A cataract is a clouding or opacification of the normally clear lens of the eye or its capsule (surrounding transparent membrane) that obscures the passage of light through the lens to the retina of the eye (1). Globally, cataract remains the leading cause of remediable blindness, accounting for a significant burden on healthcare systems, especially in developing countries (2). The development of cataract is primarily due to degenerative changes in the lens and is typically associated with aging, commonly manifesting after the age of 50 years (3). However, several studies have reported an earlier onset of cataract in developing countries compared to developed regions, attributed to factors such as nutritional deficiencies, exposure to ultraviolet radiation, and lack of healthcare access (4).

Presenile cataract, defined as cataract occurring before the age of 50 years, is increasingly recognized as a public health concern (5). According to the National Blindness and Visual Impairment Survey (NPCB and VI 2015–2019), cataract contributes to 66.2% of blindness and 71.2% of visual impairment in individuals above 50 years of age in India, underlining the magnitude of the problem (6). The emergence of presenile cataract will further burden the healthcare system by adding to the existing backlog of cataract cases and surgeries. Early identification of modifiable risk factors in younger populations is thus critical for designing preventive strategies aimed at reducing the incidence and burden of cataract-related blindness in India.

Previous studies have identified several risk factors for presenile cataract, including diabetes mellitus, smoking, prolonged steroid use, exposure to ultraviolet radiation, and genetic predisposition (5). Some studies, such as those conducted by Vashist et al. (4) and Sapkota et al. (6, 7), have emphasized the importance of lifestyle and environmental factors in the early development of cataracts. However, most research has focused on senile cataracts, with relatively fewer large-scale studies dedicated specifically to presenile cataract, especially in the Indian context. This creates a research gap in understanding the unique risk profile of younger individuals affected by cataract in developing countries. Therefore, this study aims to assess and identify the risk factors associated with presenile cataract among patients attending a tertiary eye care center. The ultimate goal is to contribute evidence that may support the development of targeted public health interventions and preventive strategies to curb the growing burden of early-onset cataract blindness.

This research was designed as a cross-sectional, hospital-based observational study. The study was undertaken to evaluate the risk factors associated with presenile cataract among patients presenting for cataract surgery. The study was conducted at Sarojini Devi Eye Hospital, a tertiary eye care center located in Hyderabad, Telangana, India. A total of 150 patients were enrolled in the study based on predefined eligibility criteria. The study period was from September 2024 to March 2025.

The study included patients attending the outpatient department for cataract evaluation and surgery. Patients who satisfied the eligibility criteria and provided informed consent were enrolled consecutively.

Inclusion Criteria

• Patients aged between 18 and 50 years.
• Presence of unilateral or bilateral cataract confirmed on slit lamp examination.

Exclusion Criteria

• Patients diagnosed with congenital or developmental cataracts.
• Patients with a history of any intraocular surgery.
• Patients with a prior history of ocular trauma.
• Patients aged below 18 years or above 50 years.
• Patients who had a history of topical or systemic corticosteroid use.

Data Collection and Methodology

After obtaining informed consent, each patient was subjected to a detailed interview using a structured questionnaire. The questionnaire captured information regarding demographic profile (age, gender, and socioeconomic status), occupational history, daily sunlight exposure duration, and history of systemic and ocular conditions. Specific questions were asked regarding previous history of uveitis, use of topical or systemic steroids, alcohol consumption, ocular trauma, ocular surgeries, family history of early cataract formation (presenile cataract), presence of myopia, history of atopy, and other systemic diseases like diabetes and hypertension.

Following the interview, all patients underwent a comprehensive ocular examination, which included:

• Visual acuity testing using Snellen’s chart.
• Anterior segment evaluation with a slit lamp biomicroscope to assess the type and severity of lens opacities.
• Fundus examination using slit lamp biomicroscopy with a 90 diopter (90D) lens to rule out posterior segment pathology.

Cataract severity and morphology were classified according to the Lens Opacities Classification System III (LOCS III), providing a standardized grading of nuclear, cortical, and posterior subcapsular opacities.

