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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 59  |  Issue : 1  |  Page : 18-22

The clinical and risk profile of presenile cataract in a semi-urban population of South India


1 Department of Ophthalmology, ACS Medical College and Hospital, Chennai, Tamil Nadu, India
2 Department of Community Medicine, ACS Medical College and Hospital, Chennai, Tamil Nadu, India

Date of Submission30-Oct-2020
Date of Decision30-Nov-2020
Date of Acceptance01-Dec-2021
Date of Web Publication27-Mar-2021

Correspondence Address:
Dr. Lily Daniel
No. 211, Annammal Road, Thiruverkadu Co-operative Nagar, Thiruverkadu, Chennai - 600 077, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjosr.tjosr_162_20

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  Abstract 


Background: The aim of this study was to assess the morphological characteristics of presenile cataract and analyze its risk profile in a semi-urban population in a South Indian state. Subjects and Methods: This cross-sectional, observational, and descriptive study was conducted in the Outpatient Department of Ophthalmology at a University Teaching Hospital, Chennai, from June 2018 to May 2019. Eighty-two consecutive study participants underwent detailed medical history, ocular examination, and blood investigations such as fasting blood sugar, fasting lipid profile, post prandial blood sugar, hemoglobin, blood urea, serum creatinine, serum calcium, thyroid function tests (TFT) and Electrocardiogram (ECG). Data analysis was done using International Business Machines, United States of America, Statistical Package for the Social Science, (IBM, US, SPSS), version 20. Results: A female predominance of 69.5% was noted. The mean age was 43.8 ± 7 years. Presenile cataract was higher in the age group of 41–49 years (odds ratio = 6.55). Posterior subcapsular cataract (PSC) was found in 65 eyes (39.6%), grade 2 nuclear sclerosis in 42 eyes (25.06%), and cuneiform cataract in 22 eyes (13.4%). The risk profile in presenile cataract was hypocalcemia (54.9%), diabetes mellitus (50%), and hypertension (17.07%). Hypertriglyceridemia was found in 22% of diabetics (P = 0.026). 25.6% was idiopathic. Conclusion: PSC was the predominant type of presenile cataract in this semi-urban population group. Patients with hypocalcemia and diabetes are significantly at risk in developing presenile cataract. Diabetics with hypertriglyceridemia have a higher risk.

Keywords: Cataract, diabetes mellitus, presenile cataract, risk profile


How to cite this article:
Daniel L, Paul CM. The clinical and risk profile of presenile cataract in a semi-urban population of South India. TNOA J Ophthalmic Sci Res 2021;59:18-22

How to cite this URL:
Daniel L, Paul CM. The clinical and risk profile of presenile cataract in a semi-urban population of South India. TNOA J Ophthalmic Sci Res [serial online] 2021 [cited 2021 Apr 23];59:18-22. Available from: https://www.tnoajosr.com/text.asp?2021/59/1/18/312299




  Introduction Top


Cataract constitutes 39% of global blindness.[1] In India alone, more than 62.6% of blindness is due to cataract, which is significantly high compared to developed countries.[2],[3] Presenile cataract refers to an onset of cataract in the adult life before 50 years of age.[4] As it occurs in the working adult population, it can affect livelihood. Various studies have shown risk factors of presenile cataract to be smoking, alcohol and diet,[5],[6],[7] atopy and axial myopia,[8] long-term use of corticosteroids, and exposure to ultraviolet ß radiation.[9] According to Rahman et al. and Jyothi et al., most cases of presenile cataract are idiopathic.[10],[11]

Objectives

The objective was to study the morphological characteristics of cataract and to analyze the risk factors associated with presenile cataract in a semi-urban population in a South Indian state. Primary outcome was to describe the morphology of presenile cataract. Secondary outcome was to assess the risk of diabetes, hypertension, bronchial asthma, smoking, alcohol, hypothyroidism and dyslipdemia in the development of presenile cataract.

Materials and Methods

This prospective, cross-sectional hospital-based observational study was conducted in the Outpatient Department of Ophthalmology (OPD) at a University Teaching Hospital, Chennai, from June 2018 to May 2019. The OPD attends to the semi-urban population with a low socioeconomic status from Thiruvallur District, South India. All patients between the age group of 19 and 49 years attending the OPD during the study period and for whom slit-lamp biomicroscopy showed the presence of cataract were included in the study. A total of 82 patients were included as study participants. 164 eyes were examined. Patients with congenital cataract, posttraumatic cataract, and complicated cataract were excluded from the study. Patients who had undergone intraocular lens implantation in one eye were included.

