Relation between cataract and metabolic syndrome and its components

PURPOSE: To estimate the prevalence of cataract in the middle-aged urban population and the relation between cataract and metabolic syndrome and metabolic syndrome components. METHODS: The survey was carried out in Kaunas City, Lithuania, from 2001 to 2002, according to WHO MONICA study protocol. The ophthalmologic investigation was performed for 1282 respondents (573 men and 709 women) aged 35-64 years. Cataract was defined at slit lamp using LOCS III method. Metabolic syndrome was defined by ATP III criteria. RESULTS: Cataract was found in 17.6% of men and 19.0% of women (p>0.05). Metabolic syndrome was detected in 19.5% of men and 25.7% of women (p<0.05). After distribution of persons into 10-year age groups (35-44, 45-54, 55-64), the prevalence of cataract and metabolic syndrome among men and women significantly increased with age. A relation between cataract and metabolic syndrome was found for men aged 55-64 years and for women aged 45-64 years: the prevalence of cataract in men with metabolic syndrome was 1.3 times higher (43.8% vs 32.9%; OR=1.59 [95% CI, 0.77-3.26]) and in women with metabolic syndrome 1.4 times higher (31.8% vs. 22.6%; OR=1.60 [95% CI, 1.03-2.49]) than in persons of the same age and sex without metabolic syndrome. For men aged 4-64 years cataract was significantly related to central obesity (OR=1.80 [95% CI, 1.01-3.20]) and for women aged 45-64 years cataract was significantly related to higher arterial pressure (OR=1.98 [95% CI, 1.21-3.25]), central obesity (OR=1.54 [95% CI, 1.01-2.35]), and elevated level of serum triglycerides (OR=1.86 [95% CI, 1.20-2.90]). CONCLUSIONS: The results of this study show that the prevalence of cataract in urban women 45-64 years of age with metabolic syndrome was significantly higher than in women of this age without metabolic syndrome.     

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.     

A dose–response meta-analysis of dietary lutein and zeaxanthin intake in relation to risk of age-related cataract

Background

Lutein and zeaxanthin are thought to have beneficial effects on protecting the lens against cataract formation, but findings from epidemiologic studies have been inconsistent. We aimed to conduct a meta-analysis of prospective cohort studies to examine the association between dietary lutein and zeaxanthin intake and risk of age-related cataract (ARC).

Methods

We systematically searched MEDLINE, EMBASE, Web of Science, and Cochrane Library databases up to March 2013. Reference lists from retrieved articles were also reviewed. The adjusted relative risks (RRs) from each study were extracted to calculate a pooled estimate with its 95 % confidence interval (CI). The dose–response relationships were assessed by using generalized least-squares trend estimation.

Results

Six prospective cohort studies were identified involving 4,416 cases and 41,999 participants. For the comparison between the highest and the lowest categories of dietary lutein and zeaxanthin intake, significant inverse association were found for nuclear cataract (RR: 0.75; 95 % CI: 0.65, 0.85), but not for cortical cataract (RR: 0.85; 95 % CI: 0.53, 1.17) and for posterior subcapsular cataract (RR: 0.77; 95 % CI: 0.40, 1.13). Dose–response analysis showed that every 300 μg/d increment in dietary lutein and zeaxanthin intake was associated with a 3 %, 1 %, or 3 % reduction in the risk of nuclear cataract (RR: 0.97; 95 % CI: 0.94, 0.99), cortical cataract (RR: 0.99; 95 % CI: 0.95, 1.02), or posterior subcapsular cataract (RR: 0.97; 95 % CI: 0.93, 1.01) respectively.

Conclusions

Dietary lutein and zeaxanthin intake is associated with a reduced risk of ARC, especially nuclear cataract in a dose–response manner, indicating a beneficial effect of lutein and zeaxanthin in ARC prevention.     

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.     

