The Impact of Smoking and Hypertension on Cataract Development in Diabetic&nbsp;Patients

Muataz H. Jaaz; Ahmed N Al-Nasrawi

doi:10.12688/f1000research.153933.1

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Research Article

The Impact of Smoking and Hypertension on Cataract Development in Diabetic Patients

[version 1; peer review: 1 not approved]

Muataz H. Jaaz¹, Ahmed N Al-Nasrawi ²

PUBLISHED 15 Aug 2024

Author details Author details

¹ Ophthalmology, College of Medicine, University of Thi-Qar, Thi-Qar, Iraq
² Orthopedic, Al-Sader Teaching Hospital, Basrah, Iraq

Muataz H. Jaaz
Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Visualization, Writing – Review & Editing

Ahmed N Al-Nasrawi
Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Software, Supervision, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

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Abstract

Background

Cataracts are a leading cause of visual impairment and blindness globally, with a particularly high incidence in diabetic patients due to the complex interplay of metabolic dysregulation and hyperglycemia-induced oxidative stress. Diabetic cataract development is influenced by several modifiable risk factors including smoking and hypertension, which may exacerbate lens opacity through various biological mechanisms. This study aims to determine the effects of smoking and hypertension on cataract development in diabetic patients.

Methods

Conducted from December 2022 to November 2023, this cross-sectional study at a specialized diabetes and ophthalmology healthcare facility involved 60 diabetic patients. The participants were divided into two groups: those with cataracts (n=32) and those without (n=28). Data collection focused on demographics, smoking history, hypertension status, and cataract presence, using structured interviews and medical record reviews. Logistic regression was employed to analyze the association between cataracts and potential risk factors, adjusting for age, diabetes duration, and glycemic control.

Results

Age and genderfi were not significantly different between the two groups, with mean ages of 50.21±14.34 years in the cataract group and 49.41±12.15 years in the non-cataract group (P=0.087). The prevalence of smoking was similar between those with cataracts (14.3%) and without (15.6%), showing no significant association (P=0.885). Hypertension was more prevalent in the cataract group (71.4%) compared to the non-cataract group (53.1%), although this difference was not statistically significant (P=0.146). Logistic regression analysis indicated that smoking had a minimal effect on cataract development (OR=1.187; 95% CI=0.264-5.33; P=0.823), and while hypertension showed a stronger association (OR=2.277; 95% CI=0.749-6.92), it also lacked statistical significance (P=0.147).

Conclusion

Neither smoking nor hypertension showed significant associations with cataract development. These findings suggest that the influence of these factors on cataract progression may differ in diabetic individuals due to the complex interplay of metabolic and vascular changes associated with the condition.

Keywords

Cataract, Diabetes, Smoking, Hypertension, Ocular health.

Corresponding author: Ahmed N Al-Nasrawi

Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright: © 2024 Jaaz MH and Al-Nasrawi AN. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Jaaz MH and Al-Nasrawi AN. The Impact of Smoking and Hypertension on Cataract Development in Diabetic Patients [version 1; peer review: 1 not approved]. F1000Research 2024, 13:928 (https://doi.org/10.12688/f1000research.153933.1) First published: 15 Aug 2024, 13:928 (https://doi.org/10.12688/f1000research.153933.1) Latest published: 15 Aug 2024, 13:928 (https://doi.org/10.12688/f1000research.153933.1)

1. Introduction

Through the navigation of metabolic health and visual impairment, cataracts emerge as a compelling focus. Diabetic cataract is a specific type of cataract that develops as a result of uncontrolled blood sugar levels, along with various other factors, which manifests as a clouding of the eye's lens, leading to blurred vision and, if left untreated, can result in vision loss.¹

Various studies demonstrated an increased prevalence of cataracts, with cortical or posterior subcapsular opacities, up to fivefold in diabetic patients in comparison to non-diabetic subjects.² The concern mostly arises from cataracts being a significant reason for blindness around the world.² An estimation was done fewer years ago which presented that more than 25 million adults and children, with 90% living in developing countries, experience blindness as a result of cataracts. This estimation was forecasted to increase due to factors such as a projected 33% rise in the population of developing countries and a doubling in the number of individuals aged 65 and above in both less economically developed and industrialized nations.³

