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One in 10 undergoes cataract surgery; diabetes, myopia tied to cataract prevalence

Jairia Dela Cruz
06 Dec 2018

One in 10 Malay, Indian and Chinese Singaporeans aged 40 years undergoes cataract surgery in at least one eye over 6 years, according to data from the Singapore Epidemiology of Eye Diseases (SEED) study. Diabetes and myopia are modifiable risk factors for cataract prevalence.

“Our findings provide greater insights on the trends of cataract surgery uptake over time and will inform planning of future provision of eye care services to target at-risk sectors of the Singapore population,” the authors said.

“Furthermore, our incident cataract surgery rates are substantially higher than those reported from less developed Asian communities, and thus provide further evidence of the need to improve access to cataract surgery in large parts of Asia, home to more than 3 billion people,” they added.

SEED included 10,033 individuals (Malays, n=3,280; Indians, n=3,400; Chinese, n=3,353) aged 40 years at baseline. Of these, only 6,762 (Malays, n=1,901; Indians, n=2,200; Chinese, n=2,661) were re-examined at the 6-year follow-up visit.

The age-adjusted incidence of cataract surgery at 6 years was 11.0 percent: 9.5 percent for Malays, 12.6 percent for Indians and 11.1 percent for Chinese. Incidence was strongly associated with age (p<0.001 for trend). [Ophthalmology 2018;125:1844-1853]

On logistic regression analysis, significant predictors of incident cataract surgery included older age (odds ratio [OR], 1.13 per 1-year increase; 95 percent CI, 1.11–1.14), diabetes (OR, 1.90; 1.54–2.33), myopia (OR, 1.78; 1.44–2.20) and baseline presence of any cataract (nuclear cataract: OR, 3.78; 2.91–4.89; cortical cataract: OR, 3.01; 2.45–3.71; posterior subcapsular cataract: OR, 5.00; 3.91–6.41).

“The impact of diabetes and myopia on incident cataract surgery in the SEED study is considerable, estimated at 17.6 percent and 19.1 percent of incident cataract surgery cases attributable to diabetes and myopia, respectively,” the authors noted.

Additionally, the results point to significant ethnic differences. Specifically, diabetes was a more significant predictor of incident cataract surgery among Malays and Indians, whereas myopia was an important determinant of cataract surgery among Chinese.

“Strategies to mitigate increasing prevalence of diabetes and myopia in these ethnic groups may help to reduce eye healthcare burden resulting from early onset of age-related cataract associated with these two common conditions,” the authors said.

In an email to MIMS, one of the study authors, Dr Jie Jin Wang from the Duke-NUS Medical School, said: “[O]ne take-home message from this report is that, type 2 diabetes is a lifestyle-related disease, if we can reduce the prevalence of diabetes, substantial healthcare cost spent on the consequences of diabetes can be saved, including eye healthcare cost.”

The study had several limitations, including the limited generalizability to other Asian countries where the prevalence rates of age-related cataract and healthcare systems differ from those in Singapore.

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