Polymorphic glutathione S-transferases as genetic risk factors for senile cortical cataract in Estonians

PURPOSE: To investigate the possible association between glutathione S-transferase GSTM1, GSTM3, GSTT1, and GSTP1 polymorphism and the occurrence of age-related cataracts in Estonian patients. METHODS: Patients with cortical (155), nuclear (77), posterior subcapsular (120), mixed type (151) of senile cataract and control individuals (202) were phenotyped for GSTM1 and GSTT1 by enzyme-linked immunosorbent assay and genotyped for GSTM3 and GSTP1 by polymerase chain reaction. RESULTS: The frequency of the GSTM1-positive phenotype was significantly higher in the cortical cataract group (60.6%) than in the controls (45.0%) with odds ratio of 1.88 (95% CI, 1.23-2.94; P = 0.004). The cortical cataract risk associated with the GSTM1-positive phenotype was increased in carriers of the combined GSTM1-positive/GSTT1-positive phenotype (OR = 1.99; 95% CI, 1.30-3.11; P = 0.002) and the GSTM1-positive/GSTM3 AA genotype (OR = 2.28; 95% CI, 1.51-3.73; P < 0.001). The highest risk of cortical cataract was observed in patients having all three susceptible genotypes (OR = 2.56; 95% CI, 1.59-4.11; P < 0.001). Also, a significant interaction between the presence of the GSTP1* A allele and cortical cataract was found with prevalence of the GSTP1* A allele among the cortical cataract cases compared with the controls. Ninety-five percent of subjects with cortical cataract had the GSTP1 (AA, AB, or AC) genotype, whereas in controls 87% of persons had a genotype with GSTP1*A allele (OR = 3.1; 95% CI, 1.31-7.35; P = 0.007). In contrast to the GSTP1*A allele, the presence of the GSTP1*B allele in one or two copies leads to decreased cortical cataract risk (OR = 0.09 for GSTP1 BB genotype). CONCLUSIONS. The GSTM1-positive phenotype as well as the presence of the GSTP1*A allele may be a genetic risk factor for development of cortical cataract.     

Glutathione S-transferase M1, T1, and P1 gene polymorphism in exudative age-related macular degeneration: a preliminary report

PURPOSE: To elucidate whether the gene polymorphisms of glutathione S-transferase (GST) M1, T1, and P1 are associated with the development of exudative age-related macular degeneration. METHODS: The authors genotyped 35 white patients with exudative age-related macular degeneration and 159 healthy controls. Genomic DNA from peripheral blood was examined using polymerase chain reaction and defined for the genetic polymorphisms of GST. RESULTS: No association was observed between GSTM1, GSTT1, and GSTP1 polymorphisms and age-related macular degeneration risk (p>0.05). The frequencies of the combination of the GSTM1 (null) and GSTP1 (mutant), GSTM1 (null), and GSTT1 (null) genotype polymorphisms in patients with exudative age-related macular degeneration differed greatly from those of the control group (p=0.001 OR [95% CI]: 7.70 [2.28-25.98] and p=0.007 OR [95% CI]: 3.88 [1.51-10.02], respectively). CONCLUSIONS: The present study suggests that the GSTM1 (null) and GSTT1 (null), GSTM1 (null), and GSTP1 (mutant) combinations may be a genetic risk factor for the development of exudative age-related macular degeneration. However, the potential role of GST polymorphisms as a marker of susceptibility to age-related macular degeneration needs further studies in a larger number of patients.     

Glutathione S transferase M1 and T1 genetic polymorphisms are related to the risk of primary open-angle glaucoma: a study in a Turkish population

BACKGROUND: Genetic factors and oxidative damage have been shown to have a role in the development of primary open angle glaucoma (POAG). AIM: To determine the effects of genetic polymorphisms of glutathione S transferase (GST)M1 and GSTT1 on the risk of POAG in a Turkish population. METHODS: Using a multiplex polymerase chain reaction (PCR), GSTM1 and GSTT1 gene polymorphisms were analysed in 144 patients with POAG and in 121 otherwise healthy controls of similar age. RESULTS: The GSTM1 positive genotype and the GSTT1 null genotype had an increased risk of developing POAG (p<0.001, OR 2.93, 95% CI 1.66 to 5.20 and OR 4.25, 95% CI 2.30 to 7.80, respectively). The risk of glaucoma also increased significantly in subjects with a combination of GSTM1 positive and GSTT1 null genotypes (p<0.001, OR 3.46, 95% CI 1.64 to 7.38). CONCLUSION: The GSTM1 positive genotype and GSTT1 null genotype or the combination of both may be associated with the increased risk of development of POAG in the Turkish population.     