Nutrition and the prevention of cataracts

PURPOSE OF REVIEW: Oxidative stress is a major cause of cataract development. Numerous studies have been published regarding the effects of nutritional supplementation on cataract progression. RECENT FINDINGS: Basic science research has demonstrated a protective effect of antioxidants on lens tissue, and supplementation with vitamin C and lutein/zeaxanthin has been associated with a decreased risk of cataract formation in multiple observational studies. One large interventional trial demonstrated a significant difference in participants treated with high-dose vitamin C versus placebo, but a more recent interventional study did not replicate these findings. In a review of the carotenoids lutein and zeaxanthin, the Food and Drug Administration concluded there is insufficient evidence to suggest that supplementation with these carotenoids lowers the risk of cataract formation. While high doses of multivitamins, antioxidants, or lutein and zeaxanthin are unlikely to be of significant ophthalmic benefit to the general public, these nutrients may help individuals exposed to high oxidative stress, such as heavy smokers, and those with poor nutrition. SUMMARY: Supplementation with vitamin C, lutein, zeaxanthin, or a multivitamin may help certain populations, but is unlikely to affect the progression of cataracts in most patients.     

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.     

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. The Italian-American Cataract Study Group*     

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.     

Association of systemic hypertension and diabetes mellitus with cataract extraction. A case-control study

The authors conducted a case-control hospital-based study to assess the prevalence of systemic diseases and drugs in 161 cataract extraction patients and 196 surgical patients matched by age, sex, and race. The data were analyzed using matched multiple logistic regressions. A statistically significant increased risk of cataract extraction was found in patients with systemic hypertension (odds ratio [OR] = 1.49, 95% confidence interval [CI] = 1.06-2.09) and diabetes mellitus (OR = 1.79, 95% CI = 1.23-2.60). Estimation of the combined effect of systemic hypertension and diabetes mellitus resulted in an even higher risk for cataract extraction (OR = 2.66, 95% CI = 1.67-4.23). A positive association of cataract extraction and treatment of systemic hypertension with the diuretic furosemide was also found (OR = 1.95, 95% CI = 1.02-3.74).     

Association between dietary antioxidants and risk for diabetic retinopathy in a Chinese population

BackgroundDiabetic retinopathy (DR) is related to oxidative stress and insufficient intake of dietary antioxidants may be associated with the onset and progression of DR. This study aimed to detect the association between main dietary antioxidants intake and the risk for DR.MethodsThis is a cross-sectional study of a Chinese urban population. Four hundred and fifty-five subjects with type 2 diabetes were recruited and divided into diabetic patients without retinopathy (DWR) group and DR group based on their retinal status. CSMO (clinically significant macular oedema) was diagnosed by stereoscopic photography. Demographic and lifestyle characteristics were ascertained by questionnaire. General physical and ophthalmic examinations were completed for all subjects. Dietary antioxidants were assessed by 3-day food records. Subjects who have taken any type of vitamin supplements were excluded from the study. The association of dietary antioxidants with the risk for DR was analysed by logistic regression with adjustment of other factors. The dietary antioxidants levels of the CSMO subjects and non-CSMO subjects were compared using the Wilcoxon rank sum test.ResultsOne hundred and nineteen subjects in DR group and 336 subjects in DWR group participated in the study. Only ten DR subjects had CSMO. The results showed that higher vitamin E (OR (95% CI):0.97 (0.95, 1.00), P = 0.036) and selenium (OR (95% CI):0.98 (0.96, 1.00), P = 0.017) intake appear to be the protective factors of DR. The dietary antioxidants levels of CSMO and non-CSMO subjects had no statistical differences (P > 0.05).ConclusionsDietary antioxidants intake, particularly vitamin E and selenium, were observed to have protective effects on DR.Subject terms: Retinal diseases, Scientific community     

Gender inequality in vision loss and eye diseases: Evidence from the Sultanate of Oman

Purpose:

The data from surveys of vision loss and monitoring of services were used to assess changes in gender inequality in Oman.

Study Design:

Retrospective review of data collection instruments.

Materials and Method:

The data sets of 12 years between 1996 and 2007 were abstracted to assess the gender equality for vision loss, eye disease prevalence, and service use. They included two surveys (1996 and 2005), Health Information from eye units (1998 and 2007), and eye screening in schools.

