Short Report &ndash; Birth Weight is Not Associated With Cataracts or Pseudophakia &ndash; Results from the Gutenberg Health Study

Achim Fieß; Sandra Gißler; Stephanie Grabitz; Philipp S Wild; Karl J Lackner; Manfred E Beutel; Michael S Urschitz; Oliver Tüscher; Thomas Münzel; Jörn M Schattenberg; Stavros V Konstantinides; Norbert Pfeiffer; Alexander K Schuster

doi:10.2147/OPTH.S502181

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Short Report

Short Report – Birth Weight is Not Associated With Cataracts or Pseudophakia – Results from the Gutenberg Health Study

Authors Fieß A , Gißler S , Grabitz S, Wild PS , Lackner KJ, Beutel ME, Urschitz MS, Tüscher O, Münzel T, Schattenberg JM , Konstantinides SV, Pfeiffer N , Schuster AK

Received 22 October 2024

Accepted for publication 10 December 2024

Published 16 January 2025 Volume 2025:19 Pages 153—156

DOI https://doi.org/10.2147/OPTH.S502181

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

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Achim Fieß,^1,^* Sandra Gißler,^1,^* Stephanie Grabitz,¹ Philipp S Wild,^{2– 5} Karl J Lackner,⁶ Manfred E Beutel,⁷ Michael S Urschitz,⁸ Oliver Tüscher,^5,^9,¹⁰ Thomas Münzel,¹¹ Jörn M Schattenberg,^12,¹³ Stavros V Konstantinides,^2,¹⁴ Norbert Pfeiffer,¹ Alexander K Schuster¹

¹Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; ²Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany; ³German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany; ⁴Preventive Cardiology and Preventive Medicine-Department of Cardiology, University Medical Center Mainz, Mainz, Germany; ⁵Institute of Molecular Biology (IMB), Mainz, Germany; ⁶Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; ⁷Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; ⁸Division of Pediatric Epidemiology, Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; ⁹Clinic for Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; ¹⁰Leibniz Institute for Resilience Research, Mainz, Germany; ¹¹Center for Cardiology-Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; ¹²Department of Internal Medicine II, Saarland University Medical Center, Homburg, Germany; ¹³Department of Internal Medicine I, University Medical Center, Mainz, Germany; ¹⁴Department of Cardiology, Democritus University of Thrace, Alexandroupolis, 68100, Greece

*These authors contributed equally to this work

Correspondence: Achim Fieß, Department of Ophthalmology, Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr 1, Mainz, 55131, Germany, Tel +49-(0)6131-17-5150, Fax +49-(0)6131-17-8495, Email [email protected]

Abstract: This study investigates the association between self-reported birth weight (BW) and the frequency of cataract and pseudophakia in a large population-based cohort in Germany, as part of the Gutenberg Health Study (GHS). Slit lamp examination and Scheimpflug imaging of 8205 participants, aged 35 to 74, were assessed and signs of cataract or pseudophakia analyzed. The research aimed to explore the correlation between fetal growth restriction and/or prematurity indicated by BW and the frequency of cataract and pseudophakia. In the univariable analysis, cataract was initially associated with low and high BW, but this association disappeared after adjusting for age, sex, examiner and cardiovascular risk factors. No association was found between low BW and pseudophakia or the frequency of cataract surgery within 5 years. The study reveals novel insights from a large population-based study specifically exploring this association.

Keywords: Cataract, pseudophakia, birth weight, epidemiology, population-based study

Introduction

The development of age-related cataract is a major cause of global visual impairment. Several risk factors have been discussed in cataract development, however research on the impact of perinatal factors, especially low birth weight (LBW) as a surrogate parameter of prematurity and/or fetal growth restriction on adult cataract development is scarce. The authors of a UK-based study suggest anatomical changes in the lens due to altered development in LBW children that may affect cataract genesis.¹ In a previous analysis in our cohort, LBW correlated with lower visual acuity² and altered ocular geometry,³ possibly indicating more severe lens opacifications. Adults born preterm may require earlier cataract surgery and face higher retinal complication risks.⁴ In another report of adults born extremely preterm, increased lens opacifications were described.⁵ Therefore, we aim to shed more light on LBW’s association with cataract and pseudophakia development as this is of high clinical relevance, aiding in early intervention and postoperative care.