Polymorphic glutathione S-transferase M1 is a risk factor of primary open-angle glaucoma among Estonians

Primary open-angle glaucoma, the most common form of glaucoma is a slowly progressive atrophy of the optic nerve, characterized by loss of peripheral visual function and is usually associated with elevated intraocular pressure. The etiology and genetic risk factors of primary open-angle glaucoma are mostly unknown. The aim of this study was to find out whether the polymorphism at GSTM1, GSTM3, GSTT1 and GSTP1 loci is associated with increased susceptibility to glaucoma, because these polymorphic enzymes are susceptibility candidates for several diseases, including such eye disease as cataract. The phenotype of GSTM1 and GSTT1 was determined by ELISA and the genotype of GSTM3 and GSTP1 was detected by polymerase chain reaction. Four hundred and fifty two Estonians (250 glaucomas and 202 controls) participated in a case-control study. A significant association of the GSTM1 polymorphism with glaucoma was observed. The frequency of the GSTM1 positive individuals among the glaucoma group was significantly higher than in controls (60 vs. 45.0%) with odds ratio of 1.83 (95% CI 1.26-2.66;P = 0.002). The risk among the GSTM1 positive individuals of developing glaucoma was even higher in the case of smoking: 62.7% of smokers were GSTM1 positive in the glaucoma group while only 33.3% of smokers had GSTM1 positive phenotype in controls (OR = 3.36; 95% CI 1.49-7.56;P = 0.012). An association with a lower level of significance was also found with the GSTM3 gene. Four% of the 250 patients with POAG were identified as carriers of the GSTM3 BB genotype, a proportion which was slightly higher than the 1.0% for the controls (OR = 4.17; 95% CI 0. 90-19.24;P = 0.144). The frequencies of the GSTT1 and GSTP1 genotypes in both groups were not statistically different. The present study suggests that the GSTM1 polymorphism may be associated with increased risk of development of primary open-angle glaucoma.     

Plasma lutein and zeaxanthin and other carotenoids as modifiable risk factors for age-related maculopathy and cataract: the POLA Study

PURPOSE: To assess the associations of plasma lutein and zeaxanthin and other carotenoids with the risk of age-related maculopathy (ARM) and cataract in the population-based Pathologies Oculaires Liées à l'Age (POLA) Study. METHODS: Retinal photographs were graded according to the international classification. ARM was defined by the presence of late ARM (neovascular ARM, geographic atrophy) and/or soft indistinct drusen (>125 microm) and/or soft distinct drusen (>125 microm) associated with pigmentary abnormalities. Cataract classification was based on a direct standardized lens examination at the slit lamp, according to Lens Opacities Classification System III. Plasma carotenoids were measured by high-performance liquid chromatography (HPLC), in 899 subjects of the cohort. RESULTS: After multivariate adjustment, the highest quintile of plasma zeaxanthin was significantly associated with reduced risk of ARM (OR=0.07; 95% CI: 0.01-0.58; P for trend=0.005), nuclear cataract (OR=0.23; 95% CI: 0.08-0.68; P for trend=0.003) and any cataract (OR=0.53; 95% CI: 0.31-0.89; P for trend=0.01). ARM was significantly associated with combined plasma lutein and zeaxanthin (OR=0.21; 95% CI: 0.05-0.79; P for trend=0.01), and tended to be associated with plasma lutein (OR=0.31; 95% CI: 0.09-1.07; P for trend=0.04), whereas cataract showed no such associations. Among other carotenoids, only beta-carotene showed a significant negative association with nuclear cataract, but not ARM. CONCLUSIONS: These results are strongly suggestive of a protective role of the xanthophylls, in particular zeaxanthin, for the protection against ARM and cataract.     

