Amiodarone keratopathy and lens opacities

Amiodarone hydrochloride is an antiarrhythmic drug which produces a keratopathy and anterior subcapsular lens opacities that are usually asymptomatic. Serial observations for eye findings were made in 21 patients on a daily dosage of 200-600 mg for periods ranging from six months to three years. Corneal deposits developed in all 21 patients and anterior lens opacities developed in 12 of 20 phakic patients. Resolving keratopathy was present in three patients for periods of at least seven to 20 months after amiodarone was discontinued.     

Electron microscopic examination of the anterior lens capsule in a case of Alport’s syndrome

Purpose: To report a case of Alport’s syndrome and to present electronmicroscopic examination findings of the anterior lens capsule of this patient. Method: A 21‐year‐old man was referred for low visual acuity and retinal pigment epithelial changes in the left eye. The patient and his relatives underwent detailed ophthalmological examination, including electrophysiological testing. The patient also underwent electronmicroscopic examination of the anterior lens capsule. Results: His visual acuity was 6/18 OD and 6/15 OS. Anterior lenticonus and subcapsular opacities were observed in the left eye. Cataract extraction by phacoemulsification with intraocular lens implantation was performed for his poor visual performance. During the capsulorhexis, the remarkably thin and fragile anterior capsule was noted and removed. Ultrastructural analysis of the anterior lens capsule showed a thinner central zone compared with the periphery. Conclusions: The course of Alport’s syndrome can be ameliorated by early diagnosis. Therefore, the ophthalmological examination of a patient with anterior lenticonus must be combined with a detailed medical evaluation. Ultrastructural analysis of the lens capsule can support the diagnosis of Alport’s syndrome.     

Lens opacities after posterior chamber phakic intraocular lens implantation

PURPOSE: To describe a case series to determine the incidence of lens opacities after posterior chamber phakic intraocular lens (IOL) implantation (STAAR Surgical, Monrovia, CA) for very high ametropias. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Fourteen eyes of 170 consecutive eyes with high ametropias in whom lens opacities developed after posterior chamber phakic IOL implant (PCPIOL). INTERVENTION: Posterior chamber phakic intraocular lens implant. MAIN OUTCOME MEASURES: Lens opacity appearance, localization, and clinical course. RESULTS: Fourteen eyes developed lens opacities 125 +/- 116 days after phakic IOL implant. All eyes had anterior subcapsular opacities, and two eyes also developed nuclear sclerosis. The anterior opacities did not extend posteriorly within the lens, and there were no posterior subcapsular cataracts. Seventy-one percent of opacities were first seen 相似文献   

Anterior subcapsular opacities and cataracts 5 years after surgery in the visian implantable collamer lens FDA trial

PURPOSE: To use the techniques of survival analysis to analyze the incidence of anterior subcapsular opacities (symptomatic and asymptomatic) and clinically significant cataract in the US Food and Drug Administration clinical trial of the Visian Implantable Collamer Lens (ICL). METHODS: Five hundred twenty-six eyes were followed for an average of 4.7 years; 89% (468 eyes), 73% (384 eyes), and 59% (311 eyes) were seen at 3, 4, and 5 years or later, respectively. Anterior subcapsular opacities were defined as trace or more (> or =0.6 LOCS III opacity). Clinically significant cataract required loss of 2 or more lines of best spectacle-corrected visual acuity (BSCVA), a significant increase in glare symptoms, or cataract extraction. Kaplan-Meier analyses of opacities and cataract were performed. RESULTS: The Kaplan-Meier cumulative probability estimate for anterior subcapsular opacities over 7+ years of follow-up was 7% whereas 31 (5.9%) eyes were actually observed. Anterior subcapsular opacities generally occurred early with 58% seen in the first year, 68% in the first 2 years, and 74% in the first 3 years. The cumulative probability estimate for clinically significant cataracts over the 7+ years of follow-up was 2% whereas 7 (1.3%) were actually observed. The difference between the Kaplan-Meier estimate and the actual observed percentage is due to the fact that the former takes into account the differences in postoperative follow-up time of individual eyes. Preoperative myopia (>12.00 diopters) and patient age (>40 years) were significant factors in the development of cataract. No loss of BSCVA was observed in any eye following cataract extraction. CONCLUSIONS: Approximately 6% to 7% of eyes develop anterior subcapsular opacities at 7+ years following ICL implantation but only 1% to 2% progress to clinically significant cataract during the same period, especially very high myopes and older patients. Visual outcome following cataract extraction was good.     

