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Study shows association between pseudoexfoliation and nuclear cataract
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Pseudoexfoliation syndrome was found to be associated with an elevated risk of nuclear cataract in older subjects, according to a large study.
Data were culled from the Blue Mountains Eye Study, a population-based cohort study conducted in Australia. Investigators examined 3,654 subjects older than 49 years at baseline and re-examined 2,564 subjects up to 10 years.
Subjects underwent lens photography and IOP measurement and participated in interviews designed to gather demographic data and medical history.
Masked graders evaluated lens photographs and used statistical analysis to gauge relationships between pseudoexfoliation syndrome and cataract.
Study results showed that eyes with pseudoexfoliation syndrome had a markedly greater prevalence of cortical cataract and nuclear cataract than eyes without pseudoexfoliation syndrome (P = .02 and P < .0001, respectively).
Data adjusted for age, gender, smoking status, diabetes, steroid use, myopia, socioeconomic status and open-angle glaucoma showed an insignificant relationship between pseudoexfoliation syndrome and cortical cataract. However, adjusted data showed a strong association between pseudoexfoliation syndrome and nuclear cataract.
Pseudoexfoliation syndrome prevalence ranged from 0% in subjects aged 49 to 54 years to 6.25% in subjects aged 85 years and older.
The relationship between pseudoexfoliation syndrome and posterior subcapsular cataract was insignificant.
Perspective
Back to TopMark Packer, MD, FACS, CPI
The Blue Mountains Eye Study supports increased incidence of nuclear sclerotic cataracts in pseudexfoliation. Cataracts in pseudoexfoliation may occur more frequently because of blood-aqueous barrier breakdown and iris vasculopathy associated with elevated homocysteine levels in the aqueous humor. Pseudoexfoliation patients also have increased levels of homocysteine in their plasma, and Yaghoubi has demonstrated that hyperhomocysteinemia is significantly associated with pseudoexfoliation syndrome (PXS) in patients with cataract. Tranchina et al have even suggested that “hyperhomocysteinemia may be an independent factor stressing vasculopathy in addition to pseudoexfoliation, so might be a modifiable risk factor for PEXG.” However, in the Blue Mountains Eye Study, the association of PXS with cataract remained even after controlling for glaucoma, suggesting that PXS “may contribute to the development of cataract through a pathway different from that responsible for elevated intraocular pressure or open-angle glaucoma and the need for glaucoma treatment.”
References:
Tranchina L, et al. Graefes Arch Clin Exp Ophthalmol. 2011;249(3):443-8.
Yaghoubi G, et al. Middle East Afr J Ophthalmol. 2007;14:22-3.
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