Introduction

A cataract is the most prevalent ophthalmic disease. It is the leading cause of blindness and visual impairment worldwide, according to the (WHO vision 2020 Report, 2014). It is defined as lens opacity or clouding, which affects the optical quality of the crystalline lens that affects vision. Consequently, cataract has a large impact on the quality of life of many elderly people, as most cataracts are age-related. Developing countries like our country will bear an increasing burden for cataract blindness because the higher incidence of cataracts and cataracts occur earlier in life with fewer country resources and lack of patient’s information about the disease (Kalua, Patel, Muhit, & Courtright, 2008). Cataracts may be partial or complete, unilateral or bilateral, stationary or progressive, hard or soft. Its main types are nuclear sclerosis, posterior subscapular and cortical. The symptoms vary depending on degree of cataract and its type, though considerable overlap occurs in between, patients with sclerotic nuclear cataract often notice a reduction in vision and decrease contrast sensitivity, those with posterior subscapular cataract usually complain of reading difficulties and nighttime driving problem and those with cortical cataract usually suffers from glare or monocular diplopia (Murthy, Gupta, John, & Vashist, 2008). Although various risk factors for cataract development like Diabetes Mellitus, drug use, trauma, smoking, UV-B light, and many others have been identified, data to develop guidelines for reducing the risk of cataract remain inconclusive. Although no means of preventing cataracts has been scientifically proven, wearing sunglasses, stop smoking with regular intake of antioxidants and some nutrients may slow its development or decrease its risk. Although a pharmacological preventive or therapeutic treatment for this potentially blinding disease is being actively sought, the solution still appears to be many years away. Therefore, surgical treatment for cataracts which includes intraocular lens implantation remains the only viable alternative with highly successful results. The main indication for cataract removal is that cataract which interferes with patient daily activity and functional ability in order to provide the patient best outcome as close as possible to their desire. Phacoemulsification under local anesthesia is the most widely used cataract surgery, and it is one of the most common surgical procedures performed in the world which uses ultrasound energy to emulsify the cataract. Complications of cataract surgery with undesirable consequences may occur intraoperatively or later in the postoperative period. Fortunately, complications resulting in permanent visual loss are rare with modern surgical technology in the hands of experienced ophthalmologists (Suryanarayana et al., 2005).

Materials and Methods

The study was a cross-sectional study with an analytic element. It was conducted in the Department of Ophthalmology in Al-Sader Teaching Hospital in Misan governorate, Iraq. During 2017, the study including the patients who attending the ophthalmology unit regarding their characteristics features (age, sex, residency, family history, smoking, chronic disease, eye trauma or surgery and drug history) also each patient underwent a full eye examination with some investigations such as random blood sugar (RBS) and dilated fundoscopy. The study was excluding any uncorrected data or information. Data was collected using a special formula, constructed by the researcher and; based on the standard criteria. The study protocol was reviewed; approval and official permission were obtained from the Ministry of Higher Education and Misan Directorate Of Health (DOH) to conduct the present study.

Statistical analysis

The analysis of data was carried out using the available Statistical packages for social science, version 20.0 (SPSS-20.0). Data were presented in the form of the table of number and percentage also as figures. Chi-square test (χ²-test) was used for testing the significance of the association between variable under study. Statistical significance was considered whenever the p-value was equal or less than 0.05.

Results and Discussion

The total study sample was 109 patients who diagnosed as cataract patient after examination of them in ophthalmological unit by a specialist doctor, out of them about 63 (57%) was female, and 46 (43%) was male. The present study was found as shown in Table 1 that there were 61(56%) of the case with age ≥ 50 years old, while the rest (44%) of the case with age less than 50-year-old. More than two-thirds of cases were lived in urban(72.5%). About 28% of cataract patients was a smoker, and 17.4% was a positive family history. The positive history of Systemic disease, Ocular disease or trauma and steroid was 50,4%, 21.1%, and 14.7, respectively.

