Association Between Endothelial Cell Density and Corneal Thickness in Medium, Short, and Long Eyes of Han Chinese Cataract Patients.

PURPOSE: To evaluate the association between the endothelial cell density (ECD) and central corneal thickness (CCT) in medium, short, and long eyes of preoperative Han Chinese cataract patients. DESIGN: Retrospective cross-sectional study. METHODS: We consecutively enrolled 410 eyes, namely, 50 short eyes (axial length [AL]<22.0 mm), 150 medium eyes (22.0≤AL<24.0 mm), 120 medium-long eyes (24.0≤AL<26.0 mm), and 90 long eyes (AL≥26.0 mm), of 410 adult patients scheduled for cataract surgery. The ECD and CCT were determined preoperatively with a noncontact specular microscope. The association between the CCT and ECD was identified by using a multivariable regression analysis. A thin cornea was defined as having a CCT less than 500 µm. RESULTS: After adjusting for age, the presence of arterial hypertension, the presence of diabetes mellitus, intraocular pressure, and AL, a positive association between the CCT and ECD was identified in short eyes (linear regression coefficient [B]=3.40; standardized B [ß]=0.52; P = .03), medium eyes (B = 2.33; ß=0.28; P = .002), medium-long eyes (B = 1.84; ß=0.25; P = .02), and long eyes (B = 2.69; ß=0.41; P = .04). In the total group, the multivariable logistic analysis showed a significant link between the presence of a thin cornea and a lower ECD (odds ratio [OR]=0.80 per 100 cells/mm2 increase; P = .001). CONCLUSIONS: For cataract patients of Han ethnicity, a significant association between a thin CCT and a lower ECD was shown across the AL spectrum and was most prominent in short eyes. Eyes with a thin cornea are more likely to have a lower ECD.

Introduction to the Special LDLensRad Focus Issue.

Recent epidemiological and experimental animal data, as well as reanalyses of data previously accumulated, indicate that the lens of the eye is more radiosensitive than was previously thought. This has resulted in a reduction of the occupational lens dose limit within the European Union countries, Japan and elsewhere. This Commentary introduces the work done by the LDLensRad Consortium contained within this Focus Issue, towards advancement of understanding of the mechanisms of low dose radiation cataract.

Pseudoexfoliation and Cataract Syndrome Associated with Genetic and Epidemiological Factors in a Mayan Cohort of Guatemala.

The Mayan population of Guatemala is understudied within eye and vision research. Studying an observational homogenous, geographically isolated population of individuals seeking eye care may identify unique clinical, demographic, environmental and genetic risk factors for blinding eye disease that can inform targeted and effective screening strategies to achieve better and improved health care distribution. This study served to: (a) identify the ocular health needs within this population; and (b) identify any possible modifiable risk factors contributing to disease pathophysiology within this population. We conducted a cross-sectional study with 126 participants. Each participant completed a comprehensive eye examination, provided a blood sample for genetic analysis, and received a structured core baseline interview for a standardized epidemiological questionnaire at the Salama Lions Club Eye Hospital in Salama, Guatemala. Interpreters were available for translation to the patients' native dialect, to assist participants during their visit. We performed a genome-wide association study for ocular disease association on the blood samples using Illumina's HumanOmni2.5-8 chip to examine single nucleotide polymorphism SNPs in this population. After implementing quality control measures, we performed adjusted logistic regression analysis to determine which genetic and epidemiological factors were associated with eye disease. We found that the most prevalent eye conditions were cataracts (54.8%) followed by pseudoexfoliation syndrome (PXF) (24.6%). The population with both conditions was 22.2%. In our epidemiological analysis, we found that eye disease was significantly associated with advanced age. Cataracts were significantly more common among those living in the 10 districts with the least resources. Furthermore, having cataracts was associated with a greater likelihood of PXF after adjusting for both age and sex. In our genetic analysis, the SNP most nominally significantly associated with PXF lay within the gene KSR2 (p < 1 × 10-5). Several SNPs were associated with cataracts at genome-wide significance after adjusting for covariates (p < 5 × 10-8). About seventy five percent of the 33 cataract-associated SNPs lie within 13 genes, with the majority of genes having only one significant SNP (5 × 10-8). Using bioinformatic tools including PhenGenI, the Ensembl genome browser and literature review, these SNPs and genes have not previously been associated with PXF or cataracts, separately or in combination. This study can aid in understanding the prevalence of eye conditions in this population to better help inform public health planning and the delivery of quality, accessible, and relevant health and preventative care within Salama, Guatemala.

