What are the causes and risk factors for premature cataract development in a 39-year-old female?

From the Guidelines

Cataracts at age 39 in a female should be evaluated by an ophthalmologist promptly, as early-onset cataracts can significantly impact quality of life and require timely intervention to prevent further vision impairment. While cataracts typically develop after age 60, younger adults can develop them due to factors like genetics, diabetes, steroid medication use, eye injuries, smoking, excessive UV exposure, or certain systemic diseases 1. The risk of cataract increases with each decade of life starting around age 40, and cataract is the leading cause of visual impairment among Americans of all studied ethnic and racial backgrounds 1. Treatment depends on how much the cataract affects vision, and if vision impairment is minimal, prescription glasses or contact lenses may help temporarily. However, when cataracts significantly impact daily activities, surgical removal is the definitive treatment, involving removing the cloudy lens and replacing it with an artificial intraocular lens, typically taking 15-30 minutes as an outpatient procedure with quick recovery. Early-onset cataracts warrant additional testing to identify underlying causes, as addressing these conditions may prevent further eye complications 1. Regular eye exams are essential for monitoring progression, and lifestyle modifications like wearing UV-protective sunglasses, quitting smoking, managing diabetes if present, and eating a diet rich in antioxidants may help slow progression. Key considerations include:

• The high prevalence of cataracts and their significant impact on vision and quality of life 1
• The importance of early detection and treatment to prevent further vision impairment and improve outcomes 1
• The need for additional testing to identify underlying causes of early-onset cataracts and address these conditions to prevent further eye complications 1
• The role of lifestyle modifications in slowing cataract progression and improving overall eye health 1

From the FDA Drug Label

The development of secondary ocular infection (bacterial, fungal, and viral) has occurred Fungal and viral infections of the cornea are particularly prone to develop coincidentally with long-term applications of steroids. Adverse reactions include ... posterior subcapsular cataract formation Prolonged use of corticosteroids may result in posterior subcapsular cataract formation

The use of prednisolone may increase the risk of cataract formation, including posterior subcapsular cataract.

• Cataract formation is a possible adverse reaction of prednisolone use.
• The FDA drug label does not provide information on the specific age of onset for cataract formation due to prednisolone use, but it does indicate that prolonged use may increase the risk 2, 2. However, the provided information does not directly answer the question regarding the relationship between cataracts at age 39 and prednisolone use.

From the Research

Cataracts at Age 39 in Females

• Cataracts are a common cause of visual impairment and blindness worldwide, and age is the strongest predictor of cataract development 3.
• However, cataracts can also occur in younger individuals, and other risk factors such as family history, diabetes, smoking, obesity, and poor nutrition may contribute to their development 3.
• A study on phacoemulsification with posterior chamber intraocular lens versus extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens for age-related cataract found that phacoemulsification may result in better visual acuity and lower complication rates compared to ECCE 4.
• Another study on intraocular lens implantation with different performances for the treatment of cataract found that Toric IOL implantation can provide good astigmatism correction treatment and improve uncorrected distance visual acuity (UDVA) in cataract patients 5.
• Combined phacoemulsification, intraocular lens implantation, and vitrectomy can be a reasonable alternative in selected patients with coexisting cataract and vitreoretinal pathology, and techniques such as careful, limited, curvilinear capsulorhexis and in-the-bag placement of IOLs can simplify surgery and reduce complications 6.
• Intracameral endoilluminator-assisted phacoemulsification surgery can provide better visualization and reduced scattering and reflection in patients with severe corneal opacity, making it a potential option for patients with cataracts and corneal opacity 7.

Risk Factors and Treatment Options

• Risk factors for cataracts include age, family history, diabetes, smoking, obesity, and poor nutrition 3.
• Treatment options for cataracts include phacoemulsification with posterior chamber intraocular lens implantation, extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens implantation, and Toric IOL implantation 4, 5.
• Combined phacoemulsification, intraocular lens implantation, and vitrectomy can be a reasonable alternative in selected patients with coexisting cataract and vitreoretinal pathology 6.
• Intracameral endoilluminator-assisted phacoemulsification surgery can provide better visualization and reduced scattering and reflection in patients with severe corneal opacity 7.