人類不同年齡晶體巰基含量的變化和年齡相關性白内障形成的關系

目的使用傳統的巰基顯色劑Ellman試劑測量并比較分析人類不同年齡段的透明及各類型白内障晶狀體樣本中非蛋白巰基(游離巰基)、蛋白巰基和蛋白結合巰基的含量,并分析其與人類年齡相關性白内障形成的關系.方法44個人類晶體按年齡大小被分爲5組,其中10個白内障晶體被分成2組(皮質性和核性).用Ellman試劑測量以上樣品的晶體非蛋白巰基、總蛋白巰基和總蛋白結合巰基含量.結果 皮質性白内障晶狀體的非蛋白巰基含量顯著高于核性白内障晶狀體(P＜0.01);而在蛋白巰基和蛋白結合巰基中,兩者則無顯著差别(P＞0.05).非蛋白巰基含量從胚胎期到年齡相關性白内障發生逐漸降低,各年齡組均顯著小于前一年齡組(P＜0.01);蛋白巰基含量在第5組顯著高于第1、2、3、4組(P＜0.05),其余各組間無顯著區别(P＞0.05);蛋白結合巰基含量除第3、4組和第4、5組間無顯著區别外(P＞0.05),其余組均顯著低于較小年齡組(P＜0.01).結論 人類年齡相關性白内障的形成過程中,晶狀體蛋白分子間巰基的氧化并不像在其它實驗性白内障模型中那樣起决定作用.     

晶状体上皮细胞转分化对老年性白内障形成的影响研究

目的 :为研究晶状体上皮细胞转分化对老年性白内障形成的影响。方法 :对 14例老年性白内障晶状体前囊上皮细胞进行角质蛋白 -8、波形纤维蛋白和纤维粘连蛋白表达的免疫组化研究。结果 :皮质性白内障晶状体上皮的波形纤维蛋白表达明显强于核性白内障 (P <0 0 5 ) ;角质蛋白 -8在皮质性白内障晶状体上皮的表达比核性白内障弱 ((P <0 0 1) ;纤维粘连蛋白在皮质性白内障晶状体上皮的表达明显强于核性白内障 ,而在正常晶状体上皮不表达。结论 :晶状体上皮细胞具有转分化为成纤维样细胞的双向化潜能。晶状体上皮获得转分化能力后而失去原来的细胞学特性。在老年皮质性白内障中 ,晶状体上皮细胞转分化成为成纤维样细胞 ,伴随波形纤维蛋白的过度表达和角质蛋白表达下降。同时合成包括纤维粘连蛋白在内的细胞外基质增多 ,而纤维粘连蛋白能促进晶状体上皮的增殖、迁移及粘附 ,因而晶状体上皮细胞转分化对老年性白内障形成及后囊混浊的形成发挥重要作用。     

Refractive error changes in cortical,nuclear, and posterior subcapsular cataracts

AIMS: To determine the effect of the three main morphological types of cataract on refractive error. METHODS: Data were prospectively collected from 77 subjects (age 67 (SD 8) years) with one morphological type of cataract. 34 had cortical, 21 had nuclear, and 21 had posterior subcapsular cataract. 22 subjects with clear lenses (60 (7) years) were recruited as controls. The spherical equivalent and astigmatic vector change between spectacle correction and optimal refraction were calculated. RESULTS: The cortical cataract group showed a significant astigmatic change of 0.71 (0.67) D (mean (1 SD)) compared to the control group (0.24 (0.20) D), with 24% outside the 95% confidence limit (0.63 D). The nuclear cataract group showed a significant myopic shift of -0.38 (0.60) D compared to the control group (+0.02 (0.21) D), with 52% beyond the minus 95% confidence limit (-0.39 D). CONCLUSION: A quarter of subjects with cortical cataract showed larger changes in astigmatism than subjects with clear lenses. This is probably because of the localised refractive index changes along cortical spoke opacities within the pupillary area. The well known myopic shift of nuclear cataract was also demonstrated.     

