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Figure 1.
Scatterplot showing the relationship between axial length and spherical equivalent at the time of cataract surgery.

Scatterplot showing the relationship between axial length and spherical equivalent at the time of cataract surgery.

Figure 2.
Distribution of age at cataract surgery. A, Scatterplot showing the relationship between age and axial length. B, Scatterplot showing the relationship between age and spherical equivalent.

Distribution of age at cataract surgery. A, Scatterplot showing the relationship between age and axial length. B, Scatterplot showing the relationship between age and spherical equivalent.

Table 1. 
Grading of LOCS III and Age in Patients at the Time of Cataract Surgery
Grading of LOCS III and Age in Patients at the Time of Cataract Surgery
Table 2. 
Grading of LOCS III and Axial Length or Spherical Equivalent in Patients at the Time of Cataract Surgery
Grading of LOCS III and Axial Length or Spherical Equivalent in Patients at the Time of Cataract Surgery
Table 3. 
Adjusted Associations Between Axial Length, Spherical Equivalent, and Incidence of Nuclear Opalescence or Nuclear Cataract 4-6 of Nuclear Opacity
Adjusted Associations Between Axial Length, Spherical Equivalent, and Incidence of Nuclear Opalescence or Nuclear Cataract 4-6 of Nuclear Opacity
1.
Lim  RMitchell  PCumming  RG Refractive associations with cataract: the Blue Mountains Eye Study. Invest Ophthalmol Vis Sci 1999;403021- 3026
PubMed
2.
Reeves  BCHill  ARBrown  NA Myopia and cataract. Lancet 1987;2964
PubMedArticle
3.
Weale  R A note on a possible relation between refraction and a disposition for senile nuclear cataract. Br J Ophthalmol 1980;64311- 314
PubMedArticle
4.
Brown  NAHill  AR Cataract: the relation between myopia and cataract morphology. Br J Ophthalmol 1987;71405- 414
PubMedArticle
5.
Chang  MACongdon  NGBykhovskaya  IMunoz  BWest  SK The association between myopia and various subtypes of lens opacity: SEE (Salisbury Eye Evaluation) project. Ophthalmology 2005;1121395- 1401
PubMedArticle
6.
Panchapakesan  JRochtchina  EMitchell  P Myopic refractive shift caused by incident cataract: the Blue Mountains Eye Study. Ophthalmic Epidemiol 2003;10241- 247
PubMedArticle
7.
Lin  HYChang  CWWang  HZTsai  RK Relation between the axial length and lenticular progressive myopia. Eye 2005;19899- 905
PubMedArticle
8.
Wong  TYFoster  PJJohnson  GJSeah  SK Refractive errors, axial ocular dimensions, and age-related cataracts: the Tanjong Pagar survey. Invest Ophthalmol Vis Sci 2003;441479- 1485
PubMedArticle
9.
Hoffer  KJ Axial dimension of the human cataractous lens. Arch Ophthalmol 1993;111914- 918
PubMedArticle
10.
Tuft  SJBunce  C Axial length and age at cataract surgery. J Cataract Refract Surg 2004;301045- 1048
PubMedArticle
11.
Chylack  LT  JrWolfe  JKSinger  DM  et al.  The Lens Opacities Classification System III: the Longitudinal Study of Cataract Study Group. Arch Ophthalmol 1993;111831- 836
PubMedArticle
12.
Leske  MCChylack  LT  JrHe  Q  et al.  Incidence and progression of cortical and posterior subcapsular opacities: the Longitudinal Study of Cataract. The LSC Group. Ophthalmology 1997;1041987- 1993
PubMedArticle
13.
Dandona  RDandona  LNaduvilath  TJSrinivas  MMcCarty  CARao  GN Refractive errors in an urban population in Southern India: the Andhra Pradesh Eye Disease Study. Invest Ophthalmol Vis Sci 1999;402810- 2818
PubMed
14.
