Document Type : Original article
Authors
1 Department of Medicine, School of Medicine, Babol University of Medical Sciences, Babol, Iran
2 Department of Ophthalmology, Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
3 Department of Biostatistics, School of Medicine, Babol University of Medical Sciences, Babol, Iran
4 Department of Ophthalmology, Islamic Azad University of Sari Branch, Sari, Iran
Abstract
Keywords
Abstract
Background: Age-Related Cataracts (ARC) is a multifactorial ocular dysfunction resulting inblurred lens, visual reduction, and blindness. Various underlying diseases are involved in increasing the risk of ARC. The purpose of this study was to investigate the association of underlying diseases and related medications with ARC in Iranian patients.
Methods: In this case-control study, 353 patients (age between 40 to 70 years) with ARC were referred to Rouhani Hospital, Babol, Iran, and 343 control individuals (age between 40 to 70 years) participated. The history of underlying diseases of participants was collected by history-taking and self-expression. The cataract intensity and type determination was based on the Lens Opacities Classification System III (LOCS Ш).
Results: Our results show that obesity (p <0.001), diabetes mellitus (OR = 0.422, 95% CI [0.285, 0.625], p<0.001) ,and hypertension (OR = 0.518, 95% CI [0.378, 0.712], p<0.001) are associated with prevalence of ARC (more prevalent in ARC patients compared to controls). The posterior subcapsular ARC is more prevalent in asthmatic ARC patients compared to non-asthmatic ARC patients (p=0.019). The prevalence of cortical ARC is higher in anemic ARC patients compared to non-anemic ARC patients (p=0.031). Cortical and posterior subcapsular ARC prevalence is higher in rheumatic ARC patients than non-rheumatic ARC patients (p=0.006). Also, atorvastatin use plays a preventive role in ARC (p=0.031).
Conclusion: Our results established that obesity, diabetes mellitus, hypertension, and asthma are associated with the prevalence of ARC. Also, atorvastatin, as a routine medication, plays a preventive role in ARC. Furthermore, asthma, anemia, and rheumatism are involved in prevalence of certain types of ARC.
Keywords: Age-related cataract, Diabetes mellitus, Hypertension, Asthma
Introduction
Age-Related Cataract (ARC) is a multifactorial ocular dysfunction resulting in blurred lenses, visual reduction, and blindness (1). Approximately, 50% of the causes of ARC are genetic, and the rest are related to aging, environmental, and systemic factors (2). Poor nutrition, male sex, white race, and age are involved in the development of ARC (3). Other factors include the use of drugs (corticosteroids), eye inflammation, diabetes, alcohol consumption, smoking, hypertension, body mass index, gender, trauma, eye diseases, and eye surgery. Therefore, the risk factors play an essential role in ARC. Surgery, which has many side effects and has many financial and economic costs, is the only therapeutic approach for ARC treatment. Therefore, applying a preventive approach to ARC leads to a reduction of ARC’s prevalence. Alongside correction of lifestyle-related risk factors, the treatment or control of underlying diseases is helpful in a decrease in ARC development. Identifying the possible risk factors for ARC can lead to effective prevention and treatment of the disease (4).
Various underlying diseases are involved in increasing the risk of ARC, i.e. secondary ocular diseases (retinopathy of prematurity, retinal detachment, aniridia, retinitis pigmentosa, and uveitis), congenital diseases (cytomegalic inclusion disease, cockayne syndrome, congenital syphilis, and rubella), genetic disorders (Down syndrome, Edwards syndrome, and Patau syndrome), infectious diseases (onchocerciasis, toxoplasmosis, leprosy, cysticercosis, and varicella), and
metabolic diseases (cerebrotendinous xanthomatosis, diabetes mellitus, Fabry disease, Lowe syndrome,
Wilson disease, galactosemia cataract, homocy-
stinuria, hypoparathyroidism, hypothyroidism, hyper-
parathyroidism, hypervitaminosis D, hypocalcemia, and mucopolysaccharidoses) (5-8). However, the association of other underlying diseases with ARC is not fully characterized yet (9).