Hyperglycemia and Hypo-HDL-cholesterolemia Are Primary Risk Factors for Age-related Cataract, and a Korean-style Balanced Diet has a Negative Association, based on the Korean Genome and Epidemiology Study.

BACKGROUND: The prevalence of cataracts is steadily increasing among the middle-aged and elderly worldwide. We hypothesized that adults aged > 50 years with age-related cataracts (ARCs) have an association with metabolic syndrome (MS) and its components, and MS has interactions with different dietary patterns and lifestyles that affect ARC risk. We examined the hypothesis using the Korean Genome and Epidemiology Study (KoGES; a large-scale hospital-based cohort study), which collected data between 2004-2013. METHODS: Participants ≥ 50 years old were classified as cases (1,972 ARC patients) and controls (38,290 healthy controls) based on a diagnosis of cataract by a physician. MS and its components were defined using WHO definitions for Asians. Dietary consumption was evaluated using a validated semi-quantitative food frequency questionnaire (SQFFQ), which contained 106 foods, and dietary patterns were analyzed by principal component analysis. After adjusting for potential covariates, logistic regression was used to investigate associations between MS and its components and between dietary patterns and a positive cataract history. RESULTS: ARC had a positive association with MS after 1.32-fold adjusting for age, sex, residence area, body mass index, and energy intake. Plasma glucose and HbA1c concentrations exhibited an increased ARC risk in the participants with MS by 1.50- and 1.92-fold and without MS by 1.35 and 1.88-fold, respectively. Serum high-density lipoprotein (HDL) concentrations were negatively associated with ARC risk only in the MS patients, but not without MS. However, blood pressure, abdominal obesity, and serum triglyceride concentrations did not associate with ARC risk regardless of MS. High intake of a Korean-balanced diet (KBD) containing fermented food exhibited a negative association with ARC risk (OR = 0.81) only in the MS group. The fat and coffee intake had a negative association with ARC only in the non-MS group. Current- and former-smokers were positively associated with ARC risk. CONCLUSION: Persons who have hyperglycemia and low-HDL-cholesterolemia had increased susceptibility of ARC prevalence. A KBD with a proper amount of fat (≥ 15%) is recommended, and smoking should be prohibited.

Evaluation of the White-to-White Distance in 39,986 Chinese Cataractous Eyes.

Purpose: To investigate the distribution of white-to-white (WTW) distance and its associations with other biometric parameters in Chinese cataractous eyes. Methods: Data on 39,986 eyes from 23,627 Chinese cataract patients were analyzed. Ocular biometric parameters, including WTW distance, corneal curvature, anterior chamber depth (ACD), lens thickness (LT), central corneal thickness (CCT), and axial length (AL), were obtained using the ZEISS IOLMaster 700. Results: The mean age of patients was 63.7 ± 12.4 years, and 57.61% were female. The mean WTW distance was 11.69 ± 0.46 mm. The WTW distance was larger in male patients than in female patients for all age groups (all P < 0.001). The WTW distance was positively correlated with corneal curvature and ACD and negatively correlated with age, LT, and CCT (all P < 0.001). Multivariable analysis revealed that a larger WTW distance was associated with younger age; male gender; larger corneal curvature, ACD, and LT; and thinner CCT (all P < 0.001). Notably, the association between WTW distance and AL was not linear. As the AL increased, the WTW distance initially increased, reached a peak in the group with ALs of 24.5 to 26 mm, and then slowly decreased. However, all of the myopic eyes (AL > 24.5 mm) still had larger WTWs than the normal and short eyes (AL ≤ 24.5 mm). Conclusions: In Chinese cataractous eyes, the WTW distance was larger in younger male patients with flatter corneas, deeper anterior chambers, thicker lenses, and thinner central corneas. The association between WTW distance and AL was not linear, and WTW distance was the largest in eyes with ALs of 24.5 to 26 mm.

Cataract surgery in New Zealand: access to surgery, surgical intervention rates and visual acuity.