Systemic associations and prevalence of exfoliation syndrome in patients scheduled for cataract surgery

PURPOSE: To study the frequency of exfoliation syndrome (XFS) and its association with intraocular pressure (IOP) and systemic diseases in patients with age-related cataract scheduled for surgery. METHODS: All 1480 cataract patients had a comprehensive systemic and eye examination, including slit-lamp biomicroscopy before and after mydriasis, IOP measurement, gonioscopy, and fundus examination. RESULTS: The percentage of XFS among patients scheduled for cataract surgery was 16.4, with no gender difference (p=0.833). The mean age of XFS patients (74.3+/-7.0 years) was significantly higher when compared to the ones without XFS (66.5+/-10.9 years) (p<0.001). XFS was unilateral in 41.3% of the subjects and bilateral in 58.7%. The number of subjects with XFS increased significantly with aging (p<0.001) (OR=1.093, 95% CI=1.073-1.14) (p<0.001). The most common type of cataract was nuclear in the XFS group (33.5%) and 24.6% of patients with mature cataract had XFS. In the XFS group, 11.2% of the subjects had glaucoma, which was statistically higher than the non-XFS group (4.6%) (p<0.001) (OR=2.67, 95% CI=1.65-4.32). Eighty-four patients had glaucoma and 27 of them (32.1%) had exfoliative glaucoma. The only systemic disease that was found to be associated with XFS was coronary heart disease with an OR of 1.49 (95% CI=1.068-2.072) (p=0.019). CONCLUSIONS: XFS is a common problem in the aging cataract population of Turkey and increased IOP, glaucomatous optic neuropathy, and coronary heart disease occur more frequently in patients with XFS compared with subjects without XFS.     

Association between metabolic syndrome and age-related cataract

AIM: To determine the effect of metabolic syndrome on age-related cataract formation.METHODS: We analyzed data for 2852 subjects [41.8% men and 58.2% women; mean (±SD) age, 52.9±13.9y], taken from the Korea National Health and Nutrition Examination Survey 2008. Metabolic syndrome was diagnosed by criteria proposed by the Joint Interim Societies. Cataract was diagnosed by using the Lens Opacities Classification System III. The association between metabolic syndrome and cataract was determined using age-adjusted and multivariable logistic regression analyses. RESULTS:In multivariable analyses, men with metabolic syndrome had a 64% increased risk of nuclear cataract [odds ratio (OR), 1.64; 95% confidence interval (CI), 1.12-2.39]. Women with metabolic syndrome had a 56% increased risk of cortical cataract (OR, 1.56; 95% CI, 1.06-2.30). Men and women with metabolic syndrome had a 46% (OR, 1.46; 95% CI, 1.01-2.12) and 49% (OR, 1.49; 95% CI, 1.07-2.08) increased risk of any cataract, respectively. The prevalence of nuclear and any cataract significantly increased with an increasing number of disturbed metabolic components in men, and prevalence of all types of cataracts increased in women. Men using hypoglycemic medication had an increased risk of nuclear (OR, 2.62; 95% CI, 1.41-4.86) and any (OR, 2.27; 95% CI, 1.14-4.51) cataract, and women using antidyslipidemia medication had an increased risk of cortical (OR, 2.18; 95% CI, 1.12-4.24) and any (OR, 2.21; 95% CI, 1.14-4.26) cataract.CONCLUSION: Metabolic syndrome and its components, such as abdominal obesity, high blood pressure, and impaired fasting glucose, are associated with age-related cataract formation in the Korean population.     

Polymorphisms of DNA repair genes XPD and XRCC1 and risk of cataract development

The association between oxidative or ultraviolet (UV) light induced DNA damage in the lens epithelium and the development of lens opacities, and the existence of DNA repair in lens epithelial cells have been reported. Polymorphisms of DNA repair enzymes may affect repair efficiency. In this study, we aimed to determine the frequency of polymorphisms in two DNA repair enzyme genes, xeroderma pigmentosum complementation group D (XPD) codon 751 and X-ray cross-complementing group 1 (XRCC1) codon 399, in a sample of Turkish patients with maturity onset cataract. By using polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP), we analysed XRCC1-Arg399Gln and XPD-Lys751Gln polymorphisms in 195 patients with cataract (75 patients with cortical, 53 with nuclear, 37 with posterior subcapsular, and 30 with mixed type) and in 194 otherwise healthy control group of similar age. There was a significant difference between frequencies for XPD-751 Gln/Gln genotype in cataract patients (12%) and healthy controls (20%) (P=0.008, OR=0.40, 95% CI=0.20-0.81). After stratification by the cataract subtypes, XPD-751 Gln/Gln genotype was found to be significantly different in patients with cortical (4%) type cataract in respect to control subjects (20%) (P=0.038, OR=0.16, 95% CI=0.04-0.64). In addition, the allele frequency of the C (Gln)-allele of XPD-Lys751Gln was found to be significantly different in mixed type cataract group (P=0.008, OR=0.48, 95% CI: 0.26-0.90). No statistically significant difference was found for the genotypic and allelic distributions of the polymorphisms in XRCC1 gene between the groups. These findings suggest that polymorphism in XPD codon 751 may be associated with the development of maturity onset cataract.     

