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.     

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.     

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.     

Five-year incidence of cataract in older persons with diabetes and pre-diabetes

PURPOSE: To investigate longitudinal associations between diabetes and the 5-year incidence of cataract and cataract surgery. (A population-based, cohort study of 2335 persons with baseline ages 49 years or older resident in the Blue Mountains region, west of Sydney, Australia). METHODS: Baseline information on diabetes history was collected during an interviewer-administered questionnaire. Impaired Fasting Glucose (IFG) was defined as venous plasma glucose between 6.0 and 7.0 mmol/L and newly diagnosed diabetes as plasma glucose >7.0 mmol/L, using fasting blood glucose measurements taken at baseline. Retroillumination lens photographs from the baseline and 5-year follow-up examinations were graded for presence of cortical, posterior subcapsular (PSC) and nuclear cataract. RESULTS: We found a 2-fold higher 5-year incidence of cortical cataract in participants with IFG, multivariate adjusted odds ratio (OR) 2.2, 95% confidence interval (CI) 1.1-4.1. Incident PSC cataract was more frequent among persons with diabetes, but this association was statistically significant only for those with newly diagnosed diabetes, multivariate adjusted OR 4.5 (CI 1.5-13.0). There were no statistically significant associations found between incident nuclear cataract or cataract surgery and either diabetes or IFG. CONCLUSIONS: These epidemiological data suggest that IFG, a pre-diabetic condition, may be a risk factor for the development of cortical cataract.     

Fasting blood glucose levels and the long‐term incidence and progression of cataract – the Blue Mountains Eye Study

Purpose: To assess the associations between fasting blood glucose and the long‐term incidence and progression of cataract. Methods: A total of 3654 persons aged 49+ years were examined at baseline with fasting blood glucose measured, and 2454 re‐examined after 5 and/or 10 years. Lens photographs from each visit were used to assess cataract incidence and progression. Associations between baseline fasting blood glucose and incidence and progression of cortical, nuclear and posterior subcapsular (PSC) cataract were assessed using discrete logistic regression and change‐point models. Results: After adjusting for potential confounders, baseline fasting blood glucose was associated with the 10‐year incidence of cortical cataract with a threshold at blood glucose level of 6.0 mm (odds ratio [OR] 1.79, 95% confidence interval [CI] 1.25–2.57 for fasting glucose ≥6.0 mm compared to fasting glucose <6.0 mm). Each 1.0 mm increase in fasting glucose was also associated with higher 5‐year progression of PSC (OR 1.25, 95% CI: 1.15–1.35), 10‐year progression of cortical (OR 1.14, 95% CI: 1.01–1.27) and nuclear (OR 1.20, 95% CI: 1.01–1.43) cataract, with no thresholds detected. Conclusions: In this primarily nondiabetic older population, baseline fasting blood glucose was associated with the long‐term incidence of cortical cataract and long‐term progression of all three cataract subtypes.     

Incidence of age-related cataract over a 10-year interval: the Beaver Dam Eye Study

OBJECTIVE OR PURPOSE: To describe the cumulative incidence of age-related cataracts and cataract surgery over a 10-year interval. DESIGN: Prospective epidemiologic study. PARTICIPANTS: Persons 43 to 86 years of age participating in the Beaver Dam Eye Study (n = 4926 at baseline, 2764 for baseline, 5-year and 10-year follow-ups). METHODS: Questionnaires and examinations were performed according to standardized protocols in a clinic setting in the town of Beaver Dam, Wisconsin. Lens photographs were obtained with specially modified cameras and were graded according to codified rules by trained graders. MAIN OUTCOME MEASURES: Nuclear, cortical, and posterior subcapsular cataracts and cataract surgery. RESULTS: In right eyes, incident nuclear cataract occurred in 19.4%, cortical cataract in 17.4%, posterior subcapsular cataract in 6.1%, and cataract surgery in 10.8%. Incidence increased for all end points with age. Women had significantly higher incidences of nuclear cataract and cataract surgery than men. Time trends seem to be influencing the incidence of cataract surgery. CONCLUSIONS: Age-related cataracts are common events in aging. Age-specific cataract surgery incidence seems to be increasing.     

