Cataracts Abstracts 3

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Efficacy of N-acetylcarnosine in the treatment of cataracts
            (Babizhayev et al., 2002)  Download
PURPOSE: To evaluate the effects of 1% N-acetylcarnosine (NAC) solution on lens clarity over 6 and 24 months in patients with cataracts. TRIAL DESIGN: Randomised, placebo-controlled study. PARTICIPANTS: 49 subjects (76 affected eyes) with an average age of 65.3 +/- 7.0 years with a diagnosis of senile cataract with minimum to advanced opacification in various lens layers. METHODS: 26 patients (41 eyes) were allocated to topical NAC 1% eyedrops twice daily. The control group consisted of 13 patients (21 eyes) who received placebo eyedrops and 10 patients (14 eyes) who did not receive eyedrops. MAIN OUTCOME MEASURES: All patients were evaluated at entry and followed up every 2 months for a 6-month period (trial 1), or at 6-month intervals for a 2-year period (trial 2), for best-corrected visual acuity and glare testing. In addition, cataract was measured using stereocinematographic slit-images and retro-illumination examination of the lens. Digital analysis of lens images displayed light scattering and absorbing centres in two- and three-dimensional scales. RESULTS: The overall intra-reader reproducibility of cataract measurements (image analysis) was 0.830, and glare testing 0.998. After 6 months, 90% of NAC-treated eyes showed improvement in best corrected visual acuity (7 to 100%) and 88.9% showed a 27 to 100% improvement in glare sensitivity. Topographic studies indicated fewer areas of posterior subcapsular lens opacity and 41.5% of treated eyes had improvement in image analysis characteristics. The overall ratios of image analysis characteristics at 6 months compared with baseline measures were 1.04 and 0.86 for the control and NAC-treated group, respectively (p < 0.001). The apparent benefits of treatment were sustained after 24 months' treatment. No treated eyes demonstrated worsening of vision. The overall visual outcome in the control group showed significant worsening after 24 months in comparison with both baseline and the 6-month follow-up examination. The overall clinical results observed in the NAC-treated group by the 24-month period of examination differed significantly (p < 0.001) from the control group in the eyes with cortical, posterior subcapsular, nuclear or combined lens opacities. Tolerability of NAC eyedrops was good in almost all patients, with no reports of ocular or systemic adverse effects. CONCLUSION: Topical NAC shows potential for the treatment and prevention of cataracts.


 