Wensor  MMcCarty  CATaylor  HR Prevalence and risk factors of myopia in Victoria, Australia. Arch Ophthalmol 1999;117658- 663
PubMedArticle
15.
Wu  SYNemesure  BLeske  MC Refractive errors in a black adult population: the Barbados Eye Study. Invest Ophthalmol Vis Sci 1999;402179- 2184
PubMed
16.
Younan  CMitchell  PCumming  RGRochtchina  EWang  JJ Myopia and incident cataract and cataract surgery: the Blue Mountains Eye Study. Invest Ophthalmol Vis Sci 2002;433625- 3632
PubMed
17.
Chen  SNLin  KKChao  ANKuo  YHHo  JD Nuclear sclerotic cataract in young patients in Taiwan. J Cataract Refract Surg 2003;29983- 988
PubMedArticle
18.
Kaufman  BJSugar  J Discrete nuclear sclerosis in young patients with myopia. Arch Ophthalmol 1996;1141178- 1180
PubMedArticle
19.
Levin  ML Opalescent nuclear cataract. J Cataract Refract Surg 1989;15576- 579
PubMedArticle
20.
Baldwin  WR The relationship between axial length of the eye and certain other anthropometric measurements of myopes. Am J Optom Arch Am Acad Optom 1964;41513- 522
PubMedArticle
21.
O'Donnell  FE  JrMaumenee  AE “Unexplained” visual loss in axial myopia: cases caused by mild nuclear sclerotic cataract. Ophthalmic Surg 1980;1199- 101
PubMed
22.
De Natale  RRomeo  GFama  FScullica  L Human lens transparence in high-myopic subjects. Ophthalmologica 1992;2057- 9
PubMedArticle
23.
Lee  KEKlein  BEKlein  RWong  TY Changes in refraction over 10 years in an adult population: the Beaver Dam Eye study. Invest Ophthalmol Vis Sci 2002;432566- 2571
PubMed
24.
Wong  TYKlein  BEKlein  RTomany  SCLee  KE Refractive errors and incident cataracts: the Beaver Dam Eye Study. Invest Ophthalmol Vis Sci 2001;421449- 1454
PubMed
25.
Micelli-Ferrari  TVendemiale  GGrattagliano  I  et al.  Role of lipid peroxidation in the pathogenesis of myopic and senile cataract. Br J Ophthalmol 1996;80840- 843
PubMedArticle
26.
Simonelli  FNesti  APensa  M  et al.  Lipid peroxidation and human cataractogenesis in diabetes and severe myopia. Exp Eye Res 1989;49181- 187
PubMedArticle
27.
Boscia  FGrattagliano  IVendemiale  GMicelli-Ferrari  TAltomare  E Protein oxidation and lens opacity in humans. Invest Ophthalmol Vis Sci 2000;412461- 2465
PubMed
28.
Palmquist  BMPhilipson  BBarr  PO Nuclear cataract and myopia during hyperbaric oxygen therapy. Br J Ophthalmol 1984;68113- 117
PubMedArticle
29.
Thompson  JT The role of patient age and intraocular gas use in cataract progression after vitrectomy for macular holes and epiretinal membranes. Am J Ophthalmol 2004;137250- 257
PubMedArticle
30.
Holekamp  NMShui  YBBeebe  DC Vitrectomy surgery increases oxygen exposure to the lens: a possible mechanism for nuclear cataract formation. Am J Ophthalmol 2005;139302- 310
PubMedArticle
31.
Lam  DSLee  WSLeung  YF  et al.  TGFbeta-induced factor: a candidate gene for high myopia. Invest Ophthalmol Vis Sci 2003;441012- 1015
PubMedArticle
32.
Ogata  NImaizumi  MMiyashiro  M  et al.  Low levels of pigment epithelium-derived factor in highly myopic eyes with chorioretinal atrophy. Am J Ophthalmol 2005;140937- 939
PubMedArticle
33.
Segev  FMor  OSegev  ABelkin  MAssia  EI Downregulation of gene expression in the ageing lens: a possible contributory factor in senile cataract. Eye 2005;1980- 85
PubMedArticle
Clinical Sciences
November 2006

Axial Length, Myopia, and the Severity of Lens Opacity at the Time of Cataract Surgery

Author Affiliations

Author Affiliations: Department of Ophthalmology, Faculty of Medical Science, University of Fukui, Fukui, Japan.