Five year incidence of cataract surgery: the Blue Mountains Eye Study

AIMS: To assess the 5 year incidence of cataract surgery in an older population based prospective cohort. METHODS: 5 Year prospective follow up of the population based Blue Mountains Eye Study (BMES) performed in 1992. The follow up study examined 2335 survivors (75.1%) of the 3654 baseline participants. Baseline and 5 year slit lamp and retroillumination lens photographs were graded for presence of cortical, nuclear, or posterior subcapsular cataract using the Wisconsin cataract grading method and cataract surgery was documented from the history and the clinical examination. RESULTS: An overall cataract surgery rate of 5.7% in first or both eyes was documented. The incidence was 0.3% in people aged 49-54 years at baseline, 1.7% for ages 55-64 years, 7.9% for ages 65 to 74 years, and 17.4% in people aged 75 years or older. The rate of surgery in first or both eyes was 6.0% in women and 5.2% in men, age adjusted p = 0.66. Bilateral cataract surgery was performed during follow up on 2.7% of participants, while 43.1% of unilateral phakic cases had second eye surgery. Presence of any posterior subcapsular (PSC) cataract, either alone or in combination with other cataract types, was the most likely type of cataract at baseline to be associated with incident cataract surgery. Baseline age was the most important non-ocular variable predicting incident cataract surgery. CONCLUSIONS: This study has documented age specific rates for 5 year incident cataract surgery in an older community. The finding of relatively similar incidence rates and ocular predictors of cataract surgery to those reported by the Beaver Dam Eye Study, Wisconsin, United States, is of interest, given previous documented similarities between these two populations.     

Incident cataract after a five-year interval and lifestyle factors: The Beaver Dam Eye Study

CONTEXT: A population-based study to investigate risk factors for age-related eye disease was begun in 1987 in a representative American community. Incidence of cataract was subsequently evaluated. SPECIFIC OBJECTIVES: To examine the relationships of cigarette smoking, alcohol, and caffeine intakes to incidence of age-related cataracts five years later. DESIGN: Observational epidemiologic incidence study of an adult population. PARTICIPANTS AND INTERVENTION: Adults 43-84 years of age were identified during a census in 1987-1988, and examined at baseline (1988-1990) and after a five-year interval (1993-1995). MAIN OUTCOME MEASURE: Standardized protocols were used at the baseline and follow-up evaluations for exposures and for objective identification of cataracts. RESULTS: Cumulative incidence of nuclear cataract in right eyes was about 12%, cortical cataract about 8%, and posterior subcapsular cataract about 3%. In multivariable analyses of the general estimating equations type, there were significant associations between nuclear cataract and: pack-years smoked (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.01, 1.09 per 10 pack-years); and current alcohol intake (OR 1.01, 95% CI 1.00, 1.02 per 10 grams ethanol/week). Cigarette smokers were more likely to have had cataract surgery in the interval between baseline and follow-up examinations. CONCLUSIONS: Cigarette smoking and alcohol consumption were associated with modestly increased risks of incident nuclear cataract over a five-year interval.     

Dietary macronutrient intake and five-year incident cataract: the blue mountains eye study

PURPOSE: To investigate the relationships between dietary macronutrient intake at baseline and the five-year incidence of the three main types of cataract in older people. DESIGN: Population-based cohort study. METHODS: Settings: An urban community near Sydney, Australia. STUDY POPULATION: The Blue Mountains Eye Study (BMES) examined 3,654 predominantly Caucasian participants aged 49+ years during 1992 to 1994, and then 2,335 survivors (71.5%) after five years. Of these 2,335 subjects, 1988 (85%) completed a Willett-derived food frequency questionnaire (FFQ) at baseline. OBSERVATION PROCEDURES: A 145-item FFQ was used to assess nutrient intakes and lens photography was used to assess the presence of cataract at both time points. MAIN OUTCOME MEASURES: Incidence of cortical, nuclear, and posterior subcapsular (PSC) cataract was assessed via lens photographic grading following the Wisconsin cataract grading method. RESULTS: After adjusting for multiple known cataract risk factors, higher dietary intakes of omega-3 polyunsaturated fatty acids (n-3 PUFA) were associated with a reduced incidence of nuclear cataract. The odds ratio (OR) for subjects in the highest quintile of intake compared to those in the lowest quintile was 0.58 (95% confidence interval [CI] 0.35 to 0.97), P(trend) = .027. Similarly, for PSC cataract, higher dietary intakes of protein were protective (OR 0.28; 95% CI 0.10 to 0.76), P(trend) = .015. Dietary macronutrient intake was not associated with incident cortical cataract. CONCLUSIONS: Higher dietary intakes of n-3 PUFA may decrease the five-year risk of nuclear cataract, whereas higher dietary intakes of protein may decrease risk for PSC cataract.     