Associated factors for age related maculopathy in the adult population in China: the Beijing eye study

BACKGROUND: To evaluate factors associated with the prevalence of age related maculopathy (ARM) in the adult Chinese population. METHODS: The Beijing Eye Study, a population based prevalence study, included 4439 out of 5324 subjects from a rural area and an urban region of greater Beijing, aged 40+ years and invited to participate (response rate 83.4%). Fundus photographs were graded using the Wisconsin Age-Related Maculopathy Grading system. The following parameters were graded: drusen size, drusen type, and the area covered by drusen; pigmentary abnormalities; geographic atrophy; and exudative ARM. RESULTS: Fundus photographs were available for 8655 eyes of 4376 (98.6%) subjects. Early age related macular degeneration (ARD), late ARD, and exudative ARD, respectively, were present in 1.4%, 0.20%, and 0.10% of the subjects. In a binary logistic regression analysis, early ARM was statistically associated with age (p<0.001; 95% CI: 1.04 to 1.08), hyperopic refractive error (p = 0.008; 95% CI: 1.04 to 1.28), rural region (p<0.001; 95% CI: 0.17 to 0.49), and lower level of education (p = 0.01; 95% CI: 1.07 to 1.65). Early ARM was not significantly associated with the optic disc size (p = 0.42), and size of beta zone of peripapillary atrophy (p = 0.28), the self reported diagnosis of diabetes mellitus (p = 0.39; OR: 1.37; 95% CI: 0.66 to 2.85), amount of cortical cataract (p = 0.72), subcapsular cataract (p = 0.98), nuclear cataract (p = 0.26), sex (p = 0.23), cataract surgery (p = 1.0; OR: 0.96; 95% CI: 0.13 to 6.95), glaucomatous optic nerve damage (p = 0.77; OR: 0.62; 95% CI: 0.15 to 2.52), and history of smoking (p = 0.66; OR: 1.14; 95% CI: 0.65 to 2.00). CONCLUSIONS: Hyperopic refractive error besides age was the single most important risk factor for ARM in adult Chinese. Other associated factors were rural region and lower level of education.     

Influence of tobacco use on cataract development

AIM: To study the influence of tobacco use on cataract formation in a rural South Indian population. METHODS: 3924 subjects from the Chennai Glaucoma Study conducted in rural south India underwent a comprehensive eye examination, including Lens Opacities Classification System II grading. Information on tobacco use, type of tobacco (smoking and smokeless), duration and quantity of use was collected. RESULTS: 1705 (male:female (M:F) 1106:599) people used tobacco and were significantly older (mean (standard deviation (SD)) age 55.80 (10.64) years) than non-users (52.23 (10.51); p<0.001). 731 (M:F 730:1) people smoked, 900 (M:F 302:598) used smokeless tobacco, and 74 (M:F, 74:0) used tobacco in both forms. The unadjusted and adjusted (age and sex) odds ratio (OR) for a positive history of tobacco use and cataract was 1.72 (95% confidence interval (CI) 1.51 to 1.96) and 1.39 (95% CI 1.15 to 1.68), respectively. The unadjusted OR for smokers and smokeless tobacco users was 1.04 (95% CI 0.88 to 1.23) and 2.74 (95% CI 2.31 to 3.26), respectively. The adjusted OR was 1.19 (95% CI 0.89 to 1.59) and 1.54 (95% CI 1.22 to 1.95), respectively. No significant association was noted between smoking and any particular type of cataract. Smokeless tobacco use was found to be significantly associated with nuclear cataract even after adjusting for age and sex (OR 1.67, p = 0.067, 95% CI 1.16 to 2.39). CONCLUSION: Tobacco use was significantly associated with cataract. Smoking was not found to be significantly associated with cataract formation; however, smokeless tobacco use was more strongly associated with cataract.     

