Quality of life assessment for nuclear, cortical, posterior subcapsular patients before and after cataract surgery / Evaluación de la calidad de vida de pacientes nucleares, corticales y subcapsulares posteriores antes y después de la cirugía de cataratas

Purpose: The impact of visual outcomes of cataract surgery can be measured using a questionnaire. The aim of our study was to evaluate how patient quality of life changes after cataract surgery and if there are differences between the responses of patients with nuclear, cortical, and posterior subcapsular cataracts, which has not been studied before. Method: We studied 210 cataract patients who were divided into 3 cataract groups based on their cataract type: nuclear (n = 80), cortical (n = 70), and posterior subcapsular (PSC) (n = 60). The patients completed the Visual Function Index (VF-14) questionnaire before, 2 weeks and 1 month after bilateral cataract surgery. The results were analysed using one-way ANOVA (significance level 5 %) and were compared over time and between the cataract groups. Results: Before the cataract surgery, cortical cataract patients had the lowest questionnaire score compared to nuclear and posterior subcapsular cataract groups (p = 0.08). After cataract surgery, cortical cataract patients experienced the greatest improvement in near distance daily activities, while PSC cataract patients experienced the greatest improvement in far distance daily activities (p = 0.38). Before surgery, nuclear cataract patients had the highest questionnaire scores compared to the other cataract groups (p = 0.08). Conclusion: At the 1 month follow-up, there were no statistically significant differences in questionnaire scores between the cataract groups for any of the questions. Overall, cortical cataract patients showed a trend to experience the greatest subjective improvement in quality of life after cataract removal, followed by nuclear and posterior subcapsular patients.(AU)

Evaluation of efficacy of new lens nucleus fragmenting forceps in cataract surgery / Avaliação da eficácia de uma nova pinça fragmentadora de núcleo do cristalino para cirurgia de catarata

ABSTRACT Objective: To evaluate the efficacy of low-cost nucleus fragmenting forceps designed to reduce the use of ultrasound during phacoemulsification. Methods: A total of 60 pig eyes enucleated 10 hours before were placed in the microwave oven, at maximum power for 10 seconds, to form cataracts with hardness comparable to a grade IV nucleus in the Lens Opacities Classification System III. Cataract extraction was performed using the Centurion® phacoemulsifier (Alcon Laboratories, Geneve, Switzerland) and Leica M620 microscope. All eyes were submitted to the pre-chop technique dividing the nucleus into four parts. After the pre-chop, the quadrants in 30 eyes were phacoemulsified with the torsional mode and were fragmented in the remaining 30 eyes after the pre-chop was with the fragmentation forceps before torsional mode phacoemulsification. The device was calibrated for all eyes by applying the following parameters: 40% linear torsional phacoemulsification; intraocular pressure of 65 mmHg; the linear vacuum of 600 mmHg; aspiration flow of 40 ccs/minute. After each procedure, the following was recorded: cumulative dissipated energy; equivalent average torsional amplitude; equivalent average ultrasonic power; estimated aspirated fluid; ultrasound total time; and total aspiration time. Statistical analysis was performed using the Kruskal-Wallis test and the IBM Statistical Package for Social Sciences. The p-value <0.05 was considered statistically significant. Results: There was a statistically significant reduction favoring the use of the nucleus fragmenting forceps in all parameters, except for the average torsional amplitude. Conclusion: The use of the nucleus fragmenting forceps contributed to improving the efficacy of torsional phacoemulsification in enucleated pig eyes.

