (p = 0.043).
CONCLUSION
Diabetes mellitus, advanced age and posterior subcapsular cataract are associated with CCA necessitating generous repetitive hydrodissection.
Topics: Aged, 80 and over; Cataract; Humans; Intraoperative Complications; Lens Implantation, Intraocular; Phacoemulsification; Prospective Studies; Tissue Adhesions
PubMed: 33674725
DOI: 10.1038/s41433-021-01482-5 -
The Canadian Veterinary Journal = La... Mar 2016
Topics: Animals; Cataract; Corneal Injuries; Dog Diseases; Dogs; Eye Diseases; Female; Lens Diseases; Uveitis
PubMed: 26933273
DOI: No ID Found