Arch Ophthalmol. 2006;124(11):1586-1590. doi:10.1001/archopht.124.11.1586
Abstract

Objective  To investigate the relationship between axial length, myopia of the eye, and the severity of lens opacity at the time of cataract surgery.

Methods  We retrospectively reviewed a consecutive series of 198 eyes of patients aged older than 50 years at Fukui University Hospital (Fukui, Japan) from June 2004 to December 2005. Patient age at the time of surgery, axial length, spherical equivalent, and the subtypes and severity of cataract (as classified according to the modification of the Lens Opacities Classification System, version III) were recorded.

Results  Axial length was significantly associated with age at the time of cataract surgery (P<.001). Regarding the severity of nuclear cataract, a significant correlation was seen between a higher score of nuclear cataract and longer axial length (P<.001). The relationship between the severity of nuclear cataract and spherical equivalent at the time of surgery showed a significant association between grading nuclear color and nuclear opalescence 4-6 and higher myopia (P<.001).

Conclusion  An increase in axial length or myopia of the eye was associated with a lower mean age at the time of surgery and higher grade of nuclear cataract.

Although an association between high myopia and the development of cataract has been proposed,13it is unclear whether myopia predisposes a person to cataract formation.46Longer axial length is a risk factor for lenticular progressive myopia.7Furthermore, nuclear cataract is associated with presumed acquired myopia.1,6The Salisbury Eye Evaluation Project5and the Tanjong Pagar Study8found that posterior subcapsular cataract was significantly associated with myopic refraction.

Patients with axial myopia are more likely to develop cataracts at an earlier age than those with shorter axial lengths.9,10In addition to increasing the risk for cataract development, longer axial length may also be associated with age at cataract surgery. We evaluated the association between axial length, subtype, and severity of cataract (as classified according to the modification of the Lens Opacities Classification System, version III [LOCS III])11; refractive status; and age in Japanese patients undergoing cataract surgery.

METHODS

We retrospectively studied 198 eyes in a consecutive series of Japanese patients who underwent cataract surgery at Fukui University Hospital in Japan from June 2004 to December 2005. Three patients aged younger than 50 years were excluded because they underwent cataract surgery to obtain a refractive benefit with grade 1 LOCS III. Eyes with ocular risk factors for the development of cataract (eg, retinitis pigmentosa, history of ocular surgery, diabetes, retinal detachment, uveitis and vitreous hemorrhage, and medication with steroids) were excluded. Age at cataract surgery, sex distribution, axial length, and refractive status were recorded, but data on systemic risk factors for cataract, such as a history of smoking or alcohol use, were not available. The type and severity of cataracts were graded and recorded by the LOCS III,11which involves the use of 6 slitlamp images for grading nuclear color (NC) and nuclear opalescence (NO), 5 retroillumination images for grading cortical cataract, and 5 retroillumination images for grading posterior subcapsular cataract. Axial length was recorded using a 10-MHz A-mode ultrasound device (Storz Compuscan; Storz, St Louis, Mo), and refractive status was measured with an autorefractor (RK-3000; Topcon, Tokyo, Japan). The refractive error recorded for each eye was converted into spherical equivalent units.

STATISTICAL METHODS

Because some patients have different values for refraction, axial length and type, and grading of cataract in each eye, analyses were run according to eye rather than patient. Correlations between axial length score, age, and spherical equivalent were analyzed using the Pearson correlation coefficient. Correlations between the LOCS III score and axial length, age, and spherical equivalent were analyzed by 1-factor analysis of variance. Multiple logistic regression analysis was used to determine the effects of categories of refraction or axial length on the odds ratio (OR) of each type of cataract, with similar adjustment made for age, gender, and grading of other subtypes of cataract in multivariate analyses. For multiple logistic regression analysis, LOCS III scores of 4.0 or more were defined as a significant nuclear cataract for NO or NC; scores of 3.0 or more as significant for cortical cataract; and scores of 3.0 or more as significant for posterior subcapsular cataract. Definitions were based on similar criteria published elsewhere.8,12All analyses were performed using StatView, version 5.0 (SAS Institute Inc, Cary, NC).