AIMS: To analyse the surgical intervention rate (SIR), best spectacle-corrected visual acuity (BSCVA) and disparities in access to public-funded cataract surgery in New Zealand. The New Zealand Ministry of Health uses the National Prioritisation Web Service (NPWS) to prioritise all patients for public-funded cataract surgery. BSCVA at prioritisation, ethnic, demographic and geographic disparities have not previously been assessed. METHODS: A retrospective cohort study. Between November 2014 and March 2019, 61,095 prioritisation events for 44,403 unique patients were identified. Cataract prioritisation events extracted from the NPWS were merged with date of birth and ethnicity extracted from the National Health Index database. All data were de-identified prior to statistical analysis. RESULTS: Mean age at prioritisation was 74.4 years, with female preponderance (56%). Overall ethnicity was 'European' in 69.8% and 'New Zealand Maori' in 9.6%. Mean Snellen BSCVA was 6/30-2 (prioritised eye), and 6/12-1 (binocular). Maori and Pasifika presented on average 10 years earlier than other ethnic groups with significantly worse BSCVA. Surgery was approved in 74.4% of prioritisation events with mean Snellen BSCVA of 6/38-2. Only 34.9% of New Zealand patients had Snellen BSCVA of 6/12 or better in the prioritised eye, compared to 58.4% in the European Union. Cataract SIR varied by region. CONCLUSIONS: New Zealand's cataract SIR is lower than most Organisation for Economic Co-operation and Development countries and patients have significantly worse BSCVA at prioritisation. Access to cataract surgery in New Zealand varies according to region. Maori and Pasifika present younger with worse BSCVA, suggesting potential barriers in accessing timely referral and prioritisation.

Ethnic variation in prevalence, self-reported barriers and outcome of cataract surgery in a rural population in southwestern China: the Yunnan minority eye study.

BACKGROUND: As a part of the Yunnan Minority Eye Studies, the purpose of this study was to determine the prevalence, barriers and visual acuity outcomes of cataract surgery in a multiethnic adult population in rural areas of southwestern China. METHODS: A population-based cross-sectional survey was conducted with participants of Bai, Yi, and Han ethnicity aged ≥50 years in Yunnan. A detailed eye examination was performed. Information on the date, setting, type, and complications of cataract surgery were recorded in the examination of cataract-operated eyes. RESULTS: Of 6546 subjects (2133 Bai ethnicity, 2208 Yi ethnicity and 2205 Han ethnicity), the prevalence of cataract surgery was 6.0%, with 4.6% in Bai, 7.0% in Yi, and 6.4% in Han ethnicity. Cataract Surgical coverage (CSC) among those with presenting visual acuity (PVA) < 20/200 in both eyes because of cataract was 53.3%, with 52.8% in Bai, 64.4% in Yi, and 45.3% in Han ethnicity. CSC was associated with Yi ethnicity, younger age, and higher education level, while unoperated cataract was associated with Han ethnicity, older age, and illiterate. The main barrier to cataract surgery was lack of awareness and knowledge, cost, and fear. Among the 525 cataract-operated eyes, PVA and best-corrected visual acuity (BCVA) of 20/63 or better was 44.5 and 67.2%, respectively, with 48.1 and 65.9% in Bai, 47.8 and 75.4% in Yi, 39.1 and 59.9% in Han ethnicity. Han ethnicity, aphakia, earlier year of surgery, lower-level surgical hospital and illiterate were associated with postoperative visual impairment defined by PVA, while Han ethnicity, aphakia, and illiterate were associated with that defined by BCVA. The principal causes of postoperative visual impairment were retinal disorders (26.8%), posterior capsule opacification (25.1%), refractive error(22.7%), and glaucoma (9.3%). CONCLUSIONS: Han ethnicity had a lower CSC and relatively poor visual outcomes compared with ethnic minorities. Further effective effort to remove barriers and provide sight restoration is warranted.

Equity was rarely considered in Cochrane Eyes and Vision systematic reviews and primary studies on cataract.