Traumatic cataract and other adverse events with the implantable contact lens

PURPOSE: To evaluate the surgical outcome and adverse events associated with implantation of the implantable contact lens (ICL) for the correction of high myopia or high hyperopia. SETTING: Helsinki University Eye Hospital, Helsinki, Finland. METHODS: In this nonrandomized prospective clinical trial, the ICL V4 was implanted in 26 eyes of 13 patients with normal enrollment criteria (younger than 45 years, a clinically clear crystalline lens) (Group 1) and the V2, V3, or V4 were implanted in 38 eyes of 22 patients with heterogeneous criteria (older than 45 years or opacities in the crystalline lens) (Group 2). The main outcome measures were lens opacity classification system (LOCS II) assessment and transparency analysis of the lens. RESULTS: In Group 1, microdensitometric assessment showed no decrease in crystalline lens transparency and no statistically significant increase in crystalline lens density at any follow-up examination (P>.05). The incidence of anterior subcapsular (AS) opacities was 7.7%, and no eye developed clinically significant cataract during the mean follow-up of 13.2 months +/- 12.3 (SD). No myopic eye lost a line of best corrected visual acuity (BCVA); 50.0% of hyperopic eyes lost 1 line of BCVA. Sixty-eight percent of myopic eyes and 75.0% of hyperopic eyes were within +/-1.0 diopter of the predicted refraction. In Group 2, the incidence of AS opacities was 47.4% and 10 eyes (26.3%) developed clinically significant cataract during the mean follow-up of 30.9 +/- 18.0 months. The visual and refractive results were similar to those in Group 1 at 1 month, but due to progressive AS opacities in the crystalline lens, 23.4% of eyes lost BCVA lines during the follow-up. Intraoperative complications were few and insignificant. CONCLUSIONS: Implantation of the ICL for correction of high myopia or high hyperopia appears to be a safe procedure with good visual and refractive results immediately. There was no decrease in the transparency or increase in the density of the crystalline lens with the latest generation of the ICL device in the normal group, indicating enhanced safety. Progressive lens opacification in the heterogeneous group shows there are risk factors for cataract formation; ie, type V3 ICL, preexisting lens opacities, and older patient age. Anterior subcapsular opacities are most likely the result of trauma.     

The comparability of estimates of retroilluminated lens opacities as judged from film-based and digital imaging

PURPOSE: Neitz film-based retroillumination cameras, the standard for documenting retroilluminated lens opacities for epidemiologic studies, are no longer produced. A digital imaging system is now available for imaging these opacities. We sought to compare gradings of images from both systems. DESIGN: Comparison of technique. METHODS: One hundred fourteen lenses were imaged with both systems and graded according to protocols. Concordance between the methods was compared using kappa statistics. RESULTS: There was moderate concordance for cortical opacities (kappa = 0.63) and good concordance for posterior subcapsular opacities (kappa = 0.83). Grades from digital images slightly underestimated the frequency and severity of cortical cataract. CONCLUSION: Digital imaging of retroilluminated lens opacities results in similar classification of the severity of opacities. It will be useful for epidemiologic studies of cortical (CC) and posterior subcapsular cataracts (PSC).     

Pigment Epithelium-derived Factor in Cataractous Aqueous Humor and Lens Epithelial Cells

Purpose: To study the characteristics of PEDF in cataractous aqueous humor and its expression in human lens epithelium. Methods: The PEDF concentration in the aqueous humor was measured by enzyme -linked immunosorbent assay in senile (130cases) and congenital (18cases) cataract patients who underwent cataract phacoemulsification extraction surgery. Anterior lens capsular specimens were obtained from these patients to count lens epithelial cells (LEC) density. The Lens Opacities Classification System Ⅲ was used to classify the senile cataracts as cortical, nuclear, posterior subcapsular and mixed types of opacity, and quantitative analysis of the nuclear opacities was performed by Pentacam Scheimpflug imaging system. Anterior lens capsular specimens from another senile (10cases) and congenital (10cases) cataract were collected for immunofluorescence with polyclonal antibodies specific to human pigment epithelium -derived factor (PEDF). Results:The mean aqueous level of PEDF was(178. 9±87. 5)ng/ml, and there was negative linear correlation of PEDF level and age (r=0. 811, P<0. 001). In senile cases, the aqueous PEDF concentration decreased with increasing nuclear opacities (r=0. 447, P < 0.01) , and the mean PEDF level in nuclear cataract was significantly lower than that in posterior subcapsular opacity (P < 0.01) . PEDF immunostaining was detected in LEC of all capsular specimens. Conclusion : The PEDF level in human aqueous humor is related to age, types of cataracts and lens opacity. PEDF also express in human LEC. The study results suggest PEDF may regulate and/or protect LEC by paracrine and autocrine, and lack of PEDF may play a role in cataractogenesis.     