Many key factors were emphasized in influencing the development and severity of lens opacities, one of them being hypertension. Various studies explored the intricate relationship between hypertension and cataract development and consequently delivered clear and significant correlation.⁴^–⁷ M. Sharma, et al.⁸ presented that hypertensive patients exhibited a higher incidence of cataracts (74%) compared to those that are not hypertensive (69.8%). Other studies specifically found a strong contribution of high systolic blood pressure to the pathogenesis of cataracts.⁹^,¹⁰ However, the Patho-physiological mechanisms through which hypertension leads to the development of cataracts is still not well explained. Some studies suggested an inflammatory component associated with cataracts¹¹ and increased inflammatory markers displayed in hypertension, such as IL-6 and TNF-a,¹² can explain the role of hypertension in the development of cataracts. Other studies attributed the role of hypertension to oxidative stress.¹³

Smoking is also highlighted as a risk factor for cataracts development, extending its detrimental impact beyond its well-known health risks. Studies have efficiently linked smoking to diabetic cataracts which further amplified the burden on ocular health in diabetic individuals. Smoking is believed to trigger oxidative stress which can further heighten the risk of cataract development and progression.¹⁴ It was also reported that smoking can induce micro and macro-vascular complications in diabetic individuals which eventually contribute to cataract development.¹⁵

This study aims to investigate the correlation between smoking habits, hypertension, and the development of cataracts in individuals diagnosed with diabetes. By examining these factors comprehensively, the research seeks to discern the specific contributions of smoking and hypertension to the progression of cataracts in diabetic patients. Through a complete analysis of data and clinical observations, the study is targeted to provide insights into potential risk factors and mechanisms underlying cataract formation in this population. Ultimately, this study aims to offer insights that can guide the development of targeted preventive measures and specialized clinical interventions for diabetic patients. The goal is to reduce the influence of modifiable risk factors, such as smoking and hypertension, on the progression of cataracts and thereby improve overall visual health outcomes.

2. Methods

2.1 Study design

The study was conducted as a cross-sectional analysis from December 2022 to November 2023 to examine the prevalence of cataracts among diabetic patients and evaluate the association with smoking and hypertension. This design allowed for the assessment of exposure and outcome variables simultaneously at a single point in time.

2.2 Setting

Research activities were carried out in a single healthcare facility with a specialized diabetes and ophthalmology unit, facilitating the recruitment of diabetic patients and the evaluation of cataract status alongside smoking and hypertension variables.

2.3 Population

The total study population comprised 60 diabetic patients. Among these, 32 patients were diagnosed with cataracts (case group), and 28 patients did not have cataracts (control group). Eligibility criteria for participants were refined to include only active smokers with a history of smoking for 5 years or more and patients with hypertension diagnosed based on the criteria of the American Heart Association, with a history of hypertension for at least 5 years.

All participants were aged 18 years and older, with a confirmed diagnosis of Type 1 or Type 2 diabetes. Patients with cataracts due to other systemic diseases, medications, trauma, or congenital factors were excluded from the study to isolate the impact of diabetes, smoking, and hypertension on cataract development.

2.4 Outcomes measurement

The presence of cataracts was the primary outcome, determined through ophthalmological examinations by qualified ophthalmologists using slit-lamp biomicroscopy. Information on smoking status and hypertension was collected through patient interviews and medical record reviews.

2.5 Data collection

Data on demographics, smoking history, hypertension status, diabetes management, and ophthalmologic findings were collected through structured interviews and review of medical records. This approach ensured comprehensive data collection on all relevant variables. Additionally, the cataract was evaluated using the (Carl Zeiss Meditec AG) 220 slit lamp manufactured in Jena, Germany with a serial number of (9707200663).

2.6 Statistical analysis

Descriptive statistics summarized the demographic and clinical characteristics of the participants. The prevalence of cataracts in the study population was calculated, and the association between cataract development and risk factors such as smoking and hypertension was analyzed using logistic regression models. Adjustments were made for potential confounders including age, duration of diabetes, and glycemic control. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported to quantify the strength of associations.

