Republic of Yemen

Hadhramout University for Science

And technology
Collage of medicine and Health
Science
Community Medicine Department
The community Project
Third year
2011 - 2012

2011 - 2012

The prevalence of cataract among elderly

patient ( 50 Year)attending the ophthalmic
outpatient clinics in Al-Mukalla city on
2011-2012
Under supervision of:
Dr. Abdulrahman Bawazir
: Prepared by

Group (8)Third year

1
2
3
4

Marwa Ba-Medhaf (Ch)

Rawia AlHamidi
Bahera Al-mansori
Fatima Bin Freejan

(R)

Manal Al-Yazeede

Mohammed Moqible

10

Nada Ba-Beher

11

Rabaa Ba-Samadi

Hanan Bin-hadia

12

Syndian Ba-Qetian

Manal Afif

13

Shereen Al-Yazeede

14

Marwa Al-dini

Yahia Abdulrhamman

Contents

Acknowledgments

Abstract

Introduction

Objectives

Methodology

Results

Discussion

Conclusions

References

Tables

Graphs

Annexes

First of all , we would like to thank Allah ,who gives us a patience to complete our
research ,and we are thankful for our supervisor Dr. Abdurrahman Bawazir for
.valuable information and guidance that help us in all steps of the research proposal
And we will not forget all officials of eyes out clinic and all doctors , and also deep
thanks for all patients who have cooperated and responded to us to make our research
.succeeds
Finally ,thank every one who helped us to prepare for this research

For the flowers of our life our mothers

For moons light for guidance.our fathers
For candles in our study trip ..our doctors

Abstract
:Background
Cataract is a clouding that develops in the crystalline lens of the eye or in its envelope
(lens capsule ) , varying in degree from slight to complete opacity and obstructing the
. passage of light
.It is an important cause of low vision in both developed and developing countries
The most cases of cataract are related to the ageing process as risk factor beside other
,risk factor suggested in many studies have relation to cataract (as diabetes
.(.. hypertension ,smoking

:
Objectives
The aim of our study was to determine the prevalence and related risk factors of
. cataract in elderly people ( 50 year ) in Al-Mukalla city
Study design and method :
A cross sectional study was done in 216 elderly patient ( 50 Year ) attending the
ophthalmic outpatient clinics in Al-Mukalla city at
( 18 Mar.--- 17 Apr.) 2012 .
Result and conclusion :
The present study revealed that the prevalence of cataract cases among elderly
patient ( 50 Year ) attending the ophthalmic outpatient clinics in Al-Mukalla city
was (69.9 % ) , this prevalence increased with age ; 30% of the patients are 50 59
year and 41 % are older than 70 .
We found the prevalence of cataract among sex was approximately higher in female
( 56 % ) than male ( 44 % ) and right eye is more affected than left eye .

The study also was founded that more related risk factor of cataract were
hypertension (31.10 %) and diabetes mellitus ( 23.80 %) , while the smoking has low
percentage (7.3%) as a risk factor for cataract.

:

. ) : (.................

:
)

50 ( .

:
)18
17 ( 2012 , .
) Statistical Package for Social Science ( SPSS ) ,
(........ ,

) 50 ( % 69.9
59 50 , % 30

% 41 70 .
) ( %56 ) ( % 44
.
.

Introduction
Cataract is clouding of the lens of the eye, which impedes the passage of light. Most
cataracts are related to ageing process but also can be develop after an injury,
. inflammation or disease

According to the latest assessment, cataract is responsible for 51% of world blindness,
which represents about 20 million people (2010). Although cataracts can be surgically
removed, in many countries barriers exist that prevent patients to access surgery.
Cataract remains the leading cause of blindness. As people in the world live longer,
the number of people with cataract is anticipated to grow. Cataract is also an
important cause of low vision in both developed and developing countries.(1)

In the United States, age-related lenticular changes have been reported in 42% of
those between the ages of 52 to 64,( 2) 60% of those between the ages 65 and 74,( 3)
and 91% of those between the ages of 75 and 85.(2)
Other reports estimated that the general prevalence of eye diseases among the study
population in Yemen namely Shabwa, Mukalla and Mahweet was 15.3% in the right
eye and 13.9% in the left eye and cataract was found to be the most frequent eye
disease in both eyes representing 58.8% in the right eye and57.9% in the left eye (4)
In Ibn-Sina hospital of Al-Mukalla city ,there are about 143 case of cataract in 2009
.and about 124 case in (June , July and August . ) 2010
In addition the number of surgical cataract operations in Haya Eye Hospital of AlMukalla city are about 718 operations in 2008 ,736 operations in 2009 and 717
operations in first eight months 2010 .(5)
5