Refractive errors and incident cataracts: the Beaver Dam Eye Study

PURPOSE: To describe the relation between refractive errors and incident age-related cataracts in a predominantly white US population. METHODS: All persons aged 43 to 84 years of age in Beaver Dam, Wisconsin, were invited for a baseline examination from 1988 through 1990 and a follow-up examination 5 years later from 1993 through 1995. At both examinations, participants had refraction and photographic assessment of cataract, according to a standardized protocol. Myopia was defined as a spherical equivalent of -1.0 diopters (D) or less, hyperopia as +1.0 D or more. The relations between refractive errors at baseline and cataract at baseline (prevalent cataract), 5-year incident cataract, and incident cataract surgery were analyzed by using generalized estimating equations. RESULTS: When age and gender were controlled for, myopia was related to prevalent nuclear cataract (odds ratio [OR], 1.67; 95% confidence interval [CI], 1.23-2.27), but not to cortical and posterior subcapsular cataracts. Myopia was not related to 5-year incident nuclear, cortical, and posterior subcapsular cataracts, but was related to incident cataract surgery (OR 1.89; CI 1.18-3.04). Hyperopia was related to incident nuclear (OR 1.56; CI 1.25-1.95) and possibly cortical (OR 1.25; CI 0.96-1.63) cataracts, but not to posterior subcapsular cataract or cataract surgery. After further adjustment for diabetes, smoking, and education, the association between myopia and incident cataract surgery was attenuated (OR 1.60; CI 0.96-2.64), but the associations between hyperopia and incident nuclear and cortical cataracts were unchanged. CONCLUSIONS: These data support the cross-sectional association between myopia and nuclear cataract seen in other population-based studies, but provide no evidence of a relationship between myopia and 5-year incident cataract. Hyperopia may be related weakly to incident nuclear and cortical cataract.     

Smoking and its association with cataract: results of the Andhra Pradesh eye disease study from India

PURPOSE: To investigate the associations between tobacco smoking and various forms of cataracts among the people of a state in India. METHODS: A population-based cross-sectional epidemiologic study was conducted in the south Indian state of Andhra Pradesh (AP). A total of 10,293 subjects of all ages from one urban and three rural areas, representative of the population of AP, were interviewed, and each underwent a detailed dilated ocular evaluation by trained professionals. Data were analyzed for 7416 (72%) of the subjects aged >15 years. RESULTS: Increasing age was significantly associated with all cataract types and history of prior cataract surgery and/or total cataract. In multivariate analyses, after adjusting for all demographic factors and for history of smoking, females, illiterate persons, and those belonging to the extreme lower socioeconomic status group were found to have a significantly higher prevalence of any cataract, adjusted odds ratio (OR)=1.60 (95% confidence interval [CI]: 1.24-1.96), 1.46 (95% CI: 1.17-1.70), and 1.92 (95% CI: 1.14-3.24), respectively. After adjustment, cigarette and cigar smokers had a significantly higher prevalence of any cataract, adjusted OR=1.51 (95% CI: 1.10-2.06) and 1.44 (95% CI: 1.12-1.84), respectively, compared with those who had never smoked ("never-smokers"). A significantly higher prevalence of nuclear, cortical cataract, and history of prior cataract surgery and/ or total cataract was found among cigarette smokers. A dose-response relationship was seen with respect to cigarette and cigar smoking. After adjustment, compared with never-smokers, cigarette smokers who smoked heavily (>14 "pack-years" of smoking) had a significantly higher prevalence of nuclear cataract (OR=1.65; 95% CI: 1.10-2.59), cortical cataract (OR=2.11; 95% CI: 1.38-3.24), and history of prior cataract surgery and/or total cataract (OR=2.10; 95% CI: 1.05-4.22). Nuclear cataract was significantly higher in cigar smokers (adjusted OR=1.55; 95% CI: 1.16-2.01) and in cigar smokers who smoked heavily (>21 person-years of smoking; OR=1.50; 95% CI: 1.10-1.95), compared with never-smokers. CONCLUSIONS: Consistent with other studies, tobacco smoking was strongly associated with a higher prevalence of nuclear and cortical cataracts and history of prior cataract surgery in this population. These findings suggest yet another need to educate the community on the importance of cessation of tobacco smoking and perhaps incorporating an antismoking message into school health programs.     