Intraocular lens implantation in phakic rabbit eyes

Three sizes (13.5 mm, 17.5 mm, and 18.5 mm) of open loop, one piece, poly(methyl methacrylate) anterior chamber intraocular lenses (IOLs) were implanted in 12 phakic rabbit eyes to evaluate the effect of the IOL on the crystalline lens and the anterior chamber. Six eyes were used as a control group. Minimum follow-up was four weeks. All the IOLs touched the crystalline lenses, and on the first postoperative day, round subcapsular lens opacities were found in all eyes in the area of IOL contact. The lens opacities became more dense with time. Only one eye in the control group showed a subcapsular opacity, which was linear rather than round. Anterior chamber inflammation was 1+ to 2+ in ten eyes (80%) in the IOL group during the first and second weeks, whereas minimal inflammatory changes occurred in the control group. These results suggest that with current IOL technology, IOL insertion in the phakic eye to correct refractive errors results in a high incidence of cataract if IOL-to-lens touch occurs.     

Prevalence of lens opacities in Latinos: the Los Angeles Latino Eye Study

OBJECTIVE: To estimate the age- and gender-specific prevalence of posterior subcapsular (PSC), nuclear, cortical, and mixed lens opacities in a population-based sample of Latinos 40 years and older. DESIGN: Population-based, cross-sectional study. PARTICIPANTS: Six thousand three hundred fifty-seven Latinos 40 years and older from 6 census tracts in Los Angeles, California. METHODS: A population-based sample of Latinos underwent a complete eye examination, including assessment of presence and severity of lens opacification, using the slit lamp-based Lens Opacities Classification System II (LOCS II). All lens changes (including pseudophakia/aphakia); any nuclear, PSC, and cortical opacities; and nuclear-only, PSC-only, and cortical-only opacities were evaluated. Frequency distributions and chi-square test analyses were used to determine the age- and gender-specific prevalences for each opacity type. MAIN OUTCOME MEASURES: Prevalences of cortical, nuclear, and posterior subcapsular opacities. RESULTS: Of the 7789 eligible subjects, 6357 completed a clinical examination (82% participation rate). Of all participants with LOCS II grading, 20% had all lens changes, 7.6% had cortical-only opacities, 3.5% had nuclear-only opacities, 0.4% had PSC-only opacities, and 5.9% had mixed-type opacities. The prevalence of all types of lens opacities increased with age (P<0.0001). Of all participants with mixed opacities, 49% had monocular visual impairment and 20% had binocular impairment. Of all 6357 participants, 3.9% had undergone cataract extraction in at least one eye. CONCLUSION: Our data provide the first population-based estimates of the prevalence and severity of lens opacities in Latinos. Cortical opacities were the most common type. The high rate of visual impairment from lens opacities suggests that programs that increase access to cataract surgery for older Latinos could help to reduce the burden of visual impairment in the United States.     

Anterior subcapsular cataracts: a review of potential etiologies

Photographs of amiodarone-induced anterior subcapsular lens opacities and axial punctate lens opacities are presented and compared for the first time. The similarities and differences between these lens opacities and phenothiazine-induced lens opacities are discussed. Potential etiologies for anterior subcapsular cataracts are reviewed. The biomicroscopic techniques required to appreciate subtle lens opacities are mentioned. The importance of recognizing and recording subtle lens opacities is discussed.     