The risk factors of ARC for the Asian population are not well-known (10). Most studies have assessed risk factors for different types of cataracts in Western countries. A small number of studies on cataracts have recently been performed in Asian countries such as Japan, Taiwan, Singapore, and China (10-13). In Iran, accurate statistics on the number of people with cataracts are not available, and it is estimated that about 100,000 cataract surgeries are performed annually in Iran (14). In this study, the purpose was to investigate the association of underlying diseases (i.e. obesity, diabetes mellitus, anemia, hypertension, rheumatoid arthritis, and asthma) with ARC in Iranian patients.
Materials and Methods
Sample
In this case-control study, 353 patients with ARC were referred to Rouhani Hospital, Babol, Iran, and 343 control individuals participated. The history of underlying diseases of participants was recorded through history-taking and self-expression. Also, participants without ARC and other ocular complications were considered as controls.
The criteria for admission were patients having ARC for more than years confirmed by clinical examination by an ophthalmologist recommending surgery. In this study, patients with congenital cataracts, a history of other eye surgeries on the eye with cataract, a history of trauma to the eye with cataract, secondary cataracts, patients with lens opacity due to contact with certain chemicals, patients with retinal and uveal disorders (like uveitis, Retinitis Pigmentosa (RP), toxoplasmosis scars), diabetic retinopathy patients, as well as patients younger than 40 years were excluded from the study. Also, individuals older than 70 years were excluded from this study (in the patient and control group) due to the normalization of participants regarding age.
Clinical experiments
The cataract intensity and type determination were based on the Lens Opacities Classification System III (LOCS Ш) (15). Accordingly, the nuclear cataract has six degrees (N1-N6), the cortical cataract has six degrees (C1-C5), and the posterior subcapsular cataract has 5 degrees (P1-P5). The types of ARC were divided into four types based on the degrees obtained with the LOCS Ш system: 1) Nuclear type (N≥4, C≤ 2 and P≤ 2), 2) Cortical type (C≥3, P≤2 and N≤3), 3) Posterior subcapsular type (P≥3, C≤2 and N≤3), 4) Mixed type (which can be in four modes: (i) N≥4, C≥3, and any P, (ii) N≥4, P≥3, and any C, (iii) N≤3, C≤2 and P≤2, and (iv) P≥3, C≥3 and any N). The intensity of ARC was divided into mild (NC≤4, C≤3 and P≤3), moderate (N=5, C=4, and P=4), and severe (N=6, C=5, and P=5). Also, anemia status was classified as anemic (hemoglobin less than 12 mg/dl) and normal (hemoglobin equal and more than 12 mg/dl) states. Hypertension was defined as systolic pressure of at least 140 or diastolic pressure of at least 90 mmHg. Also, diabetes mellitus was defined by fasting plasma glucose level of 126 mg/dL (7.0 mmol/L) or higher. Other diseases were diagnosed by specialist physicians.
Statistical analysis
All statistical analyses were performed using SPSS v.21 (IBM, USA). Due to two answer choices regarding the disease (yes/no), the number of participants in each group was reported via percentage (%). The level of significance was considered 5% (p<0.05). Also, one-way ANOVA followed by post-hoc multiple comparisons (via Bonferroni method) and chi-square were used for statistical analysis.
Results
Demographic statistics
In this cross-sectional study during 2017-2018, 353 patients with ARC (58.82±5.32-year-old) and 342 controls (58.07±4.05-year-old) have participated. From 353 ARC patients, 213 (60.3%) and 140 (39.7%) individuals were female and male, respectively. The results show that the prevalence of ARC in males is higher than in females (p<0.001). Also, there is no significant association between sex and type of ARC (p=0.107); nuclear ARC is more prevalent in males than females. Regarding ARC severity, 110 (31.2%) patients were diagnosed with mild ARC. Also, 108 (30.6%) and 135 (38.2%) cases were classified as patients with moderate and severe ARC, respectively.