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.     

晶状体密度测量在年龄相关性白内障诊断中的价值探讨

目的探讨应用Pentacam系统测量晶状体密度在不同类型年龄相关性白内障诊断中的价值。方法根据LOCSⅢ将年龄相关性白内障分成核型白内障核混浊度（NO）1～5、核颜色（NC）1～5,皮质型白内障（C）1-4和后囊下型白内障（P）1～4,每级30眼。采用Pentacam系统测量晶状体密度。分析晶状体密度值与LOCSⅢ评分值和LogMAR视力的相关性。结果核型白内障眼的晶状体密度值与LOCSⅢ评分值呈线性正相关（r=0．973,r=0．822）;晶状体密度值与LogMAR视力的相关系数r=0．867。皮质型白内障眼的晶状体密度值与C分级评分值的相关系数r=0．634;晶状体密度值与中央前房深度和前房容积均呈负相关（r=-0．453;r=-0．380）。结论核型白内障的晶状体密度值与LOCSⅢ评分值有良好的一致性,可以反映晶状体混浊程度及视力损害程度。晶状体密度和前房深度的变化可用于评价皮质型白内障的进展程度。     

Higher-order aberrations of age-related cataract

PURPOSE: To analyze higher-order aberrations induced by different types of lenticular opacities. SETTING: Federal University of S?o Paulo, S?o Paulo, Brazil. METHODS: One hundred thirty-eyes of 65 patients with bilateral cataract, classified according to the Lens Opacities Classification System III (LOCS III), had complete ophthalmic examinations, corneal topography (EyeSys Technologies), and wavefront analysis (LADARWave, Alcon Laboratories). Patients with cataracts that could not be measured by a Hartmann-Shack sensor or those with coexisting ocular disease were excluded. Higher-order aberrations were compared between the nuclear, cortical, and posterior subcapsular groups for statistical significance. RESULTS: One hundred five eyes of 65 patients were assessed. Twenty-eight eyes (23.33%) had predominantly nuclear opacification (NO1-NO6 and C1-2), and 13 (10.83%) had mainly cortical opacification (C1-4). Sixty-four eyes (65.83%) had a mixed pattern of LOCS III classification, which hindered the establishment of a correlation between the aberrometry and cataract type. Eighteen eyes that presented with dense posterior subcapsular cataract (P4-5) and 7 eyes with cortical C5 LOCS III classification were excluded. In eyes with nuclear opacification, the mean spherical aberration with a 6.0 mm pupil was 0.45 microm +/- 0.17 (SD) and the mean coma was 0.29 +/- 0.13 microm. In eyes with predominantly cortical cataract, the mean spherical aberration was 0.12 +/- 0.10 microm and the mean coma was 0.49 +/- 0.23 microm. The cortical cataract group had statistically significantly higher coma than the other groups (P<.001). The nuclear cataract group had statistically significantly higher spherical aberrations than the other groups (P<.001). CONCLUSIONS: Different types of early lenticular opacities induced different wavefront aberration profiles. Coma predominated in the cortical cataract group, and spherical aberration predominated in the nuclear cataract group.     

Total lactate dehydrogenase and its isoenzyme pattern in lens, aqueous humour, and serum in cases of senile cataract

Lens, aqueous humour and serum LDH and its isoenzyme pattern were estimated in 50 patients with senile cataract; 10 each with immature senile cortical cataract, mature senile cortical cataract, hypermature senile cortical cataract, immature senile nuclear cataract and mature senile nuclear cataract. The gradual decrease in total LDH and activity in the lens with advancement of cataract was maximum in hypermature senile cortical cataract. Aqueous LDH and its isoenzyme pattern remained unaltered with the maturity of cataract, and serum LDH and its isoenzyme pattern were found to be within normal limits. The lens LDH activity was found to be not related to the serum and aqueous humour LDH activity, but LDH3 isoenzyme showed declining trend, whereas LDH5 isoenzyme increased with the maturity of cataract. The present study concluded that significant decrease in lens LDH did not bear any relationship to LDH in serum and aqueous humour in cases of senile cataract.     