Myopic implant of the posterior chamber using a flexible Collamer lens

BACKGROUND: The purpose of this study was to report results, effectiveness and safety of implanting a negative collagen/HEMA copolymer posterior chamber phakic intraocular lens in moderate to highly myopic eyes. MATERIAL AND METHODS: 23 eyes from 12 patients with a mean preoperative spherical equivalent refraction of - 10.94 +/- 5.97 D underwent a refractive procedure with the Staar ICL trade mark posterior chamber phakic intraocular lens. The average follow-up was 12.9 +/- 7.4 months (range 4 - 24 months). Preoperative and postoperative uncorrected and best corrected visual acuity, subjective refraction, intraocular pressure, keratometry, ICL trade mark centration and anterior subcapsular opacities were evaluated. RESULTS: Postoperative uncorrected visual acuity improved in all eyes. The best corrected visual acuity increased from 0.82 +/- 0.39 preoperatively to 1.05 +/- 0.24 postoperatively. The gain in visual acuity was statistically significant (Student t-test, p = 0.0097). The mean postoperative spherical equivalent refraction was - 0.82 +/- 1.42 D (p < 0,0001). The mean postoperative intraocular pressure was 15.65 +/- 2.72 mm Hg. The intraocular contact lens remained well centred in all eyes and no anterior subcapsular opacities were observed. Three patients underwent transcient complication without affecting the visual outcome. CONCLUSION: The use of a posterior chamber phakic intraocular lens in myopic eyes is a safe procedure to correct moderate to high myopia. Long-term results are still unknown.     

Changes in the crystalline lens resulting from insertion of a phakic IOL (ICL) into the porcine eye

Background Insertion of a phakic IOL offers these advantages: the corneal optical zone is not dissected or resected; preservation of the crystalline lens results in preservation of the accommodation force; and since the phakic IOL is removable, any error or change in refraction can be countered by exchanging it. However, the cause of secondary cataracts has never been clarified or discussed to date.Methods The following ICL lenses were inserted under general anaesthesia into 20 eyes of ten 3-month-old miniature pigs: a minus lens without holes into five eyes, a plus lens in two eyes, a minus lens with four holes around the lens haptics in three eyes, and a minus lens with a central hole in the optic in three eyes; and seven eyes were used as controls. The anterior segments were then photographed 1 week, 1 month and 3 months after surgery. At 3 months after surgery, Evans blue (EB) was infused into the vitreous under general anaesthesia, and after 30 min, the eyeball was enucleated, fixed and examined.Results In the case of the ICL without holes, the anterior subcapsular opacities were observed in all the eyes, and the anterior surfaces of the crystalline lenses were not stained with EB. Use of the ICL with four holes around the lens haptics resulted in light staining of the anterior surface of the crystalline lens, but the anterior subcapsular opacities observed were mild. As for the ICL with a hole in the centre of the optic, the anterior surface of the crystalline lens was stained and no anterior subcapsular opacities were observed.Conclusion The results suggested that the insertion of an ICL brings about a change in the dynamics of the intraocular aqueous humour, reducing its circulation to the anterior surface of the crystalline lens. This is considered to cause a metabolic disturbance of the crystalline lens, resulting in anterior subcapsular opacification.     

Toxicity of ethylene oxide on the crystalline lense in an occupational milieu. Difficulty of epidemiologic surveys of cataract

Ethylene oxide is a sterilizing gas for heat-sensitive materials. Eight cases of subcapsular cataract were attributed to this compound from 1982 to 1985. This epidemiological study was conducted in 55 persons to determine the prevalence of lens opacities and cataracts in workers exposed to this gas. The 21 persons of more than 45 years of age were then compared to 16 non-exposed persons matched for age and gender. Lens opacities (independently of visual acuity) were observed in 19 of the 55 exposed. Among exposed and non-exposed persons of more than 45 years of age, there were no significantly differences with regard to the following characteristics of lens opacities: prevalence (13 in the 21 exposed; 10 in the 16 non-exposed), distribution of the localisations, morphology and importance of the cortical opacities. No link was found between the characteristics of the lens opacities and the characteristics of the exposure: habitual exposure and accidental overexposures. For cataracts, defined by the association of lens opacities and a visual acuity less than 20/25 (this loss not being attributable to another cause), their prevalence differed significantly (p less than 0.05) between the exposed (6 of 21) and the non-exposed (0 of 16). There was no relation between their existence and accidental overexposures. The risk of lens opacification by ethylene oxide, established in cases of massive exposures as previously described, could also exist during chronic exposure to low concentrations, but is to be confirmed by other studies. It could be explained by saturation of the protective mechanisms against alkylating action of this product. This study prompted us to discuss the epidemiological difficulties in studies of cataracts.     