N-Acetylcarnosine sustained drug delivery eye drops to control the signs of ageless vision: glare sensitivity, cataract amelioration and quality of vision currently available treatment for the challenging 50,000-patient population
            (Babizhayev et al., 2009)  Download
BACKGROUND: Innovative Vision Products, Inc. (IVP)'s scientists developed the lubricant eye drops (Can-C) designed as 1% N-acetylcarnosine (NAC) prodrug of L-carnosine containing a mucoadhesive cellulose-based compound combined with corneal absorption promoters in a sustained drug delivery system. Only the natural L-isomeric form of NAC raw material was specifically synthesized at the cGMP facility and employed for the manufacturing of Can-C eye drops. OBJECTIVE AND STUDY DESIGN: In the present clinical study the authors assessed vision before and after 9 month term of topical ocular administration of NAC lubricant eye drops or placebo in 75 symptomatic patients with age-related uncomplicated cataracts in one or both eyes, with acuity in one eye of 20/40 or worse (best-corrected distance), and no previous cataract surgery in either eye and no other ocular abnormality and 72 noncataract subjects ranged in age from 54 to 78 years. SETTING: Subjects in these subsample groups have reported complaints of glare and wanted to administer eye drops to get quick eye relief and quality of vision for their daily activities including driving and computer works. Following 9 months of treatment with NAC lubricant eye drops, most patients' glare scores were improved or returned to normal in disability glare tests with Halometer DG. Improvement in disability glare was accompanied with independent improvement in acuity. Furthermore, patients with the poorest pretreatment vision were as likely to regain certain better visual function after 9 months of treatment with N-acetylcarnosine lubricant eye drops as those with the worth pretreatment vision. PATIENTS OR OTHER PARTICIPANTS: The authors made a reference to electronic records of the product sales to patients who have been made the repurchase of the Can-C eye drops since December 2001. INTERVENTION: Based on this analysis of recorded adjustments to inventory, various parameters were analyzed during the continued repurchase behavior program, including testimonials from buyers. With these figures, researchers judged on the patients' compliance rate to self-administer NAC eye-drops. MAIN OUTCOME MEASURE AND RESULTS: The ophthalmic drug showed potential for the non-surgical treatment of age-related cataracts for participants after controlling for age, gender and daily activities and on a combined basis of repurchases behavior reports in more than 50,000 various cohort survivors, has been demonstrated to have a high efficacy and good tolerability for prevention and treatment of visual impairment determined for the older population with relative stable pattern of causes for blindness and visual impairment. The mechanisms of prevention and reversal of cataracts with NAC ophthalmic drug are considered which include prevention by the intraocular released carnosine of free-radical-induced inactivation of proprietary lens antioxidant enzymes (superoxide dismutase); prevention of carbohydrate and metal-catalyzed autooxidation of ascorbic acid-induced cross-linking glycation reactions to the lens proteins; transglycation properties of carnosine, allowing it to compete for the glycating agent, protecting proteins (lens crystallins) against modification; universal antioxidant and scavenging activity towards lipid hydroperoxides, aldehydes and oxygen radicals; activation with l-carnosine ingredient of proteasome activity in the lens; chaperone-like disaggregating to lens crystallins activity of NAC and of its bioactivated principal carnosine. Blindness incidence increased with advancing age, such as cataract and glaucoma, which are by far the commonest causes of blindness in our sample and in all age groups, glaucomatous neurodegeneration can be treated with developed NAC autoinduction prodrug eye drops equipped with corneal absorption promoters. The common blinding affections presenting in developed countries such as, senile macular degeneration, hereditary chorioretinal dystrophies, diabetic retinopathy are poorly represented in our current summary of vital-statistics and will be reported inherent in next N-acetylcarnosine ophthalmic drug studies. CONCLUSION: The authors present evidence, about why only a certain kind of NAC is safe, and why only certain formulas designed by IVP for drug discovery are efficacious in the prevention and treatment of senile cataract for long-term use. Overall cumulated studies demonstrate that the designed by IVP new vision-saving drug NAC eye drops help the aging eye to recover by improving its clarity, glare sensitivity, color perception and overall vision.

Preventive medical treatment of senile cataract with vitamin E and anthocyanosides: clinical evaluation
            (Bravetti, 1989)  Download
Bilberry extract (180 mg twice daily of a 25-percent anthocyanoside extract) was given with vitamin E, demonstrated arrested cataract formation in 48 of 50 patients with senile cortical cataracts.

Disturbed galactose metabolism in elderly and diabetic humans is associated with cataract formation
            (Birlouez-Aragon et al., 1993)  Download
Lactose consumption has been associated with a high incidence of cataract in northern Indian and southern Italian populations. Galactose absorbed after hydrolysis of lactose from milk in individuals with normal lactase activity is considered responsible. However, lactase-deficient subjects who often avoid drinking milk are able to digest lactose and absorb free galactose in fermented milk and yogurt. This study was conducted to evaluate the relationships between milk and yogurt consumption, galactose metabolism and cataract risk. Milk ingestion was dose-related with cataract risk in lactose digesters (particularly in diabetics) but not in lactose maldigesters. Conversely, yogurt intake had a protective dose-effect on cataract formation for the whole population. Maximal galactose concentrations after an oral galactose test increased exponentially with age. Red blood cell galactokinase activity was significantly lower in elderly subjects (> 60 y) than in young individuals (P < 0.05), and galactose-1-phosphate uridyl-transferase activity was significantly lower in institutionalized subjects and in home-living elderly with cataract than in healthy elderly subjects (P < 0.05). We conclude that the cataractogenic action of milk lactose is dependent on the disturbance of galactose metabolism in elderly subjects and that yogurt is not cataractogenic, although the mechanism of the protective effect of yogurt remains unknown.