RESUMO Objetivo: Avaliar a eficácia de uma pinça fragmentadora de núcleo, de baixo custo, desenvolvida para reduzir o uso de ultrassom durante a emulsificação do núcleo. Métodos: Sessenta olhos de porco com 10 horas de enucleação foram colocados no forno de microondas, em potência máxima por 10 segundos, para a formação de catarata com dureza comparável à de um núcleo grau IV na Lens Opacities Classification System III. A extração da catarata foi realizada com o facoemulsificador Centurion® (Alcon Laboratories, Genebra, Suíça) e microscópio Leica M620. Todos os olhos foram submetidos a técnica de pre-chop, dividindo o núcleo em quatro partes. Em 30 olhos, após o pre-chop, foi feita a facoemulsificação dos quadrantes com o modo torsional e, nos outros 30 olhos, após o pre-chop, cada quadrante foi fragmentado com a pinça antes da facoemulsificação com o modo torsional. O aparelho foi calibrado para todos os olhos com os seguintes parâmetros: faco torsional linear 40%; pressão intraocular 65 mmHg; vácuo linear 600mmHg e fluxo de aspiração 40cc/minuto. Após cada procedimento, verificaram-se energia dissipada acumulada; média da amplitude do faco torsional; média equivalente do poder ultrassônico; líquido aspirado estimado; tempo total de ultrassom e tempo total de aspiração. A análise estatística foi realizada utilizando o teste de Kruskal-Wallis com o IBM Statistical Package for Social Sciences. Valor de p<0,05 foi considerado estatisticamente significante. Resultados: Houve redução estatisticamente significante em favor do uso da pinça fragmentadora de núcleo em todos os parâmetros, menos na média de amplitude do faco torsional. Conclusão: O uso da pinça fragmentadora de núcleo contribuiu para melhorar a eficácia do faco torsional em olhos de porco enucleados.

Cataract Disease Detection by Using Transfer Learning-Based Intelligent Methods.

One of the most common visual disorders is cataracts, which people suffer from as they get older. The creation of a cloud on the lens of our eyes is known as a cataract. Blurred vision, faded colors, and difficulty seeing in strong light are the main symptoms of this condition. These symptoms frequently result in difficulty doing a variety of tasks. As a result, preliminary cataract detection and prevention may help to minimize the rate of blindness. This paper is aimed at classifying cataract disease using convolutional neural networks based on a publicly available image dataset. In this observation, four different convolutional neural network (CNN) meta-architectures, including InceptionV3, InceptionResnetV2, Xception, and DenseNet121, were applied by using the TensorFlow object detection framework. By using InceptionResnetV2, we were able to attain the avant-garde in cataract disease detection. This model predicted cataract disease with a training loss of 1.09%, a training accuracy of 99.54%, a validation loss of 6.22%, and a validation accuracy of 98.17% on the dataset. This model also has a sensitivity of 96.55% and a specificity of 100%. In addition, the model greatly minimizes training loss while boosting accuracy.

Adiposity by Differing Measures and the Risk of Cataract in the UK Biobank: The Importance of Diabetes.

Purpose: To examine the association between adiposity by differing measures and incident cataract and identify important factors contributing to the association. Methods: Our analysis included 153,139 adults from the UK Biobank, aged 40 to 70 years at baseline (2006-2010). Cataract was ascertained using hospital inpatient, and self-reported data until the early of 2021. Anthropometric measures, body fat percentage, and glycosylated hemoglobin (HbA1c) were measured at baseline. Results: During a median follow-up of 10.9 years, 15,255 cases of incident cataract were documented. HbA1c was an important contributor to the association between obesity and incident cataract. Obesity; defined by body mass index was associated with an increased risk of cataract (hazard ratio [HR], 1.21 95% confidence interval [CI], 1.16-1.26), and this association was attenuated but remained significant after additional adjustment for HbA1c (HR, 1.05; 95% CI, 1.00-1.10). Similar results were observed for obesity defined by waist circumference or waist-to-hip ratio. Obesity defined by fat percentage was associated with an increased risk of cataract before but not after adjustment for covariates. The association between obesity defined by body mass index and incident cataract was positively significant in individuals with normal HbA1c (HR, 1.07; 95% CI, 1.02-1.13), but inversely significant in those with prediabetes (HR, 0.80; 95% CI, 0.67-0.96) or diabetes (HR, 0.74; 95% CI, 0.61-0.89). Conclusions: Anthropometric measurements are more predictive of cataract than bioelectrical impedance measures. Diabetes plays an important role in the association between obesity and incident cataract.

Correlation of Sunlight Exposure and Different Morphological Types of Age-Related Cataract.