Polymorphism of GST and FTO Genes in Risk Prediction of Cataract among a North Indian Population

Background: The present study was carried out to investigate the association of GST and FTO gene polymorphisms with cataract cases and controls.

Materials and methods: The study included 131 cases and 126 controls. GST and FTO gene polymorphisms were evaluated by PCR-RFLP.

Results: The frequency of the GSTM1-positive and GSTT1-positive in cataract cases were 62.13% and 86.40% while in the controls it was 46.39% and 95.87% with odds ratios of 1.9 (95% CI, 1.08–3.32; p value 0.025) and 0.27 (95% CI, 0.09–0.86; p value, 0.019) respectively. There was a statistically significant association between the GSTM1 null genotype and the risk of cataract development with an odds ratio of 0.43 (95% CI, 0.24–0.76; p value, 0.003). Significant differences were obtained in the frequencies of FTO AA and TT genotype (p?=?0.023 and 0.023) between cases and controls.

Conclusion: The present study suggested that GSTM1, GSTT1 and FTO gene polymorphisms are associated with increased risk for cataract in North Indian populations. Due to the limited sample size, the finding on GST and FTO gene polymorphisms need further investigation.     

Risk factors for age related cataract in a rural population of southern India: the Aravind Comprehensive Eye Study

AIM: To determine risk factors for lens opacities and age related cataract in an older rural population of southern India. METHODS: A cross sectional population based study of 5150 people aged 40 years and above from 50 clusters from three districts in southern India. The lens was graded and classified after dilation using LOCS III system at the slit lamp for cataract. Definite cataract was defined as nuclear opalescence >/=3.0 and/or cortical cataract >/=3.0 and/or PSC >/=2.0. RESULTS: Definite cataracts were found in 2449 (47.5%) of 5150 subjects and the prevalence of cataract increased with age. The age adjusted prevalence of cataract was significantly lower in males (p = 0.0002). Demographic risk factors-increasing age and illiteracy-were common for the three subtypes of cataract; females were more likely to have cortical cataracts and nuclear cataracts. Additionally, nuclear cataracts were associated with moderate smoking (OR:1.28, 95% CI:1.01 to 1.64), lean body mass indices (OR: 1.37, 95% CI: 1.17 to 1.59) and higher waist to hip ratios (OR: 0.67, 95% CI: 0.54 to 0.82); cortical cataracts with hypertension (OR: 1.39 95% CI:1.11 to 1.72), pseudoexfoliation (OR:1.53,95% CI:1.17 to 2.01), and moderate to heavy smoking; and posterior subcapsular cataracts with diabetes (OR:1.55, 95% CI:1.12 to 2.15), lean body mass (OR:1.32, 95% CI:1.11 to 1.57), and high waist to hip ratios (OR: 0.77, 95% CI: 0.62 to 0.94). CONCLUSIONS: Risk factors for age related cataract in this population do not appear to be different from those reported in other populations. Further studies are required to identify the reason for the high prevalence of age related cataract and to understand better the role of each risk factor for cataractogenesis in this population.     

Cardiovascular disease,vascular risk factors and the incidence of cataract and cataract surgery: The Blue Mountains Eye Study

PURPOSE To assess whether an association exists between cardiovascular disease, vascular risk factors and incident cataract and cataract surgery. METHODS The Blue Mountains Eye Study examined 3654 participants =49 years of age during 1992–4, then 2335 survivors (75.1%) after five years. Trained interviewers administered a vascular history questionnaire; height, weight and blood pressure were measured. Lens photographs from both examinations were graded for presence of cortical, nuclear or posterior subcapsular cataract. RESULTS Obesity (body mass index =30kg/m 2 ) was significantly associated with increased incidence of both cortical [odds ratio (OR) 1.6, 95% confidence interval (CI) 1.2–2.2] and posterior subcapsular cataract (OR 2.1, CI 1.2–3.7). Hypertensive participants using medication and aged less than 65 years at baseline had a higher incidence of posterior subcapsular cataract (OR 3.4, 95% CI 1.3–8.4) than normotensive subjects. A history of angina was associated with higher cataract surgery incidence (OR 2.1, 95% CI 1.3–3.5). CONCLUSIONS These longitudinal data provide some evidence supporting a relationship between cardiovascular disease, vascular risk factors and incident cataract and cataract surgery. The findings confirm a number of associations previously documented in cross-sectional data.     