Vitamin E and age-related cataract in a randomized trial of women
            (Christen et al., 2008)  Download
OBJECTIVE: To investigate whether vitamin E supplementation decreases the risk of age-related cataract in women. DESIGN: Randomized, double-masked, placebo-controlled trial. PARTICIPANTS: Thirty-nine thousand eight hundred seventy-six apparently healthy female health professionals aged 45 years or older. INTERVENTION: Participants were assigned randomly to receive either 600 IU natural-source vitamin E on alternate days or placebo and were followed up for presence of cataract for an average of 9.7 years. MAIN OUTCOME MEASURE: Age-related cataract defined as an incident, age-related lens opacity, responsible for a reduction in best-corrected visual acuity to 20/30 or worse, based on self-report and confirmed by medical record review. RESULTS: There was no significant difference between the vitamin E and placebo groups in the incidence of cataract (1159 vs. 1217 cases; relative risk [RR], 0.96; 95% confidence interval [CI], 0.88-1.04). In subgroup analyses of subtypes, there were no significant effects of vitamin E on the incidence of nuclear (1056 vs. 1127 cases; RR, 0.94; 95% CI, 0.87-1.02), cortical (426 vs. 461 cases; RR, 0.93; 95% CI, 0.81-1.06), or posterior subcapsular cataract (357 vs. 359 cases; RR, 1.00; 95% CI, 0.86-1.16). Results were similar for extraction of cataract and subtypes. There was no modification of the lack of effect of vitamin E on cataract by baseline categories of age, cigarette smoking, multivitamin use, or several other possible risk factors for cataract. CONCLUSIONS: These data from a large trial of apparently healthy female health professionals with 9.7 years of treatment and follow-up indicate that 600 IU natural-source vitamin E taken every other day provides no benefit for age-related cataract or subtypes.

Effects of multivitamin supplement on cataract and age-related macular degeneration in a randomized trial of male physicians.
            (Christen et al., 2014)  Download
PURPOSE:  To test whether long-term multivitamin supplementation affects the incidence of cataract or age-related macular degeneration (AMD) in a large cohort of men. DESIGN:  Randomized, double-blind, placebo-controlled trial. PARTICIPANTS:  A total of 14,641 US male physicians aged ≥ 50 years. INTERVENTION:  Daily multivitamin or placebo. MAIN OUTCOME MEASURES:  Incident cataract and visually significant AMD responsible for a reduction in best-corrected visual acuity to 20/30 or worse based on self-reports confirmed by medical record review. RESULTS:  During an average of 11.2 years of treatment and follow-up, a total of 1817 cases of cataract and 281 cases of visually significant AMD were confirmed. There were 872 cataracts in the multivitamin group and 945 cataracts in the placebo group (hazard ratio [HR], 0.91; 95% confidence interval [CI], 0.83-0.99; P = 0.04). For visually significant AMD, there were 152 cases in the multivitamin group and 129 cases in the placebo group (HR, 1.19; 95% CI, 0.94-1.50; P = 0.15). CONCLUSIONS:  These randomized trial data from a large cohort of middle-aged and older US male physicians indicate that long-term daily multivitamin use modestly and significantly decreased the risk of cataract but had no significant effect on visually significant AMD.