RESULTS

Mean age at the time of cataract surgery was 74.1 ± 7.8 years (range, 51-95 years). Sex distribution showed a higher ratio of female (123 eyes in 101 patients) to male patients (75 eyes in 65 patients). Mean axial length was 23.3 ± 1.3 mm (range, 20.5-31.0 mm), and spherical equivalent at the time of surgery was −1.3 ± 4.7 diopters (D) (range, −20.8 to +6.4 D).

A strong association was seen between longer axial length in patients with higher myopia (Pearson correlation coefficient, −0.704; P<.001) (Figure 1). A scatterplot of axial length against age at surgery showed a weak correlation between earlier surgery and longer axial length (Pearson correlation coefficient, −0.236; P<.001) (Figure 2A), while a second plot of spherical equivalent against age at surgery showed a weak correlation between earlier surgery in patients with higher myopia (Pearson correlation coefficient, 0.233; P<.001) (Figure 2B). No significant association was seen between visual acuity (logMAR) and spherical equivalent or axial length at surgery (Pearson correlation coefficient, 0.009; P<.89).

The relationship between the severity of nuclear cataract (NO and NC) and age at the time of surgery showed a significant correlation between a higher grading of nuclear cataract and older age (Spearman rank correlation, P<.001; Pearson correlation coefficient, 0.253; P<.001) (Table 1). The association between the severity of cortical cataract and age at surgery showed a significant correlation between a higher grading of cortical cataract and older age (Spearman rank correlation, P<.05; Pearson correlation coefficient, 0.17; P<.02) (Table 1). No significant correlation was seen between the severity of posterior cataract and age at surgery (Table 1).

The relationship between the severity of nuclear cataract (NO and NC) and axial length at surgery showed a significant association between a higher grading (NO or NC 4-6) of nuclear cataract and longer axial length (P<.001) (Table 2). The relationship between the severity of nuclear cataract (NO and NC) and spherical equivalent at surgery showed a significant association between a higher grading of nuclear cataract and higher myopia (1-factor analysis of variance, P<.001) (Table 2). There was no significant correlation between the severity of cortical cataract or posterior cataract and axial length, or cortical cataract or posterior cataract and spherical equivalent at surgery (Table 2).

In multiple logistic regression analysis, a statistically significant increase in the risk of incident NO or NC 4-6 nuclear cataract (OR, 45.30 or 42.20; P<.001) was found in highly myopic eyes (spherical equivalent <−6.0 D) compared with low myopic and hyperopic eyes (spherical equivalent >−0.5 D) at the time of cataract surgery, after adjustment for age and sex or multivariate adjustment (OR, 45.30 or 42.20, respectively; P<.001) (Table 3). An association between longer axial length (>24.00 mm) and incidence of NO or NC 4-6 nuclear cataract at surgery was statistically significant, after adjustment for age and sex or multivariate adjustment (OR, 5.15 or 5.77, respectively; P = .01) (Table 3). No statistically significant associations were found at the time of surgery between spherical equivalent or axial length and the incidence of cortical or posterior 3-5 cataract after multivariate adjustment.

