Presenile Cataract As A Distinct Clinical Entity: A Case Control Study Of Risk Factors And Morphological Patterns

Cataract remains the leading cause of blindness worldwide and is traditionally considered an age-related disease. However, increasing incidence of cataract in young adults presents significant clinical and socioeconomic implications, particularly in developing countries. Presenile cataract in the working-age population may have modifiable systemic and lifestyle risk factors, however data for this population is limited. This study aimed to identify risk factors, systemic associations and clinical patterns of presenile cataract in the 18-40 years age group.

This study was conducted at a high-volume tertiary eye care center in South India serving a large urban and rural population with standardized cataract evaluation and surgical services.

A hospital-based case–control study was performed including 266 participants aged 18–40 years. The study enrolled 133 patients diagnosed with cataract and 133 age and gender-matched controls without cataract. Detailed demographic, systemic, ocular, and lifestyle histories were obtained using a structured questionnaire. Socioeconomic status was assessed using the Modified Kuppuswamy scale. All participants underwent comprehensive examination including visual acuity assessment, slit-lamp biomicroscopy, intraocular pressure measurement, axial length evaluation, and cataract grading using the LOCS III system.  Statistical analysis compared risk factors and clinical characteristics between groups to identify significant associations.

The mean age of participants was 34.5 years with a female predominance (56%). Lower socioeconomic status demonstrated a very strong association with presenile cataract (p<0.001). Systemic factors with significant association include diabetes mellitus (p=0.008), asthma (p=0.01), and history of systemic corticosteroid use (p=0.02). Lifestyle factors such as cigarette smoking (p=0.02) and reduced physical activity (p=0.03) were also significant contributors.

Posterior subcapsular cataract was the predominant morphology, (81.4% of eyes), followed by nuclear opalescence (31.6%). Most cataracts were bilateral (65.4%) and immature (80.5%), although nearly one-fifth (19.5%) presented as mature cataracts despite the young age group. 

The findings of this study show the multifactorial nature of presenile cataract. Lower socioeconomic status was found to be a significant risk factor. Lifestyle risk factors such as cigarette smoking, physical inactivity were found to be significant along with systemic associations such as Diabetes Mellitus, asthma and corticosteroid use. The predominance of posterior subcapsular cataract and high rates of bilateral involvement emphasize the need for early detection and surgical intervention. Recognizing these early can guide targeted screening programs, timely intervention and prevention strategies