OBJECTIVE: We sought to understand the extent to which Cochrane Eyes and Vision systematic reviews of interventions for cataract, and primary studies, consider equity. STUDY DESIGN AND SETTING: This is a review of Cochrane Eyes and Vision systematic reviews (CSRs) on cataract published on the Cochrane Library (end of March 2019) (n = 23), and recently published primary studies included in those reviews (n = 62), using the PROGRESSPlus framework. RESULTS: One CSR considered equity as a topic. Four (17%) CSRs included a low- and middle-income country (LMIC) author; one of them was a first author. The CSR with equity as a main topic restricted primary studies to those conducted in LMICs; otherwise none of the systematic reviews used PROGRESS factors as inclusion or exclusion criteria. None of the CSRs reported subgroup analyses by any PROGRESS factor, although these were planned in two. Two of the primary studies were led by an LMIC author; 42% involved LMIC authors; 37% were conducted in LMICs; 73% of studies reported on gender/sex of participants, but other PROGRESS factors were less frequently reported. Three studies reported subgroup analyses by sex; one reported subgroup analyses by race/ethnicity. CONCLUSION: PROGRESS factors and equity are rarely considered in studies of interventions for cataract, and this is reflected in the associated Cochrane reviews.

Ratio of Axial Length to Corneal Radius in Japanese Patients and Accuracy of Intraocular Lens Power Calculation Based on Biometric Data.

PURPOSE: To evaluate the features of the axial length-to-corneal radius (AL/CR) ratio in Japanese patients with cataracts and to determine the accuracy of intraocular lens (IOL) power calculation formulas according to the AL/CR features and the axial length (AL). DESIGN: Retrospective observational case series. METHODS: Setting was a clinical practice. Patient population was a total of 1,135 eyes (1,135 patients) with cataracts. Observation procedures included measurement of the AL and corenal radius (CR) by optical biometry and evaluation of the refractive outcomes by using the SRK/T, Holladay 1, Hoffer Q, Haigis, and Barrett Universal II formulas. Main outcome measurements were the features of the AL/CR ratio and the accuracy of IOL power calculations based on the AL/CR ratio and the AL. RESULTS: The mean AL/CR ratio was 3.15 ± 0.19. Significant weak negative correlations were observed between the spherical equivalent (SE) and AL (r = -0.7489; P < .001) and between the SE and AL/CR ratio (r = -0.8069; P < .001); no correlation was found between the SE and CR (r = 0.0208, P = .483). For medium ALs and high AL/CR ratios, the SRK/T formula performed less accurately. For long ALs and high AL/CR ratios, the Holladay 1 and Hoffer Q formulas performed less accurately. The Barrett Universal II formula performed well across a range of ALs and AL/CR ratios. CONCLUSIONS: The AL/CR ratio explained the total variation in the SE better than the AL alone. Surgeons should pay attention to the selection of IOL power calculation formulas in eyes with high AL/CR ratios.

Psychometric Properties of the Vietnamese Catquest-9 Short Form Questionnaire.

SIGNIFICANCE: The Catquest-9 Short Form (SF) has good psychometric properties but was not available in Vietnamese. This study provides the Vietnamese Catquest-9SF and evidence supporting for its use in hospital settings along with clinical assessment to evaluate visual function. PURPOSE: The purpose of this study was to evaluate the psychometric properties of the Vietnamese Catquest-9SF. METHODS: Literate patients with unilateral/bilateral cataract, without severe systemic and ocular comorbidities, aged 50+ years, and scheduled for first-eye surgery were screened and recruited at the University of Medicine and Pharmacy at Ho Chi Minh City and Trung Vuong Hospital. Age, sex, and education were self-reported. The Catquest-9SF and the 25-item National Eye Institute Visual Function Questionnaire were used to assess vision-related quality of life (VRQOL). Best-corrected unilateral and bilateral log of the minimum angle of resolution (logMAR) visual acuity was measured, as was best-corrected Pelli-Robson contrast sensitivity. Rasch analysis was performed on the Vietnamese version of the Catquest-9SF. Criterion validity and convergent validity were also evaluated. RESULTS: Andrich thresholds and response categories on each Catquest-9SF item were ordered, indicating that patients were able to discriminate VRQOL levels. Person separation index and reliability were 2.51 and 0.86, respectively, indicating that the Catquest-9SF was able to distinguish between patients with low- and high-vision difficulties. The tool was unidimensional, with all items fitting well within the construct. There was no evidence of differential item functioning by sex, age group, or cataract status. The tool also showed criterion validity, correlating significantly with visual acuity in the better eye (r = -0.46), the worse eye (r = -0.39), and both eyes (r = -0.44), and with contrast sensitivity for the better eye (r = 0.41), the worse eye (r = 0.32), and both eyes (r = 0.39). A strong correlation between the Catquest-9SF and the 25-item National Eye Institute Visual Function Questionnaire (r = 0.87) indicated convergent validity. CONCLUSIONS: The Vietnamese Catquest-9SF is valid and psychometrically robust for assessing VRQOL among cataract patients.