COMMENT

Many population-based studies have shown an association between myopia and the onset of cataract.5,8,1316In the present study, we analyzed the association between axial length and cataract type and severity as classified according to the LOCS III in cataract patients at the time of cataract surgery. Results showed no significant relationship between posterior or cortical cataract and myopic refractive change or axial length. In contrast, patients with NO and NC 4-6 nuclear cataract had a longer axial length and higher myopic refractive change than those with NO and NC 1-3. Younger patients had a longer axial length and higher myopia than older patients at surgery. In our study, there was no significant association between visual acuity and refractive change, because we did not select cataract surgery for a refractive benefit at an earlier age. These findings suggest that patients with longer axial length and/or higher myopia may have a greater risk of developing severe nuclear cataract, leading to cataract surgery at a younger age. Finally, our study supports the findings of previous studies, that an increase in the axial length of the eye is associated with a lower mean age at the time of cataract surgery.10

The Tanjong Pagar Survey8found that there was no significant difference in axial length between eyes with NO or NC 1-3 nuclear cataracts and those with NO or NC 4-6 nuclear cataracts in a cross-sectional study. However, Chen et al17and Lin et al7suggested that longer axial length may be an important factor predisposing a person to lenticular progressive myopia. In 1987, Reeves et al2described a form of nuclear cataract that induces myopic refractive changes, resulting in lenticular progressive myopia. Nuclear sclerosis and cataract may result in significant myopic refractive changes.18,19In the present study, because most patients had mixed types of cataract, we performed multivariant adjustment for age, sex, and the severity of other types of cataract to study the association between the prevalence of NO or NC 4-6 nuclear cataract, or cortical or posterior 3-5 cataract, and myopia severity or axial length. On the basis of the results, we suggest that higher myopia and longer axial length (>24.0 mm) may be risk factors for NO or NC 4-6 nuclear cataract, given ORs of 42.20 for myopia of 6.0 D or more and of 5.77 for an axial length of 24.0 mm or more on multivariate study. Although a previous study has found that longer axial length and nuclear sclerosis also cause myopic refractive changes,20we were unable to determine whether myopia causes nuclear cataract. Nuclear sclerotic cataract as a cause of visual loss in young patients with axial myopia was described as early as 1980.21Furthermore, consistently higher lens opacity values in myopic eyes with axial myopias than in emmetropic eyes have been reported.22

The Tanjong Pagar Survey8found that myopia was associated with nuclear and posterior subcapsular, but not cortical, cataracts in adult Chinese patients. Eyes with posterior subcapsular cataract were more likely to have deeper anterior chambers, thinner lenses, and longer vitreous chambers, although no relationship was seen between posterior subcapsular cataract and axial length.8In our study, no relationship was seen between posterior cataract and spherical equivalent or axial length. To analyze the primary effect of axial length, myopia, and cataract at the time of cataract surgery, we excluded eyes with ocular risk factors for the development of cataract (eg, diabetes, steroid medication), explaining why 61.1% of eyes had P 1 or 2 posterior cataract in this study. This exclusion also highlights the limitations of this study in analyzing the association between posterior cataract and axial length or myopia. On the other hand, our study does support previous findings that cortical cataract is not related to refractive errors or axial length, either cross-sectionally1,23or longitudinally.8,24

The mechanism of the apparent relationship between axial length and nuclear cataract at the time of cataract surgery is unclear. It has been hypothesized that decreased diffusion of metabolites or nutrients to the back of the lens as an effect of a longer vitreous cavity may inhibit the oxidative defense system5,10,2527and thereby promote cataract. The rapid development of nuclear cataracts in patients under hyperbaric oxygen treatment strongly supports this oxidative theory of nuclear cataract formation.28Nuclear sclerosis is a frequent occurrence after successful pars plana vitrectomy.29Vitrectomy surgery significantly increases intraocular oxygen tension during and for prolonged periods after surgery,30exposing the crystalline lens to abnormally high oxygen levels, which may lead to nuclear cataract formation.30These various findings suggest that changes in vitreous circumstances caused by longer axial length may induce nuclear or other types of cataract.

Cataractogenesis is associated with numerous changes in the genetic profile of the lens epithelial cells. For example, the expression of many features, such as transforming growth factor β–induced factor31and pigment epithelium–derived factor,32are altered in highly myopic eyes with chorioretinal atrophy. Because pigment epithelium–derived factor genes are known to play important roles in the physiology and morphology of the transparent lens, Segev et al33suggest that substantial down-regulation of pigment epithelium–derived factor expression might contribute to the formation of senile cataract. Thus, the low concentration of pigment epithelium–derived factor may contribute to cataract formation in highly myopic eyes with longer axial length.