The association of obesity, diabetes mellitus, hypertension, and asthma with the prevalence of ARC
Obesity significantly increases the risk of ARC (p<0.001). In normal Body Mass Index (BMI) (18.5 to 25 kg/m2), there was no significant difference between patients and controls, but chi-square analysis showed that the prevalence of ARC is more in obese individuals. Also, diabetes mellitus (OR=0.422, 95% CI [0.285, 0.625], p<0.001) and hypertension (OR=0.518, 95%CI [0.378, 0.712], p<0.001) were significantly more prevalent in ARC patients compared to normal individuals.
Our results show that there is a reveres significant association between heart failure (OR=3.727, 95% CI [2.173, 6.394], p<0.001), renal failure (OR=3.203, 95% CI [1.256, 8.169], p=0.010), osteoporosis (OR=5.269, 95% CI [2.940, 9.442], p<0.001), osteoarthritis (OR=16.604, 95% CI [0.347, 26.645], p<0.001), and allergy (OR=15.636, 95% CI [6.700, 36.490], p<0.001) with ARC. In other words, the mentioned diseases are less prevalent in ARC patients compared to the normal group. Furthermore, our results established no association between anemia (OR=1.129, 95% CI [0.821, 1.552], p=0.454) and rheumatism (OR=1.602, 95%CI [0.914, 2.807], p=0.098) with the prevalence of ARC (Tables 1 and 2).
The association of anemia and rheumatism with the type of ARC
Anemia is not associated with ARC, but in ARC patients, anemia status was significantly associated with the type of ARC (p=0.031). The prevalence of cortical ARC is higher in anemic ARC patients compared to non-anemic ARC patients. Also, rheumatism was not associated with the prevalence of ARC, but in ARC patients, rheumatism status was significantly associated with the type of ARC (p=0.006). The prevalence of cortical and posterior subcapsular ARC is higher in rheumatic ARC patients compared to non-rheumatic ARC patients. Other underlying diseases and medications are not associated with the type of ARC. Also, none of the underlying diseases and medications are associated with the intensity of ARC (Table 3).
The association of atorvastatin and corticos- teroids with prevalence of ARC, its type, and intensity
Our statistical analysis shows a significant association between the use of atorvastatin and the prevalence of ARC (p=0.031). In other words, atorvastatin plays a preventive role in ARC. However, there were no associations between atorvastatin and corticosteroids with the type (p=0.192 and 0.435, respectively) and intensity of ARC (p=0.463 and 0.935, respectively).
Discussion
ARC are multifactorial ocular pathologic states culminating in blurred vision and blindness (1). As a multifactorial disease, ARC is affected by underlying diseases and lifestyles. Due to the high-cost burdens of ARC, it is crucial to reduce the risk of ARC. The correction of lifestyle is a preventive approach to reducing ARC’s complications (6,16). Furthermore, the treatment of underlying diseases, which play a critical role in development of ARC, can prevent ARC. The purpose of this study was to investigate the possible associations between underlying diseases and ARC.
Our results show that obesity, diabetes mellitus, hypertension, and asthma are associated with ARC in Iranian patients. A 2014 study by Rim et al on South Korean people over the age of 40 was conducted and examined the association of cataracts with the diet of individuals between 2008 and 2010. It was found that older age, low monthly income, low education, hypercholesterolemia, hypertension, and diabetes mellitus were independently associated with any type of cataracts (17). This study suggests that optimal control of blood pressure, blood sugar, and cholesterol can help reduce the prevalence of cataracts in the South Korean population. In a 2013 meta-analysis by Prokofyeva et al on a selective population ranging in age from 40 to 95 years (between 1990 and 2009) who were clinically diagnosed with cataracts, it was found that smoking, diabetes mellitus, chronic asthma, bronchitis, and cardiovascular diseases increase the risk of cataracts (18).