Each patient underwent a complete preoperative evaluation, which included:

• A-scan biometry for axial length measurement.
• Keratometry to measure corneal curvature.
• Intraocular pressure measurement using non-contact tonometry.
• Lacrimal syringing to assess nasolacrimal duct patency.

To assess the general health and rule out systemic contributory factors, the following laboratory investigations were carried out for all patients:

• Complete Blood Picture (CBP)
• Random Blood Sugar (RBS)
• Post-Lunch Blood Sugar (PLBS)

All clinical examinations and investigations were performed using standardized procedures by experienced ophthalmologists.

 Ethical Considerations

The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Institutional ethical committee approval was obtained prior to commencement of the study. Written informed consent was taken from all participants after explaining the purpose and nature of the study.

Table 1: Distribution of Patients Based on Visual Acuity at Presentation

Table 1 shows the distribution of visual acuity among the 150 patients included in the study. The majority of patients (40%) were able to count fingers at a distance of 1 meter, followed by 27% who could count fingers at 2 meters. About 13% of patients could only count fingers close to the face, and 10% had visual acuity limited to just the perception of light. Another 10% of patients were able to count fingers at a distance between 3 meters and 6 meters.

Table 2: Age-wise Distribution of Patients with Presenile Cataract

This study aimed to assess the distribution and risk factors associated with presenile cataract among patients aged 18–50 years. Among the 150 patients included, a majority were in the 41–50 years age group, suggesting that the incidence of cataract significantly rises as individuals approach the later part of the fourth decade of life. Visual acuity at presentation revealed that a substantial proportion of patients had moderate to severe visual impairment, with 40% being able to count fingers at 1 meter and only 10% limited to light perception.

Morphologically, posterior subcapsular cataract (PSCO) was the most common type observed, consistent with its known association with metabolic disorders, steroid use, and ultraviolet light exposure. Similar trends have been observed in earlier studies on younger populations. In terms of risk factors, the largest group (38%) was classified as idiopathic, with no specific cause identified, a finding that echoes the results of Jyothi R. et al (8).

Sunlight exposure emerged as the most common modifiable risk factor (20%), particularly among individuals involved in outdoor occupations such as farming, construction work, and vending. This observation aligns with the studies conducted by Patel et al., (9) both of which reported a higher prevalence of cataract in rural outdoor workers, especially among those over 40 years of age.

Diabetes mellitus was the third most frequent risk factor in this study (17%), following closely behind sunlight exposure. Although Jyothi et al. identified diabetes as the leading cause of presenile cataract, in the present study, it ranked second. The increasing prevalence of diabetes, attributed to sedentary lifestyle, obesity, and dietary changes, may contribute to the earlier onset of lens opacification.

Alcohol consumption was identified as a contributing factor in 11% of patients, though its impact was less prominent compared to findings by Patel et al. Similarly, high myopia was observed in 4% of cases, whereas Verma et al., (10) reported it as an equally significant contributor alongside diabetes, suggesting regional or demographic variability in risk profiles.

Other less common but notable contributors in this study included atopy (5%), consanguinity (4%), and a positive family history (1%). Atopy, an allergic predisposition, may play a role through chronic inflammation, though it remains less established in literature and warrants further study.

Overall, the findings from this study reinforce the importance of recognizing both modifiable and non-modifiable risk factors. The modifiable factors sunlight exposure, diabetes mellitus, and alcohol consumption represent key targets for preventive strategies. Non-modifiable factors like high myopia and genetic predisposition also require early screening and follow-up.

This study adds to the growing evidence that presenile cataract is becoming more prevalent, particularly due to changes in lifestyle and environmental exposures. There is a need for awareness programs targeting high-risk groups, especially those with occupational exposure to sunlight and individuals with metabolic diseases. Preventive measures, early detection, and timely surgical management are essential in reducing the burden of vision loss in economically productive age groups.

FURTHER STUDIES

To strengthen the understanding of presenile cataract etiology, future research should be conducted on a larger scale, involving more diverse populations. Further studies should explore the role of dietary patterns, systemic medications, antioxidant status, and chronic heat exposure (e.g., during cooking) in the early onset of cataract. Longitudinal studies would also help establish causal relationships and guide targeted public health interventions.

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