Clinical characteristics of congenital lamellar cataract and myopia in a Chinese family.

To investigate the clinical characteristics and the genetic defect in a Chinese family with congenital lamellar cataract with myopia. Three generations of a single family were recruited in the present study. A detailed family history and clinical data were recorded. A total of 100 unrelated ethnically matched controls without family history of congenital cataracts and myopia were also recruited. Genomic DNA was extracted from peripheral blood leukocytes. The sequencing of candidate genes was performed to screen out the disease-causing mutation. The effects of amino acid changes on the structure of proteins were predicted by bioinformatics analysis. Affected individuals presented lamellar lens opacities and myopia. Direct sequencing revealed a heterozygous c. 34 C>T variation in the αA-crystallin protein (CRYAA) gene, which resulted in the replacement of a highly conserved arginine by cystine at codon 12 (p.R12C). This mutation co-segregated with all affected individuals and was not observed in unaffected members or the 100 normal controls. Bioinformatic analysis showed that a highly conserved region was located around Arg12, an increase in local hydrophobicity was shown around the substitution site and the secondary structure of the mutant CRYAA protein has been changed. This is the case of a congenital lamellar cataract phenotype with myopia associated with the mutation of Arg12Cys (p.R12C) in CRYAA. Our finding confirms the high rate of mutations at this dinucleotide. In addition, these results demonstrate a myopia susceptibility locus in this region, which might also be associated with the mutation in CRYAA.

Systemic medications and cortical cataract: the Singapore Epidemiology of Eye Diseases Study.

BACKGROUND/AIMS: To evaluate the association between systemic medications and cortical cataract prevalence in an Asian population. METHODS: The Singapore Epidemiology of Eye Diseases Study recruited 10 033 Chinese, Malay and Indian residents aged 40+ years living in Singapore. Information on medication use was collected at interview using questionnaires. The presence and severity of cortical cataract were assessed from lens photographs using the modified Wisconsin Cataract Grading System. Associations between medications and the presence of cortical cataract were assessed using logistic regression. Associations between medications and greater severity of cortical cataract (none, minimal, early and late) were assessed using ordinal logistic regression. RESULTS: A total of 8965 participants were included, the mean age was 57.6 (SD=9.8) years, and 4555 (50.8%) were women. After adjusting for age, gender, ethnicity, body mass index, smoking status, socioeconomic status, hypertension, hyperlipidaemia, diabetes, duration of diabetes and cardiovascular disease, ACE inhibitors (OR=1.27; 95% CI 1.05 to 1.55), fibrates (OR=1.57; 95% CI 1.05 to 2.35), alpha-glucosidase inhibitors (AGIs) (OR=1.85; 95% CI 1.13 to 3.02) and insulin (OR=1.80; 95% CI 1.11 to 2.93) were significantly associated with the presence of cortical cataract. Further adjusting for concurrent medication use did not alter these associations. Consistently, the four medications were also associated with a greater severity level of cortical cataract. CONCLUSION: ACE inhibitors, fibrates and AGIs were associated with increased prevalence of cortical cataract in this Asian population, independent of the presence of hypertension, hyperlipidaemia and diabetes, respectively. Whether they contribute to the risk of cortical cataract needs confirmation in longitudinal studies.

Association of African-American ethnicity and smoking status with total and individual damage index in systemic lupus erythematosus.