Lens opacities in a rural population of southern India: the Aravind Comprehensive Eye Study

OBJECTIVES: To determine the prevalence of lens opacities in an older population in rural southern India. METHODS: A cross-sectional study of 5150 persons aged 40 years and more who were selected as part of a representative sample from three southern districts of the state of Tamil Nadu in southern India. All lenses were graded and classified for opacities and other disorders by slit lamp after pupillary dilation, using the Lens Opacification Classification System (LOCS) III and standard photographs. Definite cataract was defined as either LOCS III nuclear opalescence of grade 3.0 or more and/or cortical cataract of grade 3.0 or more and/or posterior subcapsular cataract (PSC) of grade 2.0 or more. RESULTS: Definite cataract was present in one or both eyes in 2499 (47.5%) of 5150 subjects. The age-adjusted prevalence (adjusted to U.S. population estimates for 2000) of definite cataract in this population was 61.9% (95% CI, 60.6-6.3). The prevalence was significantly lower in men (P=0.0002). In those eyes with cataracts, nuclear cataract (59.7%) was most common, and cortical cataract was present in 20.0% and PSC in 24.3%. Cataract surgery had been performed in 9.4% persons, including 3.0% who had bilateral surgery for cataracts. Best corrected visual acuity was less than 6/60 in 3.7% of aphakic eyes and in 0.8% of pseudophakic eyes. CONCLUSIONS: The higher age-adjusted prevalence and relatively early onset of age-related cataract in this population suggest that the cataract-centered approach to minimizing preventable blindness, adopted by the National Program for Prevention of Blindness in India, is appropriate.     

Lutein and zeaxanthin and the risk of cataract: the Melbourne visual impairment project

PURPOSE: To evaluate the association of cortical, nuclear, or posterior subcapsular (PSC) cataract with dietary intake of lutein-zeaxanthin (LZ) in a population-based sample. METHODS: For the study, 3271 (83% of the eligible residents) permanent residents aged > or =40 years were recruited in 1992 to 1994 via a cluster random sampling. In 1997 to 1999, 2594 (79%) attended the follow-up examination including lens photography, a life-style questionnaire, and a food-frequency questionnaire (FFQ). Cases were those with cortical opacity > or =4/16, nuclear opacity grade > or =2.0, or PSC opacity > or =1 mm2. Logistic regression was used to calculate the odds ratios for cataract by daily LZ intake, or its quintile indicator with the lowest quintile as the baseline category, controlling for energy-adjusted fat intake and variables previously found to be associated with the cataract outcomes. RESULTS: Of the 2322 participants who attended the follow-up survey and completed the FFQ, 1841 (79%), 1955 (84%), and 1950 (84%) were included in the analyses of cortical, nuclear, and PSC cataract, respectively. There were 182 (9.9%), 387 (19.8%), and 177 (9.1%) cases for cortical, nuclear, and PSC cataract, respectively. Cortical and PSC cataract were not significantly associated with LZ intake. For nuclear cataract the odds ratios were 0.67 (0.46-0.96) and 0.60 (0.40-0.90) for every 1-mg increase in crude and energy-adjusted daily LZ intake, respectively. The odds ratios (95% CI) for those in the top quintile of crude LZ intake was 0.58 (0.37-0.92; P = 0.023 for trend), and it was 0.64 (0.40-1.03) for energy adjusted LZ intake (P = 0.018 for trend). CONCLUSIONS: This study found an inverse association between high dietary LZ intake and prevalence of nuclear cataract.     