3. Results

The analysis reveals no significant age difference between cataract and non-cataract groups, with the former being older (P 0.087). Gender shows no significant impact on cataract occurrence (p=0.628) (Table 1).

Table 1. The demographical data distribution between the two groups.

Variables		Cataract group (No. 28)	Non-Cataract group (No. 32)	P-value
Age (years) (mean±SD)		50.21±14.34	49.41±12.15	0.087
Sex	Male	14 (50.0%)	14 (43.8%)	0.628
Sex	Female	14 (50.0%)	18 (56.3%)	0.628

The dataset shows no significant difference in smoking rates between individuals with cataracts (14.3%) and without (15.6%), indicated by a p-value of 0.885. Similarly, while there's a higher prevalence of hypertension in the Cataract Group (71.4%) compared to the Non-Cataract Group (53.1%), the difference is not statistically significant (p-value=0.146). These findings suggest that neither smoking nor hypertension significantly correlates with cataract formation in this sample, although a trend toward higher hypertension rates in cataract patients is noted (Table 2).

Table 2. The social and medical factors data distribution between the two groups.

Variables		Cataract group (No. 28)	Non-Cataract group (No. 32)	P-value
Smoking	Yes	4 (14.3%)	5 (15.6%)	0.885
Smoking	No	24 (85.7%)	27 (84.4%)	0.885
Hypertension	Yes	20 (71.4%)	17 (53.1%)	0.146
Hypertension	No	8 (28.6%)	15 (46.9%)	0.146

The table analyzes the impact of Smoking and Hypertension on an outcome using logistic regression. Smoking shows a modest effect with an OR of 1.187 but lacks statistical significance (p=0.823), indicated by a wide CI (0.264-5.33) and a high standard error, suggesting uncertainty in the estimate. Hypertension displays a stronger association, with an OR of 2.277, yet also lacks statistical significance (p=0.147), despite a narrower CI (0.749-6.92), pointing to a potential but unconfirmed impact. Both variables' associations with the outcome are not statistically significant (Table 3).

Table 3. Logistic regression analysis of the smoking and hypertension among diabetic patients with Cataract.

Variables	Coefficient regression	Odd ratio	Standard error	P-Value	95% CI
Smoking	0.172	1.187	0.767	0.823	0.264-5.33
Hypertension	0.823	2.277	0.568	0.147	0.749-6.92

4. Discussion

This cross-sectional study aimed to investigate the potential impact of smoking and hypertension on the development of cataracts among diabetic patients. Despite the hypothesized risks associated with these variables, the results of this analysis did not establish a statistically significant correlation between smoking or hypertension and the incidence of cataracts in the diabetic population studied.

4.1 Smoking and cataract development

The findings indicate that smoking does not significantly affect the development of cataracts among diabetic patients. With a p-value of 0.885 and an odds ratio of 1.187, the results suggest a negligible impact of smoking on cataract incidence. This contradicts some previous studies which have suggested a potential link between oxidative stress induced by smoking and cataract formation.¹⁶ One of the mechanisms of lens damage and cataract formation is disruption of the protective function of alpha crystalline, a vital protein in the lens that acts as a chaperone to prevent the aggregation of denatured proteins, which can lead to light scattering and opacity in the lens.¹⁷ P-parabenzoquinone which is a compound found in cigarette smoke, disrupts the structure of alpha-crystalline, contributing to cataract formation.¹⁸ Moreover, smoking directly exposes the lens epithelial cells to harmful toxins and indirectly decreases levels of antioxidant molecules, like ascorbic acid and nicotinamide. Heavy metals present in cigarettes, such as lead and cadmium, further exacerbate oxidative stress by depleting crucial antioxidant defenses like glutathione.¹⁸^,¹⁹