Pterygium, pinguecula, and 5-year incidence of cataract

PURPOSE: To assess longitudinal associations between pterygium, pinguecula, and 5-year incident cataract. DESIGN: Population-based cohort study. METHODS: The Blue Mountains Eye Study examined 3,654 residents aged > or =49 years during 1992 to 1994 and reexamined 2,335 (75.1% of survivors) 5 years later. Slit-lamp examination recorded pterygium and pinguecula. Cataract was assessed using masked grading of lens photographs. Incidence was assessed in participants without cataract at baseline. Eye-specific data were analyzed using generalized estimating equation models, adjusting for age, sex, smoking, diabetes, and corticosteroid use. RESULTS: Pinguecula was associated with a borderline-significant, increased risk of developing cortical cataract (adjusted odds ratio, 1.3; 95% confidence interval, 1.0 to 1.7). We found no significant association between baseline pterygium and the incidence of cortical, nuclear, or posterior subcapsular cataract. CONCLUSIONS: Longitudinal data from the same study population provide weak support for cross-sectional associations between pinguecula and cortical cataract previously reported from our study.     

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.     

Plasma antioxidant vitamins and carotenoids and age-related cataract.

OBJECTIVE: To investigate the relationships between plasma concentrations of antioxidant vitamins and carotenoids and nuclear, cortical, and posterior subcapsular cataracts in a group of elderly men and women. DESIGN: Cross-sectional survey. PARTICIPANTS: Three hundred seventy-two men and women, aged 66 to 75 years, born and still living in Sheffield, England. METHODS: The Lens Opacities Classification System (LOCS) III was used to grade nuclear, cortical, and posterior subcapsular lens opacities. Fasting blood samples were taken to assess plasma concentrations of vitamin C, vitamin E, alpha-carotene, beta-carotene, lycopene, lutein, zeaxanthin, and beta-cryptoxanthin. MAIN OUTCOME MEASURES: Logistic regression analyses of the associations between plasma vitamin concentrations and cataract subtype, adjusting for age, gender, and other risk factors. RESULTS: After adjustment for age, gender, and other risk factors, risk of nuclear cataract was lowest in people with the highest plasma concentrations of alpha-carotene (odds ratio [OR], 0.5; 95% confidence interval [CI], 0.3-0.9, P for trend 0.006) or beta-carotene (OR, 0.7; 95% CI, 0.4-1.4, P for trend 0.033). Risk of cortical cataract was lowest in people with the highest plasma concentrations of lycopene (OR, 0.4; 95% CI, 0.2-0.8, P for trend 0.003), and risk of posterior subcapsular cataract was lowest in those with higher concentrations of lutein (OR, 0.5; 95% CI, 0.2-1.0, P for trend 0.012). High plasma concentrations of vitamin C, vitamin E, or the carotenoids zeaxanthin and beta-cryptoxanthin were not associated with decreased risk. CONCLUSIONS: These findings suggest that a diet rich in carotenoids may protect against cataract development, but because they are based on observational data, they need to be confirmed in randomized controlled trials.     

Lens retrodots and vacuoles and their associations with the prevalence and incidence of age-related cataract

Aim

To assess the prevalence of retrodots and vacuoles and their associations with the prevalence and long-term incidence of age-related cataract in an older Australian cohort.

Methods

Of 3654 baseline participants of the Blue Mountains Eye Study aged 49+ years (1992–1994), 2335 and 1952 were re-examined after 5 and 10 years, respectively. Lens photographs were graded for cataract, retrodots, and vacuoles. Eye-specific data were used to assess the associations between retrodots or vacuoles at baseline and the prevalence and 10-year incidence of nuclear, cortical, and posterior subcapsular (PSC) cataract and cataract surgery.