Results:

In 1996, the prevalence of bilateral blindness in ≥ 40 years of age was higher in females [Odd''s Ratio (OR) = 0.36 (95% Confidence Interval (CI) 0.24 – 0.53)]. Gender differences in the prevalence of cataract [OR = 0.82 (95% CI 0.63 – 1.03)] were not significant while trachomatous trichaisis (TT) was less in males [OR = 0.33 (95% CI 0.22-0.48)]. In 2005, gender differences in the prevalence of bilateral blindness [OR = 0.97 (95% CI 0.71 – 1.34)] and TT [OR = 0.66 (95% CI 0.42- 1.04)] were not statistically significant. But males were associated with higher prevalence of cataract [OR = 1.26 (95% CI 1.00 – 1.59)]. Surgery rates for cataract, glaucoma and TT were not different by gender. More male compared to female patients with diabetic retinopathy were treated. Myopia was significantly higher in girls. Compliance of spectacle wear was higher in girls.

Conclusions:

Gender inequality for eye care seems to have reduced in the last 10 years in Oman. However, apart from TT and glaucoma patients the difference in service utilization by gender was not statistically significant.     

Diabetes,hypertension, and central obesity as cataract risk factors in a black population: The Barbados Eye Study

ObjectiveThe increased cataract prevalence of black populations, especially of cortical cataract, remains unexplained. The authors evaluate the relationships of diabetes, hypertension, and obesity patterns to lens opacities, by age, among 4314 black participants in the Barbados Eye Study.Design and participantsPrevalence study of a random sample of the Barbados population, ages 40 to 84 years (84% participation).Main outcome measuresAssociations with age-related lens changes (grade ≥2 in the Lens Opacities Classification System II at the slit lamp) were evaluated in logistic regression analyses by age (persons <60 years and ≥60 years). Results are presented as odds ratios (OR) with 95% confidence intervals.ResultsOf the 1800 participants with lens changes, most had cortical opacities. Diabetes history (18% prevalence) was related to all lens changes, especially at younger ages (age <60 years: OR = 2.23 [1.63, 3.04]; age ≥60 years: OR = 1.63 [1.22, 2.17]). Diabetes also increased the risk of cortical opacities (age <60 years: OR = 2.30 [1.63, 3.24]; age ≥60 years: OR = 1.42 [1.03, 1.96]); additional risk factors were high diastolic blood pressure (age <60 years: OR = 1.49 [1.00, 2.23]) and higher waist/hip ratio (all ages: OR = 1.36 [1.00, 1.84]). Diabetes was also related to posterior subcapsular opacities. Glycated hemoglobin levels were positively associated with cortical and posterior subcapsular opacities. Overall, 14% of the prevalence of lens changes could be attributed to diabetes.ConclusionsThe high prevalence of cortical opacities was related to diabetes, hypertension, and abdominal obesity, which also are common in this and other black populations. Interventions to modify these risk factors, especially in populations in which they are highly prevalent, may have implications to control visual loss from cataract, which is the first cause of blindness worldwide.     

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.     

An ideal ocular nutritional supplement?*

The role of nutritional supplementation in prevention of onset or progression of ocular disease is of interest to health care professionals and patients. The aim of this review is to identify those antioxidants most appropriate for inclusion in an ideal ocular nutritional supplement, suitable for those with a family history of glaucoma, cataract, or age-related macular disease, or lifestyle factors predisposing onset of these conditions, such as smoking, poor nutritional status, or high levels of sunlight exposure. It would also be suitable for those with early stages of age-related ocular disease. Literature searches were carried out on Web of Science and PubMed for articles relating to the use of nutrients in ocular disease. Those highlighted for possible inclusion were vitamins A, B, C and E, carotenoids beta-carotene, lutein, and zeaxanthin, minerals selenium and zinc, and the herb, Ginkgo biloba. Conflicting evidence is presented for vitamins A and E in prevention of ocular disease; these vitamins have roles in the production of rhodopsin and prevention of lipid peroxidation respectively. B vitamins have been linked with a reduced risk of cataract and studies have provided evidence supporting a protective role of vitamin C in cataract prevention. Beta-carotene is active in the prevention of free radical formation, but has been linked with an increased risk of lung cancer in smokers. Improvements in visual function in patients with age-related macular disease have been noted with lutein and zeaxanthin supplementation. Selenium has been linked with a reduced risk of cataract and activates the antioxidant enzyme glutathione peroxidase, protecting cell membranes from oxidative damage while zinc, although an essential component of antioxidant enzymes, has been highlighted for risk of adverse effects. As well as reducing platelet aggregation and increasing vasodilation, Gingko biloba has been linked with improvements in pre-existing field damage in some patients with normal tension glaucoma. We advocate that vitamins C and E, and lutein/zeaxanthin should be included in our theoretically ideal ocular nutritional supplement.     

