Risk Factors Associated with Incident Cataracts and Cataract Surgery in the Age-Related Eye Disease Study (AREDS)

Abstract

Objective To investigate potential risk factors associated with incident nuclear, cortical, and posterior subcapsular (PSC) cataracts and cataract surgery in participants in the Age-Related Eye Disease Study (AREDS). Design Clinic-based prospective cohort study. Participants Persons (N=4425), aged 60 to 80 years of age enrolled in a controlled clinical trial of antioxidant vitamins and minerals, AREDS, for age-related macular degeneration (AMD) and cataract. Methods Lens photographs were graded centrally for nuclear, cortical, and PSC opacities using the AREDS System for Classifying Cataracts. Type-specific incident cataracts were defined as an increase in cataract grade from none or mild at baseline to a grade of moderate at follow-up, with also a grade of at least moderate at the final visit, or cataract surgery. Cox regression analyses were used to assess baseline risk factors associated with type specific opacities and cataract surgery. Main Outcome Measures Moderate cataract was defined as a grade of ≥4.0 for nuclear opacity, ≥10% involvement within the full visible lens for cortical opacity, and ≥5% involvement of the central 5 mm circle of the lens for PSC opacity. These were graded on baseline and annual lens photographs. Results A clinic-based cohort of 4425 persons aged 55–80 years at baseline was followed for an average of 9.8 ± 2.4 years. The following associations were found: increasing age with increased risk of all types of cataract and cataract surgery; males with increased risk of PSC and decreased risk of cortical cataracts; non-whites with increased risk of cortical cataract; hyperopia with decreased risk of PSC, nuclear cataract, and cataract surgery; Centrum use with decreased risk of nuclear cataract; diabetes with increased risk of cortical, PSC cataract, and cataract surgery; higher educational level with decreased risk of cortical cataract; and smoking with increased risk of cortical cataract and cataract surgery. Estrogen replacement therapy in female participants increased the risk of cataract surgery. Conclusions Our findings are largely consistent with the results of previous studies, providing further evidence for possible modifiable risk factors for age-related cataract.

The Impact of Race and Ethnicity on Cataract Surgery in the Nationwide All of Us Cohort

“… 31 However, a clinic-based study looking at cataract surgery risk factors did not find significant associations between lower socioeconomic status and likelihood of cataract surgery. 32 Our results contrast with previous studies among Latino patients which suggested that financial barriers impede access to surgery 33 and national health survey studies which showed that education status was also a significant factor in having eye care visits. 34 Furthermore, lower income individuals have multiple barriers to care including cost, lack of insurance, and concerns about transportation and lost wages that could lead to later presentation of cataracts.…”

The Impact of Race and Ethnicity on Cataract Surgery in the Nationwide All of Us Cohort

“… 31 However, a clinic-based study looking at cataract surgery risk factors did not find significant associations between lower socioeconomic status and likelihood of cataract surgery. 32 Our results contrast with previous studies among Latino patients which suggested that financial barriers impede access to surgery 33 and national health survey studies which showed that education status was also a significant factor in having eye care visits. 34 Furthermore, lower income individuals have multiple barriers to care including cost, lack of insurance, and concerns about transportation and lost wages that could lead to later presentation of cataracts.…”

Prevalence of and Risk Factors for Age-Related and Anterior Polar Cataracts in a Korean Population

“…Diabetes was associated with a significantly higher risk for nuclear cataract and PSC. In contrast to the results of the AREDS study [7] , cortical cataract was not significantly associated with diabetes in the current study. The Blue Mountains study confirmed diabetes as a risk factor for nuclear cataract and implicated impaired fasting glucose as a possible risk factor for cortical cataract [22] .…”

“…Increasing age was a significant risk factor for nuclear cataract, cortical cataract, and PSC, which is consistent with previous reports [2] , [7] , [12] , [15] , . In contrast to the results for other types of cataracts, the prevalence of and odds ratio for APCs were highest in the 50–59-year-old age group, suggesting that these cataracts develop during early adulthood; therefore, age may not be a significant factor in the pathogenesis of APC.…”