This study was found that the site of cataract was presented in both eyes followed by left eye and less in right eye (40, 39 and 30 in both, left and right eyes respectively), also the study reported that most of case were immature 75(68.8%), and the intra-orbital pressure and fundus were normal in about 84% and 87% of cataract eye(respectively), while the visual acuity was effect by cataract when the study found that 74% of eye was abnormal. As shown in Table 2.

There was three types of cataract was noted by our study and reported as follows; nuclear sclerotic was 53%, posterior sub-capsular was 34%, and cortical was 13% as shown in Figure 1.

There were 62% of posterior sub-capsular of age < 50 years while 56% of Nuclear sclerotic and 100% of cortical were with age ≥ 50 years this showed a statistically significant association between cataract types and patients age where p-value 0.006. (Table 3). The study was found that 91%, 62%, and 64% of posterior sub-capsular, Nuclear sclerotic and cortical type respectively were lived in urban area with a statistically significant association between them (Table 3), also found that 96% nuclear sclerotic, 93% of cortical and 62% of posterior sub-capsular types were not received steroid while 37% of posterior sub-capsular was had history of steroid treatment with highly statistical significant association (p-value 0.001) as shown in Table 3. From other aspect there was a significant association between orbital characteristics (maturity and IOP) and cataracts type when p-value was (0.07 and 0.01) in which most of posterior sub-capsular (83%) and nuclear sclerotic (65%) were immature while it reverses in cortical most of them was mature (57%). For IOP, most of them were normal (100%, 85% and 73% as posterior sub-capsular, cortical and nuclear sclerotic respectively) as shown in Table 3.

The present study was found that there was no statistically significant association between the types of cataract and others variables like smoking, family history, systemic disease, Ocular disease and trauma, site, fundus and visual acuity where the p-value was (0.4, 0.7, 0.1, 0.5, 0.6, 0.6. And 0.7 respectively) as shown in Table 4.

Finally, the present study was reported that 55(50.5%) case of cataract treated by surgery, then about 29(26.6%) were treated by glasses and the rest (25 case,22.9%) were treated by drop only, as shown in Figure 2.

The occurrence of cataracts increases with age starting around age 50 (National Eye Institute, 2016). Cataracts are the leading cause of visual impairment among most of the developed countries and are the leading cause of treatable blindness among population descent age 40 and older (Congdon, 2004; Cotter, Varma, Yinglai, Azen, & Klein, 2006). There were most of cataract patient of 50-year-old and more and it increased with aging, more than half of nuclear sclerotic and all of the cortical cataract type were in age more than 50 years, while near to one third of posterior sub-capsular had age less than 50 years, this represents an association between age and type of cataract. A similar result was reported by other studies that conduct in different parts of world, which found that age considered as risk factor for cataract occurrence, likes study done in china by (Foster, 2003) and other a review study done in Europe by (Prokofyeva, Wegener, & Zrenner, 2013). The prevalence of cataract was higher in a female patient in our study than the male that in agreement with another study which found most cataract patients was man while some other study revealed that the occurrence of cataract was more or high in male patients (Foster, 2003; Prokofyeva et al., 2013). The present study was noticed that more than two-thirds of cases were lived in urban which are quite similar to the results of studies done by Foster and Elena in different areas (Foster, 2003; Prokofyeva et al., 2013).

The smoking rate was high among patient of our study sample also, and there was a positive family history this was similar to other studies such as (Esteban et al., 2007). The positive history of Systemic disease, Ocular disease, trauma, and steroid was high in the present study which in agreement with another study which found the same results (Seah, Wong, Foster, Ng, & Johnson, 2002). This study was found that the site of cataract was presented in both eyes followed by left eye and less in right eye, also the study reported that most of case were immature and the intra-orbital pressure and fundus were normal in cataract eye (respectively), while the visual acuity was effect by cataract when the study found that 74% of eye was abnormal. (Theodoropoulou et al., 2011; WHO vision 2020 Report, 2014). Regarding the treatment; our study found that more than 50% of cases treated with surgery and the rest were treated by glasses and by the drop (Baltussen, Sylla, & Mariotti, 2004).

Conclusion

Cataract mostly occurs in females more than male and age more than 50 years old patients and related to steroid use. The common treatment was surgery.