In our study, the frequency of mixed cataracts (43.6%) and the frequency of nuclear type (24.1%) were higher than other types. Also, the severe type of ARC with 38.2% frequency was the most prevalent one regarding intensity among patients. In our study, out of 353 patients, 213 (60.3%) were women, and this percentage was not statistically significant, but in the subgroups, according to Bonferroni’s method, it was found that the frequency of nuclear cataracts in men (30.7%) is significantly more than women (19.7%). In a 2014 study by Rim et al in South Korea, it was found that all types of cataracts (anterior polar cataracts) were more common in women compared to men (17).
In our study, a significant difference was observed in the BMI in the control group and the patient group, and it was found that BMI>25 is associated with ARC. In a 2011 study in Tehran by Sahebalzamani et al on 322 patients with ARC, it was stated that most patients are in the obesse group with BMI between 25 to 30 kg/m2 (19). In our study, diabetes mellitus was a risk factor for ARC, and statisticallysignificant differences were found between two groups of patients and controla. Similar to our findings, in the study by Prokofyeva et al, Hojati et al, and Rim et al, diabetes mellitus was considered a risk factor for ARC (17,18,20).
The difference between the two groups of patients and controls over asthma was statistically significant in our study, indicating that asthma is an effective factor for development of ARC. Also, Prokofyeva et al found that asthma and chronic bronchitis increased the risk of cataracts (18). Also, our study found a significant association between asthma and posterior subcapsular ARC.
In our study, there was no statistically significant difference between corticosteroid use and ARC. Prokofyeva et al found that corticosteroids increase the risk of cataracts (18). In a study by Hekari et al, corticosteroid was a predisposing factor for ARC (21). Also, there was no significant relationship between corticosteroid use and certain types of ARC in our study.
It is recommended that a future prospective study be implemented that put a regimen for people on a special diet for 5 to 10 years, and then investigate the reduced effect of mentioned factors on decreasing the risk of ARC.
Table 1. The association of underlying diseases and ARC
Type |
Parameters |
Group |
Total |
OR (95%CI) |
p-value |
|||
Case |
Control |
|||||||
Demographic data |
Sex |
Female |
Count |
213 |
255 |
468 |
1.905 (1.379, 2.630) |
<0.001 |
% within sex |
45.5% |
54.5% |
100.0% |
|||||
Male |
Count |
140 |
88 |
228 |
||||
% within sex |
61.4% |
38.6% |
100.0% |
|||||
|
Body Mass Index (BMI) |
Normal (18.5 to 25) |
Count |
86 |
93 |
179 |
- |
<0.001 |
% within BMI |
48.0% |
52.0% |
100.0% |
|||||
Fat (25 to 30) |