Iris color and incident cataract and cataract surgery: the Blue Mountains Eye Study

PURPOSE: To assess whether an association exists between iris color and the incidence of cataract and cataract surgery. DESIGN: Population-based cohort study. METHODS: The Blue Mountains Eye Study examined 3654 predominantly Caucasian participants aged 49+ years during 1992-1994, and then 2335 survivors (75.1%) after 5 years. Iris color was determined by comparison with four standard photographs. Slit-lamp and retro-illumination lens photographs were graded for presence and severity of cortical, nuclear, or posterior subcapsular cataract. Incident cataract surgery was recorded by history and from the photographs. RESULTS: Participants with dark brown iris color had an increased incidence of nuclear cataract, odds ratio (OR) 1.8, 95% confidence interval (CI) 1.2 to 2.8, and cataract surgery (OR, 2.5; CI, 1.4-4.2) in multivariate models, compared with participants with blue iris color. CONCLUSION: Incidence data from this study support previous cross-sectional findings linking dark brown iris color with age-related cataract.     

Myopia and incident cataract and cataract surgery: the blue mountains eye study

PURPOSE: To assess whether an association exists between myopia and incident cataract and cataract surgery in an older population-based cohort study. METHODS: The Blue Mountains Eye Study examined 3654 participants aged 49 years or more during 1992 to 1994 and then 2334 (75.1%) of the survivors after 5 years. A history of using eyeglasses for clear distance vision was obtained. Objective refraction was performed with an autorefractor, followed by subjective refraction with a logarithm of minimum angle of resolution (logMAR) chart. Emmetropia was defined as a spherical equivalent refraction between +1 D and -1 D, hyperopia as more than +1 D, and myopia as less than -1 D. Slit lamp and retroillumination lens photographs were graded for presence of cortical, nuclear, or posterior subcapsular cataract, according to the Wisconsin Cataract Grading System. Generalized estimating equation models analyzed data by eye. RESULTS: There was a statistically significant association between high myopia (-6 D or less) and incident nuclear cataract (odds ratio [OR] 3.3, 95% confidence interval [CI] 1.5-7.4). Incident posterior subcapsular cataract was associated with any myopia (OR 2.1, 95% CI 1.0-4.8), moderate to high myopia (-3.5 D or less, OR 4.4, 95% CI 1.7-11.5), and use of distance glasses before age 20 (OR 3.0, 95% CI 1.0-9.3), after adjustment for multiple potential confounders, including severity of nuclear opacity. Incident cataract surgery was significantly associated with any myopia (OR 2.1, 95% CI 1.1-4.2) as well as moderate (-3.5 to more than -6D; OR 2.9, 1.2-7.3) and high myopia (OR 3.4, 95% CI 1.0-11.3). CONCLUSIONS: These epidemiologic data provide some evidence of an association between myopia and incident cataract and cataract surgery, after adjustment for multiple confounders and severity of nuclear opacity. These data support other cross-sectional and longitudinal population-based findings.     

中老年人高血压和糖尿病与年龄相关性白内障的关系

目的：探讨中老年人高血压、糖尿病与年龄相关白内障（age-relatedcataract,ARC）危险性之间的关系。方法：采用以医院为基础的病例对照研究方法。病例由45～85岁的360例因患ARC施行白内障手术摘除的患者组成,对照由同期入住相同医院的360例非白内障患者组成,采取1∶1匹配。采用标准调查表对研究对象进行面对面调查,内容包括人口学特征、生活方式、疾病既往史等,同时对血压、血糖进行测量。应用多因素Logistic回归分析估计高血压及糖尿病与ARC关联的比值比（OR）及其相应的95%可信区间（CI）。结果：在调整了年龄和性别因素后,高血压与ARC呈显著正相关（OR=1.573,P=0.005）。与收缩压正常者相比较,收缩压≥180mmHg者发病的危险性增加（OR=2.812,95%CI：1.450～5.455,P=0.002）。高血压病程10a～的研究对象发病的危险性显著地高于病程〈10a者（OR=1.867,95%CI：1.053～3.307,P=0.033）。同样,与非糖尿病患者相比,糖尿病患者发生ARC的危险性显著升高（OR=2.151,95%CI：1.470～3.149,P〈0.001）。与非糖尿病患者相比,糖尿病病程〈10a和10～19a者发生ARC的OR分别为2.374（95%CI：1.502～3.752,P〈0.001）和2.683（95%CI：1.267～5.683,P=0.010）。结论：ARC患病率增高与高血压、糖尿病及其病程增加有关。对这些可变危险因素采取干预性措施,尤其是对高危人群,可能意味着对ARC导致的视觉障碍必须采取控制性措施,因为此症是全球致盲的首要原因。     