Blood levels of vitamin C, carotenoids and retinol are inversely associated with cataract in a North Indian population
            (Dherani et al., 2008)  Download
PURPOSE: To examine the association of blood antioxidants with cataract. METHODS: Cross-sectional study of people aged >or=50 years identified from a household enumeration of 11 randomly sampled villages in North India. Participants were interviewed for putative risk factors (tobacco, alcohol, biomass fuel use, sunlight exposure, and socioeconomic status) and underwent lens photography and blood sampling. Lens photographs (nuclear, cortical, and posterior subcapsular) were graded according to the Lens Opacities Classification System (LOCS II). Cataract was defined as LOCS II grade >or=2 for any opacity or ungradable, because of dense opacification or history of cataract surgery. People without cataract were defined as LOCS II <2 on all three types of opacity, with absence of previous surgery. RESULTS: Of 1443 people aged >or=50 years, 94% were interviewed, 87% attended an eye examination, and 78% gave a blood sample; 1112 (77%) were included in the analyses. Compared with levels in Western populations, antioxidants were low, especially vitamin C. Vitamin C was inversely associated with cataract. Odds ratios (OR) for the highest (>or=15 micromol/L) compared with the lowest (<or=6.3 micromol/L) tertile were 0.64, (95% confidence interval [CI] 0.48-0.85; P < 0.01). Tertiles of zeaxanthin (P < 0.03), alpha-carotene (P < 0.05), and retinol (P < 0.02) were associated with decreased odds of cataract. In analysis of continuous data, significant inverse associations were found for vitamin C, zeaxanthin, lutein, lycopene, alpha- and beta-carotene, and beta-cryptoxanthin, but not for alpha- or gamma-tocopherol. CONCLUSIONS: Inverse associations were found between cataract and blood antioxidants in an antioxidant-depleted study sample.


 

Metabolic syndrome and risk of age-related cataract over time: an analysis of interval-censored data using a random-effects model
            (Ghaem Maralani et al., 2013)  Download
PURPOSE: To investigate whether the effect of metabolic syndrome (MetS) and its components on the incidence of different cataract subtypes (cortical, nuclear, and posterior subcapsular cataract [PSC]) change with time. METHODS: A prospective cohort of persons 49 years of age and older were followed over 10 years in the Blue Mountains Eye Study, west of Sydney, Australia. MetS components as defined by the International Diabetes Federation criteria were measured at baseline (1992-1994), after 5 years (1997-1999), and after 10 years (2002-2004). The incidence of different cataract subtypes was obtained from standard photographic grading at these intervals (n = 1997). Using a random-effects complementary log-log regression model with time to cataract development in discrete time interval, we estimated the effect of MetS and its components on the incidence of different cataract subtypes at different time intervals. RESULTS: After accounting for changes in MetS components over time and controlling for possible confounders, MetS was found to be associated with an increased 5-year incidence of cortical cataract (hazard ratio [HR] 1.48; 95% confidence interval [CI], 1.05-2.09) and PSC cataract (HR 1.75; 95% CI, 1.01-3.04). Among the five MetS components, high glucose and obesity predicted an increased 5-year incidence of cortical cataract. In addition, low high-density lipoprotein and high glucose were associated with an increased 10-year incidence of cortical and PSC cataracts, respectively. CONCLUSIONS: Changes in MetS predicted the 5-year incidence of cortical and PSC cataracts. Different MetS components predicted the incidence of cortical and PSC cataracts at varying time intervals.

Prevalence and risk factors for cataracts in persons with type 2 diabetes mellitus
            (Kim and Kim, 2006)  Download
PURPOSE: This study was performed to quantitatively evaluate the prevalence and risk factors of cataracts in Korean patients with type 2 diabetes mellitus. METHODS: Eight hundred fifty patients (males: 342, mean age: 58.07 +/- 8.60 years) with diabetes who underwent ophthalmologic evaluation were studied retrospectively. Diabetic patients were classified into a cataract group and control group (i.e. a group without cataracts). Risk factors like sex, age, duration of diabetes, fasting blood sugar, HbA1c, BUN, creatinine, and total cholesterol were compared between patients with and without cataracts. RESULTS: Four hundred twenty-five patients (50.00%) had cataracts at evaluation. Females were more common in the cataract group than the control group. The mean age did not differ between the two groups. Total cholesterol, triglyceride, and LDL cholesterol levels were not different between the two groups. Duration of diabetes was significantly longer in patients in the cataract group than in the control group (13.03 +/- 6.96 years vs. 7.03 +/- 6.04 years, p < 0.001). The patients in the cataract group also had higher levels of HbA1c, BUN, creatinine, and fasting blood sugar than those in the control group. Multiple regression analysis revealed that the duration of diabetes (p < 0.001) was significantly correlated with the presence of cataracts. CONCLUSIONS: The duration of diabetes was the most significant risk factor for cataracts in patients with diabetes. This finding indicates that the accumulated effect of hyperglycemia is related to lens transparency in patients with diabetes.