Results

At baseline, retrodots were present in 142 persons (4%) and vacuoles in 1333 persons (40%). Prevalence of both lens features increased with increasing age (Pfor trend <0.0001). After adjusting for age and gender, vacuoles were associated with prevalent PSC cataract at baseline (odds ratio (OR), 1.60, 95% confidence interval (CI), 1.25–2.05). After adjusting for age, gender, smoking, hypertension, diabetes, education, and use of inhaled/oral steroids, baseline retrodots were associated with an increased incidence of cataract surgery (OR 2.90, 95% CI 1.71–4.91), while 3+ vacuoles at baseline were associated with an increased risk of PSC cataract (OR 3.56, 95% CI 2.13–5.95) and cataract surgery (OR 1.84, 95% CI 1.22–2.77).

Discussion

Lens retrodots and vacuoles were found to be positively associated with 10-year incidence of cataract surgery, and vacuoles associated with PSC cataract, a finding suggestive of shared risk factors or pathogenesis between these two lens features and the development of PSC cataract.     

Statin use and the long-term risk of incident cataract: the Blue Mountains Eye Study

PURPOSE: To assess the association between statin use and long-term incident cataract. DESIGN: Population-based cohort study. METHODS: Of 3,654 baseline (1992 to 1994) elderly participants in the Blue Mountains Eye Study (BMES), 2,335 (75% of survivors) were reexamined after five years (1997 to 1999) and 1,952 (76% of survivors) after 10 years (2002 to 2004). Lens photographs were taken and graded using the Wisconsin Cataract Grading System. History, physical examination, and fasting blood samples provided data on possible risk factors. Discrete linear logistic models were used to assess the risk of cataract. RESULTS: After controlling for age, gender, and other factors, statin use was protective for any cataract (hazard ratio [HR] 0.52; 95% confidence interval [CI] 0.29-0.93), but was not significantly associated with incident nuclear (HR 0.66; CI 0.35 to 1.25), cortical (HR 0.76; CI 0.44 to 1.33), or posterior subcapsular (PSC) cataract (HR 1.47; CI 0.70 to 3.08). CONCLUSIONS: Statin use was found to reduce by 50% the risk of cataract development, principally nuclear or cortical cataract subtypes.     

Refractive associations with cataract: the Blue Mountains Eye Study.

PURPOSE: To assess the relationship between myopia and age-related cataract in a defined older population. METHODS: A cross-sectional study of 3654 people aged 49 to 97 years was conducted in the Blue Mountains near Sydney, Australia, from 1992 through 1994. General medical, eye, and refractive history and information about confounders were collected by questionnaire. Participants had a detailed determination of refraction, and the spherical equivalent refraction of each eye was calculated. The Wisconsin Cataract Grading System was used in masked grading of slit lamp and retroillumination lens photographs, to assess presence and severity of nuclear, cortical, and posterior subcapsular (PSC) cataract. Data from both eyes were analyzed by the generalized estimating equation method, adjusting for cataract risk factors. RESULTS: Included in the analysis were 7308 eyes. A history of wearing distance glasses, excluding eyes with current hyperopic refraction, was used as a proxy for myopia. Subjects who had worn distance glasses were more likely to have nuclear cataract (odds ratio [OR] 1.3; confidence interval [CI] 1.0-2.1). After stratification by age at first wearing distance glasses, this relationship remained only for people who first wore distance glasses after age 40 years (OR 1.3; CI 1.0-1.8), which suggested a myopic refractive shift from developing nuclear opacity and was supported by the weak association found between current myopic refraction and nuclear cataract (OR 1.3; CI 1.0-1.6). Eyes with onset of myopia before age 20 years had the greatest PSC cataract risk (OR 3.9; CI 2.0-7.9). This was supported by the finding of an association between current myopic refraction and PSC cataract (OR 2.5; CI 1.6-4.1). PSC cataract was inversely associated with hyperopia (OR 0.6; CI 0.4-0.9). Refraction-related increasing odds were found between PSC cataract and myopia: low myopia (OR 2.1; CI 1.4-3.5), moderate myopia (OR 3.1; CI 1.6-5.7), and high myopia (OR 5.5; CI 2.8-10.9). High myopia was associated with PSC, cortical, and late nuclear cataract. CONCLUSIONS: Early-onset myopia (before age 20 years) may be a strong and independent risk factor for PSC cataract. The findings suggest the possibility of a dose response between levels of myopia and PSC cataract. Nuclear cataract was associated with presumed acquired myopia, whereas high myopia was associated with all three types of cataract.     