Count |
138 |
180 |
318 |
||||
% within BMI |
43.4% |
56.6% |
100.0% |
|||||
Obese (more than 30) |
Count |
129 |
70 |
199 |
||||
% within BMI |
64.8% |
35.2% |
100.0% |
|||||
Diabetes mellitus |
Disease |
Count |
93 |
45 |
138 |
0.422 (0.285, 0.625) |
<0.001 |
|
% within diabetes |
67.4% |
32.6% |
100.0% |
|||||
Normal |
Count |
260 |
298 |
558 |
||||
% within diabetes |
46.6% |
53.4% |
100.0% |
|||||
Underlying diseases |
Hypertension |
Disease |
Count |
150 |
95 |
245 |
0.518 (0.378, 0.712) |
<0.001 |
% within hypertension |
61.2% |
38.8% |
100.0% |
|||||
Normal |
Count |
203 |
248 |
451 |
||||
% within hypertension |
45.0% |
55.0% |
100.0% |
|||||
Heart failures |
Disease |
Count |
19 |
60 |
79 |
3.727 (2.173, 6.394) |
<0.001 |
|
% within heart failures |
24.1% |
75.9% |
100.0% |
|||||
Normal |
Count |
334 |
283 |
617 |
||||
% within heart failures |
54.1% |
45.9% |
100.0% |
|||||
Renal failures |
Disease |
Count |
6 |
18 |
24 |
3.203 (1.256, 8.169) |
0.010 |
|
% within renal failures |
25.0% |
75.0% |
100.0% |
|||||
Normal |
Count |
347 |
325 |
672 |
||||
% within renal failures |
51.6% |
48.4% |
100.0% |
|||||
Anemia |
Anemic |
Count |
109 |
115 |
224 |
1.129 (0.821, 1.552) |
0.454
|
|
% within anemia |
48.7% |
51.3% |
100.0% |
|||||
Normal |
Count |
244 |
228 |
472 |
||||
% within anemia |
51.7% |
48.3% |
100.0% |
|||||
|
Asthma |
Disease |
Count |
9 |
0 |
9 |
- |
0.003 |
|
% within asthma |
100.0% |
0.0% |
100.0% |
||||
|
Normal |
Count |
344 |
343 |
687 |
|||
|
% within asthma |
50.1% |
49.9% |
100.0% |
||||
|
Osteoporosis |
Disease |
Count |
15 |
65 |
80 |
5.269 (2.940, 9.442) |
<0.001 |
|
% within osteoporosis |
18.8% |
81.3% |
100.0% |
||||
|
Normal |
Count |
338 |
278 |
616 |
|||
|
% within osteoporosis |
54.9% |
45 .1% |
100.0% |
||||
|
Rheumatism |
Disease |
Count |
22 |
33 |
55 |
1.602 (0.914, 2.807) |
0.098
|
|
% within rheumatism |
40.0% |
60.0% |
100.0% |
||||
|
Normal |
Count |
331 |
310 |
641 |
|||
|
% within rheumatism |
51.6% |
48.4% |
100.0% |
||||
Medications |
Osteoarthritis |
Disease |
Count |
23 |
184 |
207 |
16.604 (10.347, 26.645) |
<0.001 |
% within osteoarthritis |
11.1% |
88.9% |
100.0% |
|||||
Normal |
Count |
330 |
159 |
489 |
||||
% within osteoarthritis |
67.5% |
32.5% |
100.0% |
|||||
Allergy |
Disease |
Count |
6 |
73 |
79 |
15.636 (6.700, 36.490) |
<0.001 |
|
% within osteoarthritis |
7.6% |
92.4% |
100.0% |
|||||
Normal |
Count |
347 |
270 |
617 |
||||
% within osteoarthritis |
56.2% |
43.8% |
100.0% |
|||||
Corticosteroids |
Using |
Count |
19 |
9 |
28 |
0.474 (0.211, 1.062) |
0.064 |
|
% within corticosteroids |
67.9% |
32.1% |
100.0% |
|||||
Not using |
Count |
334 |
334 |
668 |
||||
% within corticosteroids |
50.0% |
50.0% |
100.0% |
|||||
|
Atorvastatin |
Use |
Count |
75 |
131 |
206 |
2.290 (1.638, 3.203) |