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.     

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.     

准分子激光原位角膜磨镶术患者的生命质量调查及影响因素分析

目的探讨准分子激光原位角膜磨镶术（LASIK）对近视患者生命质量（QOL）的影响,并对其影响因素进行分析。方法应用中文版的屈光矫正者生命质量量表（QIRC）对115例近视患者LASIK术前及术后3个月的生命质量进行打分。该量表包括症状、视功能与身体机能、社会活动及精神心理4个模块,共20项指标。115例近视患者中,女性64例,男性51例;年龄18～40岁,平均（22．7±4．8）岁;其中术前低、叶1度近视组（〈-6．0D）70例,高度及超高度近视组（≥-6．0D）45例。应用SPSS16．0统计软件对数据进行处理,采用配对t检验分析LASIK手术前、后QOL总分及不同性别、年龄和屈光状态下近视患者QOL得分改变情况,以Logistic回归模型分析术后QOL的影响因素。结果术后3个月,近视患者QOL得分由术前39．15±4．23提高到术后41．78±4．76,差异有统计学意义（t=-4．63,P〈0．01）。其中,高度及超高度近视组患者LASIK手术前、后QOL得分改变量（4．60±1．08）与中、低度近视组患者（3．83±1．18）的差异无统计学意义（t=1．53,P=0．22）;男性患者组QOL得分改变量（3．57±0．18）与女性患者组（4．28±1．26）的差异无统计学意义（t=1．83,P=0．58）;〈23岁患者组QOL得分改变量（3．64±0．73）与≥23岁患者组（3．56±1．31）的差异无统计学意义（t=1．73,P=0．75）。在影响术后QOL的相关岗素中,有用眼保护（OR=5．93,95％CI：1．57—22．36）、较少并发症（OR=15．13,95％CI：2．57—88．94）、较低相关医药费（OR=7．80．95％CI：1．66—36．71）、日常生活便利性（OR=10．36,95％CI：2．44—44．05）、被他人认同感（OR=3．90,95％CI：1．08—14．13）及自信心（OR=12．73．95％CI：2．97—54．57）等因素仔在,则能提高QOL得分,而年龄、性别、术前屈光度等均不是LASIK术后QOL的影响因素。结论LASIK手术后,大部分近视患者的生命质量较术前提高。术后用眼保护、手术并发症、相关医药费用、日常生活便利性、被认同感及自信心等是影响LASIK患者术后生命质量的重要因素。     

Nuclear cataract shows significant familial aggregation in an older population after adjustment for possible shared environmental factors

PURPOSE: To quantify the association between siblings in age-related nuclear cataract, after adjusting for known environmental and personal risk factors. METHODS: All participants (probands) in the Salisbury Eye Evaluation (SEE) project and their locally resident siblings underwent digital slit lamp photography and were administered a questionnaire to assess risk factors for cataract including: age, gender, lifetime sun exposure, smoking and diabetes history, and use of alcohol and medications such as estrogens and steroids. In addition, blood pressure, body mass index, and serum antioxidants were measured in all participants. Lens photographs were graded by trained observers masked to the subjects' identity, using the Wilmer Cataract Grading System. The odds ratio for siblings for affectedness with nuclear cataract and the sibling correlation of nuclear cataract grade, after adjusting for covariates, were estimated with generalized estimating equations. RESULTS: Among 307 probands (mean age, 77.6 +/- 4.5 years) and 434 full siblings (mean age, 72.4 +/- 7.4 years), the average sibship size was 2.7 per family. After adjustment for covariates, the probability of development of nuclear cataract was significantly increased (odds ratio [OR] = 2.07, 95% confidence interval [CI], 1.30-3.30) among individuals with a sibling with nuclear cataract (nuclear grade > or = 3.0). The final fitted model indicated a magnitude of heritability for nuclear cataract of 35.6% (95% CI: 21.0%-50.3%) after adjustment for the covariates. CONCLUSIONS: Findings in this study are consistent with a genetic effect for age-related nuclear cataract, a common and clinically significant form of lens opacity.     