Research results in many studies showed that the prevalence of self-reported cataract
increased with age and was significantly higher in older women than in older men.
Cataracts were associated with age, diabetes, antihypertensive medication and folate
insufficiency in older men, and with age and antihypertensive medication in older
women. In addition, age > 75 yrs remained a risk factor for cataract in those without
diabetes, not taking hypertensive medication and with normal folate status (6)

The growing life expectancy worldwide ,and particularly in developing countries is

already leading to a rapid increase in the number of elderly people .(7)
This led to increase attention to age-related diseases . cataract is the most common
condition affecting visual function in older people and nationwide population-based
data has revealed that cataract is the leading cause of visual disability in elderly
people .(6)
increase number of cataract cases in Al-Mukalla city in recent years make it a public
health problem that needs to be addressed.

: General objectives*
To determine the prevalence of cataract in elderly people( 50 year ) in Al-Mukalla .city at 2011-2012

: Specific objectives*
.To determine the prevalence of cataract in elderly people in Al-Mukalla city(1
To compare the prevalence of cataract between old men and old women .2(
To identify related risk factors of cataract(age, diabetes mellitus, hypertension (3
. ,smoking ,.)

Material and method

7

A cross sectional study was performed in three ophthalmic out clinic in AL-Mukalla
city , which was conducted ( from 18 Mar. to 17 Apr. ) 2012 .
The sample was composed of 216 elderly patient ( 50 Year ) attending the
ophthalmic outpatient clinics in Al-Mukalla city . The sample was calculated by
computer when we entered the following data which were taken from other studies
which done in other countries :

Sample size

P= expected proportion of people with cataract from all eye diseases = 15%
(Alamuddin M et al 1997)
Q=proportional of people with other eye diseases (not cataract) =85%
Z =confidencel level = 95%
D =the worse expected results
N= 1585 (1.96)2
2
(5)

196

( We add 10% to avoid bias in the results)

Sample size = 216

We start to collect data at ( 18 Mar. to 17 Apr. ) 2012 in three ophthalmic out
clinic selected randomly in AL-Mukalla city : Haya Eye Hospital , Al-nour clinic ,
. Dr. Khaleed Baharetha clinic
To achieve this goal the students divided in to three subgroups each consists of 3
students .
The total number of elderly patient ( 50 Year )attending Haya Eye Hospital was
(52 ) ,while in ALnour clinic was (130) and in Dr. Khaleed clinic we founded (34 ).

The data collected by interviewing elderly patient and questionnaire are used which is
included the following questions:
name , age ,sex , name of out clinic which attended to it , main complain , group of
the most risk factors and diseases of cataract that mentioned in many studies and
suggested in our group as diabetes ,hypertension , smoking
Finally data were summarized and analyzed by the SPSS program .

Result
This study includes 216 elderly patient ( 50 Year ) attending the 3 ophthalmic
outpatient clinics in Al-Mukalla city ( 94 male and 122 female ) .
The age group subjected in this study was divided into 3 groups (50-59,60-69 , 70 )
The present study revealed that the prevalence of cataract cases was(69.9%) Graph (1)
, this prevalence increased with age ; 30% of the patients are 50 59 year and 41 %
are older than 70 , So The most significant age group associated with cataract was (
70 year old ) . Table no. ( 1 ) .
We found the prevalence of cataract according sex was approximately higher in
female ( 56 % ) than male ( 44 % ) and from these affected elderly people ,the
percentage of patients who came with right eye affected were about (45.7%) while
with left eye affected were ( 35.1 % ) . There was also 19.2 % of patients came with
both eyes affected . Graph no. ( 2) , (3) respectively .
The study also was founded that more related risk factor of cataract were
hypertension (31.10 %) and diabetes mellitus ( 23.80 %) .
Family history appears in association with cataract ( 21.2 %) .
The glaucoma also has association with cataract ; the prevalence was about 11.3% ,
while the smoking has low percentage (7.3%) as a risk factor for cataract . Graph
no. (4) .