Nucleotide levels in human lens: regional distribution in different forms of senile cataract

Sensitive high-performance liquid chromatography methods were employed to assess regional distribution of adenine, guanosine and uridine nucleotides in clear and cataractous human eye lenses. According to slit-lamp examination, three forms of senile cataract were distinguished: (1) supranuclear or deep cortical cataract (typical senile cataract), (2) primary nuclear cataract (cataracta brunescens) and (3) subcapsular cortical cataract associated either with a supranuclear (3a) or a secondary nuclear cataract (3b). Except for AMP, which was highest in the nuclear fraction, all other nucleotides (ATP, ADP, GTP, and UTP) were predominantly located in the anterior cortex (plus epithelium) of clear as well as cataractous lenses, that is, ATP levels in the nucleus amounted to 20% of those found in the anterior cortex (plus epithelium); ATP levels in the posterior cortex were about 60% of those in the anterior cortex (plus epithelium). Significant differences in the absolute regional nucleotide level existed between the different forms of cataract. Highest ATP levels were found in the anterior cortex (plus epithelium) of clear lenses and deep or supranuclear cortical cataract. The ATP level was slightly diminished in primary nuclear cataract and in supranuclear cortical cataract when associated with an early subcapsular cortical cataract. ATP levels were depressed to less than 30% in the anterior cortex (plus epithelium) of lenses with a subcapsular cortical cataract when associated with either an early secondary nuclear or a mature cataract. Furthermore, the ATP/ADP ratio was decreased in this form of senile cataract. The decrease in lens nucleotide level did not correlate with increased age. These data suggest that decreases in regional ATP level are a secondary event and do not appear to be causally involved in the genesis of the 'cataracta senilis'.     

The influence of cortical, nuclear, subcortical posterior, and mixed cataract on the results of microperimetry

Purpose

Microperimetry is a useful instrument for evaluating sensitivity threshold due to retinal pathologies. The aim of the study is to assess the impact of different forms of cataract on microperimetry results.

Methods

In a prospective design, patients were recruited for cataract surgery at the Department of Ophthalmology, Medical University of Vienna. Exclusion criteria were any other ophthalmic disease except cataract, that is, macular pathology. Using the Lens Opacities Classification System III classification, patients were classified into four groups: nuclear, cortical, subcapsular posterior, and mixed cataract. Then patients underwent microperimetry: results were analyzed for magnitude of retinal sensitivity loss and correlated to the forms and density of the cataract.

Results

Mean density of cataract was LOCS 3.2–3.5 in the four groups. Differences were not statistically significant. The best-corrected visual acuity (BCVA) was LogMAR 0.5±0.13 in nuclear, LogMAR 0.49±0.21 in cortical, and LogMAR 0.58±0.12 in mixed cataract patients, and significantly worse in patients with subcapsular posterior cataract (LogMAR 0.64±0.12). Microperimetry shows a mean sensitivity of 11.4–12.6 dB without significant group differences. The BCVA is correlated with microperimetry in patients with nuclear and cortical cataract. Density of cataract is highly correlated with microperimetry results in all groups.

Conclusion

The present study shows a good correlation of microperimetry results with the BCVA of patients with nuclear and cortical cataract. In patients with subcapsular posterior cataract, microperimetry results were better than estimated by BCVA. Density of cataract is highly correlated with macular sensitivity. A reduction of 1 dB in microperimetry per 1 posterior capsule opacification score increase can be estimated for these patients.     

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.     