Cortical and subcapsular cataracts: significance of physical forces

Cortical cataracts usually begin with either sharp limited clear fluid clefts, resulting in opaque spokes, or clear lamellar separations, resulting in cuneiform opacities. They do not commence prior to 45 years of age. From this age on an increase in lens nuclei hardening can be detected. Therefore, during disaccommodation in older lenses, mechanical shear stresses must develop between the soft remaining cortices and the harder nuclei. These shear stresses are significant regarding the different cortical ruptures in predisposed lenses: in a privileged radial direction (according to zonular traction) of the sharp limited cortical spokes, or in parallel microridges at the commencement of lamellar separations, as observed when a rubber surface slides against a harder object. In pure cortical cataracts the ion pump (K+ > Na+) and investigated metabolic parameters remain largely intact. Therefore, it is not surprising that, in contrast to subcapsular cataracts, subcapsular opacities do not occur. Subcapsular cataracts are known to be caused by a variety of factors: aging, diabetes, corticosteroids, iridocyclitis, or X-ray, among many others. In contrast to cortical cataracts, subcapsular cataracts were found to be closely associated with ion pump damage (Na+ > K+) and a variety of metabolic activity alterations. In subcapsular cataracts passive fluids (from the vitreous and camera anterior) enter externally through the lens capsule. This initially forms numerous free clear, secondary grey, subcapsular fluid vacuoles. If the ion pump (metabolic barrier) is more severely damaged fluids may also enter the lens nucleus (secondary grey nuclear cataract), which rarely results in intumescent cataract. In cortical and subcapsular cataracts and lens perforations the main cause of grey opalescence appears to be the result of lens proteins (water-soluble crystalline) coming into direct contact with free fluids (water). In cortical cataracts this happens in the area of sharp limited mechanical cortical ruptures (fluid clefts), and in subcapsular cataracts during passive, external fluid entry, resulting in subcapsular fluid vacuoles and opacities, and also later grey-white nuclear opacities. The importance of water contact with water-soluble lens crystallines in behalf of light scattering and turbidness also has been investigated experimentally.     

Outcome of cataract surgery in patients with retinitis pigmentosa

AIM: To determine the visual benefit of cataract extraction in patients with retinitis pigmentosa and to identify risk factors for poor outcome. METHODS: A retrospective analysis was undertaken of a continuous series of 142 eyes of 89 patients with retinitis pigmentosa undergoing cataract surgery between 1985 and 1997. RESULTS: Mean age at surgery was 47.5 years (range 24-81 years). In 100 eyes there was posterior subcapsular lens opacity alone, 37 eyes also had moderate nuclear sclerosis, and five had only nuclear sclerosis. All patients had central visual fields of <10 degrees. Overall, mean visual acuity improved from 1.05 (SD 0.38) preoperatively to 0.63 (SD 0.49) postoperatively on the logMAR scale. Significant postoperative capsular opacification occurred in 88/139 eyes (63%) and 45.1% required capsulotomy. Anterior capsulotomy was undertaken in 5/52 (9.6%) eyes undergoing phacoemulsification. Postoperative macular oedema was noted in 20 (14%) eyes. Visual acuity improved in 109 eyes (77%), was unchanged in 29 eyes (20.5%), and worsened after surgery in four eyes (2.5%). 86/89 patients reported major improvement of visual function. CONCLUSIONS: Cataract surgery for relatively minor lens opacities is beneficial in patients with retinitis pigmentosa, and most report subjective improvement of visual symptoms. The incidence of capsular opacification is high and anterior capsular contraction may occur. The number of eyes with poor vision due to macular oedema was unexpectedly low.     

Early lens changes in Macaca fascicularis monkeys under topical treatment with echothiophate or carbachol studied by slit-image photography.

Cynomolgus monkeys were given topical treatment with echothiophate or carbachol, and the lens changes were followed by slit-image photography. Both drugs caused an early retrodisplacement of the anterior zone of disjunction due to swelling of the most superficial lens cortex. Deeper layers of the cortex did not swell. The exact cause of the swelling is not known, but there must be a true cholinergic link. Accommodation as such is not the cause, since (1) the effect was seen also in a monkey eye which had its ciliary muscle disinserted from the scleral spur and therefore had little accommodation left and (2) acute accommodation produced by systemic pilocarpine did not cause the effect. Anterior subcapsular opacities were quantified and appeared very early in the echothiophate-treated eyes but were not seen with the doses of carbachol used.     