10

In our study the prevalence of cataract re present

69.9% among elderly cases admitted in
ophthalmologic out clinic. This prevalence rate
was closed to many studies as Vashist et al.
(2011) in India who reported that the prevalence
of cataracts was similar in north (73.8%) and
south India (71.8%) (8) .There was also another
study ; Hamad et al. (2010 ) at Qatar who found
that the prevalence of cataracts was ( 68.2% ) (9)
and Raman et al.(2010) at Sankara Nethralaya
who found that the prevalence of cataract in the
study was (65.7%) also is close to our study. (10).
Age is the most important risk factor of cataract in which the prevalence was
increased with age in our study ; 30% of the patients are 50 59 year ,29 % are 60
-69 year and 41 % are older than 70 .This result is confirmed by other study in
North-East Region of Poland, operated on cataract in the years 1986-1995 who
reported that 52% of the patients are older than 70, 43% are in the age of 51-70 years.
(11).
In both women and men, and for the all cataract types, increasing age was the most
important predictor of incident cataract surgery.(12) Cataract reflects well described
ageing processes in the lens. Our prevalence data indicated that by the age of 70 years,
most old people either had significant cataract present in one or both eyes or had
undergone cataract surgery .

11

The prevalence of cataract according to sex in our study was higher in female
(56.29%) than in male (43.71%) . This result agreement with Vashist et al. (2011) at
India who reported that the prevalence of cataract was higher in women than men(8).
Other study in China 2012 Apr. also is revealed that the overall prevalence of cataract
was 20.8% (95% CI, 19.8, 21.8), higher in women than in men after adjusting for
age. (13) It may reflect either differences in cataract prevalence(14 ) and incidence
(15) between men and women or alternatively it could reflect a tendency for women
to access health services earlier than men.

According to our study results the right eye (45.7%) is more affected than left eye
(35.1%) and this result going with confirmed by other study ; Alamuddin M et al.
(1997)at Yemen who reported (58.8%in right eye ,57.9% in left eye).(4)
Our study also revealed that about (19.2%) of elderly patient with both eye affected
which agree with USA study(2004) that reported presence of cataract by( 17.2%) in
both eyes (16 )

Hypertension represent the highest percentage (31.10%) among the risk factors
associated with cataract in our study . Studies in different parts of world show
different prevalence rate indicated to the same conclusion ; Basanta et al.(2012) at
India reported that the prevalence of hypertension among cataract cases was 20.59(17)
, in Karachiand Pakistan was 43.75% and Sabanayagam C. et al found a significant
.increase in incidence of cataract with hypertension (18)
North-East Region of Poland also reported that the hypertension percentage was
(14%) ( 14).
12

Diabetes mellitus (23.80%) is the second risk factor associated with cataract in our
study and this result enclosed with study of Janghorbani et al.(2004)at Iran who
reported that diabetes mellitus represented that (20%)in patient with cataract .(19)
Sabanayagam C. et al found a significant increase in incidence of cataract with
diabetes(18)

Also in our study, glaucoma represents (11.30%) in cataract patient and this in
agreement with Cumurcu et al. (2010) at Turkey who found that the glaucoma was
(9.8%) in cataract patient .(19).

21.2% of patients in association with positive family history in our study . Study
( 2011) in the Asian subcontinent cataract patient aged 50-70 year revealed that
about 80% had a family history of cataracts (20 ). In both study family history has
significant association with cataract ,although their percentage (Asian subcontinent
cataract patient ) is higher and this is due to this result enclosed in low-income
group ,while our study included all community groups .

Other study( 2000 Nov) Victorian population aged 40 years and older
revealed that one of Significant risk factors for cortical cataract included family
history of cataract (parents or siblings ). (21)

13

in a prospective study found that 20 or more years after quitting smoking had relative
risk of cataract.
smoking has low percentage (7.3%) as a risk factor for cataract and this in agreement
with Christen et al. who found that 20 or more years after quitting smoking had
relative risk of cataract.(22)
Smoking is thought to increase risk of cataract, at least in part, by increasing oxidative
stress in the lens. Oxidative stress can be caused by free radicals produced by
reactions in the presence of tobacco smoke or other air pollutants; these free radicals
may directly damage lens proteins and the fiber cell membrane in the lens. Intake of
certain antioxidants has been shown to decrease cataract in a number of studies,
including our own (23-24).

14

1. The prevalence of cataract in elderly people( 50 year ) in this study is( 69.9%).
2. Females were more affected than males , 56.29%, 43.71% respectively.
3. Our study found that right eye (45.7% ) more affected than left eye (35.1%) and in
both eyes (19.2%) in patient with cataract.
4 . Age is the most important risk factor of cataract in which the prevalence was
increased with age in our study ; 30% of the patients are 50 59 year ,29 % are 60
-69 year and 41 % are older than 70.
5. According to related risk factors of cataract in our study represent that the highest
risk factor in elderly patient with cataract is hypertension (31.10%) followed by
diabetes mellitus (23.80%) .
6. 21.2% of patients in association with positive family history in our study .
7. Glaucoma and smoking have less percentage as risk factor for cataract in which
glaucoma about (11.30%) and smoking about (7.3%) .