The study adhered to the tenets of the Declaration of Helsinki. A written informed consent was obtained from each participant before the commencement of the study. A detailed history including the age, sex of the patient, medical history of diabetes, hypertension (HT), thyroid dysfunction, and history of smoking and alcohol was collected using a questionnaire. Every patient diagnosed to have presenile cataract by slit-lamp biomicroscopy underwent best-corrected visual acuity testing, intraocular pressure check, and stereoscopic fundus evaluation. Cataract was classified as posterior subcapsular cataract (PSC), cuneiform cataract (CC), grade 1–3 nuclear sclerosis with or without PSC, and mature cataract in accordance with slit-lamp biomicroscopy by a single observer. The nuclear sclerosis was graded as per the WHO cataract grading system.[12] All patients were subjected to blood investigations such as fasting blood sugar, fasting lipid profile, postprandial blood sugar, hemoglobin, blood urea, serum creatinine, and serum calcium. Only 51 patients could undergo thyroid function tests (TFT). The rest could not because of financial constraints. HbA1c was also not done in any of the patients for the same reason. Electrocardiogram (ECG) was done for all patients.

Data analysis was done using Statistical Packages for the Social Sciences (SPSS) version 20. The different types of presenile cataract was calculated as percentage. The secondary outcomes were studied with statistical tests like chi square test, independent sample t test and odds ratio appropriately calculated and P value of < 0.05 was considered as significant.


  Results Top


Among the 82 study participants, there were 57 (69.5%) females and 25 (30.5%) males. Twenty-one (25.6%) belonged to the age group of 18–40 years and 61 (74.4%) to 41–49 years. 63 (76.8%) (48 females) had bilateral cataracts. PSC was found in 65 eyes (39.6%) at presentation and CC was found in 22 eyes (13.4%). Grade 2 nuclear sclerosis was found in 42 eyes (25.6%) and was more common than grade 1 and 3 nuclear sclerosis. Twenty-two eyes with grade 2 nuclear sclerosis had associated PSC. Mature cataract was found in 19 eyes (11.6%) [Table 1]. It was found that all patients with CC had normal visual acuity of 6/6 and N6 at presentation.
Table 1: Dilated slit-lamp examination in study participants

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Forty-one (50%) were known diabetics and 17 (20.7%) were known hypertensives. Fourteen (17.07%) had both diabetes mellitus (DM) and HT. Three (3.7%) gave a history of bronchial asthma 2 (2.4%) of photodermatitis, 4 (4.9%) of smoking, and 5 (6.1%) of alcohol consumption [Table 2]. Four patients out of 82 gave a history of hypothyroidism. Twenty-one (25.6%) had no history of diabetes, hypertension, bronchial asthma, photodermatitis, smoking, alcohol consumption or hypothyroidism.
Table 2: Sociodemographic profile of the study subjects

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On assessing the association between patients with presenile cataract and DM, with age group and gender, the age group was found to have a statistically significant association with the development of presenile cataract among diabetic patients. It was found that patients in the age group of 41–49 years were 6.55 times at higher risk of developing presenile cataract compared to patients who were <40 years of age (P = 0.0023) [Table 3]. Although the number of females with diabetes was found to be higher, it was not statistically significant. Correlating diabetes and cataract, of the 41 diabetic patients, 38 eyes (46.3%) had PSC of which 10 had associated grade 2 NS.
Table 3: Association between diabetes in presenile cataract and certain factors

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Sixteen patients had DM of more than 5 years duration, 3 of whom had bilateral nonproliferative diabetic retinopathy (NPDR). Totally 11 eyes had NPDR.

In this study, there were 32.9% and 26.8% of participants with raised fasting and postprandial blood sugars, respectively. On assessing the lipid profile, there were 11%, 22%, 6.1%, 7.3%, and 39% of cases with increased total cholesterol, increased triglycerides, decreased high-density lipoproteins, increased low-density lipoproteins, and increased very low-density lipoproteins, respectively. Forty-five (54.9%) patients (32 females) were found to have hypocalcemia and 14 (17.1%) were anemic (8 females). Renal parameters such as urea and creatinine were elevated in 7.35 and 8.5% of cases, respectively [Table 4].
Table 4: Investigation profile of presenile cataract patients

