Nobuyo Katoh

Risk Factors for Nuclear Lens Opacification: The Reykjavik Eye Study

PURPOSE The purpose of this study is to examine risk factors for nuclear lens opacification in citizens of Reykjavik. METHODS 1,045 persons, 583 females and 462 males aged 50 years and older, were randomly sampled and underwent a detailed eye examination and answered a questionnaire. In all Scheimpflug photography of the anterior eye segment was done including the lens as well as retroilluminated photography of the lens. These photographs were used for the diagnosis of lens opacification. The data was analyzed using a logistic regression model. RESULTS An increased risk for all grades of nuclear opacifications was found with ageing (OR = 1.228, 95% CI = 1.192-1.264, p = 0.000), cigarette smoking for more than 20 pack/years (OR = 2.521, 95% CI = 1.521-4.125, p = 0.000) and pipe or cigar smoking (OR = 2.478, 95% CI = 1.200-5.116, p = 0.014). Outdoor exposure, cortical lens opacification grade II and III and computer usage were not found to be linked to higher risk of nuclear opacification. No correlation was found between nuclear opacification and the consumption of vitamins, herring, sardines and shrimps, cod-liver oil or plant oil, nor were iris color, hyperopia, systemic steroid use, cardiovascular disease, diabetes, glaucoma and pseudoexfoliation found to have a significant effect. CONCLUSIONS Ageing is a major risk factor for nuclear lens opacification, and smoking is a major modifiable risk factor. Cortical and nuclear lens opacifications do not share the same modifiable risk factors.

High Prevalence of Nuclear Cataract in the Population of Tropical and Subtropical Areas

The authors have conducted cataract epidemiological studies in four climatically and racially different places and compared the data. The survey places were Noto and Amami in Japan, Reykjavik in Iceland, and Singapore. The evaluation and grading of lens opacities were done using graphic analysis of Scheimpflug and retro-illumination images. The prevalence of nuclear opacity was extremely high in the Singapore group, followed by Amami. The main type of lens opacity was nuclear in the Singapore group and cortical in the Noto and Icelandic groups. The characteristic lens opacity in Amami was in between the above two groups. No significant difference was seen in the prevalence of nuclear opacity between males and females in any of the groups. Although the common factors of the living conditions in the subjects with a high prevalence of nuclear opacity appear to be high UV exposure and high ambient temperature, future investigations should be made to disclose the possible cause.

The Reykjavik Eye Study--prevalence of lens opacification with reference to identical Japanese studies.

Purpose: A population-based cataract epidemiological study, the Reykjavik Eye Study, was conducted to determine the prevalence and characteristics of lens opacities in Iceland. The results were compared with those from previous surveys in Japan to determine the influence of race and environmental factors. Methods: 1,635 randomly selected residents of Reykjavik, Iceland, were enrolled, and among them, 1,045 responded and took part in the study. The subjects received ophthalmological examination of both the anterior and the posterior segments. Changes in the crystalline lens were examined and photographed under maximal pupillary dilation. Classification of the opacity types and grading of the extent of lens opacificiation were done using a standardized scheme, and the data were analyzed with Student’s test, the χ2 test and the Mantel-Haenszel test. Results: The prevalence of lens opacities in subjects in their 50s, 60s, 70s and in those 80 years and older was 42.7, 61.0, 85.3 and 100%, respectively. Grade II and III lens opacities were found in 2.2% of subjects in their 50s and in 10.5, 35.9 and 62.3% in their 60s, 70s, and over 80 years, respectively. Cortical opacities predominated in all age groups followed by nuclear opacities; subcapsular opacities, on the other hand, were quite rare. A unique type of opacity, i.e., granular opacity, seldom seen among the Japanese, was found in 6.6% of the Icelandic subjects. Conclusions: Our results show that cortical opacity is the major type of opacity in Icelandic subjects, although its prevalence was lower than that in the Japanese subjects. Interestingly, the first appearance of lens opacities of grades II and III in Icelanders was delayed by 10 years compared to the Japanese suggesting fewer or less severe risk factors for cataract formation in Iceland.

Epidemiological Survey of Ocular Diseases in K Island, Amami Islands: Prevalence of Cataract and Pterygium

PURPOSE An epidemiological survey of ocular disease was performed in a town of the Amami Islands in southwestern Japan. OBJECT AND METHODS A total of 339 participants over 40 years joined the survey. Among the 339 participants, the lens findings of 602 eyes of 301 subjects were analyzed. RESULTS The prevalence of lens opacification was 32.0, 54.0, 83.1, 96.9% and 100% among subjects in their 40, 50, 60, 70 s, and over 80 years. Lens opacification over grade II was 4.0, 12.7, 26.2, 60.0% and 83.3%. The cataract type most frequently seen was cortical (96.1%), followed by 48.5% with nuclear opacity and 14.7% with subcapsular type. A high prevalence was seen of pterygium at 25.4%. Although the prevalence of lens opacification was higher in the group with pterygium in their 70 s, no significant difference was noticed in persons in their 40, 50, 60 s, and over 80 years old between the pterygium and non-pterygium groups. CONCLUSIONS Similarly to the results of a previous survey in Okinawa, Noto, and Hokkaido, the main type of lens opacification was cortical in Amami. The prevalence of nuclear opacification and pterygium was higher than in Noto and Hokkaido, and close to that seen in Okinawa.

Visual acuity disturbance in subjects over 50 years of age in a population-based cataract survey

Visual acuity is still an essential examination item in cataract epidemiological studies, even though this parameter lacks objective reliability. A population-based epidemiological study was conducted in a rural area of Japan to find out the relationship between visual acuity levels and cataracts, the types of gradings of which were evaluated by an objectively reliable method through lens images, and to serve as a sample for researchers who perform epidemiological studies on cataract but lack the latest methodology. 863 participants above 50 years of age were examined and those previously diagnosed with ocular diseases which affect visual acuity were excluded from the analysis as much as possible. The mean visual acuity (LogMAR) in subjects in their 50s, 60s, 70s and over 80 years of age was 1.1, 1.0, 0.7 and 0.4, respectively. Both the mean and the distribution of visual acuity showed a statistically significant relationship to ageing (p < 0.01, p < 0.01). Both age and cataract grading showed a statistically significant relationship to visual acuity (p < 0.01), but there was no significant interaction effect between these two variables upon visual acuity. Visual acuity worsened remarkably with ageing in the eyes with grade III, whereas that of eyes with grades I and II remained fairly stable at a level of 0.7-1.0, except for those above 80 years of age. A fairly good visual acuity of 1.0, 0.8 and 0.7 remained in the eyes with pure cortical cataract of grades I, II and III, respectively, whereas those with mixed type cataract were 0.9, 0.6 and 0.3, respectively.