PURPOSE: The previous lab and clinical studies of the correlation between the ultraviolet B and age-related cataract (ARC) did not reach in the universal agreement, especially in different morphological types of ARC. It is important to systemically summarize those previous data of epidemiological studies, which might penetrate the relevance between three morphological types of ARC, cortical, nuclear, and posterior capsular (PSC), with sunlight exposure. METHODS: PubMed, Web of Science, CNKI, Embase, and Cochrane were searched online. Data were extracted and recalculated, and quality check was performed by hand. Review Manager was used to perform the fixed effects meta-analysis on ARC and its morphological types. The highest exposed dose group was defined as the exposed group, and the lowest dose group as the control group as possible. RESULTS: Finally, the number of analyzed studies was 31: 20 for ARC and twelve, eleven, and nine for the morphological types cortical, nuclear, and PSC, respectively. The pooled OR for ARC was 1.15 (range 1.00~43.78, 95% CI 1.09 to 1.21). The cortical cataract revealed a slightly higher risk, and pooled OR was 1.03 (range 0.67~2.91, 95% CI 1.02 to 1.03). But the pooled OR for nuclear and PSC were 1.00 (range 0.50~5.35, 95% CI 1.00 to 1.00) and 0.99 (range 0.57~1.87, 95% CI 0.95 to 1.01), respectively. CONCLUSIONS: The systemic analysis of epidemiological articles reported till now reveals a significantly increased risk of ARC for those exposed with more sunlight, especially the morphological type of cortical cataract.

[Signs, symptoms, and clinical forms of cataract in adults]. / Sémiologie et formes cliniques de la cataracte chez l'adulte.

Cataract is a partial or total opacification of the crystalline lens. In adults, cataract is acquired; the most common form is the age-related cataract. Assessment of the functional impact of a cataract is clinical. The common symptom is loss of visual acuity, but other symptoms (photophobia, monocular diplopia, myopic shift, change in color vision, etc.) may be found depending on the anatomical distribution of the opacities (nuclear, posterior subcapsular, cortical). Diagnosis is based on slit-lamp examination after pupillary dilation. This allows classification of the opacities according to their anatomical distribution and can help direct any etiologic work-up. A number of potential causes should be ruled out before concluding that a cataract is age-related. Cataracts may be iatrogenic, associated with other ocular or systemic disease, or induced by ocular trauma. Knowledge of the signs, symptoms, and clinical forms of cataract helps to establish proper indications for cataract surgery in accordance with preferred practice patterns in ophthalmology.

Real-time intraoperative dynamics of white cataract-intraoperative optical coherence tomography-guided classification and management.

PURPOSE: To evaluate morphological characteristics and intraoperative dynamics of different types of white cataract using intraoperative optical coherence tomography (iOCT). SETTING: Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India. DESIGN: Prospective interventional study. METHODS: Fifty eyes with white cataract undergoing phacoemulsification were evaluated. The primary outcome measure was the classification of white cataract based on morphology and intraoperative dynamics on iOCT. The secondary outcome measure was rhexis-related complications. RESULTS: Four types of white cataract were identified based on iOCT-type I (9 eyes), type II (3 eyes), type III (24 eyes), and type IV (14 eyes). Type I had regularly arranged lamellar cortical fibers, type II had continuous hyperreflective bands of cortical fibers with intralenticular clefts, type III had intralenticular clefts combined with areas of homogenous ground-glass appearance, and type IV had homogenous ground-glass appearance of the anterior lens cortex. Capsulorhexis in type I cataract was uneventful. In type II cataract, cortical bulge was observed in the anterior chamber on creating the initial nick, indicating raised intralenticular pressure (ILP) with an imminent risk of rhexis extension. A bimanual irrigation/aspiration was performed until lowering of ILP was observed on iOCT. In types III and IV, fluid release was observed on initiation of rhexis leading to partial (type III) or complete (type IV) lowering of ILP, with a mild-moderate risk of capsulorhexis extension. A continuous curvilinear capsulorhexis was achieved in all cases, with no case of posterior capsular tear or vitreous loss. CONCLUSIONS: Intraoperative OCT helped elucidate intraoperative dynamics of the spectrum of white cataracts and facilitates completion of capsulorhexis.

Correlation between lens thickness and lens density in patients with mild to moderate cataracts.

PURPOSE: To determine the relationships between lens thickness (LT), lens density and anterior segment parameters in patients with mild to moderate cataracts. SETTING: Oftalmosalud Instituto de Ojos, Lima, Perú. DESIGN: Prospective, single-centre, cross-sectional study. METHODS: 169 eyes with age-related mild to moderate cataracts had lens density assessed using the Lens Opacification Classification System III, the built-in Pentacam HR Nucleus Staging software and ImageJ software. LT and axial length (AL) were measured with the IOLMaster 700, and angle parameters were measured using anterior segment optical coherence tomography. Pearson correlation coefficients and Kruskal-Wallis tests were used for statistical analyses. RESULTS: Nuclear colour score was the only clinical parameter with a weak significant correlation with LT (r=0.24, p=0.003) after accounting for age, AL, gender and anterior chamber depth (ACD). The maximum value of average lens density and the mean nuclear density were significantly correlated with LT (r=0.24, p=0.003 and -0.17, p=0.03, respectively) after controlling for the same factors. Central LT greater than 4.48 mm was present in 54.5% of the eyes with a nuclear opalescence grade 1. CONCLUSIONS: LT is independent of lens density in mild to moderate cataracts after accounting for age, AL, ACD and gender contrary to previous studies.