Protracted low-dose radiation exposure and cataract in a cohort of Chinese industry radiographers

“…It has even been shown that there is a dose–response relationship, and that smoking cessation can decrease the risk of cataract 27. Overall, smoking and diabetes mellitus have consistently been modifiable risk factors for cataract progression 24 27. Our results also showed obesity and hypertension to be significant risk factors for PSC or cortical cataracts, in agreement with previous studies 24 28.…”

The Impact of Race and Ethnicity on Cataract Surgery in the Nationwide All of Us Cohort

“… 31 However, a clinic-based study looking at cataract surgery risk factors did not find significant associations between lower socioeconomic status and likelihood of cataract surgery. 32 Our results contrast with previous studies among Latino patients which suggested that financial barriers impede access to surgery 33 and national health survey studies which showed that education status was also a significant factor in having eye care visits. 34 Furthermore, lower income individuals have multiple barriers to care including cost, lack of insurance, and concerns about transportation and lost wages that could lead to later presentation of cataracts.…”

Prevalence of and Risk Factors for Age-Related and Anterior Polar Cataracts in a Korean Population

“…Diabetes was associated with a significantly higher risk for nuclear cataract and PSC. In contrast to the results of the AREDS study [7] , cortical cataract was not significantly associated with diabetes in the current study. The Blue Mountains study confirmed diabetes as a risk factor for nuclear cataract and implicated impaired fasting glucose as a possible risk factor for cortical cataract [22] .…”

“…Increasing age was a significant risk factor for nuclear cataract, cortical cataract, and PSC, which is consistent with previous reports [2] , [7] , [12] , [15] , . In contrast to the results for other types of cataracts, the prevalence of and odds ratio for APCs were highest in the 50–59-year-old age group, suggesting that these cataracts develop during early adulthood; therefore, age may not be a significant factor in the pathogenesis of APC.…”

Protracted low-dose radiation exposure and cataract in a cohort of Chinese industry radiographers

“…It has even been shown that there is a dose–response relationship, and that smoking cessation can decrease the risk of cataract 27. Overall, smoking and diabetes mellitus have consistently been modifiable risk factors for cataract progression 24 27. Our results also showed obesity and hypertension to be significant risk factors for PSC or cortical cataracts, in agreement with previous studies 24 28.…”

The Impact of Race and Ethnicity on Cataract Surgery in the Nationwide All of Us Cohort

“… 31 However, a clinic-based study looking at cataract surgery risk factors did not find significant associations between lower socioeconomic status and likelihood of cataract surgery. 32 Our results contrast with previous studies among Latino patients which suggested that financial barriers impede access to surgery 33 and national health survey studies which showed that education status was also a significant factor in having eye care visits. 34 Furthermore, lower income individuals have multiple barriers to care including cost, lack of insurance, and concerns about transportation and lost wages that could lead to later presentation of cataracts.…”

Prevalence of and Risk Factors for Age-Related and Anterior Polar Cataracts in a Korean Population

“…Diabetes was associated with a significantly higher risk for nuclear cataract and PSC. In contrast to the results of the AREDS study [7] , cortical cataract was not significantly associated with diabetes in the current study. The Blue Mountains study confirmed diabetes as a risk factor for nuclear cataract and implicated impaired fasting glucose as a possible risk factor for cortical cataract [22] .…”

“…Increasing age was a significant risk factor for nuclear cataract, cortical cataract, and PSC, which is consistent with previous reports [2] , [7] , [12] , [15] , . In contrast to the results for other types of cataracts, the prevalence of and odds ratio for APCs were highest in the 50–59-year-old age group, suggesting that these cataracts develop during early adulthood; therefore, age may not be a significant factor in the pathogenesis of APC.…”

Protracted low-dose radiation exposure and cataract in a cohort of Chinese industry radiographers

“…It has even been shown that there is a dose–response relationship, and that smoking cessation can decrease the risk of cataract 27. Overall, smoking and diabetes mellitus have consistently been modifiable risk factors for cataract progression 24 27. Our results also showed obesity and hypertension to be significant risk factors for PSC or cortical cataracts, in agreement with previous studies 24 28.…”