All About Cataracts

Smoking is associated with increased risk of cataracts among Malaysian adults, with nearly 20 percent of nuclear cataracts in Malay men attributable to smoking.

Smoking increases cataract risk, study finds.

That’s the conclusion of a new study published in this month’s issue of Archives of Ophthalmology.

Researchers in Singapore evaluated 2,927 Malaysian adults ages 40 to 80 who underwent comprehensive eye exams that included lens photographs. Among this study population, 1,338 (45.7 percent) had cataracts.

After adjusting for age, sex and other factors, current smokers were 48 percent more likely to have cataracts. The association between smoking and cataracts was strongest for nuclear cataracts; current smokers were twice as likely as nonsmokers to have this type of cataract.

Among the study participants, 43.5 percent of men currently smoked, compared with only 3.2 percent of women.

Analysis of the study data also revealed that two indicators of low socioeconomic status — low education and low monthly income — also were associated with greater risk for nuclear cataracts in this sample population.

August is Cataract Awareness Month, and to mark the occasion the American Academy of Ophthalmology (AAO) recently issued the following tips to help consumers maintain healthy vision and make the right choices when cataracts develop:

When cataracts interfere with daily activities, it's time to consider surgery.

• Have an eye exam if you are over age 40. Advancing age is a risk factor for cataracts and other eye problems. Based on the findings of your exam, your eye doctor will advise you how often you should have your eyes examined in the future.

• Know the risk factors for cataracts. In addition to advancing age, risk factors for cataracts include smoking, extensive exposure to the sun’s harmful UV rays, a history of a serious eye injury or inflammation, having diabetes, prolonged used of steroid medications and a family history of cataracts.

• Know how to reduce your cataract risk. A healthy diet, exercise, maintaining control of your blood sugar if you have diabetes, avoiding smoking and protecting your eyes from the sun’s harmful rays with UV-blocking sunglasses and a wide-brimmed hat may help reduce your risk of cataracts.

• Evaluate how cataracts affect your life. If you have cataracts, the decision when to have cataract surgery should be based on your daily activities and how much interference your cataracts are causing. If you are noticing blurred vision, glare, halos, reduced color perception or other cataract-related problems when driving or performing other daily activities, it’s time to consider surgery.

The AAO offers additional information about cataracts and cataract surgery at its EyeSmart consumer website.

Implantation of a popular multifocal intraocular lens (IOL) during cataract surgery provides clear and stable visual acuity — both for distance vision tasks such as driving and for near vision tasks such as computer work and reading.

Tecnis Multifocal IOL (Image: Abbott Medical Optics)

That’s the finding of a new study published this month in Journal of Cataract & Refractive Surgery.

Researchers in Japan conducted a retrospective study of 72 eyes (of 41 patients) that were implanted with the Array Multifocal IOL (Abbott Medical Optics, Santa Ana, Calif.) after cataract extraction.

The mean age of patients in the study was 48.7 years (range: 18 to 71 years) and all participants were followed for a period of four years after surgery.

Among the results:

• At one month after surgery, mean uncorrected distance visual acuity (VA) was between 20/20 and 20/25, and mean uncorrected near VA was between 20/30 and 20/40.
• Visual acuity remained stable for the four-year study period, but patient satisfaction with near vision decreased at two years after surgery.
• A follow-up laser eye surgery — laser capsulotomy — was performed on 48 eyes (66.7 percent) due to formation of posterior capsular opacification (PCO).

PCO is a clouding of the posterior portion of the lens capsule — the normally clear sac-like structure that holds the eye’s natural lens in place — that is intentionally left in place during cataract removal to prevent certain cataract surgery complications.

Laser capsulotomy is a brief outpatient procedure that uses a special laser (called an Nd:YAG laser) to create a central opening in the lens capsule to restore vision.

The mean time for laser capsulotomy surgery was approximately two years after cataract surgery.

The researchers concluded that the Array Multifocal IOL provided good and stable distance and near visual acuities over the four-year follow-up, despite a significant percentage of eyes receiving the lens implant experiencing posterior capsule opacification that affected near vision and required subsequent surgical treatment.

Ed. note: The Array Multifocal IOL, which was the first FDA-approved multifocal IOL, is no longer available. Abbott Medical Optics has replaced the Array IOL with two new multifocal IOLs: the ReZoom and Tecnis Multifocal IOL. Ask your cataract surgeon for details.

Taking a daily aspirin and/or prescription medicine to prevent blood clotting does not appear to cause a significant risk of bleeding during and after cataract surgery.

That’s the finding of a new study in Japan that assessed the risk for bleeding during and after phacoemulsification cataract removal among patients taking anti-platelet and/or anti-coagulant medicines (blood thinners) to reduce the risk of heart attack and stroke.

In the study, a total of 355 patients taking aspirin, the prescription anti-clotting drug warfarin (brand name: Coumadin) or both underwent modern phacoemulsification cataract surgery.

Patients were randomly assigned to two groups: 182 patients discontinued their anti-clotting medicine at least one week prior to cataract surgery (discontinuation group) and 173 patients continued taking aspirin and/or warfarin up to the day of their cataract surgery (maintenance group).

All patients were followed for a period of one month after surgery to monitor visual outcomes and any cataract surgery complications.

Results of the study included:

• No eyes in either group had significant bleeding during cataract surgery.

• Minor post-surgical bleeding occurred in seven eyes (2.5 percent) in the discontinuation group and in 11 eyes (4.0 percent) in the maintenance group.

• A total of 31 eyes (10.8 percent) in the discontinuation group and 47 eyes (16.5 percent) in the maintenance group experienced a subconjunctival hemorrhage after cataract surgery.

• Vision improvement following surgery was comparable in the two groups.

The researchers concluded that though patients taking blood thinners up to the time of cataract surgery were more likely to experience a subconjunctival hemorrhage following surgery than those who discontinued their medications one week prior to surgery, there was no significant difference between the two groups in the incidence of cataract surgery complications or in visual outcomes following surgery.

A full report of the study appears in the July 2010 issue of Journal of Cataract & Refractive Surgery.