The impact of smoking on cataract formation has been widely documented²⁰^,²¹; however, the effect size can vary significantly depending on individual smoking behaviors.²² The inconsistency in the smoking impact might also be attributed to variations in the duration, intensity, and cessation of smoking habits among the subjects in this study. This variation could dilute the observable impact of smoking on cataract development in a relatively small cohort. Furthermore, as cessation timing varies among individuals, the cumulative exposure to the harmful components of tobacco smoke necessary to influence cataract pathogenesis may not have been reached uniformly across this study sample. This aligns with the existing literature that provides evidence of a dose-response effect of smoking on ocular morbidity.²³ This is due to several factors. Higher smoking intensity can exacerbate oxidative stress, leading to increased damage to proteins in the lens. This damage disrupts various cellular processes crucial for repair and recovery. Over time, this cumulative damage not only affects the lens but also extends to other ocular tissues.²³^,²⁴

4.2 Hypertension and its influence

Although the prevalence of hypertension was higher in the cataract group, the statistical analysis (p-value of 0.146) failed to show a significant correlation. The odds ratio of 2.277 suggests a potential trend or risk association, yet the confidence intervals and the high p-value underscore a lack of statistical certainty. Hypertension has been previously identified as a risk factor for cataracts development.²⁵ It triggers an inflammatory response in the eye, leading to elevated levels of pro-inflammatory cytokines such as tumor necrosis factor-alpha (TNF-a), interleukin-6 (IL-6), and C-reactive protein (CRP). This chronic inflammatory state contributes to oxidative stress and cellular damage within the lens, accelerating cataract formation.²⁶^,²⁷ Hypertension also directly impact the structure of lens proteins, as proposed by Lee et al.,²⁸ potentially exacerbating protein aggregation and lens opacity. Additionally, experimental animal studies have implicated the renin-angiotensin system, a key regulator of blood pressure, in the pathogenesis of cataracts.²⁹ Ornek et al.³⁰ demonstrated that elevated nitrite levels in cataractous lenses of hypertensive patients is crucial in cataracts formation. Interestingly, several studies have suggested an association between hypertension (HTN) and cataract formation, partly attributed to the use of anti-hypertensive medications. Cumming et al.³⁰ highlighted a significant link between cataract risk and potassium-sparing diuretics, which aligns with biological plausibility. These anti-HTN drugs have the potential to disturb the electrolyte balance across lens fibers, thereby contributing to cataract development. The lack of significant findings in the present study might suggest that while hypertension could contribute to cataracto genesis, its effect might be less direct and perhaps mediated by other diabetic complications or vascular factors that were not controlled for in this analysis.

The study has some limitations that warrant consideration. Firstly, the sample size of 60 participants may limit the generalizability of the findings and the statistical power to detect small effect sizes. Secondly, the cross-sectional design of the study precludes conclusions about causality between smoking, hypertension, and cataract development. Additionally, the reliance on self-reported data for smoking and hypertension status could introduce recall bias and misclassification, potentially obscuring true associations.

5. Conclusion

This study aimed to explore the impact of smoking and hypertension on cataract development in diabetic patients. The results indicated no significant association between these factors and the presence of cataracts in the study population. While smoking and hypertension are established risk factors in the general population, their influence may vary in diabetic individuals due to the complex interplay of metabolic and vascular changes associated with diabetes.

Ethics and consent

This study was approved by the Ethical Committee of Thi-Qar University. The approval was granted with reference (No. 7810), dated (10 October 2022). A written informed consent was obtained from all participants prior to the commencement of the study. Each participant was thoroughly informed about the study's objectives, procedures, potential risks, and benefits. They were given sample time to ask questions and discuss any concerns before voluntarily agreeing to participate.

Data availability

Data are available at Figshare under the title (The impact of smoking and hypertension on cataract development in diabeticpatients). https://doi.org/10.6084/m9.figshare.25962676.³¹

The project contains the following underlying data:

• Smoking and hypertension. xlsx. (data on the effect of smoking and HTN on cataract development).