Materials and Methods

The Gutenberg Health Study (GHS) is an interdisciplinary, population-based, prospective cohort study (n=15,010 participants at baseline). In the present study, the presence of cataracts and pseudophakia was determined as part of a slit lamp examination at baseline. During a 5-year follow-up (5FU) examination, the lens status was assessed using Scheimpflug imaging.⁶ Self-reported birth weight (BW) was categorized as low (<2500g), normal (2500–4000g) and high (>4000g). Only participants with reported birth weight, slit lamp examination at baseline and sufficient Scheimpflug imaging were included in this study (n=8205). Logistic regression models with generalized estimating equations (GEE) were used to investigate the association of birth weight categories with the presence of cataract, pseudophakia at baseline and cataract surgery within a 5-year interval. The analyses were then adjusted for age, sex, and slit lamp examiner (model 1) and additionally for smoking, arterial hypertension, dyslipidemia, obesity, socioeconomic status, alcohol consumption, diabetes, glaucoma, and steroid medication (model 2).

Results

In the study, 16410 eyes of 8205 adults were included (age 51.49 ± 10.62 years, 4386 women). Further participant characteristics are listed in Table 1. In univariable analysis, the results suggested 1.6-fold (p<0.001) higher odds for cataract development with LBW and 1.19-fold higher odds (p=0.05) with high birth weight (HBW). However, in model 1, after adjustment for age and sex, both effects did not remain significant (LBW OR 1.26, p=0.15; HBW OR 0.93, p=0.55). In model 2, adjusted for several confounders, birth weight also showed no significant association (LBW: OR 1.24, p=0.18; HBW: OR 0.9, p=0.37) at baseline. There was also no association between the presence of pseudophakia and BW, neither in univariable nor multivariable analysis (Model 2: continuous: OR 1.02, p=0.14; LBW: OR 0.91, p=0.77; HBW: OR 1.25, p=0.32) at baseline. When investigating the association of BW with the frequency of cataract surgery within 5 years, we also did not find significant associations in either model.

Table 1 Characteristics of the GHS Sample at Baseline (n=8205), Stratified by Study Groups

Discussion

In our cohort, LBW as a surrogate marker for prematurity and fetal growth restriction was not associated with an increased frequency of cataracts or pseudophakia in adulthood.

So far, studies assessing the effects of BW on the prevalence of cataract and the frequency of cataract operations have been scarce. A UK-based study from 2001 by Hall et al did not find consistent associations between size at birth and age-related cataract, when assessing this relation in logistic regression,¹ which is in line with our results. Nevertheless, they found that nuclear cataract was associated with increased intrauterine growth, while other cataract types showed no significance. Their cohort, however, was about 20 years older than ours, which might be a crucial explanation to their results. In the Gutenberg Prematurity Study, the authors were able to find an increased lens opacification in participants born extremely preterm (≤28 weeks gestational age).⁵ Therefore, there may be an association of cataract and pseudophakia with prematurity rather than low birth weight, as these two factors cannot be used interchangeably. However, due to the missing knowledge of gestational age at birth of the participants in the GHS, we were unfortunately not able to assess this association. The results of the present study are further limited because the GHS included only a few participants with extremely low birth weight—a condition often linked to premature birth—and we may not have detected a significant association due to the lack of power. Furthermore, we may not have detected early lens changes due to a dependency of age and reported BW in our cohort, as well as ophthalmic examination in non-mydriatic eyes. We conclude that neither low nor high BW is associated with a higher presence of cataract or pseudophakia in participants aged 35 to 74 years. However, as previous reports have revealed a higher occurrence of ocular complications in individuals with LBW,^4,7,8 BW is still a relevant parameter to be further assessed in the future, ie, using quantitative measures of lens opacities in an older cohort with less age variability.

Data Sharing Statement

The analysis presents clinical data of a large-scale population-based cohort with ongoing follow-up examinations. This project constitutes a major scientific effort with high methodological standards and detailed guidelines for analysis and publication to ensure scientific analyses on the highest level. Therefore, data are not made available for the scientific community outside the established and controlled workflows and algorithms. To meet the general idea of verification and reproducibility of scientific findings, we offer access to data at the local database in accordance with the ethics vote upon request at any time. The GHS steering committee, which comprises a member of each involved department and the coordinating PI of the Gutenberg Health Study (PSW), convenes once a month. The steering committee decides on internal and external access of researchers and use of the data and biomaterials based on a research proposal to be supplied by the researcher. Interested researchers make their requests to the coordinating PI of the Gutenberg Health Study (Philipp S. Wild; [email protected]). More detailed contact information is available at the homepage of the GHS (www.gutenberghealthstudy.org).