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On assessing the association between presence and absence of DM with other parameters among the cases with presenile cataract, increased triglyceride levels were noted among the cases with diabetic presenile cataract when compared to nondiabetic presenile cataract patients. This association was found to be statistically significant (P = 0.026) [Table 5], whereas other factors such as renal parameters, parameters of lipid profile (except triglycerides), hemoglobin, and calcium were found to have no statistically significant association between presenile cataract cases in diabetics and nondiabetics. Only five patients had ECG abnormalities (one anteroseptal infarct, two left anterior fascicular blocks, and two old inferior wall infarcts). There was no significant association of thyroid dysfunction in those who could undergo TFT.
Table 5: Association between diabetes in presenile cataract and laboratory parameters

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  Discussion Top


In this present study, female preponderance (69.5%) was reported which is consistent with the reports of Das et al.[13] and Raman et al.[14] Raman et al., in a large clinical and epidemiological study undertaken at the Sankara Nethralaya in Chennai, had found female preponderance (51.4%) in 1283 participants with cataract. The female preponderance in our study could be due to a higher female sex ratio of 999 in Thiruvallur district against the state average of 996 according to Census 2011.

In this study, PSC was the most common cataract in 65 eyes (39.6%). This finding is consistent with the findings of Praveen et al.[8] Vasudevan and Premnath,[9] and Das et al.[13] This is because PSC causes early impairment of vision, which prompts patients to report to the Ophthalmologist early.

Hypocalcemia was found in 45 (54.9%) of the study group. Animal models have shown that decreased calcium in the aqueous humor leads to increased sodium which leads to cataractogenesis.[15] No study has been undertaken to assess serum calcium as a risk factor in the development of cataract, to the best of our knowledge. However, vitamin D deficiency has been found to be associated with PSC.[16]

Several studies have identified diabetes as a risk factor for the development of cataract.[14] Our study had shown 41 (50%) patients with DM. This concurred with other studies on the presenile age group that showed an increased incidence of diabetes in the study population.[10],[11] On assessing the association between patients with DM and age group, there was a statistically significant association. It was found that patients with presenile cataract in the age group of 41- 49 years were 6.55 times at higher risk of diabetes compared to patients who were less than 40 years of age (P = .0023) [Table 3] Although the number of females with diabetes was found to be higher, it was not statistically significant..

Raman et al.[14] had found elevated serum triglycerides as a significant risk factor in their large study group. We found a statistically significant association of hypertriglyceridemia with diabetes among patients with presenile cataract (P = 0.026). According to the Framingham studies, fasting hypertriglyceridemia (≥250 mg/dl) was associated with an increased risk of PSC cataract in men.[17] HT has been identified as a risk factor in age-related cataracts.[18],[19] None of the studies on presenile cataract have remarked on the risk of HT. In our study, 17 (20.7%) of the subjects were hypertensives. Fourteen (17.07%) had both DM and HT. It is clear that the study of risk factors in age-related cataracts in large study groups have found significant associations between diabetes, hypertriglyceridemia, and HT. On the other hand, studies on presenile cataract have involved smaller population groups as is expected and have not found significant associations like in the former.

We found 17.1% of patients with anemia. Increased iron-binding capacity has been found in patients with presenile cataract indicating iron deficiency anemia.[5]

Several studies had shown a significant association between smoking and cataract.[20],[21] There were no significant associations between smoking and presenile cataract in our study. Furthermore, there was no significant association between alcohol consumption and presenile cataract. Blood urea and serum creatinine were elevated in 7.35% and 8.5% of cases. These were not statistically significant.

Delaying the onset of cataract by 10 years would reduce the need for surgery by 45%.[22] Thus, the diagnosis of cataract in the presenile age group becomes important in reducing the morbidity and the economic burden in a semi-urban population with a low socioeconomic status.


  Conclusion Top


This cross-sectional descriptive study in a semi-urban population revealed a significantly high association between diabetes and cataract in the presenile age group with the statistically significant association of hypertriglyceridemia among diabetics. PSC is the most common type of presenile cataract. PSC unlike CC causes significant visual impairment which leads to early diagnosis of presenile cataracts. It is important to subject patients with a history of DM and HT to dilated slit-lamp biomicroscopy to detect early peripheral cortical opacities as these patients present with normal visual acuity.

Screening of risk profile in patients with presenile cataract should include serum calcium and hemoglobin apart from the usual screening for DM, HT, and hypercholesterolemia. Early detection of presenile cataracts and control of hyperglycemia, hypertriglyceridemia, and treatment of associated hypocalcemia and anemia can delay the progression of these cataracts. A larger study population and age-matched case-controlled studies in this age group would confirm the risk factors of presenile cataract.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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