Risk factors for nuclear,cortical and posterior subcapsular cataracts in the Chinese population of Singapore: the Tanjong Pagar Survey

AIM: To describe risk factors for nuclear, cortical, and posterior subcapsular (PSC) cataracts in Chinese Singaporeans. METHODS: A population based cross sectional study was carried out on ethnic Chinese men and women aged 40-81 years. A stratified, clustered, disproportionate (more weights to older people), random sampling procedure was used to initially select 2000 Chinese names of those aged 40-79 years from the 1996 electoral register in the Tanjong Pagar district in Singapore. Eligible subjects (n = 1717) were invited for a standardised ocular examination and interview at a centralised clinic, following which an abbreviated examination was conducted for non-respondents in their homes. Cataract was graded clinically using to the Lens Opacity Classification System (LOCS) III system. The main outcome measures were adjusted odds ratio for risk factors for specific cataract types (nuclear, cortical and PSC), any cataract and cataract surgery, examined in multiple logistic regression models. RESULTS: Out of the 1232 (71.8%) examined, 1206 (70.2%) provided lens data for this analysis. Increasing age was associated with all cataract types, any cataract, and cataract surgery. There was no significant sex difference in presence of any cataract, specific cataract types or cataract surgery. After controlling for age, sex, and other factors, diabetes was associated with cortical cataract (3.1; 95% CI: 1.6 to 6.1), PSC cataract (2.2; 95% CI 1.2 to 4.1), any cataract (2.0; 95% CI: 0.9 to 4.5), and cataract surgery (2.3; 95% CI: 1.3 to 4.1). Lower body mass index was associated with cortical cataract (1.8; 95% CI: 1.1 to 2.9; lowest versus highest quintile) and any cataract (2.3; 95% CI: 1.3 to 4.0). Current cigarette smoking was associated with nuclear cataract (1.7, 95% CI: 1.0 to 2.9; more than 10 cigarettes per day versus none). A non-professional occupation was associated with nuclear cataract (2.9; 95% CI: 1.5 to 5.8; for production or machine operators and 2.6; 95% CI: 1.2 to 5.5; for labourers or agricultural workers, both versus professionals). Lower education was associated with nuclear cataract (2.3; 95% CI: 1.0 to 5.2, none versus tertiary), while lower household income was associated with PSC cataract (4.7, 95% CI: 1.1 to 20.0; income S$4000). CONCLUSIONS: Age related cataracts are associated with a variety of risk factors among Chinese people in Singapore, similar to those reported in European, Indian, and African derived populations. These data support common aetiological mechanisms for age related cataracts, irrespective of ethnic origin.     

Markers of inflammation, vascular endothelial dysfunction, and age-related cataract

PURPOSE: To examine the associations of systemic markers of inflammatory disease and vascular endothelial dysfunction with three types of age-related cataract. DESIGN: Cross-sectional analyses of data from a population-based sample of adults. METHODS: Standardized protocols for blood collection, measurement of markers, administration of a questionnaire, and grading of lens photographs to determine cataract were used. Univariable and multivariable analyses were performed. Settings: Cohort in Beaver Dam, Wisconsin. Study population: A random sample of 396 persons who were > or =50 years of age. Main outcome measure: Prevalent age-related nuclear, cortical, and posterior subcapsular cataract. RESULTS: Interleukin-6 and intracellular adhesion molecule-1 were associated significantly with prevalent nuclear cataract (odds ratio for each quartile, 1.45 and 2.17, respectively). Many of the associations of markers with cataract types were not linear. There were no significant associations between the markers and cortical or posterior subcapsular cataract. CONCLUSION: Two serum markers of systemic inflammation and vascular endothelial dysfunction were associated with nuclear cataract.     

A case-control study on risk factors for nuclear, cortical and posterior subcapsular cataract: The Casteldaccia Eye Study