Relation of ocular trauma to cortical, nuclear, and posterior subcapsular cataracts: the Beaver Dam Eye Study

BACKGROUND: The consequences of minor ocular trauma in the general population are unclear. The relation of self reported ocular trauma to cortical, nuclear, and posterior subcapsular cataracts is described in a defined population. METHODS: Population based, cross sectional study involving all people aged 43 to 86 years, living in Beaver Dam, Wisconsin (n=4926). Ocular trauma was ascertained by interview and cataract was graded from lens photographs. The relation of ocular trauma to cortical, nuclear, and posterior subcapsular cataracts was examined. RESULTS: People with a history of ocular trauma were more likely to have cortical (odds ratio (OR): 1.5; 95% confidence interval (CI): 1.0 to 2.2) and posterior subcapsular (OR: 1.7; 95% CI: 1.0 to 3.1) cataracts, compared to people without a history of trauma. These associations were stronger for people with previous trauma caused by a blunt object (OR: 3.3; 95% CI: 1.6 to 6.9 for cortical cataract, and OR: 4.1; 95% CI: 1.5 to 10.8 for posterior subcapsular cataracts). However, in analyses comparing the frequencies of cataract between traumatised and non-traumatised eyes among people with unilateral ocular trauma, the ocular trauma association for cortical cataract was no longer present, although the association for posterior subcapsular cataract persisted (OR: 2.4; 95% CI: 0.8 to 7.8). CONCLUSION: The data provide evidence of a possible association between self reported ocular trauma and posterior subcapsular cataract.     

Factors related to vision care in an older adult cohort.

PURPOSE: This study provides cross-sectional data on eye care utilization in a community-based adult population. METHODS: Data are from a questionnaire administered during the 7-year follow-up of the Epidemiology of Hearing Loss Study in 2000 to 2002. Participants in the population-based Beaver Dam Eye Study were eligible for the Epidemiology of Hearing Loss Study, which began in 1997. The primary outcome was self-reported vision testing within the past year. RESULTS: Subject ages ranged from 55 to 99 years (n = 2433), and 60.4% were female. Fifty-three percent of subjects reported they had their vision tested in the past year. Diabetes was self-reported by 11.5% of subjects, and 70.9% of diabetic participants had their vision tested in the past year. A current hospitalization or health insurance plan was reported by 98.6% of subjects. In multivariate analyses, self-reported factors significantly associated with having a vision test in the past year were female gender (odds ratio [OR] = 1.27; 95% confidence interval [CI] 1.06-1.52), current use of refractive correction for distance (OR = 1.98; 95% CI 1.56-2.52), glaucoma (OR = 3.52; 95% CI 2.37-5.24), cataract surgery (OR = 1.57; 95% CI 1.21-2.03), age-related macular degeneration (ARMD) (OR = 1.74; 95% CI 1.22-2.47), diabetes (OR = 2.46; 95% CI 1.83-3.31), visiting a primary care practitioner for any reason in the past year (OR = 1.72; 95% CI 1.32-2.25), having a hearing test in the past year (OR = 1.79; 95% CI 1.40-2.28), and the cessation of driving because of poor vision (OR = 1.64; 95% CI 1.16-2.52). In participants 65 years of age or older, having private insurance was associated with increased odds (OR = 3.39, 95% CI 1.82-6.31) of vision testing in the past year. CONCLUSION: This study suggests that chronic ocular conditions, diabetes, health insurance beyond government entitlements, and the use of other healthcare services are associated with increased eye care utilization.