15

To Ministry of Health:
1)Health educational programs must be established to provide the population
by information about prides posing factors, symptoms and signs of cataract to
prevent them.
2)Ophthalmic out clinic must be provided with new technical equipments
which are necessary for treatment of cataract.
TO Doctors and Health workers in Ophthalmic out clinic:
1)Intensive medical care (early diagnosis and treatment ) must be given to the
patients with cataract to prevent blindness.

2)The follow up should done to discover early complication of cataract

surgery.
3)Other researches must be done about this subject by other who are
interested in this field .

Tables and Graphs :

16

The prevalence of cataract among elderly(

Table (1) :

50 year )patients according age group .

Age
groups
59 50
69 60
70

Affected
Frequency Percentage
35
23.18%
42
27.81%
74
49.01%
151
100%

Non affected
Frequency
Percentage
30
46.15%
19
29.23%
16
24.62%
65
100%

Table (2 ) : the prevalence of hypertension as risk factor of

cataract Cases admitted to the ophthalmic out clinic .

Cases admitted to the

.ophthalmic out clinic
Positive
Cataract

Negative
Total

Hypertension
Positive
Negative
47
104

Total
151

12

53

65

59

157

216

Table ( 3 ) : the prevalence of diabetes mellitus as risk factor of

cataract Cases admitted to the ophthalmic out clinic.

Cases admitted to
the ophthalam.
.Depart
Positive

Diabetes mellitus

Total

Positive

Negative

36

115

151

Negative

56

65

Total

45

171

216

Table ( 4 ) :

17

Glaucoma

Cataract

Total

Positive

Negative

Positive

17

134

151

Negative

12

53

65

Total

29

187

216

Table (5) :

Family History

Cataract

Total

Positive

Negative

Positive

32

119

151

Negative

60

65

Total

37

179

216

Table ( 6 ) :

Smoking

Cataract

Total

Positive

Negative

Positive

11

140

151

Negative

11

54

65

Total

22

194

216

18

Graph ( 1 ) :The

prevalence of cataract among elderly

people ( 50 ) in Al-Mukalla city .

Graph 2 :

19

Graph 3 :

Graph ( 4 ): The related risk factors of cataract .

20

World Health Organization .priority eye disease online.Available at : (1

www.WHO/priority eye disease .com
. a. Accessed 2012
Sperduto RD, Seigel D., Seigel D. Sperduto RD). "Senile lens and senile macular (2
.changes in a population-based sample". Am J Ophthalmol . Jul 1980; 90 (1): 8691
Kahn HA, Leibowitz HM, Ganley JP, Kini MM, Colton T, Nickerson RS, Dawber

(3

TR ."The Framingham Eye Study. I. Outline and major prevalence findings". Am J

.Epidemiol . Jul 1977; 106 (1): 1732
4) Alamuddin M et al. " prevalence and elimination of cataract in a rural setting in
Yemen". Eastern Mediterranean Health Journal. 1997; 3:408-414.
5)Available records of Ibn-Sina and Haya Eye Hospital
Ju Chen-Kuan and Fong lin-Bi. " Associations between folate statues , diabetes (6
,anti-hypertensive medication and age-related cataract in elderly Taiwanese ". The
.journal of nutrition ,health and aging . 2011;volume15: 304-10
World health organization. " Management of cataract in primary health care (7
.services" .2nd edition . England: world health organization Geneva . 1996: p 5
8) Vashist P, Talwar B, Gogoi M, Maraini G, Camparini M, Ravindran RD, Murthy
GV, Fitzpatrick KE, John N,Chakravarthy U, Ravilla TD, Fletcher AE. " Prevalence
of cataract in an older population in India". the India study of age-related eye disease.
Feb 2011 Feb;118(2):272-8 .
9) Hamad Al Gamra1, Fatima Al Mansouri1, Rajiv Khandekar2, Maha
Elshafei1,Omar Al Qahtani1, Rajvir Singh1, Shakeel P. Hashim1, Amjad
Mujahed1, Alaa Makled1, Anant Pai1. " Prevalence and Causes of Blindness, Low
21