<0.001 |
|
% within atorvastatin |
36.4% |
63.6% |
100.0% |
||||
|
Not using |
Count |
278 |
212 |
490 |
|||
|
% within atorvastatin |
56.7% |
43.3% |
100.0% |
Table 2. The association of underlying diseases and type of ARC
Type |
Parameter |
Type of ARC |
p-value |
||||||
Nuclear |
Cortical |
Posterior subcapsular |
Mixed |
Total |
|||||
Demographic |
Sex |
Female |
Count |
42 |
41 |
55 |
75 |
213 |
0.107 |
% within sex |
19.7% |
19.2% |
25.8% |
35.2% |
100.0% |
||||
Male |
Count |
43 |
21 |
29 |
47 |
140 |
|||
% within sex |
30.7% |
15.0% |
20.7% |
33.6% |
100.0% |
||||
|
Body Mass Index (BMI) |
Normal (18.5 to 25) |
Count |
27 |
17 |
16 |
26 |
86 |
0.057
|
% within BMI |
31.4% |
19.8% |
18.6% |
30.2% |
100.0% |
||||
Fat (25 to 30) |
Count |
36 |
28 |
29 |
45 |
138 |
|||
% within BMI |
26.1% |
20.3% |
21.0% |
32.6% |
100.0% |
||||
Obese (more than 30) |
Count |
22 |
17 |
39 |
51 |
129 |
|||
% within BMI |
17.1% |
13.2% |
30.2% |
39.5% |
100.0% |
||||
|
Diabetes mellitus |
Disease |
Count |
16 |
15 |
22 |
40 |
93 |
0.155 |
|
% within diabetes |
17.2% |
16.1% |
23.7% |
43.0% |
100.0% |
|||
|
Normal |
Count |
69 |
47 |
62 |
82 |
260 |
||
|
% within diabetes |
26.5% |
18.1% |
23.8% |
31.5% |
100.0% |
|||
|
Hypertension |
Disease |
Count |
28 |
30 |
34 |
58 |
150 |
0.141
|
|
% within hypertension |
18.7% |
20.0% |
22.7% |
38.7% |
100.0% |
|||
|
Normal |
Count |
57 |
32 |
50 |
64 |
203 |
||
|
% within hypertension |
28.1% |
15.8% |
24.6% |
31.5% |
100.0% |
|||
|
Heart failures |
Disease |
Count |
1 |
4 |
5 |
9 |
19 |
0.251
|
|
% within heart failures |
5.3% |
21.1% |
26.3% |
47.4% |
100.0% |
|||
|
Normal |
Count |
84 |
58 |
79 |
113 |
334 |
||
|
% within heart failures |
25.1% |
17.4% |
23.7% |
33.8% |
100.0% |
|||
Underlying diseases |
Renal failures |
Disease |
Count |
1 |
0 |
2 |
3 |
6 |
0.601 |
% within renal failures |
16.7% |
0.0% |
33.3% |
50.0% |
100.0% |
||||
Normal |
Count |
84 |
62 |
82 |
119 |
347 |
|||
% within renal failures |
24.2% |
17.9% |
23.6% |
34.3% |
100.0% |
||||
Anemia |
Anemic |
Count |
19 |
27 |
22 |
41 |
109 |
0.031 |
|
% within anemia |
17.4% |
24.8% |
20.2% |
37.6% |
100.0% |
||||
Normal
|
Count |
66 |
35 |
62 |
81 |
244 |
|||
% within anemia |
27.0% |
14.3% |
25.4% |
33.2% |
100.0% |
||||
Asthma |
Disease |
Count |
0 |
1 |
6 |
2 |
9 |
0.019 |
|
% within asthma |
0.0% |
11.1% |
66.7% |
22.2% |
100.0% |
||||
Normal |
Count |
85 |
61 |
78 |
120 |
344 |
|||
% within asthma |
24.7% |
17.7% |
22.7% |
34.9% |
100.0% |
||||
|
Osteoporosis |
Disease |
Count |
1 |
4 |
4 |
6 |
15 |
0.407 |
|
% within osteoporosis |
6.7% |
26.7% |
26.7% |
40.0% |
100.0% |
|||
|
Normal |
Count |
84 |
58 |
80 |
116 |
338 |
||
|
% within osteoporosis |
24.9% |
17.2% |
23.7% |
34.3% |
100.0% |
|||
|
Rheumatism |
Disease |
Count |
0 |
4 |
11 |
7 |
22 |
0.006 |
|