CLINICAL TYPES OF CATARACTS IN A LONG-TERM PERIOD AFTER ACUTE RADIATION SICKNESS. / KLINIChNI RIZNOVYDY KATARAKTY U VIDDALENOMU PERIODI PISLIa PERENESENOÏ GOSTROÏ PROMENEVOÏ KhVOROBY.

OBJECTIVE: to describe the clinical types of cataracts in the remote period after acute radiation sickness (ARS). MATERIALS AND METHODS: Twenty four - thirty three years after the emergency exposure, a complete ophthalmolog- ic examination of 53 reconvalescents of ARS conducted. The average age of patients at the time of the examination was (64.6 ± 1.2) years, the average radiation dose of the examined patients was (2.39 ± 0.17) Gy. Ophthalmologic examination included visometry with and without correction, tonometry, autorefractokeratometry, biomicroscopy on a slit lamp, retroillumination photography (infrared and color) of a lens. To evaluate the results of surveys used statistical methods: calculation of average values of quantitative indicators, estimation of probability difference by Student's method. RESULTS: In 10 patients (17 eyes) of the 53 reconvalescents of ARS in the remote period after irradiation artifakia after surgical treatment was recognized. In all other patients, changes in the transparency of the lens were detect- ed, and most patients had combined changes. Radiation cataract with it's characteristic clinical picture was detect- ed in 32 people, and in one more case, it's first signs were recorded. But 14 reconvalescents of ARS in the remote period after irradiation had not radiation cataract. CONCLUSIONS: Radiation cataract has not been detected in 14 reconvalescents of ARS in the remote period after irra- diation; the radiation doses of these patients significantly exceeds the threshold levels. Therefore, the absence of it's signs in the remote period in individuals exposed to doses above 2 Gy may indicate that this well-known radia- tion-induced effect is stochastic. Further analysis of the clinical features of the len's pathology in the reconvales- cents of ARS is promising for the study of the mechanism of damage to the lens in this category of victims of the Chornobyl accident.

Universal artificial intelligence platform for collaborative management of cataracts.

PURPOSE: To establish and validate a universal artificial intelligence (AI) platform for collaborative management of cataracts involving multilevel clinical scenarios and explored an AI-based medical referral pattern to improve collaborative efficiency and resource coverage. METHODS: The training and validation datasets were derived from the Chinese Medical Alliance for Artificial Intelligence, covering multilevel healthcare facilities and capture modes. The datasets were labelled using a three-step strategy: (1) capture mode recognition; (2) cataract diagnosis as a normal lens, cataract or a postoperative eye and (3) detection of referable cataracts with respect to aetiology and severity. Moreover, we integrated the cataract AI agent with a real-world multilevel referral pattern involving self-monitoring at home, primary healthcare and specialised hospital services. RESULTS: The universal AI platform and multilevel collaborative pattern showed robust diagnostic performance in three-step tasks: (1) capture mode recognition (area under the curve (AUC) 99.28%-99.71%), (2) cataract diagnosis (normal lens, cataract or postoperative eye with AUCs of 99.82%, 99.96% and 99.93% for mydriatic-slit lamp mode and AUCs >99% for other capture modes) and (3) detection of referable cataracts (AUCs >91% in all tests). In the real-world tertiary referral pattern, the agent suggested 30.3% of people be 'referred', substantially increasing the ophthalmologist-to-population service ratio by 10.2-fold compared with the traditional pattern. CONCLUSIONS: The universal AI platform and multilevel collaborative pattern showed robust diagnostic performance and effective service for cataracts. The context of our AI-based medical referral pattern will be extended to other common disease conditions and resource-intensive situations.

A comparative evaluation of cataract classifications based on shear-wave elastography and B-mode ultrasound findings.