In conclusion, our results suggest a significant association between the axial length of eyes and age at cataract surgery. Longer axial length may precede and predispose a person to nuclear cataract. A significant association exists between myopia and nuclear cataract formation. However, given that nuclear sclerosis of the lens causes a myopic shift in refractive status, it is unclear whether myopia precedes nuclear cataract. The mechanism of the development of nuclear cataract in eyes with longer axial length is still unclear, and further study is required.

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Article Information

Correspondence: Y. Akagi, MD, PhD, Department of Ophthalmology, Faculty of Medical Science, University of Fukui, 23-3 Shimoaiduki, Matsuoka, Fukui 910-1193, Japan (akagiy@fmsrsa.fukui-med.ac.jp).

Submitted for Publication: March 2, 2006; final revision received April 28, 2006; accepted May 4, 2006.

Financial Disclosure: None reported.

Funding/Support: This study was supported by the University of Fukui, Fukui, Japan.

References
1.
Lim  RMitchell  PCumming  RG Refractive associations with cataract: the Blue Mountains Eye Study. Invest Ophthalmol Vis Sci 1999;403021- 3026
PubMed
2.
Reeves  BCHill  ARBrown  NA Myopia and cataract. Lancet 1987;2964
PubMedArticle
3.
Weale  R A note on a possible relation between refraction and a disposition for senile nuclear cataract. Br J Ophthalmol 1980;64311- 314
PubMedArticle
4.
Brown  NAHill  AR Cataract: the relation between myopia and cataract morphology. Br J Ophthalmol 1987;71405- 414
PubMedArticle
5.
Chang  MACongdon  NGBykhovskaya  IMunoz  BWest  SK The association between myopia and various subtypes of lens opacity: SEE (Salisbury Eye Evaluation) project. Ophthalmology 2005;1121395- 1401
PubMedArticle
6.
Panchapakesan  JRochtchina  EMitchell  P Myopic refractive shift caused by incident cataract: the Blue Mountains Eye Study. Ophthalmic Epidemiol 2003;10241- 247
PubMedArticle
7.
Lin  HYChang  CWWang  HZTsai  RK Relation between the axial length and lenticular progressive myopia. Eye 2005;19899- 905
PubMedArticle
8.
Wong  TYFoster  PJJohnson  GJSeah  SK Refractive errors, axial ocular dimensions, and age-related cataracts: the Tanjong Pagar survey. Invest Ophthalmol Vis Sci 2003;441479- 1485
PubMedArticle
9.
Hoffer  KJ Axial dimension of the human cataractous lens. Arch Ophthalmol 1993;111914- 918
PubMedArticle
10.
Tuft  SJBunce  C Axial length and age at cataract surgery. J Cataract Refract Surg 2004;301045- 1048
PubMedArticle
11.
Chylack  LT  JrWolfe  JKSinger  DM  et al.  The Lens Opacities Classification System III: the Longitudinal Study of Cataract Study Group. Arch Ophthalmol 1993;111831- 836
PubMedArticle
12.
Leske  MCChylack  LT  JrHe  Q  et al.  Incidence and progression of cortical and posterior subcapsular opacities: the Longitudinal Study of Cataract. The LSC Group. Ophthalmology 1997;1041987- 1993
PubMedArticle
13.
Dandona  RDandona  LNaduvilath  TJSrinivas  MMcCarty  CARao  GN Refractive errors in an urban population in Southern India: the Andhra Pradesh Eye Disease Study. Invest Ophthalmol Vis Sci 1999;402810- 2818
PubMed
14.
Wensor  MMcCarty  CATaylor  HR Prevalence and risk factors of myopia in Victoria, Australia. Arch Ophthalmol 1999;117658- 663