Selenium and mercury in the Brazilian Amazon: opposing influences on age-related cataracts
            (Lemire et al., 2010)  Download
BACKGROUND: Age-related cataracts (ARCs) are an important cause of blindness in developing countries. Although antioxidants may be part of the body's defense to prevent ARC, environmental contaminants may contribute to cataractogenesis. In fish-eating populations of the lower Tapajos region, elevated exposure to mercury (Hg) has been reported, and blood levels of selenium (Se) range from normal to very high (> 1,000 microg/L). OBJECTIVES: We examined ARCs in relation to these elements among adults (> or = 40 years of age) from 12 riverside communities. METHODS: Participants (n = 211) provided blood samples and underwent an extensive ocular examination. Inductively coupled plasma mass spectrometry was used to assess Hg and Se in blood and plasma. RESULTS: One-third (n = 69; 32.7%) of the participants had ARC. Lower plasma Se (P-Se; < 25th percentile, 110 microg/L) and higher blood Hg (B-Hg; > or = 25th percentile, 25 microg/L) were associated with a higher prevalence odds ratio (POR) of ARC [adjusted POR (95% confidence interval), 2.69 (1.11-6.56) and 4.45 (1.43-13.83), respectively]. Among participants with high P-Se, we observed a positive but nonsignificant association with high B-Hg exposure, whereas among those with low B-Hg, we observed no association for P-Se. However, compared with the optimum situation (high P-Se, low B-Hg), the POR for those with low P-Se and high B-Hg was 16.4 (3.0-87.9). This finding suggests a synergistic effect. CONCLUSION: Our results suggest that persons in this population with elevated Hg, the cataractogenic effects of Hg may be offset by Se. Because of the relatively small sample size and possible confounding by other dietary nutrients, additional studies with sufficient power to assess multiple nutrient and toxic interactions are required to confirm these findings.

A randomized, double-masked, placebo-controlled clinical trial of multivitamin supplementation for age-related lens opacities. Clinical trial of nutritional supplements and age-related cataract report no. 3
            (Maraini et al., 2008)  Download
OBJECTIVE: To evaluate the effect of a multivitamin/mineral supplement on development or progression of age-related lens opacities. DESIGN: Randomized, double-masked, single center, placebo-controlled clinical trial. PARTICIPANTS: One thousand twenty participants, 55 to 75 years old and with early or no cataract, were randomly assigned to a daily tablet of a multivitamin/mineral formulation or a placebo. METHODS: Baseline and annual lens photographs were graded for severity of lens opacities according to a modification of the Age-Related Eye Disease Study system for classifying cataracts. MAIN OUTCOME MEASURES: The primary outcome was a prespecified increase from baseline in nuclear, cortical, or posterior subcapsular cataract (PSC) opacity grades or cataract surgery. Secondary outcomes included an increase in type-specific opacity grades, cataract surgery, and visual acuity (VA) loss from baseline > or =15 letters. RESULTS: Participants were observed for an average of 9.0+/-2.4 years. There was a decrease in total lens events in participants assigned to the multivitamin/mineral formulation compared with those assigned to the placebo (hazard ratio [HR], 0.82; 95% confidence interval [CI], 0.68-0.98; P = 0.03). Nuclear events were significantly less common (HR, 0.66; 95% CI, 0.50-0.88; P = 0.004) and PSC events significantly more common (HR, 2.00; 95% CI, 1.35-2.98; P<0.001) in participants taking the multivitamin/mineral formulation than in those assigned to the placebo. No statistically significant treatment effects were seen for cortical opacities, moderate VA loss, or cataract surgery. CONCLUSIONS: Lens events were less common in participants who took the multivitamin/mineral formulation, but treatment had opposite effects on the development or progression of nuclear and PSC opacities, the 2 most visually important opacity subtypes.