In this study, a comparison is made of the findings of B-mode ultrasound and ultrasound elastography with the Lens Opacities Classification (LOCS) grade in patients with senile cataracts. A total of 74 patients with cataracts and 32 age-matched healthy volunteers as the control group were evaluated in the departments of ophthalmology and radiology between 2016 and 2017. In the patient group, cataracts were graded according to LOCS, and B-mode sonographic appearance and elasticity measurements were recorded, after which the cataract grade and sonoelastography/B-mode ultrasound findings were compared using statistical methods. Among the 74 patients with cataracts, 38 were females (51.4%) and 36 were males (48.6%), and the mean age was 62.05 ± 7.95 (43-78) years. A Chi-square test revealed a significant relationship between ultrasound echogenicity of cataract and grade of cataract (p < 0.005). The ultrasound elastography revealed a mean shear-wave velocity of 2.90 m/s ± 0.371 (2.13-3.53) among patients with grade 3 cataracts, 3.1 m/s ± 0.45 (2.26-3.98) among patients with grade 4, 3 m/s ± 0.58 (2.35-4.60) among patients with grade 5 and 3 m/s ± 0.528 (2.31-4.50) among patients with grade 6 cataracts, and 3 m/s ± 0.258 (2.36-3.58) among the normal subjects. No statistically significant difference was noted in the analysis of variance (p > 0.005). While cataract grade and B mode echogenicity were directly proportional, there was no significant difference in lens elasticity.

Automatic cataract grading methods based on deep learning.

BACKGROUND AND OBJECTIVE: The shortage of ophthalmologists in rural areas in China causes a lot of cataract patients not getting timely diagnosis and effective treatment. We develop an algorithm and platform to automatically diagnose and grade cataract based on fundus images of patients. This method can help government assisting poor population more accurately. METHODS: The novel six-level cataract grading method proposed in this paper focuses on the multi-feature fusion based on stacking. We extract two kinds of features which can effectively distinguish different levels of cataract. One is high-level features extracted from residual network (ResNet18). The other is texture features extarcted by gray level co-occurrence matrix (GLCM). Then a frame is proposed to automatically grade cataract by the extracted features. In the frame, two support vector machine (SVM) classifiers are used as base-learners to obtain the probability outputs of each fundus image, and fully connected neural network (FCNN) are used as meta-learner to output the final classification result, which consists of two fully-connected layers. RESULT: The accuracy of six-level grading achieved by the proposed method is up to 92.66% on average, the highest of which reaches 93.33%. The proposed method achieves 94.75% accuracy on four-level grading for cataract, which is at least 1.75% higher than those of the exiting methods. CONCLUSIONS: Six-category cataract classification algorithm show that Multi-feature & Stacking proposed in this paper helps achieve higher grading performance and lower volatility than grading using high-level features and texture features respectively. We also apply our algorithm into four-level cataract grading system and it shows higher accuracy compared with previous reports.

Visual Function and Functional Decline in Patients With Waterclefts.

Purpose: To investigate visual function in eyes with three subtypes of waterclefts (WCs). Methods: Of patients in Kanazawa Medical University Hospital (2013-2017) and participants of Monzen Eye Study (2013-2016), 77 transparent lenses, mean age 66.7 years, and 70 eyes with only WC opacity of 70 patients, mean age 68.1 years, divided into peripheral-, central-, and total-type WC groups, were analyzed. Opacity was classified by one ophthalmologist using slit-lamp microscopy. Corrected-distance visual acuity (CDVA), contrast visual acuity (CVA), spherical equivalent (SE), astigmatism values, corneal refractive power (CP), axial length (AL), straylight, backward light scattering (BLS), and higher order aberrations (HOA) were measured and lenticular refractive power (LP) was calculated based on the values of AL, CP, and SE. Results: Central-type WC showed significant decrease in CDVA and CVA and increase in straylight compared with control. Total-type WC showed significant decreases in CDVA, CVA, and LP, and increase in straylight, compared with control and peripheral-type WC. Total- and central-type WCs had significantly higher ocular total HOA and total-type WC had significantly higher internal total HOA than control. HOA correlated positively with CDVA (P < 0.001) and straylight (P = 0.020), and CDVA negatively with straylight in eyes with WCs (P = 0.008). Conclusions: Total-type WC was associated with decreased LP, causing hyperopia, decreased CDVA and higher straylight; thus, such lenticular change should be considered for surgery indication. Significant correlations between HOA and both CDVA and straylight suggested increased HOA may decrease visual function in eyes with WCs.

miR-15a: a potential diagnostic biomarker and a candidate for non-operative therapeutic modality for age-related cataract.

