Characterization of Biochemical Risk Factors for Senile Cataract among Ghanaian Adults (40years) Visiting Eye Clinic in the Komfo Anokye Teaching Hospital (KATH)

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Senile Cataract, the opacity of the lens due to age is a major public health problem which if not detected and treated early could lead to blindness, and other morbidities. It is the leading cause of avoidable blindness in Ghana. Various risk factors have been identified with aetiology and pathogenesis of senile cataract including: reduced functional status, social interaction and quality of life, depression and falls. However, there are few reports on the biochemical risk factors elsewhere and no such study report could be found in Ghana. The study seeks to identify the biochemical risk factors and derrangement associated with senile cataract, elucidates the association between serum biochemical markers (its intrinsic processes that leads to such derangement) and senile cataract for future prognosis and management outcome of such condition compared to those who are clinically without the condition. Case-control study of outpatients attending eye clinic department of the Komfo Anokye Teaching Hospital (KATH) between July 2009 and September 2010 were recruited for the study. A total of 200 out patients above 40years comprising 100 clinically newly diagnosed adults cataract patients and 100 patients who are clinically without the condition. Laboratory test values in cases and controls were compared and expressed as odds ratio at 95% confidence interval. Biochemical analysis of the Patients with cataract (cases) the matched control pairs reveals that, four out of ten (4/10) biochemical variables measured were significant risk factors associated with the senile cataract development. (Table 4.4) Persons with HDL C abnormalities were twice as likely to develop senile cataract (odds ratio, 2.52 p=0.095). Within the normal reference ranges of FBG, and low uric acids (UA) levels increased risk for senile cataract (odds ratio, 1.20; p=0.106 and odds ratio1.01 p=0.011 respectively). Exposure to sodium in the absence of other biochemical risk factors remained the most significant factor associated with senile cataract (odds ratio, 0.60; p=0.001). there was a statistically significant difference between the mean serum Na+ level (Rf=135-145) in senile cataract patients (143.2±6.76) and normal individuals (139.3±1.96; p=0.0000).The low level of mean concentrations of High Density Lipoprotein (1.114±0.42 mmol L-1, p =1.000) in cataract patients were different compared to that in control patients (1.04±0.10 mmol L-1 and 2.94±1.06 respectively Also, the mean uric acid concentrations level was 210.0±113.8 µmol L-1 lower in the cases compared to 311.1±117 µmol L-1 of the controls (p=1.000). The mean concentration of fasting blood glucose (Rf=3.6-6.4). of the cataract patients 4.92±2.09 mmol L-1 were also lower than the control group of 6.01±2.96 mmol L-1 p= 0.9986 but the differences were not significant. The mean concentration of High Density Lipoprotein -Cholesterol [HDL-C] mmol L-1 in cataract patients 1.14±0.42 vs. 1.04±0.10 mmol L-1; p=0.000 (reference range, 1.15-1.68 mmol L-1) was different compared to that in control patients). Below HDL-C level of 1.5 mmol/l subjects had a three-fold higher calculated probability of developing senile cataract. (ORs 3.17(1.79-5.61) and HDL–C were significantly associated with senile cataract among the study population. Similarly, mean serum uric acid [UA]level (reference ranges was 143-417 µmol L-1) were lower in the cataract group than in the control group (210.0±113.8 vs. 311.1±117; p=0.000) respectively and ORs (95%CI) 0f 1.01(1.01-1.02) whilst the mean concentration of fasting blood sugar (FBS) of the cataract patients 4.92±2.09 mmol L-1 were also lower than the control group of 6.01±2.96 mmol L-1) ) respectively and ORs (95%CI) 0f 1.25(1.O6-1.49)p=0.008 (reference range (3.6-5.8) mmol/l).(table 4.2).The trend in the likelihood ratio test indicate a very strong association between increasing order of level of exposure to sodium, uric acid, HDL-C, FBS and the probability of developing the senile cataract The study found that Human serum components such [Sodium], [Uric acid], [HDL-CHOLESTEROL], Fasting Blood Glucose are biochemical risk factors association with the developing of senile cataract and diets with high Na+ content may leads to high level of serum Na+ associated with senile cataract. Whilst in aging processes biochemical derangement such as reduced efficiency of metabolic processes and a decrease in antioxidant defense mechanism may result in low serum level of HDL-C and reduction in serum uric acid levels. These intrinsic processes may mire uric acid strong endogenous antioxidant role and both HDL-C antioxidative and anti-inflammatory activities leading to such derangement associated with senile cataract. Human blood component play significant role as both potential osmotic and oxidative stress associated with age related or senile cataract causing avoidable blindness.
A Thesis Submitted in Fulfillment of the requirements for the Degree of Master of Philosophy in the Department Of Molecular Medicine, School Of Medical Sciences.