Increased risk of cataract among 28,000 patients with celiac disease
            (Mollazadegan et al., 2011)  Download
Vitamin deficiencies are prevalent in celiac disease (CD) and are associated with cataract formation, but it is unknown whether persons with CD are at increased risk of cataract. The authors' objective in this population-based cohort study was to determine the risk of cataract among persons with biopsy-verified CD. Data on CD were collected from reports on small intestinal biopsies performed between July 1969 and February 2008 in the 28 regional pathology departments in Sweden. The authors identified 28,756 persons with CD (villous atrophy, Marsh pathology stage 3). For each person with CD, Statistics Sweden selected up to 5 controls matched for age and sex from the Total Population Register. Data on cataract were obtained from the Swedish National Hospital Discharge Register and the National Day-Surgery Register. Cox regression analysis was used to estimate the risk of cataract. During a median follow-up period of 9 years, the authors identified 1,159 cataracts among persons with CD (909 were expected) (hazard ratio = 1.28, 95% confidence interval: 1.19, 1.36). The absolute risk of cataract was 397/100,000 person-years in CD, with an excess risk of 86/100,000 person-years. In conclusion, this study found an increased risk of developing cataract in patients with CD.


 

Vision loss in older persons.
            (Pelletier et al., 2009)  Download
Family physicians have an essential role in assessing, identifying, treating, and preventing or delaying vision loss in the aging population. Approximately one in 28 U.S. adults older than 40 years is visually impaired. Vision loss is associated with depression, social isolation, falls, and medication errors, and it can cause disturbing hallucinations. Adults older than 65 years should be screened for vision problems every one to two years, with attention to specific disorders, such as diabetic retinopathy, refractive error, cataracts, glaucoma, and age-related macular degeneration. Vision-related adverse effects of commonly used medications, such as amiodarone or phosphodiesterase inhibitors, should be considered when evaluating vision problems. Prompt recognition and management of sudden vision loss can be vision saving, as can treatment of diabetic retinopathy, refractive error, cataracts, glaucoma, and age-related macular degeneration. Aggressive medical management of diabetes, hypertension, and hyperlipidemia; encouraging smoking cessation; reducing ultraviolet light exposure; and appropriate response to medication adverse effects can preserve and protect vision in many older persons. Antioxidant and mineral supplements do not prevent age-related macular degeneration, but may play a role in slowing progression in those with advanced disease.

Diabetic and hypertensive retinopathy therapy with Vaccinium myrtillus anthocyanosides (Tegens®): Double-blind, placebo-controlled clinical trial
            (Perossini et al., 1987)  Download
In a double-blind study, 14 patients with diabetic and/or hypertensive retinopathy were supplemented with bilberry extract equivalent to 115 mg anthocyanosides daily (or placebo) for one month. Significant improvements were observed in the ophthalmoscopic parameters of 11 subjects receiving bilberry, and 12 patients showed improvement in angiographic parameters.

