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.

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.

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.

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.

That’s the finding of a large-scale study presented at the World Ophthalmology Congress held last month in Berlin.

Irmingard Neuhann, MD, who practices at Tuebingen University Eye Hospital in Germany, reported the results of a retrospective study of 1,519 consecutive patients with high myopia that underwent modern phacoemulsification cataract surgery. The surgery was performed on a total of 2,356 eyes that had an axial length greater than 27 millimeters.

Axial length is the distance between the front surface of the eye (cornea) and the back of the eye (retina), usually measured in millimeters (mm).

A normal adult eye typically has an axial length of approximately 24 mm. Eyes with axial length greater than 24 mm usually are nearsighted, and each additional millimeter corresponds to approximately -2.50 diopter (D) of myopia. Therefore, an axial length greater than 27 mm typically corresponds to myopia of -7.50 D or more.

The incidence of retinal detachment following cataract surgery among the eyes in the study was approximately 2 percent, according to Dr. Neuhann. The patients were followed for a period of 2 years.

Though this rate is higher than the rate of detached retina among the general population, no large study has ever demonstrated that this rate is different than that of spontaneous retinal detachment in nearsighted individuals with eyes of comparable axial length, she said.

High myopia associated with increased axial length of the eye is believed to be a risk factor for retinal detachment because, as the eye elongates during development, the peripheral retina becomes thinner and more fragile in these longer-than-normal eyes.

[Resource: Cataract surgery not a risk factor for retinal detachment in highly myopic eyes, study says. Published online June 8, 2010 on Ocular Surgery News website.]

Clifford W. Brooks III, MD, warns, however, that post-cataract surgery sunglasses are not true safety glasses and should not be worn in high risk situations that warrant a higher degree of eye protection. Dr. Brooks is an ophthalmologist at Wilford Hall Medical Center, Lackland Air Force Base, Texas.

In this month’s issue of Journal of Cataract & Refractive Surgery, Dr. Brooks and colleagues report the case of a male cataract surgery patient who ruptured his eyeball 3 months after surgery in a fall while playing tennis. The patient was wearing the protective sunglasses given to him after cataract surgery, and damage to the sunglasses during the fall is the suspected cause of the severe eye injury.

Dr. Brooks and his colleagues warned that the large sunglasses given to patients after cataract surgery are not designed for activities that pose a risk of significant impact or injury to the eye.

The authors also said patients should be counseled to use protective sports eyewear or other safety eyewear specifically designed and approved for the sport or activity they participate in.

SOURCE:  Globe rupture with post cataract-surgery safety sunglasses. Journal of Cataract & Refractive Surgery. July 2010.

That’s the finding of a large study of adult men and women published recently in British Medical Journal. Researchers studied more than 2 million patients at 368 general practices in England and Wales. All patients were between the ages of 30 and 84, and 225,922 (10.7 percent) were new users of statins.

The objective of the study was to quantify unintended effects of the use of statin medications, according to type, dose and duration of use.

The researchers found that each statin studied was associated with an increased risk of cataract in both men and women (apart from Leschol in men due to the small number of men in the study taking this medication).

The mean increased risk of cataract formation ranged from from 25 percent to 56 percent among male and female patients being treated with Zocor, Lipitor, Pravachol and Crestor.

A direct comparison test showed no significant difference between the effects of individual statins in men or in women, and there was no evidence of greater risk of cataract with higher doses compared with lower doses.

Risk of cataract was significantly increased within one year of starting statin treatment, persisted during treatment, and returned to normal within the first year after stopping treatment.

The results of this study suggest patients taken statins should be proactively monitored for cataract formation with routine eye exams by an optometrist or ophthalmologist.

The outcomes of this study contradict results of a previous Israeli study that found statins may reduce cataract risk among men and women age 45 to 54.

SOURCE:  Unintended effects of statins in men and women in England and Wales: population based cohort study using the QResearch database. British Medical Journal (BMJ). May 20, 2010.

That’s the finding of a long-term retrospective study conducted by researchers at the University of Wisconsin School of Medicine and Public Health.

The researchers examined the relationship between the use of sun-sensitizing medications — including commonly prescribed anti-depressant, antibiotic and anti-inflammatory medicines — and the occurrence of age-related cataract among a population of more than 2,000 Wisconsin residents over a 15-year period.