Cataract: refractive error, diabetes, and morphology.

A retrospective analysis of 388 records of patients undergoing surgery for cataract between the years 1968 and 1978 showed that more women than men were admitted. About 13.7% of the patients were diabetic, and there was a striking excess of women over men with diabetes and cataract. The diabetic patients required surgery at an earlier age than the non-diabetics. Patients who had been refracted at least 5 years before surgery showed an incidence of myopia of -1.00 D or more of 25.4%. In 34% of the whole series the aphakic refraction was less than +11.00 D, again suggesting that myopes are more likely to develop a cataract than non-myopes. Posterior subcapsular lens changes alone or in combination with nuclear or cortical opacities were present in over 40% of all patients and the mean age of patients with this type of change alone was significantly lower than patients with predominantly nuclear or cortical changes. Posterior subcapsular opacities seem to be more common in Iowa than in England or India. The morphological similarity of this type of lens change with known types of secondary cataract suggests that it is not entirely a senile change but may be due to environmental or dietetic factors.     

Correlation between clinical, physical and histopathological characteristics of the cataractous lens

• Background: Preoperative evaluation of lcns opacity is used to prcdict surgical qualities of the lens arid the expected improvement in visual acuity. The prescrit study was conducted to ascertain whether preoperative clinical examination findings correlate with actual physical hardness of the lens arid its histopathologic microstructure. • Methods: Two classification systems for clinical evaluation of lcns opacity were compared: simple grading arid the Lens Opacities Classification System II (LOCS II). Physical hardness of 65 lens nuclei extracted manually was measured using a specially designed hydrostatic guillotine. Lens material was then studied by low-magnification inspection of stained nuclei arid by histo logic examination. • Results: Multiple observers' simple grading of lens opacities was almost identical to a single observer's LOCS II evaluation. Hardness of the lens demonstrated high correlation with grading of nuclear sclerosis, but not with cortical or subcapsular opacities. Preoperative visual acuity correlated with lens hardness only in eyes with visual acuity less than 6/24. The lamellar structure of the lens is maintained also in dense nuclear cataract. We did not identify microscopie parameters that correlated with clinical appearance or hardness of the lenses. • Conclusions: Preoperative clinical examination of the eye provides reliable information that can be used to predict the physical qualities of the cataractous 1ens.     

A new method for documenting lens opacities

We tested an anterior segment camera and digital analyzer on 32 eyes of 22 patients to determine whether its measurement of lens opacities correlated with measurements obtained by a standardized clinical grading system. The lenses were graded clinically for nuclear opacity, nuclear color, cortical opacity, and posterior subcapsular opacity. The lenses were then photographed and analyzed with this new device, and the results were compared. The camera system showed good reproducibility. Its results correlated well with the clinical gradings for nuclear capacity (P = .001) and cortical opacity (P = .001) but less well with posterior subcapsular opacity (P = .3), although there were only seven eyes with posterior subcapsular opacities. This camera system could help document and follow up lens opacity with more accuracy and reproducibility than has been previously possible.     

Prevalence of lens opacities in North India: the INDEYE feasibility study

PURPOSE: To obtain estimates of the prevalence of lens opacities in an Indian setting by using photographically acquired lens images. METHODS: In 11 randomly sampled villages from a rural district of Haryana, North India, 1443 people (median age 60 years), 52% women, were identified from enumeration of the > or =50-year age group; 87% attended an eye examination. Digital images of cortical and posterior subcapsular opacities and photographs of nuclear opacities were graded using the Lens Opacity Classification System (LOCS) II. The prevalence of opacities was based on a grade of 2 or higher in the worse eye for nuclear, cortical, or posterior subcapsular opacities. RESULTS: Of the participants, 1071 people had gradable images; a further 163 had undergone surgery or had dense opacities. Nuclear opacities were the most common type, with an overall prevalence of 56.9% (95% CI, 53.0-60.6). Posterior subcapsular opacities occurred in 20.6% (95% CI, 17.9-25.8) and cortical opacities in 21.6% (95% CI, 17.9-25.8). Prevalence rose steeply with age for all opacities and was higher in the women than in the men for cortical opacities (P = 0.03). The prevalence of any type of lens opacity including surgical cases and dense opacities was 75.3% (95% CI, 71.4-78.81). CONCLUSIONS: These results highlight the substantial excess of lens opacities in India compared with Western populations.