A systematic review of risk factors for cataract in type 2 diabetes

Abstract

Type 2 diabetes (T2D) is a risk factor for cataract development. With T2D prevalence increasing, the burden of cataract-associated vision loss will also increase. We aimed to characterise cataract diabetes-specific risk factors to assist prevention and management strategies. As part of a systematic review, two investigators independently searched online electronic databases according to a predetermined protocol for relevant published data to end-March 2018. Studies were included if they were longitudinal with ≥100 participants, diabetes was defined, a description of cataract assessment was provided, data were from humans, and the reports were in English. Study quality was assessed using the Newcastle Ottawa Scale and GRADE. Of 5255 publications identified, 19 from 13 study populations were included. The overall risk of bias was low. There was between-study variability. Age and glycaemic control were consistently associated with cataract development in T2D, but blood pressure, diabetes duration, sex, and aspirin use were not. Serum lipids and smoking remain possible risk factors, but available data are inconclusive. Glycaemia is the only consistent modifiable risk factor amongst a range of candidate variables. Due to the lack of consistency of the available evidence, and since mortality associated with T2D is declining with the likelihood of increased cataract-associated vision loss, additional well-conducted longitudinal studies are needed to identify modifiable risk factors that could prevent or delay cataract formation.

The elevated risk of sight-threatening cataract in diabetes with retinopathy: a cohort study

“…[32] About the follow up period, the mean disease interval of DM in the current study was about 10 years, which was above the average compared to the previous studies. [23] Thus, the significant correlation between DR and sight-threatening cataract in the current study may with lesser bias.…”

“…Whether the duration of DM was a risk factor of developing cataract showed conflicting results in the previous studies. [18,23] In addition, the presence of diabetic retinopathy (DR), which indicates a worse ocular condition in DM patients, [19,24] may also influence the incidence of cataract but has rarely been reported elsewhere. Moreover, the DR can be categorized into non-proliferative diabetic retinopathy (NPDR) and a more severe proliferative diabetic retinopathy (PDR), [25] while the effect of different DR severity on cataract formation that needs surgery is also unknown.…”

Trust, culture and communication: determinants of eye health and care among Indigenous people with diabetes in Australia

“…The two leading causes of blindness among Indigenous Australians include cataract (40%) and diabetic retinopathy (20%) 6. Diabetes is associated with an approximate twofold increase in cataract detection rates,7 with previous studies noting g lycaemic control as an associated risk factor 8. Diabetic retinopathy remains asymptomatic until later stages, reinforcing the need for annual screening and early intervention to prevent irreversible vision loss.…”

Visual Outcomes, Quality of Life and Satisfaction After Phacoemulsification in Patients With Type 2 Diabetes Mellitus and Patients Without Diabetes

“…With the increasing prevalence of type 2 diabetes mellitus (DM) in the community (1), largely due to an aging population and a sedentary lifestyle, DR-related visual impairment has become a serious public health issue. In addition, diabetic patients have been shown to develop cataract earlier in life and at a higher rate compared to nondiabetic subjects, which puts them at greater risk of requiring surgery (2). Although cataract surgery provides an effective mean to restore visual acuity and function, patient satisfaction may be limited (3,4).…”