INTRODUCTION: Smoking has been associated with increased incidence, severity of cutaneous lupus, and lupus activity. We looked at the association of both smoking and ethnicity with the individual damage items from the SLICC/ACR Damage Index. METHODS: Poisson regression was used to model the total SLICC/ACR Damage Index score against ever smoking. Cox regression was used to assess the relationship between time to individual damage items and ever smoking. Furthermore, we compared SLICC/ACR Damage Index items among African-American and Caucasian ever smokers. RESULTS: The study included 2629 patients, 52.6% Caucasian and 39.3% African-American. The prevalence of ever smokers was 35.8%. There was no significant difference in total SLICC/ACR Damage Index score between ever smokers and never smokers after adjustment for ethnicity, gender, age at diagnosis, and years of education. Ever smokers had more atherosclerotic cardiovascular damage and skin damage compared to non-smokers. Caucasian SLE patients who ever smoked were more likely to have muscle atrophy and atherosclerosis compared to Caucasian non-smokers. African-American patients who ever smoked were more likely to have skin damage compared to African-American non-smokers. African-Americans who smoked were more likely to have many more damage items (cataract, renal damage, pulmonary hypertension, cardiomyopathy, deforming or erosive arthritis, avascular necrosis, skin damage, and diabetes) compared to Caucasians who smoked. CONCLUSION: Our analysis proved the major effect of smoking on cardiovascular and cutaneous damage. Surprisingly, cardiovascular damage items had higher hazard ratios in Caucasian smokers than non-smokers while skin damage items hazard ratios were higher in African-American smokers compared to non-smokers.Key Points• This study is the largest cohort study to date evaluating the effect of smoking on the cumulative SLICC/ACR Damage Index and its individual damage items.• It is the only study that examined the effect of smoking on individual items of the SLICC/ACR Damage Index in terms of Caucasians vs. African-American ethnicity.• Our analysis proved the major effect of smoking on cardiovascular and cutaneous damage. Compared to non-smokers, Caucasian smokers had higher risk of cardiovascular damage while African-American smokers had more skin damage.• African-Americans who smoked were more likely to have many more damage items (cataract, renal damage, pulmonary hypertension, cardiomyopathy, deforming or erosive arthritis, avascular necrosis, skin damage, and diabetes) compared to Caucasians who smoked.

Crystalline lens changes after selective laser trabeculoplasty in Afro-Caribbean patients with open-angle glaucoma; report 4 of the West Indies Glaucoma Laser Study (WIGLS).

PURPOSE: To characterize changes in nuclear, cortical, and posterior subcapsular lens opacities after selective laser trabeculoplasty (SLT) in Afro-Caribbean eyes with primary open-angle glaucoma (POAG). SETTING: Three clinical practices, Saint Lucia and Dominica. DESIGN: Prospective case series. METHODS: Patients with POAG in the West Indies Glaucoma Laser Study (WIGLS) had 360-degree SLT after medication washout. No antiinflammatory therapy was used after SLT. Nuclear, cortical, and posterior subcapsular lens opacities were graded through dilated pupils using the Lens Opacification Classification System III (LOCS III) at baseline and 12, 24, and 36 months after SLT, with the grader masked to all previous values after baseline assessment. Changes in opacity scores from baseline were evaluated using paired t tests. RESULTS: Seventy-two patients (142 phakic eyes) were evaluated. The mean (±SD) baseline LOCS III opacity scores in right eyes and left eyes, respectively, were 2.44 ± 1.23 and 2.40 ± 1.16 (nuclear), 0.39 ± 1.08 and 0.30 ± 0.85 (cortical), and 0.22 ± 0.59 and 0.15 ± 0.36 (posterior subcapsular). Other than a small improvement in bilateral nuclear opacity scores at 12 months, no statistically or clinically significant changes in any opacity score occurred in either eye up to 36 months postoperatively. Three eyes (2.1%) with preexisting lens opacities had cataract surgery for progressive lens changes at 3 months, 21 months, and 26 months, respectively, after SLT. CONCLUSIONS: Selective laser trabeculoplasty was not associated with clinically significant changes in nuclear, cortical, or posterior subcapsular lens opacities in glaucomatous Afro-Caribbean eyes. The rate of cataract surgery is consistent with reported rates from longitudinal natural history studies in Caribbean and non-Caribbean populations.

[PREVALENCE OF ASTIGMATISM BEFORE ROUTINE CATARACT SURGERY: COMPARISON BETWEEN BEDOUIN AND JEWISH POPULATION IN SOUTHERN ISRAEL].

