Refractive Status and Cataract Incidence

HOT TOPIC

Refractive Error Type May Affect Cataract Risk

A recent study published in the journal Medicine reveals that individuals with hyperopia may have a lower risk of developing cataracts than those with myopia or emmetropia. The research, conducted by a University of Ottawa Eye Institute team, analyzed data from more than 4,000 participants between 40 and 69 years of age from the UK Biobank. Participants underwent comprehensive eye examinations, which included refractive measurements and cataract assessments via slit-lamp biomicroscopy. The findings indicate that hyperopes had a significantly reduced likelihood of cataract formation, with an odds ratio suggesting a protective effect. This contrasts with myopes, who showed a higher cataract incidence, potentially linked to the increased axial length of their eyes, which may cause lenticular stress over the years.

The study suggests that refractive status could influence cataract risks through both biomechanical and/or metabolic mechanisms. In hyperopia, the shorter axial length might reduce the mechanical strain on the lens, while in myopia, elongated eyeballs could accelerate lens opacification. Also, hyperopes may differ in lens protein stability or oxidative stress responses, although these hypotheses should be explored further. The researchers adjusted for confounders in the study, including age, sex, diabetes, and smoking. Quite notably, the protective effect was more pronounced in cortical cataracts, which predominantly affect the lens periphery, than in nuclear or posterior subcapsular cataracts.

My Two Cents

A pretty fascinating study! If you read the newsletter often, you know I’m a geek for studies! This one is practical and something I’ve never considered, but its findings make sense. However, there are some concerns: For one, the age range is pretty narrow, in that it only included patients up to 69 years of age. I would have liked to see that expanded to older patients. In addition, this type of data could easily be pulled from various large clinics to further evaluate the hypothesis that myopes develop cataracts faster.

OUTSIDE THE LANE

First New Oral Antibiotic for UTIs Approved in 30 Years

The FDA has approved gepotidacin (Blujepa, GlaxoSmithKline), marking the first new oral antibiotic for “uncomplicated” urinary tract infections (UTIs) in nearly 3 decades. Gepotidacin’s targeted market is females 12 years of age and older, which addresses a growing need for effective UTI treatments amid rising antibiotic resistance. UTIs, which affect nearly half of all women at some point in their lives, often recur due to resistant bacteria. Gepotidacin employs a novel antibiotic mechanism that inhibits bacterial DNA replication by targeting two enzymes essential for bacterial survival. This innovative approach may reduce the likelihood of bacterial resistance.

Clinical trials for the product involved more than 3,000 participants and demonstrated gepotidacin efficacy, showing comparable or superior results with those of nitrofurantoin, the current frontline antibiotic for UTIs. The drug is administered as a pill taken twice daily, with mild side effects, such as diarrhea and nausea occasionally reported. The approval is supported by data from the company’s EAGLE-2 and EAGLE-3 trials, highlighting gepotidacin’s therapeutic and microbiological success.

Quite interestingly, gepotidacin’s development received funding from US government agencies, thereby emphasizing its importance in combating recurrent infections and alleviating strain on the American health care system. The drug is expected to be commercially available in the latter half of 2025.

My Two Cents

This is an essential story because we all likely encounter UTIs professionally or personally. But more than that, it’s important that we, as members of the health care community, stay on top of the most significant advances in health care, be they directly related to the eye care sector or simply related to general health.

CAN YOU RELATE

The standard Acuvue Oasys with Hydraclear Plus Technology (Johnson & Johnson Vision Care) contact lens is a 2-week lens. There is also the Acuvue Oasys 1-Day with Hydra Luxe Technology and the Acuvue Oasys Max 1-Day. No, this isn’t an advertisement for Johnson & Johnson or any of its lenses; however, I’m tired of hearing patients say they’ve been told their Acuvue Oasys lens lasts 1 month. It doesn’t. To those doctors telling their patients their Oasys lens lasts 1 month: STOP. JUST STOP. Johnson & Johnson has a lens called Acuvue Vita that lasts 1 month.

Again, this is not an ad for Johnson & Johnson; however, I see a disproportionate number of patients with dry eye and corneal neovascularization from overwearing the 2-week Acuvue Oasys than any other lens out there. Please stop putting patients into a Survivor-style situation with their eye health. While the lenses may feel fine to them, remember these devices are like bacteria-filled sponges waiting to instigate a rebellion on their corneas. You wouldn’t tell a patient to wear the same pair of underwear for weeks at a time or eat yogurt after the expiration date, would you? It’s time to let your patient’s contact lenses retire gracefully after their expected 2 weeks. Or here’s a better idea: Switch them to a daily lens or put them in an actual monthly lens!

I can’t be the only one who hears—on a near daily basis—that their patient was told this lens lasts a month? Rant over.