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Participants with bilateral cataract extraction were excluded from this group. Thus, participants with unilateral cataract extraction were included in this definition if the contralateral eye had gradable lens opacity. Single and mixed types of LOP were defined as the presence of one or more types of opacity in the same individual.
Participants were considered to have a single opacity categorized as PSC only, nuclear only, or cortical only if that was the only type present in both eyes. Participants were categorized as having mixed opacities if more than one type was present. All 4 categories PSC only, nuclear only, cortical only, and mixed were mutually exclusive. For this definition, if a participant had unilateral cataract extraction, the LOCS II grading from the contralateral phakic eye was used to define the lens opacity in that person.
The frequency of each lens opacity type among all graded participants within each age- and sex-specific group was used to determine the sex- and age-specific prevalence for each opacity type all lens changes, any lens opacity, and single and mixed opacities. Chi-square analyses were used to evaluate the presence of statistically significant differences in age- by decades and sex-specific frequencies by opacity type.
The United States Asian population was used to calculate the age-adjusted prevalence rates for each study. In addition, the reproducibility of LOCS II grading between 2 examiners was evaluated throughout the data collection period by having each of the graders perform independent replicate grading on 50 participants every 6 months.
All analyses were conducted assuming a 0. Of the eligible participants, completed a clinical examination at the LEEC corresponding to a participation rate of Participation flow chart and completeness of lens examination data for the Chinese American Eye Study. Eligible participants who chose to participate compared to nonparticipants of the CHES clinical eye examination were similar in age mean age of 61 vs. Participants and nonparticipants were similar with respect to marital status, income, health and vision insurance, history of diabetes, history of cataract and macular degeneration.
Of the participants completing the clinical examination , 6. Participants with missing LOCS II grading were mainly those who had cataracts that could not be graded due to poor pupillary dilation or those who refused to allow pupillary dilation.
The prevalence of all lens changes in the CHES population was The prevalence was more than 3. The overall prevalence of any PSC, nuclear, and cortical opacities before age-standardization was 2. After adjustment for age, Chinese-American females were more likely to have cortical opacities than Chinese-American males The severity of lens opacification by type is presented in Table 3 ; most of the participants Among Chinese Americans 70 years and older, 2.
The most prevalent single and mixed types of opacities were nuclear only The age-specific prevalence of mixed opacities was 3. Similarly, the age-specific prevalence of nuclear only opacities was In contrast, the prevalence of cortical only opacity was higher from age groups 50 to 79 years old prevalence, 6. Prevalence of cortical only opacities was higher in females Of the participants who completed a clinical examination, 9. The prevalence of bilateral pseudophakia in our cohort was 6.
The prevalence of pseudophakia in either eye unilateral and bilateral ranged from 1. There was no significant difference in the prevalence of pseudophakia between female 9. The prevalence of bilateral aphakia prosthesis or phthisis bulbi were not included in our cohort was 0. There was no significant difference in the sex-specific prevalence of aphakia female 0. Age-specific prevalence of pseudophakia and aphakia in at least one eye in the Chinese American Eye Study. The prevalence of VI in the worse-seeing eye of participants with cortical only, nuclear only, PSC only, and mixed opacities was The prevalence of VI in the better-seeing eye of participants with cortical only, nuclear only, PSC only, and mixed opacities was 3.
The presence of VI attributed to lens opacity was more common in individuals with PSC only opacities and mixed opacities Fig. In addition, if one considers monocular VI, To our knowledge, CHES is the first population-based study of eye disease among persons 50 years and older of Chinese ancestry in the United States to examine the age- and sex specific prevalence and burden of LOP in the fastest growing ethnic group Chinese of Asian Americans in the United States population.
The prevalence of lens changes among all participants was almost 4-fold higher in those 80 years and older The prevalence of lens changes also was higher in females Prevalence of any cataract extraction in CHES was higher 9. Differences observed in the prevalence of cataract extraction may be explained by variation in the prevalence of LOP by population, or differences in access to or use of cataract surgery.
However, when evaluating the age-adjusted prevalence of LOP, our data suggested that Chinese Americans in CHES have a higher prevalence of age-adjusted nuclear opacities Participants in the CHES also have a lower prevalence of cortical opacities Differences observed in the prevalence of opacities may be influenced by differences in study protocols and grading procedures, but also due to differences in lifestyle or environmental exposures.
For example, some studies 27 , 28 , 30 have reported smoking, history of myopia and use of hormone replacement therapy were associated with nuclear opacities, while myopia, higher fasting glucose, and history of diabetes were associated with PSC, and higher systolic blood pressure, history of cigarette smoking, and diabetes were associated with cortical opacities.
To ensure consistency of grading, a regular evaluation of intergrader agreement of LOCS II grading was performed with a second ophthalmologist masked to the initial results.
Moderate to excellent agreement 0. Thus, grading of LOP was consistent among ophthalmologists. A potential limitation of this study is that the prevalence of nuclear opacities compared to cortical opacities may be underestimated because nuclear opacity may be more likely to lead to cataract surgery than other types of opacities e.
However, a subanalysis after including and excluding cases of unilateral cataract surgery revealed no difference in the prevalence of any PSC opacities 2.
The exclusion of a small number of participants who did not undergo pupil dilation because of narrow angles or diagnosis of angle-closure glaucoma could have resulted in a slight underestimate of the true cataract prevalence, since these participants are more likely to have cataract.
While there are small differences in demographic characteristics between the Chinese Americans persons included in this study and those in the United States, we believe these data are likely to provide an accurate representation of LOP prevalence in Chinese American individuals. However, caution is warranted when extrapolating these estimates to Chinese populations of different geographic or genetic heritage as differences in these characteristics may contribute to differences in the burden of LOP.
Age- and sex-specific or standardized estimates should be used to compare prevalence differences across Chinese populations. These data suggested that Chinese Americans in CHES have a high prevalence of VI associated with LOP, and specifically a high prevalence of nuclear opacities, especially among adults age 60 years and older.
The authors alone are responsible for the content and writing of this paper. Varma , None; J. Sun , None; M. Torres , None; S. Wu , None; C. Hsu , None; S. Azen , None; R. National Center for Biotechnology Information , U. Invest Ophthalmol Vis Sci. Received Aug 12; Accepted Nov 9. One night they go into their bedroom, they kiss and hug, and have sex. What do you get when you do that? A family is at the dinner table. In her 30s and 40s, they are like pears, still nice, hanging a bit.
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