Informed Consent

The study protocol and study documents were approved by the local ethics committee of the Medical Chamber of Rhineland-Palatinate, Germany (reference no. 837.394.17; original vote: 22.3.2007, latest update: 28.06.2022). According to the tenets of the Declaration of Helsinki, written informed consent was obtained from all participants prior to entering the study.

Acknowledgment

Achim Fieß and Sandra Gißler are co-first authors for this study. We thank all study participants for their willingness to provide data for this research project, and we are indebted to all coworkers for their enthusiastic commitment.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

NP receives financial support and grants from Novartis, Ivantis, Santen, Thea, Boehringer Ingelheim Deutschland GmbH & Co. KG, Alcon, and Sanoculis. AKS acted as a consultant for Apellis and AbbVie, and received financial and research support by AbbVie, Bayer Vital, Heidelberg Engineering, Novartis, Santen. PSW is funded by the Federal Ministry of Education and Research (BMBF 01EO1503); report grants and/or personal fees from Boehringer Ingelheim, Philips Medical Systems, Bayer AG, Novartis Pharma, Pfizer Pharma, Bristol Myers Squibb, Astra Zeneca, Daiichi Sankyo, TRON GmbH, and Sanofi Aventis, outside the submitted work. PSW and TM are PI of the German Center for Vascular Research (DZHK). JMS acts as consultant to Apollo Endosurgery, Bayer, Boehringer Ingelheim, BMS, Gilead Sciences, GSK, Intercept Pharmaceuticals, Ipsen, Inventiva Pharma, Madrigal, MSD, Northsea Therapeutics, Novartis, Novo Nordisk, Pfizer, Roche, Sanofi, Siemens Healthineers. Research Funding: Gilead Sciences, Boehringer Ingelheim, Siemens Healthcare GmbH. He also reports personal fees from Akero, Alentis, Alexion, Altimmune, Astra Zeneca, 89Bio, Bionorica, Boehringer Ingelheim, Gilead Sciences, GSK, HistoIndex, Ipsen, Inventiva Pharma, Madrigal Pharmaceuticals, Kríya Therapeutics, Lilly, MSD Sharp & Dohme GmbH, Nordic Bioscience, Northsea Therapeutics, Novartis, Novo Nordisk, Pfizer, Roche, Sanofi, Siemens Healthineers; speaker honoraria from AbbVie, Boehringer Ingelheim, Gilead Sciences, Ipsen Novo Nordisk, Madrigal Pharmaceuticals; stock options from Hepta Bio, outside the submitted work. The authors report no other conflicts of interest in this work.

References

1. Hall NF, Gale CR, Syddall H, Martyn CN, Phillips DIW. Relation between Size at Birth and Age-Related Cataract. Invest Ophthalmol Visual Sci. 2001;42(3):614–619.

2. Fieß A, Schuster AK, Nickels S, et al. Association of low birth weight with myopic refractive error and lower visual acuity in adulthood: results from the population-based Gutenberg Health Study (GHS). Br j Ophthalmol. 2019;103(1):99–105. doi:10.1136/bjophthalmol-2017-311774

3. Fieß A, Schuster AK, Nickels S, et al. Association of Low Birth Weight With Altered Corneal Geometry and Axial Length in Adulthood in the German Gutenberg Health Study. JAMA ophth. 2019;137(5):507–514.

4. Kaiser RS, Fenton GL, Tasman W, Trese MT. Adult Retinopathy of Prematurity: retinal Complications from Cataract Surgery. Am J Ophthalmol. 2008;145(4):729–735.e721. doi:10.1016/j.ajo.2007.11.007

5. Fieß A, Fauer A, Mildenberger E, et al. Refractive error, accommodation and lens opacification in adults born preterm and full-term: results from the Gutenberg Prematurity Eye Study (GPES). Acta Ophthalmol. 2022;100(7):e1439–e1450. doi:10.1111/aos.15116

6. Hohn R, Kottler U, Peto T, et al. The ophthalmic branch of the Gutenberg Health Study: study design, cohort profile and self-reported diseases. PLoS One. 2015;10(3):e0120476. doi:10.1371/journal.pone.0120476

7. Fieß A, Nickels S, Schulz A, et al. The relationship of ocular geometry with refractive error in normal and low birth weight adults. J Optom. 2021;14(1):50–57.

8. Fieß A, Urschitz MS, Nagler M, et al. Association of birth weight with corneal aberrations in adulthood - Results from a population-based study. J Optom. 2023;16(1):42–52.

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