OBJECTIVES: To assess the prevalence of corneal astigmatism among patients before routine cataract surgery and overall ocular difference between Jewish and Bedouin population in the south of Israel. METHODS: Retrospective research collecting biometric information from IOLMaster (Carl Zeiss Meditec AG, Germany) in patients attending cataract surgery at Soroka University Medical Center, Beer-Sheva, Israel between the years 2015 -2016. RESULTS: Mean corneal astigmatism among all cohorts was 1.20D ± 0.83, with 1.26D ± 0.84 in Bedouins patients vs 1.17D ± 0.82 in Jews patients (p-value=0.08). Corneal astigmatism lower than 0.5D was seen in 20% of the population, 28% of the population had corneal astigmatism above 1.5D and 9% showed corneal astigmatism higher than 2.5D. When comparing axial length and keratometric characteristics between the two populations, Bedouins had shorter axial length (23.41mm± 1.62 vs. 23.67mm ± 1.55, p=0.01), and flatter corneas on both axes (flat - 43.18D ± 1.76 vs. 43.62D ± 1.79, p<0.01); (steep - 44.44D ± 1.84 vs. 44.77D± 1.89, p<0.01). Higher astigmatism was found in men than in women (1.24D vs.1.15D p- value=0.04) of study group. CONCLUSIONS: In our study we found more than 25% of patients had astigmatism more than 1.5D. Patients attending cataract surgery may therefore benefit the use of advanced IOL types and surgical techniques. In addition, a statistically significant difference between the Bedouin and Jewish populations biometric measurements in patients attending cataract surgery found.

The prevalence of visually significant cataract in the Australian National Eye Health Survey.

PURPOSE: To describe the prevalence of visually significant cataract in Indigenous and non-Indigenous Australians. METHODS: A total of 3098 non-Indigenous Australians aged 50 years and over and 1738 Indigenous Australians aged 40 years and over, residing in 30 randomly selected Australian sites, were examined as part of the population-based National Eye Health Survey (NEHS). For those with visual acuity worse than 6/12, photos of the anterior and posterior segment were taken with a nonmydriatic fundus camera and assessed for cataract. Visually significant cataract was assigned in eyes with best-corrected visual acuity worse than 6/12 and cataract that was determined to be the primary cause of vision loss in that eye. RESULTS: In total, 99.2% (4797/4836) participants had complete data for visual acuity and cataract assessment. The overall weighted prevalence of visually significant cataract was 2.7% (95% CI: 2.0, 3.5) in non-Indigenous Australians and 4.3% (95% CI: 3.1, 5.9) among Indigenous Australians. After adjusting for age and gender, the odds of visually significant cataract were almost three times higher among Indigenous participants compared to non-Indigenous participants (adjusted odds ratio (OR) 2.95, 95% CI: 2.03, 4.29). Only 54.8% of non-Indigenous Australians and 38.9% of Indigenous Australians with visually significant cataract self-reported a known history of cataract. CONCLUSIONS: Our results suggest that continued efforts are required to build sustainable cataract surgery services within Indigenous communities. Furthermore, given the significant ageing of the Australian population, maintaining high cataract surgery rates amongst the non-Indigenous population is critical to reduce cataract-related vision loss.

Cataract Surgery Incidence Trends in a Tertiary Public Hospital in Malaysia.

Background Since cataract is the leading cause of blindness and no study has been done on the surgical incidence trends, we conducted this research in Melaka. Objective To describe incidences of cataract surgery according to basic demographic variables and types of surgery performed. Method Using the National Eye Database (NED), we performed descriptive statistics calculating incidence rates per 1,000 population by demographic features and types of cataract operations to look at the trends of surgeries in the population. Statistics for population were obtained from the department of statistics. Result From 2007-2010, 6270 patients mostly 60-69 years underwent cataract surgery. Phacoemulsification (78.2%) was the commonest surgery performed. The annual incidence rate of cataract surgery reduced from 2.05 per 1000 population in 2007 to 2.02 per 1000 population in 2010 (p<0.05). Incidence rates for those aged 60 and above rose while for those aged below nine years it declined. Indians had the highest incidence rates followed by Chinese and Malays per 1000 population. Females had a higher incidence rate although there was a declining trend over the years. Conclusion Cataract surgery rates showed a decline. Public health education and awareness on detection and operating upon cataracts should be increased and especially targeted towards vulnerable groups such as women, individuals of Indian ethnicity and those aged 50 years and above.

Philadelphia Telemedicine Glaucoma Detection and Follow-up Study: Ocular Findings at Two Health Centers.

Blindness from glaucoma can be prevented by early detection and treatment. Telemedicine improves access to treatment in high-risk populations that face barriers to receiving adequate ophthalmic care. We used a practice-based telemedicine screening model at two health centers. Telemedicine imaging of the fundus and optic nerve, followed by a complete eye exam at the same location for participants with abnormal findings, unreadable images, or ocular hypertension (OHTN), was performed. A total of 182 participants were screened, of whom 108 qualified for a complete eye exam. Of these, 62 (34.1%) had abnormal images, 12 (6.6%) had OHTN, and 34 (18.7%) had unreadable images. Eighty-nine of the 108 (82%) returned for the complete eye exam. Predominantly, participants were African American with glaucoma suspect and cataract. Screening location was an important factor for follow-up. Assessment of the fundus and optic disc using telemedicine resulted in early detection of glaucoma and other ocular pathology.