Introduction: In order to better understand the role of hsa-miR-15a in the pathogenesis of age-related cataracts, we hypothesised altered expression, and of target anti-apoptotic genes, BCL-2 and MCL-1, in lens epithelial cells amongst age-related cataract patients.Material and methods: Reverse transcription quantitative polymerase chain reaction (RT-qPCR) quantified the expression of hsa-miR-15a and the target genes BCL-2 and MCL-1 in lens epithelial cells of 120 age-related cataract patients (40 patients with cortical cataracts, 40 patients with nuclear cataracts and 40 patients with posterior subcapsular cataracts) and 40 controls. Sixty specimens (15 normal and 45 cataracts) were stained immunohistochemically with BCL-2 and MCL-1 markers.Results: The expression of hsa-miR-15a was significantly increased (p = 0.003) in lens epithelial cells of cataract patients compared to the control group. BCL-2 and MCL-1 expression levels were significantly decreased in cataract patients (p < 0.001). A significant increase in hsa-miR-15a expression in the cortical subtype compared to the posterior subcapsular subtype (p = 0.003) and a significant decrease in BCL-2 and MCL-1 expressions in the cortical subtype compared to the nuclear and the posterior subcapsular subtype was detected.Conclusions: The increased expression of hsa-miR-15a in lens epithelial cells of cataract patients may repress the expression of BCL-2 and MCL-1. The expression of hsa-miR-15a and the subsequent apoptosis of lens epithelial cells are part of the pathogenesis of age-related cataracts.

Dysfunctional Lens Index Serves as a Novel Surgery Decision-Maker for Age-Related Nuclear Cataracts.

Purpose: To study the correlations between subjective and objective cataract metrics with dysfunctional lens index. To investigate the potential of the DLI as a novel surgery decision-maker. Methods: In this prospective, cross-sectional study, we measured the dysfunctional lens index (DLI), Lens Opacities Classification System III nuclear opalescence (LOCS III NO) grading, preoperative corrected distance visual acuity (CDVA), objective scatter index (OSI) and Scheimpflug-based average lens density (ALD) in eyes with nuclear cataract. Eyes were classified as Surgical and Non-Surgical groups. Correlations among the DLI, OSI, ALD, LOCS III NO grading, and preoperative CDVA were analyzed. The receiver operating characteristic (ROC) curve analysis was performed for DLI, OSI, and CDVA to determine optimal cut-off values to separate between surgical and non-surgical cataracts. Results: The DLI showed the strongest correlation with the OSI (r= -0.712, P< .001), followed by LOCS III NO score (r= -0.661, P< .001), ALD (r= -0.596, P< .001) and preoperative CDVA (r= 0.563, P< .001). The area under ROC curves (AUCs) of the DLI, OSI and preoperative CDVA curve were 0.972, 0.912 and 0.844 (All P< .001), respectively. The DLI cut-off value of 5.7 implied higher levels of sensitivity (91.67%) and specificity (91.84%) than the OSI cut-off value of 2.9 and the CDVA cut-off value of 0.55 (sensitivity of 89.58% and 71.92%; specificity of 81.63% and 85.71%, respectively). Conclusion: The surgery criterion of DLI ≤ 5.7 behaved better than the surgery criterions of OSI ≥ 2.9 and preoperative CDVA ≤ 0.55 in discrimination between surgical and non-surgical nuclear cataracts.

The Lens Opacities Classification System III Grading in Irradiated Uveal Melanomas to Characterize Proton Therapy-Induced Cataracts.