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

References

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2. Obrosova IG, Chung SSM, Kador PF: Diabetic cataracts: mechanisms and management. Diabetes Metab. Res. Rev. 2010; 26(3): 172–180. Publisher Full Text
3. Tasman W, Jaeger EA: Duane's ophthalmology. Lippincott Williams & Wilkins; 2007.
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18. Chowdhury A, Choudhury A, Chakraborty S, et al.: p-Benzoquinone-induced aggregation and perturbation of structure and chaperone function of α-crystallin is a causative factor of cigarette smoke-related cataractogenesis. Toxicology. 2018; 394: 11–18. PubMed Abstract | Publisher Full Text
19. Mosad SM, Ghanem AA, El-Fallal HM, et al.: Lens Cadmium, Lead, and Serum Vitamins C, E, and Beta Carotene in Cataractous Smoking Patients. Curr. Eye Res. 2010; 35(1): 23–30. PubMed Abstract | Publisher Full Text
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23. Lindblad BE, Håkansson N, Wolk A: Smoking Cessation and the Risk of Cataract: A Prospective Cohort Study of Cataract Extraction Among Men. JAMA Ophthalmol. 2014; 132(3): 253–257. PubMed Abstract | Publisher Full Text
24. Tsai CC, Cheng CY, Liu CY, et al.: Oxidative stress in patients with Graves' ophthalmopathy: relationship between oxidative DNA damage and clinical evolution. Eye (Lond.). 2009; 23(8): 1725–1730. PubMed Abstract | Publisher Full Text
25. Ang MJ, Afshari NA: Cataract and systemic disease: A review. Clin. Experiment. Ophthalmol. 2021; 49(2): 118–127. Publisher Full Text
26. Bautista L, Vera L, Arenas I, et al.: Independent association between inflammatory markers (C-reactive protein, interleukin-6, and TNF-α) and essential hypertension. J. Hum. Hypertens. 2005; 19(2): 149–154. PubMed Abstract | Publisher Full Text
27. Klein BE, Klein R, Lee KE, et al.: Markers of inflammation, vascular endothelial dysfunction, and age-related cataract. Am. J. Ophthalmol. 2006; 141(1): 116–122. PubMed Abstract | Publisher Full Text
28. Lee SM, Lin SY, Li MJ, et al.: Possible mechanism of exacerbating cataract formation in cataractous human lens capsules induced by systemic hypertension or glaucoma. Ophthalmic Res. 1997; 29(2): 83–90. Publisher Full Text
29. Choudhary R, Shree J, Singh A, et al.: Role of the renin–angiotensin system in the development of cataract formation in angiotensin-II-induced experimental rats. J. Biochem. Mol. Toxicol. 2021; 35(7): e22789. PubMed Abstract | Publisher Full Text
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31. Al-Nasrawi A, Jaaz MH: The impact of smoking and hypertension on cataract development in diabetic patients. [dataset]. Figshare. 2024. Publisher Full Text

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Author details Author details

¹ Ophthalmology, College of Medicine, University of Thi-Qar, Thi-Qar, Iraq
² Orthopedic, Al-Sader Teaching Hospital, Basrah, Iraq

Muataz H. Jaaz
Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Visualization, Writing – Review & Editing

Ahmed N Al-Nasrawi
Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Software, Supervision, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Competing interests

No competing interests were disclosed.

Grant information

The author(s) declared that no grants were involved in supporting this work.

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https://doi.org/10.12688/f1000research.153933.1

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© 2024 Jaaz MH and Al-Nasrawi AN. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Jaaz MH and Al-Nasrawi AN. The Impact of Smoking and Hypertension on Cataract Development in Diabetic Patients [version 1; peer review: 1 not approved]. F1000Research 2024, 13:928 (https://doi.org/10.12688/f1000research.153933.1)

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Reviewer Report 05 May 2025

Geeta Behera, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

Not Approved

https://doi.org/10.5256/f1000research.168894.r371678

The authors have compared smoking and hypertension status in two limited groups of diabetic patients with and without cataracts (n=60) and concluded that there is no significant association, and also that "the influence of these factors on cataract progression may ... Continue reading

The authors have compared smoking and hypertension status in two limited groups of diabetic patients with and without cataracts (n=60) and concluded that there is no significant association, and also that "the influence of these factors on cataract progression may differ in diabetic individuals due to the complex interplay of metabolic and vascular changes associated with the condition." The few concerns about the study are:
1. The authors fail to state how they identified cataract. Most people above the age of 40 have some degree of nuclear sclerosis. Do they mean visually significant cataract (BCVA cut-offs must be defined), or was it as per the LOCS III classification?
2. Again, the exclusion criteria are not robust. There are many exclusions before terming it as age-related cataracts.
3. The sample size is too limited and the study design too simplistic (only two variables in the logistic regression) to draw conclusions related to the association of hypertension and smoking with the presence of cataract among diabetic patients.
4. "the influence of these factors on cataract progression may differ in diabetic individuals due to the complex interplay of metabolic and vascular changes associated with the condition." is grossly overstating the study's claims. The study design does not evaluate cataract progression at all.