Associations between plasma levels of vitamins and cataract in the Italian-American Clinical Trial of Nutritional Supplements and Age-Related Cataract (CTNS): CTNS Report #2

PURPOSE: To investigate the association at baseline between plasma levels of selected vitamins and the presence and type of cataract in the participants in The Italian-American Trial of Nutritional Supplements and Age-related Cataract. METHODS: At baseline, the participants (1020, 710 with "early cataract" and 310 with "no cataract," 55-75 years of age) received an ocular examination, photographic lens grading, and measurement of plasma levels of vitamins A, C, E, beta-carotene, and of red blood cell glutathione reductase activity. RESULTS: In multiple logistic models adjusted for potential confounders, high vitamin C levels were associated with a protective effect on nuclear (N) [OR: 0.54; 95% CI: 0.30, 0.97] and posterior subcapsular (PSC) cataract (OR: 0.37; 95% CI: 0.15, 0.93). High vitamin E levels were associated with increased prevalence of cortical cataract (C) (OR: 1.99; 95% CI: 1.02-3.90), PSC (OR: 3.27; 95% CI: 1.34, 7.96) and of any cataract (OR: 1.86; 95% CI: 1.08, 3.18). Conclusions: In agreement with some earlier studies, we found higher plasma levels of vitamin C to be associated with reduced prevalence of N and PSC cataracts. The finding of an increased prevalence of some types of cataract with higher levels of vitamin E was unexpected, has not been previously reported, and could be due to unadjusted confounding.     

Drug use and five-year incidence of age-related cataracts: The Beaver Dam Eye Study

OBJECTIVE: To evaluate incident cataract after a 5-year interval with respect to medication use. DESIGN: Population-based incidence study. MAIN OUTCOME: Incident cataract judged from standard photographs. SETTING: Study subjects were adults 43 to 86 years of age in 1988 to 1990 and again in 1993 to 1995. All participants were examined and interviewed, and photographs were taken. All procedures and grading were done by protocols at both examinations. All medications in current use, prescribed as well as over-the-counter, were brought to the examination site, and the names were recorded at that time. RESULTS: There were 678 drug preparations (active ingredients) being used at the baseline examination. Significantly lower incidences of nuclear cataracts 5 years later occurred in those who took thiazide diuretics (odds ratio [OR] = 0.79, 95% confidence interval [CI] 0.63, 1.00) and aspirin (OR = 0.76, 95% CI 0.61, 0.95) at the baseline examination. There were significantly more incident cortical cataracts in those taking oral steroids (OR = 2.59, 95% CI 1.45, 4.62), amitriptyline (OR = 2.03, 95% CI 1.09, 3.79), oral hypoglycemic agents (OR 2.06, 95% CI 1.23, 3.44), and insulin (OR = 3.38, 95% CI 1.61, 7.08). There were significantly more incident posterior subcapsular cataracts in those taking potassium-sparing diuretics (OR = 2.13, 95% CI 1.42, 3.18) and oral hypoglycemic agents (OR = 2.89, 95% CI 1.57, 5.33). Considering past use with never and current use did not alter the patterns of associations. We were not able to separate the effects of antihypertensive or diuretic agents from that of hypertension. However, hypoglycemic agents were no longer associated with any cataract type after stratifying by diabetes status. CONCLUSIONS: Although many different medications were being used at the baseline examination in the Beaver Dam Eye Study cohort, few were associated with incident cataract. However, with the high frequency of use of medications and the possibility that effects of current exposure may occur in the future, it is reasonable to follow this and other older cohorts for the development of cataract.     

Diabetes,fasting blood glucose and age-related cataract: the Blue Mountains Eye Study

AIMS. To examine the relationship between diabetes and the presence of cortical, nuclear and posterior subcapsular (PSC) cataract in a defined older population, while controlling for known cataract risk factors. METHODS. Slit-lamp and retroillumination lens photographs were taken on 3654 participants attending the population-based Blue Mountains Eye Study during 1992-94. Masked grading of the photographs was performed using the Wisconsin Cataract Grading System. RESULTS. 217 subjects (5.9% of the population) had previously diagnosed diabetes and 66 (1.8%) had diabetes diagnosed from fasting blood glucose measurements. Cortical cataract, PSC and past cataract surgery were associated with known diabetes in age-sex adjusted models. However, only PSC (odds ratio (OR) 1.8, 95% confidence interval (CI) 1.0-3.1) and past cataract surgery (OR 2.5, CI 1.5-4.2) remained statistically significantly associated with diabetes after further adjustment for other known cataract risk factors. Increasing therapy, as an index of diabetes severity (oral or insulin treatment, compared to treatment by diet alone), was associated with a markedly increased risk of PSC (OR 5.4). CONCLUSIONS. These findings support previous research showing that diabetes has a harmful effect on the lens. The markedly increased risk for PSC may also have been reflected in the association found between diabetes and past cataract surgery. Contrary to findings from the Beaver Dam Eye Study, we found only a weak association with cortical cataract, which was not statistically significant after adjusting for other known cataract risk factors.     