PURPOSE: To evaluate the use of the Lens Opacities Classification System III grading (LOCS III) for the characterization of radiation-induced cataract, and to correlate the proton beam projection onto the lens with cataract location and grade as defined by the LOCS III. DESIGN: Prospective, interventional case series. METHODS: Fifty-two consecutive patients with cataract following proton therapy were included. All cataracts were graded using LOCS III. Relationships between proton beam and cataract subtypes, as well as between dose, proportion of lens irradiated, and extent of cataracts, were assessed. RESULTS: Tumor diameter, volume, stage, and equatorial tumor location were associated with extent of posterior subcapsular cataracts (PSC) that were diagnosed at a median (interquartile range) 36 months (22;83) after treatment. In multivariate analysis, the tumor volume (P < .01) and an equatorial tumor location (P = .01) were risk factors for extensive PSC. Lens irradiation was avoided in 10 patients. In the remaining 42 patients (81%), the extent of PSC significantly correlated with the dose to the lens receiving 10, 26, and 47 Gy (P = .03, P = .03, and P = .04, respectively), the dose to the lens periphery receiving 10 and 26 Gy (P = .02 and P = .02, respectively), and the dose to the ciliary body receiving 10 and 26 Gy (P = .03 and P = .02, respectively). Nuclear color significantly correlated with the dose to the ciliary body receiving 10 Gy (P = .03) and 26 Gy (P = .02). After adjustment of the results on tumor volume and tumor location, the volume of lens receiving 10 Gy (P = .04) and 26 Gy (P = .03) remained significantly associated with the extent of PSC. CONCLUSIONS: Proton dose correlated with the occurrence of PSC and nuclear color cataracts as defined by LOCS III grading. Better characterization of cataracts with the LOCS III after irradiation may help to further fill gaps in the current understanding of the mechanisms of radiation-induced cataracts.

Riesgo de catarata en fumadores: metaanálisis de estudios observacionales / Risk of cataract in smokers: A meta-analysis of observational studies

Objetivo: El propósito del estudio fue comparar el riesgo de catarata en fumadores y exfumadores. Métodos: La búsqueda sistemática de estudios observacionales se realizó en las bases de datos Medline, Embase y Lilacs. Se seleccionaron estudios que hubieran evaluado la asociación entre fumar cigarrillos y cualquier tipo de catarata diagnosticada clínicamente. Se extrajeron los estimadores de asociación ajustados al menos por edad y se combinaron mediante modelos de efectos aleatorios, por tipo de estudio observacional (cohorte, casos y controles y transversal), por tipo de catarata (nuclear, cortical o subcapsular posterior) y de exposición (fumador actual o exfumador). Se evaluaron heterogeneidad estadística, análisis de meta-regresión y sesgo de publicación. Resultados: Fueron seleccionados 13 estudios de cohortes, 12 de casos y controles y 18 de corte transversal. Se encontró riesgo de catarata en fumadores actuales: cohortes (OR: 1,41; IC 95%: 1,24-1,60), casos y controles (OR: 1,45; IC 95%: 1,08-1,96) y transversales (OR: 1,21; IC 95%: 1,09-1,34) y riesgo de catarata nuclear: cohortes (OR: 1,71; IC 95%: 1,47-1,98), casos y controles (OR: 1,79; IC 95%: 1,43-2,25) y corte transversal (OR: 1,45; IC 95%: 1,27-1,65). No se observó riesgo de catarata cortical ni subcapsular posterior en exfumadores. Conclusiones: En fumadores existe riesgo de catarata, especialmente de tipo nuclear. Con estudios transversales se obtienen resultados similares a los obtenidos con cohortes y casos y controles

Objective: The aim of the study was to compare the risk of cataract in smokers and ex-smokers. Methods: A systematic search of observational studies was carried out in Medline, Embase, and Lilacs databases. Studies that have evaluated the association between cigarette smoking and any type of clinically diagnosed cataract were selected. The association estimators were extracted, adjusted at least by age, and were combined using random-effects models, by subtype of study (cohort, case control and cross sectional), subtype of cataract (nuclear, cortical, and posterior subcapsular), and exposure (current smoker or ex-smoker). Statistical heterogeneity, meta-regression analysis and publication bias were assessed. Results: A total of 13 cohort studies, 12 case-control studies, and 18 cross-sectional studies were selected. A risk of cataract was found in current smokers: cohort (OR: 1.41; 95% CI: 1.24-1.60), cases and controls (OR: 1.45; 95% CI: 1.08-1.96), and cross-sectional studies (OR: 1.21; 95% CI: 1.09-1.34); risk of nuclear cataract: cohort (OR: 1.71; 95% CI: 1.47-1.98), case-control (OR: 1.79; 95% CI: 1.43-2.25), and cross sectional studies (OR: 1.45; 95% CI: 1.27-1.65). There was no risk of cortical or posterior subcapsular cataract in ex-smokers. Conclusions: There is a risk of cataract in smokers, particularly nuclear type. With cross-sectional studies, similar results are obtained with cohorts and cases and controls

Cataract grading systems: a review of past and present.