PURPOSE: To investigate risk factors for nuclear, cortical and posterior subcapsular age-related cataract. METHODS: A case-control study was carried out on subjects aged 40 years and older, living in Casteldaccia, Sicily. Twenty-seven potential risk factors were investigated. Nuclear, cortical and posterior subcapsular opacities of the lens were classified according to the Lens Opacities Classification System II. Subjects with advanced lens opacities represented the cases, while an identical number of subjects without or with early cataract, matched for sex and age, were recruited as controls from within the same population. RESULTS: Univariate analysis showed that myopia and iris atrophy were significantly associated with nuclear cataract. Iris atrophy, use of corticosteroids, pseudoexfoliation syndrome and familial occurrence of cataract were positively correlated with cortical cataract. Myopia, iris atrophy, use of corticosteroids and familial occurrence of cataract presented an association with posterior subcapsular cataract. After multivariate analysis, the variables that remained significantly associated were myopia and iris atrophy for nuclear cataract; iris atrophy, pseudoexfoliation syndrome and familial occurrence of cataract for cortical cataract; and myopia, iris atrophy and familial occurrence of cataract for posterior subcapsular cataract. CONCLUSION: In addition to well known risk factors such as myopia or use of corticosteroids, the Casteldaccia case-control study shows that iris atrophy represents a previously unrecognized risk factor for each of the three types of cataract.     

Detection of the cross-linking amino acid, histidinoalanine, in human brown cataractous lens protein

In human nuclear cataract, with its progression, high polymers protein mass, which is aggregated and strengthened by disulfide cross-links and other covalent cross-links, accumulates in the nuclear region to cause hardening of the lens nucleus. However, the structure of non-disulfide covalent cross-links has not been clearly confirmed yet. Recently a cross-linking amino acid, histidinoalanine, was discovered in connective tissue and is thought to cause hardening of the tissue with aging. The content of this amino acid in the lens nucleus was studied. Nuclear cataract was classified on the basis of nuclear color as described by Pirie (1986). The content of histidinoalanine was found to be 0.05 +/- 0.03 nmol mg-1 in normal nucleus; 0.06 +/- 0.03 nmol mg-1 in grade I (uniform pale yellow); 0.05 +/- 0.03 nmol mg-1 in grade II (deep yellow nucleus); 0.38 +/- 0.07 nmol mg-1 (P less than 0.01) in grade III (hazel-brown nucleus) and 3.35 +/- 2.76 nmol mg-1 (P less than 0.01) in grade IV (deep brown nucleus). The result suggests that histidinoalanine is one of the non-disulfide cross-links of lens proteins in nuclear cataract and is closely related to the grade of 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.     

白内障眼的波前像差、对比敏感度及眩光敏感度研究

目的分析早期年龄相关性白内障患者的波前像差、对比敏感度和眩光敏感度改变。设计前瞻性病例对照研究。研究对象年龄相关性白内障患者62例(107眼),其中皮质性白内障组31例(50眼)、核性白内障组17例(32眼)、后囊下白内障组14例(25眼);正常对照组36例(36眼)。方法使用主观像差仪和自动眩光对比敏感度检查仪对受试者进行波前像差、对比敏感度及眩光敏感度检测。主要指标波前像差、对比敏感度及眩光敏感度。结果各组白内障患者整体像差和总高阶像差普遍高于正常对照组(P均<0．05)。皮质性白内障组和核性白内障第5阶像差高于正常组(P均<0．05)。所有受试者眩光敏感度均比对比敏感度下降明显(P均<0．05)。与正常组相比,皮质性白内障组的对比敏感度和眩光敏感度在低频段和中频段下降显著,核性白内障组的对比敏感度和眩光敏感度在低频段下降显著,后囊下白内障组的对比敏感度和眩光敏感度在全频段下降显著(P<0．05)。白内障组对比敏感度及眩光敏感度和高阶像差存在相关性,但在不同类型白内障,在对比敏感度和眩光敏感度的不同频段,在各阶像差中结果有所不同(r=-0．716-0．191,P<0．05)。结论早期白内障患者波前像差增高,对比敏感度及眩光敏感度下降。对比敏感度及眩光敏感度检查和波前像差测定结合进行,可有效、客观、定量地反映早期白内障患者的视觉质量下降。     