% within rheumatism |
0.0% |
18.2% |
50.0% |
31.8% |
100.0% |
|||
|
Normal |
Count |
85 |
58 |
73 |
115 |
331 |
||
|
% within rheumatism |
25.7% |
17.5% |
22.1% |
34.7% |
100.0% |
|||
|
Osteoarthritis |
Disease |
Count |
5 |
1 |
6 |
11 |
23 |
0.283 |
|
% within osteoarthritis |
21.7% |
4.3% |
26.1% |
47.8% |
100.0% |
|||
|
Normal |
Count |
80 |
61 |
78 |
111 |
330 |
||
|
% within osteoarthritis |
24.2% |
18.5% |
23.6% |
33.6% |
100.0% |
|||
|
Allergy |
Disease |
Count |
1 |
1 |
3 |
1 |
6 |
0.481 |
|
% within osteoarthritis |
16.7% |
16.7% |
50.0% |
16.7% |
100.0% |
|||
|
Normal |
Count |
84 |
61 |
81 |
121 |
347 |
||
|
% within osteoarthritis |
24.2% |
17.6% |
23.3% |
34.9% |
100.0% |
|||
Medications |
Corticosteroids |
Use |
Count |
1 |
3 |
7 |
8 |
19 |
0.192 |
% within Corticosteroids |
5.3% |
15.8% |
36.8% |
42.1% |
100.0% |
||||
Not use |
Count |
84 |
59 |
77 |
114 |
334 |
|||
% within Corticosteroids |
25.1% |
17.7% |
23.1% |
34.1% |
100.0% |
||||
|
Atorvastatin |
Use |
Count |
14 |
14 |
16 |
31 |
75 |
0.435 |
|
% within atorvastatin |
18.7% |
18.7% |
21.3% |
41.3% |
100.0% |
|||
|
Not use |
Count |
71 |
48 |
68 |
91 |
278 |
||
|
% within atorvastatin |
25.5% |
17.3% |
24.5% |
32.7% |
100.0% |
Table 3. The association of underlying diseases and intensity of ARC
Type |
Parameter |
Intensity |
p-value |
|||||
Mild |
Moderate |
Severe |
Total |
|||||
Demographic |
Sex |
Female |
Count |
59 |
66 |
88 |
213 |
0.181 |
% within sex |
27.7% |
31.0% |
41.3% |
100.0% |
||||
Male |
Count |
51 |
42 |
47 |
140 |
|||
% within sex |
36.4% |
30.0% |
33.6% |
100.0% |
||||
|
Body Mass Index (BMI) |
Normal (18.5 to 25) |
Count |
28 |
26 |
32 |
86 |
0.866 |
% within BMI |
32.6% |
30.2% |
37.2% |
100.0% |
||||
Fat (25 to 30) |
Count |
44 |
45 |
49 |
138 |
|||
% within BMI |
31.9% |
32.6% |
35.5% |
100.0% |
||||
Obese (more than 30) |
Count |
38 |
37 |
54 |
129 |
|||
% within BMI |
29.5% |
28.7% |
41.9% |
100.0% |
||||
Underlying diseases |
Diabetes mellitus |
Disease |
Count |
24 |
27 |
42 |
93 |
0.241 |
% within diabetes |
25.8% |
29.0% |
45.2% |
100.0% |
||||
Normal |
Count |
86 |
81 |
93 |
260 |
|||
% within diabetes |
33.1% |
31.2% |
35.8% |
100.0% |
||||
Hypertension |
Disease |
Count |
42 |
41 |
67 |
150 |
0.102 |
|
% within hypertension |
28.0% |
27.3% |
44.7% |
100.0% |
||||
Normal |
Count |
68 |
67 |
68 |
203 |
|||
% within hypertension |
33.5% |
33.0% |
33.5% |
100.0% |
||||
|
Heart failures |
Disease |
Count |
4 |
6 |
9 |
19 |
0.576 |
|
% within heart failures |
21.1% |
31.6% |
47.4% |
100.0% |
|||
|
Normal |
Count |
106 |
102 |
126 |
334 |
||
|
% within heart failures |
31.7% |
30.5% |
37.7% |
100.0% |
|||
|
Renal failures |
Disease |
Count |
1 |
2 |
3 |
6 |
0.724 |
|
% within renal failures |
16.7% |
33.3% |
50.0% |
100.0% |
|||
|
Normal |
Count |
109 |
106 |
132 |
