Age-related cataract is the leading cause of blindness in the world, affecting approximately 20 million

people, particularly in sub-Saharan Africa.1 Its prevalence increases from 2.9% in the 43- to 54-year age
group to 40% in those older than 75 years of age. As the worlds population ages, cataract will remain a
serious healthcare and socioeconomic burden, in terms of both healthcare provision and blindness in
less-developed countries.
Nuclear cataract is the most common form of age-related cataract.2 Apart from age, other factors
associated with nuclear cataract are smoking, oxidative stress, and dietary antioxidant intake. However,
studies of the effect of dietary vitamin C intake, serum vitamin C concentrations, and vitamin C
supplementation6, on nuclear cataract formation often have given conflicting results. Case-control
studies and some cohort studies have found protective effects. Other prospective cohort studies have
found no effect overall or protective effects only in subgroups. Similarly to vitamin C, di-etary and
supplemental14,17 vitamin E intake and vitamin E blood concentrations6, have been shown to be
related inversely with nuclear cataract. Randomized clinical trials of vitamins C and E supplementation
alone or in combination with other vitamins failed to find an effect. Vitamin A has been associated with
a reduced risk of nuclear cataract, as have lutein and zeaxanthin. The studies exploring dietary nutrients
and cataract progression have findings similar to those looking at prevalent cataract, with cohort studies
finding a protective effect. However, supplement trials largely have failed to find an effect.
Nuclear cataract was measured using a quantitative measure of nuclear density obtained from digital
Scheimpflug images. Dietary data were available from EPIC food frequency questionnaires. Heritability
was modeled using maximum likelihood structural equation twin modeling. Association between
nuclear cataract change and micronutrients was investigated using linear and multinomial regression
analysis. The mean interval between baseline and follow-up examination was 9.4 years.
Main Outcome Measures: Nuclear cataract progression.
The best-fitting model estimated that the heritability of nuclear cataract progression was 35% (95%
confidence interval [CI], 13e54), and individual environmental factors explained the remaining 65% (95%
CI, 46e87) of variance. Dietary vitamin C was protective against both nuclear cataract at baseline and
nuclear cataract progression (b = _0.0002, P = 0.01 and b = _0.001, P = 0.03, respectively), whereas
manganese and intake of micronutrient supplements were protective against nuclear cataract at
baseline only (b = _0.009, P = 0.03 and b = _0.03, P = 0.01, respectively).
Genetic factors explained 35% of the variation in progression of nuclear cataract over a 10-year period.
Environmental factors accounted for the remaining variance, and in particular, dietary vitamin C
protected against cataract progression assessed approximately 10 years after baseline.
Ophthalmology 2016;- :1e8 (http://dx.doi.org/10.1016/j.ophtha.2016.01.036)