PubMedArticle
15.
Wu  SYNemesure  BLeske  MC Refractive errors in a black adult population: the Barbados Eye Study. Invest Ophthalmol Vis Sci 1999;402179- 2184
PubMed
16.
Younan  CMitchell  PCumming  RGRochtchina  EWang  JJ Myopia and incident cataract and cataract surgery: the Blue Mountains Eye Study. Invest Ophthalmol Vis Sci 2002;433625- 3632
PubMed
17.
Chen  SNLin  KKChao  ANKuo  YHHo  JD Nuclear sclerotic cataract in young patients in Taiwan. J Cataract Refract Surg 2003;29983- 988
PubMedArticle
18.
Kaufman  BJSugar  J Discrete nuclear sclerosis in young patients with myopia. Arch Ophthalmol 1996;1141178- 1180
PubMedArticle
19.
Levin  ML Opalescent nuclear cataract. J Cataract Refract Surg 1989;15576- 579
PubMedArticle
20.
Baldwin  WR The relationship between axial length of the eye and certain other anthropometric measurements of myopes. Am J Optom Arch Am Acad Optom 1964;41513- 522
PubMedArticle
21.
O'Donnell  FE  JrMaumenee  AE “Unexplained” visual loss in axial myopia: cases caused by mild nuclear sclerotic cataract. Ophthalmic Surg 1980;1199- 101
PubMed
22.
De Natale  RRomeo  GFama  FScullica  L Human lens transparence in high-myopic subjects. Ophthalmologica 1992;2057- 9
PubMedArticle
23.
Lee  KEKlein  BEKlein  RWong  TY Changes in refraction over 10 years in an adult population: the Beaver Dam Eye study. Invest Ophthalmol Vis Sci 2002;432566- 2571
PubMed
24.
Wong  TYKlein  BEKlein  RTomany  SCLee  KE Refractive errors and incident cataracts: the Beaver Dam Eye Study. Invest Ophthalmol Vis Sci 2001;421449- 1454
PubMed
25.
Micelli-Ferrari  TVendemiale  GGrattagliano  I  et al.  Role of lipid peroxidation in the pathogenesis of myopic and senile cataract. Br J Ophthalmol 1996;80840- 843
PubMedArticle
26.
Simonelli  FNesti  APensa  M  et al.  Lipid peroxidation and human cataractogenesis in diabetes and severe myopia. Exp Eye Res 1989;49181- 187
PubMedArticle
27.
Boscia  FGrattagliano  IVendemiale  GMicelli-Ferrari  TAltomare  E Protein oxidation and lens opacity in humans. Invest Ophthalmol Vis Sci 2000;412461- 2465
PubMed
28.
Palmquist  BMPhilipson  BBarr  PO Nuclear cataract and myopia during hyperbaric oxygen therapy. Br J Ophthalmol 1984;68113- 117
PubMedArticle
29.
Thompson  JT The role of patient age and intraocular gas use in cataract progression after vitrectomy for macular holes and epiretinal membranes. Am J Ophthalmol 2004;137250- 257
PubMedArticle
30.
Holekamp  NMShui  YBBeebe  DC Vitrectomy surgery increases oxygen exposure to the lens: a possible mechanism for nuclear cataract formation. Am J Ophthalmol 2005;139302- 310
PubMedArticle
31.
Lam  DSLee  WSLeung  YF  et al.  TGFbeta-induced factor: a candidate gene for high myopia. Invest Ophthalmol Vis Sci 2003;441012- 1015
PubMedArticle
32.
Ogata  NImaizumi  MMiyashiro  M  et al.  Low levels of pigment epithelium-derived factor in highly myopic eyes with chorioretinal atrophy. Am J Ophthalmol 2005;140937- 939
PubMedArticle
33.
Segev  FMor  OSegev  ABelkin  MAssia  EI Downregulation of gene expression in the ageing lens: a possible contributory factor in senile cataract. Eye 2005;1980- 85
PubMedArticle
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