PURPOSE OF REVIEW: To provide a comprehensive summary of past cataract grading systems, how they have shaped current grading systems, and the developing technologies that are being used to assess and grade cataracts. RECENT FINDINGS: This summary of cataract grading systems examines the development and limitations that existed in past grading systems and how they have shaped the grading systems of present time. The Lens Opacities Classification System III (LOCS III) system is currently used both clinically and for research purposes. Recent advancements in imaging technologies have allowed researchers to create automatic systems that can locate lens landmarks and provide cataract grading scores that correlate well with LOCS III clinical grades. Utilizing existing technologies, researchers demonstrate that fundus photography and optical coherence tomography can be used as cataract grading tools. Lastly, deep learning has proved to be a powerful tool that can provide objective and reproducible cataract grading scores. SUMMARY: Cataract grading schemes have provided ophthalmologists with a way to communicate clinical findings and to compare new developments in diagnostic technologies. As technologies advance, cataract grading can become more objective and standardized, allowing for improved patient care.

Epidemiology and clinical presentation of feline cataracts in france: A retrospective study of 268 cases.

OBJECTIVE: To describe the epidemiology and the clinical presentation of cataracts in a population of cats in France. PROCEDURES: A review of medical records of cats presented to the Ophthalmology Unit of the National Veterinary School of Alfort between January 2010 and June 2017 was carried out to identify cats affected by cataracts. The signalment of affected cats, medical history, etiology of cataract, age of onset, stage of development, location of opacities, and concurrent ocular lesions were evaluated. RESULTS: Of 2054 cats which were presented to the Ophthalmology Unit of the National Veterinary School of Alfort during the study period, 268 (383 eyes) were diagnosed with a cataract (13%; CI [11.3-14.7]). The median age of all cats affected by cataract was 9.5 years (range: 0.1-18.6 years). Eighteen breeds were represented. The recorded causes of cataract were uveitis (35.8%), congenital (15.7%), aging (10.8%), presumed hereditary (8.2%), trauma (7.8%), lens luxation (3.3%), glaucoma (1.5%) and diabetes mellitus (0.4%). In 16.4% of the cases, the etiology could not be determined. The domestic short-hair was significantly overrepresented in cats with uveitis-related cataract (P < .001). The most common ocular lesions associated with cataracts were lens subluxation or luxation (17.8%), glaucoma (14.9%), and retinal detachment (4.4%). Lens subluxation/luxation and glaucoma were also significantly associated with uveitis-related cataract (P < .001). CONCLUSIONS: In a French population of referred cats, 13% were affected by cataract. The main causes identified were anterior uveitis, congenital, and aging. Lens subluxation/luxation and glaucoma were associated with uveitis-related cataract.

Cataract quantification using swept-source optical coherence tomography.

PURPOSE: To develop and evaluate a cataract quantification method using a swept-source optical coherence tomography (SS-OCT) device (IOLMaster 700). SETTING: Hanusch Hospital, Vienna, Austria. DESIGN: Prospective multicenter case series. METHODS: This study included patients with cataract in at least 1 eye. Two independent examiners performed Lens Opacities Classification System II (LOCS II) grading at the slitlamp independently. Corrected distance visual acuity, contrast sensitivity, and SS-OCT measurements were also performed. In addition, the phacoemulsification energy and time were recorded. To develop an objective SS-OCT-based cataract quantification system, all SS-OCT scans were segmented and the local pixel intensity unit of the lens was analyzed using Matlab's grayscale counting. The pixel intensity unit of the lens nucleus (OCT-based cataract quantification system score) was equated to the clinician's subjective nuclear opalescence grading. RESULTS: The study evaluated 186 eyes (113 patients). The correlation between the independent examiners' LOCS grading was good (0.91) (P < .01). The correlation between the LOCS grading and OCT-based cataract quantification system score was 0.86 for examiner 1 and 0.76 for examiner 2 (both P < .01). In 24 patients, phacoemulsification time, power, and energy; visual acuity; and contrast sensitivity were available and included in the study. The OCT-based cataract quantification system scores correlated significantly with phacoemulsification time (0.71) and energy (0.64) (both P < .01). CONCLUSIONS: Cataract density could be evaluated using an SS-OCT device, and the OCT-based cataract quantification system values correlated with the conventional LOCS II classification. Swept-source OCT measurements allowed quantification and documentation cataract density.