A novel mutation in the CRYAA gene associated with congenital cataract and microphthalmia in a Chinese family.

BACKGROUND: Congenital cataract is the leading cause of blindness in children worldwide. Approximately half of all congenital cataracts have a genetic basis. Protein aggregation is the single most important factor in cataract formation. METHODS: A four-generation Chinese family diagnosed with autosomal dominant congenital cataracts and microphthalmia was recruited at the Shengjing Hospital of China Medical University. Genomic DNA was extracted from the peripheral blood of the participants. All coding exons and flanking regions of seven candidate genes (CRYAA, CRYBA4, CRYBB2, CRYGC, GJA8, MAF, and PITX3) were amplified and sequenced. Restriction fragment length polymorphism (RFLP) assays were performed to confirm the candidate causative variant, c.35G > T in the CRYAA gene. We constructed pcDNA3.1(+)-CRYAA expression plasmids containing either the wild-type or the R12L mutant alleles and respectively transfected them into HEK293T cells and into HeLa cells. Western blotting was performed to determine protein expression levels and protein solubility. Immunofluorescence was performed to determine protein sub-cellular localization. RESULTS: A heterozygous variant c.35G > T was identified in exon 1 of CRYAA, which resulted in a substitution of arginine to leucine at codon 12 (p.R12L). The nucleotide substitution c.35G > T was co-segregated with the disease phenotype in the family. The mutant R12L-CRYAA in HEK293T cells showed a significant increase in the expression level of the CRYAA protein compared with the wild-type cells. Moreover, a large amount of the mutant protein aggregated in the precipitate where the wild-type protein was not detected. Immunofluorescence studies showed that the overexpressed mutant CRYAA in HeLa cells formed large cytoplasmic aggregates and aggresomes. CONCLUSIONS: In summary, we described a case of human congenital cataract and microphthalmia caused by a novel mutation in the CRYAA gene, which substituted an arginine at position 12 in the N-terminal region of αA-crystallin. The molecular mechanisms that underlie the pathogenesis of human congenital cataract may be characterized by the prominent effects of the p.R12L mutation on αA-crystallin aggregation and solubility. Our study also expands the spectrum of known CRYAA mutations.

Mutation profiles of congenital cataract genes in 21 northern Chinese families.

Purpose: To identify disease-causing gene mutations in 21 northern Chinese families with congenital cataracts. Methods: Medical record collection and ophthalmologic examinations were conducted for 21 families with congenital cataracts. A volume of 5 ml of peripheral blood was drawn from each participant for genomic DNA isolation. Thirty-four known candidate genes for congenital cataracts were analyzed in the probands of 21 families with targeted next-generation sequencing (NGS). Bioinformatics analysis of the sequence variants was performed through computational predictive programs. Sanger sequencing was used to perform the cosegregation analysis. Genotyping and haplotype analyses were performed in two patients with a p.V44M mutation in the GJA8 gene. Results: Twelve disease-causing mutations were detected in 13 of the 21 patients, and the mutation detection rate was 61.9%. The 12 gene mutations included one nonsense, one splice site, seven missense, and three insert and deletion (INDELs) mutations. Four mutations were novel. Of the 13 patients with pathogenic gene mutations, five (38.5%) were affected by mutations in lens crystallin genes, three (23%) were affected by mutations in connexin genes, three (23%) were affected by mutations in transcription factor genes, one (7.7%) was affected by a mutation in a transmembrane transporter gene, and one (7.7%) was affected by a mutation in a chromatin-modifying protein gene. Two families carried the p.V44M mutation in the GJA8 gene. Haplotype analysis revealed a chromosome region of 475 kb containing the mutation in the GJA8 gene was harbored by two families. Conclusions: Compared with traditional Sanger sequencing, targeted NGS for genetic testing of congenital cataracts markedly increases the mutation detection rate and is cost-effective. The p.V44M mutation in the GJA8 gene was the most common mutation and was due to a founder effect within the Chinese cohort studied. The results of this study expand the gene mutation spectrum of congenital cataracts.