Sun exposure was estimated from the residential history of adults in the community of Beaver Dam, Wisconsin. Medication history was reported at each examination, and cataract presence was determined by photographs of the lens inside the eye.

When considered separately, sun exposure and the use of sun-sensitizing medications did not appear to increase the risk of cataracts, compared with an age- and sex-matched control population. However, the combination of increased sun exposure and the use of sun-sensitizing medications resulted in a statistically significant increase in the risk of a specific type of age-related cataract called a cortical cataract.

Use of hats with brims or use of sunglasses for at least half the time spent outdoors did not appear to decrease the added risk of cataracts among the study group.

(The study authors noted, however, that data regarding use of hats and sunglasses were obtained from only about half of the study population, and that they could not assess the effect of this association on the entire population.)

The researchers said additional study of other populations is needed to confirm the finding of the study, and that if the finding is confirmed, it may have important implications for future medication use.

SOURCE:  Selected sun-sensitizing medications and incident cataract. Archives of Ophthalmology. Published online June 14, 2010.

Dr. Culbertson is professor of ophthalmology and director of cornea and refractive surgery services at the Bascom Palmer Eye Institute, University of Miami Miller School of Medicine (Miami, Fla.).

The laser used in laser-assisted cataract surgery is the same type of femtosecond (FS) laser used to create the flap on the surface of the eye during all-laser LASIK surgery. In cataract surgery, it is used to create self-sealing incisions in the cornea, through which the cataract surgeon inserts surgical instruments to remove the cataract and replace the cloudy lens with an intraocular lens (IOL) to restore vision.

The FS laser also can be used to create small, partial-thickness cuts in the cornea (called limbal relaxing incisions) during cataract surgery to correct astigmatism. It also can be used to make a precise opening in the anterior portion of the capsule that surrounds the eye’s natural lens to give the surgeon easy access to the cataract and reduce risks associated with creating this opening with a hand-held surgical tool.

Dr. Culbertson and colleagues recently conducted a study of a proprietary femtosecond laser system (OptiMedica) for cataract surgery in the Dominican Republic. They found that the added precision of the femtosecond laser in creating the opening in the anterior lens capsule may help surgeons more accurately position an IOL in the eye during cataract surgery.

Proper centration of the intraocular lens is essential for optimal visual outcomes, especially when premium aspheric IOLs, multifocal IOLs and accommodating IOLs (Crystalens) are used.

Researchers also are finding the femtosecond laser can be used to segment and soften the cloudy lens, reducing the energy required to break up the cataract with an ultrasonic probe (phacoemulsification) and remove it from the eye with suction, Dr. Culbertson said.

Disclosure:  Dr. Culbertson serves as a consultant to OptiMedica, a medical device company that has developed a femtosecond laser-assisted cataract surgery system. At this time, the OptiMedica system is not FDA approved for use in the United States.

SOURCE:  Benefits of femtosecond laser extend to cataract surgery. Ophthalmology Times. June 15, 2010.

The Pediatric Cataract Initiative will utilize the resources of both organizations to identify, fund and promote innovative methods of overcoming childhood cataracts for the long-term benefit of children, their families and their communities, according to a press release issued by Bausch + Lomb.

Causes of congenital cataracts include maternal infections during pregnancy such as rubella (also known as German measles). Other causes include metabolic disorders and genetically transmitted syndromes. Causes of pediatric cataracts affecting older children include trauma to the eye.

During its first year, the Pediatric Cataract Initiative’s primary focus will be on the People’s Republic of China, where at least 40,000 children are estimated to suffer from pediatric cataract. The prevalence of pediatric cataract ranges from one to four children per 10,000 births in developing countries – 10 times the rate of occurrence in developed nations.

Surgery to remove a congenital cataract must take place soon very early in life to prevent amblyopia and permanent vision loss. The cloudy lens can be replaced with an intraocular lens during the cataract surgery, or the infant or young child can be prescribed contact lenses to correct his or her eyesight and promote normal vision development.

In less successful cases, access to low vision services may be needed.

For additional information, visit www.PediatricCataract.org.