Low-dose aspirin and risk of cataract and subtypes in a randomized trial of U.S. physicians

PURPOSE: To examine whether low-dose aspirin (325 mg on alternate days) reduces the risk of age-related cataract and subtypes. This report extends previous findings, including both subtypes and additional newly identified incident cases since the earlier report. METHODS: All 20,979 participants in the Physicians' Health Study, a randomized trial of aspirin and beta-carotene among U.S. male physicians age 40-84 in 1982, who did not report cataract at baseline were included. Average follow-up was five years. The main outcome measure was incident, age-related cataract responsible for a reduction in best-corrected visual acuity to 20/30 or worse, based on self-report confirmed by medical record review. RESULTS: 501 age-related cataracts were diagnosed during follow-up, including 416 with nuclear sclerosis and 212 with a posterior subcapsular component; 318 cataracts progressed to surgical extraction. Overall, there were 245 cataracts in the aspirin group and 256 in the placebo group (relative risk [RR], 0.94; 95% confidence interval [CI], 0.79 to 1.13; P=0.52). Cataract extractions were 19% less frequent in the aspirin than in the placebo group (RR, 0.81; 95% CI, 0.65 to 1.01; P=0.06). In subgroup analyses of subtypes, aspirin takers had a lower risk of posterior subcapsular cataract (RR, 0.74; 95% CI, 0.57 to 0.98; P=0.03) but not nuclear sclerosis (RR, 0.96; 95% CI, 0.79 to 1.16; P=0.65) cataract. CONCLUSIONS: Overall, these randomized trial data tend to exclude a large benefit of five years of low-dose aspirin therapy on cataract development and extraction. The data are compatible with a modest benefit on cataract extraction for this duration of aspirin therapy. Subgroup analyses raise the possibility of a modest, but potentially important, protective effect of aspirin on posterior subcapsular cataract, a particularly disabling subtype.     

Diabetes, cardiovascular disease, selected cardiovascular disease risk factors, and the 5-year incidence of age-related cataract and progression of lens opacities: the beaver dam eye study

PURPOSE: To describe the relationships of diabetes mellitus, cardiovascular disease, and selected cardiovascular disease risk factors to cumulative incidence of age-related cataract and to progression of lens opacities over a 5-year interval.METHODS: A follow-up examination of the Beaver Dam Eye Study cohort was performed 5 years after the baseline evaluation. Ages at the census prior to baseline ranged from 43 to 84 years of age. Protocols for examination, lens photography, and grading were the same for both examinations.RESULTS: Age at baseline was the most significant characteristic associated with incidence of nuclear, cortical, and posterior subcapsular cataract in those without diabetes (P < .001) for all cataracts. The positive association of age with cataract was found for nuclear and cortical cataract in the worse eye (P ≤ .04) but not posterior subcapsular cataract in those with diabetes. Progression of nuclear sclerosis was common, occurring in about 70% of subjects when considering either eye. Incident cortical and posterior subcapsular cataracts (P ≤ .001 for worse eye for each lesion) and progression of cortical and posterior subcapsular opacities were more common in those with diabetes (P ≤ .001 for either eye for each lesion). Increased glycated hemoglobin level was associated with increased risk of nuclear and cortical cataracts in those with diabetes. Relationships of risk factors to posterior subcapsular cataracts, especially among those with diabetes, were often in the expected direction but lacked significance possibly due to small samples.CONCLUSIONS: Diabetes mellitus is associated with incidence over 5 years of cortical and posterior subcapsular cataract and with progression of more minor cortical and posterior subcapsular lens opacities. These changes may be related to level of glycemia. Cardiovascular disease and its risk factors have little effect on incidence of any age-related cataract.