Vision and Status of Cataract in 50 Years and Older Citizen of Qatar ".A Community
Based Survey. October 2010; Vol. 17, No. 5 , Pages 292-300.
10 ) Raman R, Pal SS, Adams JS, Rani PK, Vaitheeswaran K, Sharma T. " Prevalence
and risk factors for cataract in diabetes: Sankara Nethralaya Diabetic Retinopathy" .
Epidemiology and Molecular Genetics Study. report no. 17. 2010 Dec ;
51(12):625361.
11) Stankiewicz A, Mariak Z, Mikita A, Obuchowska I, Zywalewski B, Moskalonek
E. "Incidence of cataract and risk factors in Northeastern Poland" . National institute
of health . 1997; 99(6): 385-91.
12). Klein BE, Klein R, Moss SE. Incident cataract surgery: the Beaver Dam eye
study. Ophthalmology 1997;104:57380. [PubMed
13) Duan XR, Liang YB, Wang NL, Wong TY, Sun LP, Yang XH, Tao QS, Yuan RZ,
Friedman DS. Prevalence and associations of cataract in a rural Chinese adult
population: the Handan Eye Study. Graefes Arch Clin Exp Ophthalmol. 2012 Apr 11;
PMID: 22527317.[PubMed]
14). Klein BE, Klein R, Linton KL. Prevalence of age-related lens opacities in a
population. The Beaver Dam Eye Study. Ophthalmology 1992;99:54652. [PubMed]
15 ). Hiller R, Sperduto RD, Ederer F. Epidemiologic associations with nuclear,
cortical, and posterior subcapsular cataracts. Am J Epidemiol. 1986;124:91625.
[PubMed]
16 ) Harris MI and Klein R. Prevalence of Cataract and Pseudophakia/Aphakia
Among Adults in the United States . Archives of Ophthalmology. 2004;122:487-494
17) B.K. Behera, K. Satish , S.K. Jena , M.A. Hussain , S. Samal: Prevalence Of
Hypertension And Diabetes Mellitus Among People Seeking Cataract Surgery In
Rural South India.. The Internet Journal of Epidemiology. 2012 Volume 10 Issue 2.
18) Sabanayagam C, Wang JJ, Mitchell P, Tan AG, Tai ES, Aung T, Saw SM, Wong
TY. Metabolic syndrome components and age-related cataract: the Singapore Malay
eye study. Invest Ophthalmol Vis Sci, 2011; 52(5):2397-2404.
19) Tarwadi KV, Agte VV. Cataract in type 2 diabetes mellitus .Ophthalmic
epidemiol. 2011 Jan;27(1):40-5. [PubMed]

22

20) Tarwadi KV, Agte VV. Interrelationships between nutritional status,

socioeconomic factors, and lifestyle in Indian cataract patients. Agharkar
Research Institute. 2011 Jan ; 27(1):40-5.
21 ) McCarty CA, Nanjan MB, Taylor HR. Attributable risk estimates for cataract to
prioritize medical and public health action. Invest Ophthalmol Vis Sci. 2000 Nov ;
41(12):3720-5.
22 ) Christen WG, Glynn RJ, Ajani UA, et al. Smoking cessation and risk of agerelated cataract in men. JAMA . 2000 ; 284:71316.
23 ) Brown L, Rimm EB, Seddon JM, et al. A prospective study of carotenoid intake
and risk of cataract extraction in US men. Am J Clin Nutr. 1999;70:51724.
24) Jacques PF, Chylack LT Jr. Epidemiologic evidence of a role for the antioxidant
vitamins and carotenoids in cataract prevention. Am J Clin Nutr.
1991;53(suppl):352S5.

23

Annex
Hadhramout University
Collage of Medicine
HUCOM

Annually Community
Project (3rdYear)
2011-2012

The Prevalence of Cataract among elderly patient attending to eyes outclinic

In al-Mukalla city 2011-2012
Name of pt. :
Age :
Sex :

Male

Female

Name of out clinic :

Main Complain :
Do you suffer from cataract ?

Yes

If the answer Yes: In which eye :

Left eye

Did you do an operation of cataract before ?

No
Right eye

Yes

No

If the answer Yes : Is your vision improved after operation?

Yes

Do you have family history of cataract?

No

Yes

Are you suffering from glaucoma?

The associated disease :

Yes

Diabetes

Do you smoke ?

Yes

No

24

No
Hypertension

Other disease mention it :

Both eyes

No

Annex
/

2012_2011

)50 ( 2012-2011 .
:----------------------------------------- ----------:
:

:
-----------------------:
:

: :

) (
:

:
:

25