347 |
||
|
% within renal failures |
31.4% |
30.5% |
38.0% |
100.0% |
|||
|
Anemia |
Anemic |
Count |
34 |
33 |
42 |
109 |
0.996 |
|
% within anemia |
31.2% |
30.3% |
38.5% |
100.0% |
|||
|
Normal |
Count |
76 |
75 |
93 |
244 |
||
|
% within anemia |
31.1% |
30.7% |
38.1% |
100.0% |
|||
|
Asthma |
Disease |
Count |
2 |
2 |
5 |
9 |
0.556 |
|
% within asthma |
22.2% |
22.2% |
55.6% |
100.0% |
|||
|
Normal |
Count |
108 |
106 |
130 |
344 |
||
|
% within asthma |
31.4% |
30.8% |
37.8% |
100.0% |
|||
Medications |
Osteoporosis |
Disease |
Count |
3 |
3 |
9 |
15 |
0.208 |
% within osteoporosis |
20.0% |
20.0% |
60.0% |
100.0% |
||||
Normal |
Count |
107 |
105 |
126 |
338 |
|||
% within osteoporosis |
31.7% |
31.1% |
37.3% |
100.0% |
||||
Rheumatism |
Disease |
Count |
5 |
8 |
9 |
22 |
0.659 |
|
% within rheumatism |
22.7% |
36.4% |
40.9% |
100.0% |
||||
Normal |
Count |
105 |
100 |
126 |
331 |
|||
% within rheumatism |
31.7% |
30.2% |
38.1% |
100.0% |
||||
Osteoarthritis |
Disease |
Count |
4 |
11 |
8 |
23 |
0.138 |
|
% within osteoarthritis |
17.4% |
47.8% |
34.8% |
100.0% |
||||
Normal |
Count |
106 |
97 |
127 |
330 |
|||
% within osteoarthritis |
32.1% |
29.4% |
38.5% |
100.0% |
||||
|
Allergy |
Disease |
Count |
0 |
2 |
4 |
6 |
0.201 |
|
% within osteoarthritis |
0.0% |
33.3% |
66.7% |
100.0% |
|||
|
Normal |
Count |
110 |
106 |
131 |
347 |
||
|
% within osteoarthritis |
31.7% |
30.5% |
37.8% |
100.0% |
|||
|
Corticosteroids |
Use |
Count |
4 |
8 |
7 |
19 |
0.463 |
|
% within Corticosteroids |
21.1% |
42.1% |
36.8% |
100.0% |
|||
|
Not use |
Count |
106 |
100 |
128 |
334 |
||
|
% within Corticosteroids |
31.7% |
29.9% |
38.3% |
100.0% |
|||
|
Atorvastatin |
Use |
Count |
23 |
22 |
30 |
75 |
0.935 |
|
% within atorvastatin |
30.7% |
29.3% |
40.0% |
100.0% |
|||
|
Not use |
Count |
110 |
108 |
135 |
353 |
||
|
% within atorvastatin |
31.2% |
30.6% |
38.2% |
100.0% |
Conclusion
ARC is a multifactorial ocular dysfunction that results from aging. There are various risk factors associated with the progression of ARC. In this study, the purpose was to investigate the possible associations between underlying diseases and ARC. In brief, it was found that obesity, diabetes mellitus, hypertension, and asthma are potential risk factors of the prevalence of ARC. Also, the use of atorvastatin as a routine medication for hyperlipidemia has a negative association with the prevalence of ARC. Furthermore, asthma, anemia, and rheumatism are involved in prevalence of certain types of ARC.
Acknowledgements
We thank the staff at Babol University of Medical Sciences, Babol, Iran. This study was approved by the ethics committee of Babol University of Medica Sciences (approval ID: IR.MUBABOL.HRI.REC.1398.091).
Conflict of Interest
All authors declare that there is no conflict of interest.