Plasma Homocysteine, Folate and Vitamin B(12) levels in senile cataract
            (Sen et al., 2008)  Download
Elevated plasma Homocysteine level is an independent risk factor for age related (senile) cataract. Certain nutritional deficiencies, in particular Folate, Vitamin B(12), Vitamin B(6) relate inversely with Homocysteine level. This study was undertaken to evaluate the plasma level of Vitamin B(12), Folate, and Homocysteine of cataract patients and to study the interplay between them. Serum Homocysteine level is significantly increased in cataract patients when compared with control (p< 0.001). There was a significant decrease in the level of Folate as compared with control (p<0.001). There was a negative correlation between Homocysteine vs. Vitamin B(12) (p<0.01) and Folate (p<0.01) in the Cataract patients. Our findings suggest that increased plasma Homocysteine level is associated with decreased plasma levels of Folate and VitaminB(12) in Cataract patients, which might have a possible role in the root cause of cataract pathogenesis.

 


References

Babizhayev, M. A., et al. (2002), ‘Efficacy of N-acetylcarnosine in the treatment of cataracts’, Drugs R D, 3 (2), 87-103. PubMed: 12001824
Babizhayev, M. A., et al. (2009), ‘N-Acetylcarnosine sustained drug delivery eye drops to control the signs of ageless vision: glare sensitivity, cataract amelioration and quality of vision currently available treatment for the challenging 50,000-patient population’, Clin Interv Aging, 4 31-50. PubMed: 19503764
Birlouez-Aragon, I., et al. (1993), ‘Disturbed galactose metabolism in elderly and diabetic humans is associated with cataract formation’, J Nutr, 123 (8), 1370-76. PubMed: 8336207
Bravetti, G (1989), ‘Preventive medical treatment of senile cataract with vitamin E and anthocyanosides: clinical evaluation’, Ann Ottalmol Clin Ocul, PubMed:
Christen, W. G., et al. (2008), ‘Vitamin E and age-related cataract in a randomized trial of women’, Ophthalmology, 115 (5), 822-829 e1. PubMed: 18067963
Christen, WG, et al. (2014), ‘Effects of multivitamin supplement on cataract and age-related macular degeneration in a randomized trial of male physicians.’, Ophthalmology, 121 (2), 525-34. PubMed: 24268861
Dherani, M., et al. (2008), ‘Blood levels of vitamin C, carotenoids and retinol are inversely associated with cataract in a North Indian population’, Invest Ophthalmol Vis Sci, 49 (8), 3328-35. PubMed: 18421094
Ghaem Maralani, H., et al. (2013), ‘Metabolic syndrome and risk of age-related cataract over time: an analysis of interval-censored data using a random-effects model’, Invest Ophthalmol Vis Sci, 54 (1), 641-46. PubMed: 23258144
Kim, S. I. and S. J. Kim (2006), ‘Prevalence and risk factors for cataracts in persons with type 2 diabetes mellitus’, Korean J Ophthalmol, 20 (4), 201-4. PubMed: 17302203
Lemire, M., et al. (2010), ‘Selenium and mercury in the Brazilian Amazon: opposing influences on age-related cataracts’, Environ Health Perspect, 118 (11), 1584-89. PubMed: 20716509
Maraini, G., et al. (2008), ‘A randomized, double-masked, placebo-controlled clinical trial of multivitamin supplementation for age-related lens opacities. Clinical trial of nutritional supplements and age-related cataract report no. 3’, Ophthalmology, 115 (4), 599-607 e1. PubMed: 18387406
Mollazadegan, K., et al. (2011), ‘Increased risk of cataract among 28,000 patients with celiac disease’, Am J Epidemiol, 174 (2), 195-202. PubMed: 21624959
Pelletier, AL, J Thomas, and FR Shaw (2009), ‘Vision loss in older persons.’, Am Fam Physician, 79 (11), 963-70. PubMed: 19514694
Perossini, M, et al. (1987), ‘Diabetic and hypertensive retinopathy therapy with Vaccinium myrtillus anthocyanosides (Tegens®): Double-blind, placebo-controlled clinical trial’, Ann Ottalmol Clin Ocul, PubMed:
Sen, S. K., P. Pukazhvanthen, and R. Abraham (2008), ‘Plasma Homocysteine, Folate and Vitamin B(12) levels in senile cataract’, Indian J Clin Biochem, 23 (3), 255-57. PubMed: 23105765