Lutein and zeaxanthin status and risk of age-related macular degeneration

PURPOSE: To investigate the relation between plasma concentrations of lutein and zeaxanthin and age-related macular degeneration in a group of elderly men and women. METHODS: The Wisconsin Age-Related Maculopathy Grading System was used to grade features of early and late macular degeneration in 380 men and women, aged 66 to 75 years, from Sheffield, United Kingdom. Fasting blood samples were taken to assess plasma concentrations of lutein and zeaxanthin. RESULTS: Risk of age-related macular degeneration (early or late) was significantly higher in people with lower plasma concentrations of zeaxanthin. Compared with those whose plasma concentrations of zeaxanthin were in the highest third of the distribution, people whose plasma concentration was in the lowest third had an odds ratio for risk of age-related macular degeneration of 2.0 (95% confidence interval [CI] 1.0-4.1), after adjustment for age and other risk factors. Risk of age-related macular degeneration was increased in people with the lowest plasma concentrations of lutein plus zeaxanthin (odds ratio [OR] 1.9, 95% CI 0.9-3.5) and in those with the lowest concentrations of lutein (OR 1.7, 95% CI 0.9-3.3), but neither of these relations was statistically significant. CONCLUSIONS: These findings provide support for the view that zeaxanthin may protect against age-related macular degeneration.     

Determinants of glaucoma awareness in a general eye clinic

PURPOSE: Heightened public awareness about glaucoma may increase the chance of identifying undetected cases. To ascertain determinants of glaucoma awareness, we surveyed a population visiting a general eye clinic. DESIGN: Cross-sectional study. PARTICIPANTS: 1197 general eye clinic patients and their companions. METHODS: We designed and administered a questionnaire about glaucoma to general eye clinic patients and their companions. We created multivariate logistic regression models to ascertain the effect of demographic and clinical features on the likelihood of being unaware of glaucoma. MAIN OUTCOME MEASURES: Adjusted odds ratio (OR) with 95% confidence intervals of survey attributes associated with self-perceived unfamiliarity with glaucoma. RESULTS: Glaucoma awareness overall (72%) approached that found in the subgroup self-reporting a diagnosis of glaucoma (80%). Survey attributes associated with an increased likelihood of being unaware of glaucoma were African American race (OR = 1.69 [1.28-2.20], Hispanic ethnicity (OR = 2.13 [1.46-3.02]), and less than a college education (OR = 1.67 [1.37-2.05]). Age was also a determinant of glaucoma awareness (for ages 50-64 years, OR = 0.60 [0.44-0.80] and for ages 65-79 years, OR = 0.56 [0.41-0.75] compared with ages less than 35 years). A self-report of glaucoma was not a determinant of glaucoma awareness (OR = 0.63 [0.33-1.17]), although there was a trend toward enhanced glaucoma awareness in this subgroup. Finally, respondents with a history of employment in the health field (OR = 0.63 [0.49-0.82]) myopia (OR = 0.68 [0.56-0.82]), glaucoma in a first-degree relative (OR = 0.68 [0.53-0.87]), and respondents who reported having a dilated eye examination (OR = 0.53 [0.42-0.66]) were less likely to be unaware of glaucoma than those who did not have these attributes. CONCLUSIONS: Although glaucoma awareness in this population was high, Hispanics, African Americans, and those with less than a college education were more likely to be unfamiliar with the disease. Interestingly, a self-report of having glaucoma was not a statistically significant determinant of glaucoma awareness.