Is the work clearly and accurately presented and does it cite the current literature?

Partly
Is the study design appropriate and is the work technically sound?

No
Are sufficient details of methods and analysis provided to allow replication by others?

Partly
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

No

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: clinical studies on anterior segment (cataract, glaucoma, cornea)

I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.

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Geeta Behera, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

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05 May 2025 | for Version 1

Geeta Behera, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

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Not Approved

The authors have compared smoking and hypertension status in two limited groups of diabetic patients with and without cataracts (n=60) and concluded that there is no significant association, and also that "the influence of these factors on cataract progression may differ in diabetic individuals due to the complex interplay of metabolic and vascular changes associated with the condition." The few concerns about the study are:
1. The authors fail to state how they identified cataract. Most people above the age of 40 have some degree of nuclear sclerosis. Do they mean visually significant cataract (BCVA cut-offs must be defined), or was it as per the LOCS III classification?
2. Again, the exclusion criteria are not robust. There are many exclusions before terming it as age-related cataracts.
3. The sample size is too limited and the study design too simplistic (only two variables in the logistic regression) to draw conclusions related to the association of hypertension and smoking with the presence of cataract among diabetic patients.
4. "the influence of these factors on cataract progression may differ in diabetic individuals due to the complex interplay of metabolic and vascular changes associated with the condition." is grossly overstating the study's claims. The study design does not evaluate cataract progression at all.

Is the work clearly and accurately presented and does it cite the current literature?

Partly
Is the study design appropriate and is the work technically sound?

No
Are sufficient details of methods and analysis provided to allow replication by others?

Partly
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

No

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

clinical studies on anterior segment (cataract, glaucoma, cornea)

I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.

Respond to this report

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[1] 1. Klein BE, Klein R, Wang Q, et al.: Older-onset diabetes and lens opacities. The Beaver Dam Eye study. Ophthalmic Epidemiol. 1995; 2(1): 49–55. PubMed Abstract | Publisher Full Text

[2] 2. Obrosova IG, Chung SSM, Kador PF: Diabetic cataracts: mechanisms and management. Diabetes Metab. Res. Rev. 2010; 26(3): 172–180. Publisher Full Text

[3] 3. Tasman W, Jaeger EA: Duane's ophthalmology. Lippincott Williams & Wilkins; 2007.

[4] 4. Seddon J, Fong D, West SK, et al.: Epidemiology of risk factors for age-related cataract. Surv. Ophthalmol. 1995; 39(4): 323–334. Publisher Full Text

[5] 5. Wang S, Xu L, Jonas JB, et al.: Major Eye Diseases and Risk Factors Associated with Systemic Hypertension in an Adult Chinese Population: The Beijing Eye Study. Ophthalmology. 2009; 116(12): 2373–2380. PubMed Abstract | Publisher Full Text

[6] 6. Leske MC, Wu S-Y, Hennis A, et al.: Diabetes, hypertension, and central obesity as cataract risk factors in a black population: the Barbados Eye Study. Ophthalmology. 1999; 106(1): 35–41. PubMed Abstract | Publisher Full Text

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The Impact of Smoking and Hypertension on Cataract Development in Diabetic Patients

Abstract

Background

Methods

Results

Conclusion

Keywords

1. Introduction

2. Methods

2.1 Study design

2.2 Setting

2.3 Population

2.4 Outcomes measurement

2.5 Data collection

2.6 Statistical analysis

3. Results

Table 1. The demographical data distribution between the two groups.

Table 2. The social and medical factors data distribution between the two groups.

Table 3. Logistic regression analysis of the smoking and hypertension among diabetic patients with Cataract.

4. Discussion

4.1 Smoking and cataract development

4.2 Hypertension and its influence

5. Conclusion

Ethics and consent

Data availability

References

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