Cataract surgery and subtype in a defined, older population: the SEECAT Project

AIM: To describe the distribution of cataract subtypes present before surgery among a defined population of older, bilaterally pseudophakic individuals. METHODS: This was a cohort study of bilaterally pseudophakic individuals participating in the Salisbury Eye Evaluation (SEE), and their locally resident siblings. Subjects underwent slit lamp and retroillumination photography and grading using the Wilmer Cataract Grading System. For all individuals determined to be bilaterally pseudophakic, an attempt was made to determine for each eye the type(s) of cataract present before surgery, based on previous SEE photographs (for SEE participants) and/or medical records obtained from the operating ophthalmologist (for both SEE participants and their siblings). RESULTS: The mean age of 223 participants providing data in this study was 78.7 (SD 5.2) years, 19.3% of subjects were black and 60.1% female. The most common surgically removed cataract subtype in this population was pure nuclear (43.5%), followed by nuclear combined with posterior subcapsular cataract (PSC) (20.6%), and nuclear combined with cortical (13.9%); less common types were pure cortical (4.9%), pure PSC (4.5%), and PSC combined with cortical (2.7%). Factors such as sex and source of lens data (study photograph versus clinical record) did not significantly affect the distribution of lens opacity types, while PSC was significantly (p = 0.01) more common among younger people and nuclear cataract was significantly (p = 0.001) more common among white compared to black people. CONCLUSION: Epidemiological studies have suggested that the different subtypes of cataract are associated with different risk factors. As studies begin to identify new prevention strategies for cataract, it would appear likely that different strategies will be efficacious against different types of cataract. In this setting, it will be helpful to know which cataract types are most frequently associated with surgery. Among this older, majority white population, nuclear cataract showed a clear predominance among individuals having undergone surgery in both eyes. This may be contrasted with both clinic and population based studies of younger people, which have generally found PSC cataract to predominate.     

Use of vitamin supplements and cataract: the Blue Mountains Eye Study.

PURPOSE: To investigate relationships between use of vitamin supplements and the three principal cataract types in a population-based sample. METHODS: We studied 2873 of the 3654 participants (79%) aged 49 to 97 years attending the cross-sectional Blue Mountains Eye Study who completed a detailed food frequency questionnaire, which included type, dose, and duration of vitamin supplement use. Masked grading of nuclear, cortical, and posterior subcapsular opacities from lens photographs was performed, using the Wisconsin method. RESULTS: Use of multivitamin supplements was associated with reduced prevalence of nuclear cataract, odds ratio 0.6, 95% confidence interval 0.4 to 1.0, P =.05. For both nuclear and cortical cataract, longer duration of multivitamin use was associated with reduced cataract prevalence (nuclear cataract, trend P =.02; cortical cataract, trend P =.03). Use of thiamin supplements was associated with reduced prevalence of nuclear (odds ratio 0.6, confidence interval 0.4 to 1.0, P =.03, dose trend P =.03) and cortical cataract (odds ratio 0.7, confidence interval 0.5 to 0.9, P =.01, dose trend P =.02). Riboflavin (odds ratio 0.8, confidence interval 0.6 to 1.0, P =.05) and niacin (odds ratio 0.7, confidence interval 0.6 to 1.0, P =.04) supplements exerted a weaker protective influence on cortical cataract. Vitamin A supplements were protective against nuclear cataract (odds ratio 0.4, confidence interval 0.2 to 0.8, P =.01, dose trend P =.01). Folate (odds ratio 0.4, confidence interval 0.2 to 0.9, P =.03) appeared protective for nuclear cataract, whereas both folate (odds ratio 0.6, confidence interval 0.3 to 0.9, P =.01, dose trend P =.04) and vitamin B12 supplements (odds ratio 0.7, confidence interval 0.5 to 1.0, P =.03, dose trend P =.02) were strongly protective against cortical cataract. CONCLUSIONS: Long-term use of multivitamins, B group and vitamin A supplements was associated with reduced prevalence of either nuclear or cortical cataract. A strong protective influence on cortical cataract, from use of folate or vitamin B12 supplements, is a new finding.