Cataract is mainly associated with old age in the developed world, but its prevalence can be increased by certain diseases and clinical conditions. For example, myotonic dystrophy (MD) carries a greatly increased risk of cataract, with most carriers showing opacities by age 40. Indeed, in many individuals the early onset of cataract is the only indication of the disease.
1 In a study of more than 300 individuals from 9 MD families all affected members above 20 years of age had cataracts.
2 In the initial stages MD cataract is characterized by white, light-scattering opacities in the outermost regions of the lens. The later stages show evidence of cortical swelling along the suture lines, and this finally progresses to a mature cataract in which, in slit lamp examination, “an iridescent display of scintillating colors” (Ref.
1 ) can often be seen. Recently, specific changes in the lens epithelium have been identified in patients with MD.
3 Exposure to a variety of stresses, including radiation, oxidation, and several drug therapies, also accelerates the onset of many forms of cataract. For example, phenothiazine treatment for schizophrenia
4 carries an increased risk of cataract. There are also some reports that the disease itself may be associated with an increased incidence of cataract.
5 Although the mechanisms underlying MD and schizophrenia are not completely understood, changes in the genes encoding for the Ca
2+-activated SK family of channel proteins are believed to play a role in both conditions.
6 7 8 9 The only Ca
2+-activated K
+ channel type that has been unequivocally identified in the human lens is the large-conductance Ca
2+-activated K
+ (BK) channel,
10 but no association with cataract development has been made. K
+ channels in general play an obviously important role in determining the overall membrane potential of the lens, and there has also been one report of the involvement of K
+ channels (of unspecified type) in controlling lens growth in early chick lens development.
11 In fact a disturbance of Ca
2+ homeostasis itself has long been known to play a critical role in cortical cataract formation.
12