Alcohol Use and Lens Opacities in the
Beaver Dam Eye Study
Linda L. Ritter, MS; Barbara E. K. Klein, MD, MPH; Ronald Klein, MD, MPH; Julie A. Mares-Perlman, PhD
\s=b\ The relationship between alcohol use
and lens opacities was examined in a
large (N=4926) population-based study of
adults aged 43 to 86 years in Beaver Dam,
Wis. These data were collected from 1988
to 1990. Alcohol history was determined
by a standardized questionnaire. Preva-
lence and severity of cataract were deter-
mined by masked grading of photographs
obtained using a slit-lamp camera and
retroillumination. A history of heavy
drinking was related to more severe nu-
clear sclerotic, cortical, and posterior
subcapsular opacities (odds ratios, 1.34,
1.38, and 1.57, respectively). These rela-
tionships remained after adjusting for
other risk factors such as smoking. Mod-
erate liquor consumption was associated
with less severe nuclear sclerosis (odds
ratio, 0.81). Participants who drank wine
had less severe nuclear sclerosis (odds
ratio, 0.84) and cortical opacities (odds
ratio, 0.84) than those who did not. In-
creased consumption of beer was related
to increased risk of cortical opacities.
(Arch Ophthalmol. 1993;111:113-117)
TTLxcessive alcohol is associated
use
-^ with numerous chronic health
problems, such as liver disease, varicos-
ities, blood dyscrasias, and elevated
blood pressure. Some studies14 have re¬
ported a relationship between alcohol
consumption and cataract, while other
studies5,6 have found no relationship.
One study3 reported that both abstain¬
ers and heavy drinkers were more likely
to have cataract than moderate users,
while another1 found that total abstain¬
ers were more likely to have cataract
than alcohol users. Drinking as well as
dietary and other social customs that
may influence the relationship between
reported alcohol use and cataract may
differ from community to community
and may result in different estimates of
an effect. This study describes the rela¬
tionship between alcohol use and lens
opacities (or cataract) in the population-
based study of the rural American com¬
munity of Beaver Dam, Wis.
Accepted for publication September 23, 1992.
From the Department of Ophthalmology, Uni-
versity of Wisconsin Medical School, Madison.
Presented in part at the Society for Epidemio-
logic Research 24th Annual Meeting, Buffalo, NY,
June 14, 1991.
Reprint requests to University of Wisconsin Med-
ical School, Clinical Sciences Center, E5/351, 600
Highland Ave, Madison, WI 53792-3220(Dr B. Klein).
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SUBJECTS, MATERIALS, AND
METHODS
Subjects included all participants in the
Beaver Dam Eye Study. The sampling and
selection procedures have been described
elsewhere.7 Briefly, all persons between
ages 43 and 86 years residing in Beaver Dam,
Wis (5925 persons), were identified by pri¬
vate census. Of these, 660 (11.1%) refused
participation, 225 (3.8%) had died before ex¬
amination, 91 (1.5%) had moved, and 23
(0.4%) could not be located. A total of 4926
See also 110.
participated. Informed consent was obtained
for each subject. Medical history and social
and demographic characteristics were ob¬
tained from responses to an interviewer-
administered questionnaire. Responses used
for these analyses include date of birth,
highest level of school completed, history of
diabetes, history of cigarette smoking, and
history of drinking alcoholic beverages.
Each participant was asked about his or her
use of beer, wine, and liquor in the last year.
From responses to these questions, subjects
were classified as current drinkers (any drink¬
ing in the last year) or nondrinkers for each al¬
cohol type. The amount of alcohol usually con¬
sumed in 1 week was converted to grams of
ethanol in an average serving size, estimating
that 336 g (12 oz) ofbeer contains 12.96 g of eth¬
anol; 48 g (4 oz) of wine, 11.48 g; and a 42-g
(1.5-oz) shot of liquor, 14.0 g. If an individual
consumed an average of four or more such
drinks each day, he or she was considered a
current "heavy" drinker. Current nondrinkers
were asked if they had ever consumed alcohol.
Those who answered no were classified as life¬
time abstainers. All past and current drinkers
were asked, "Has there ever been a time in
your life when you drank four or more alcoholic
beverages daily?" Positive response to this
question resulted in subjects being classified
as past or current heavy drinkers. Subjects not
classified as current heavy drinkers but who
responded that they had at one time been
heavy drinkers were considered to be past
heavy drinkers. Heavy drinking was coded as
two dummy variables in the logistic regression
analyses: nonheavy vs past heavy drinkers and
nonheavy vs current heavy drinkers.
Consumption of beer was divided into four
categories: no consumption and light, moder¬
ate, and heavy consumption. Light consump¬
tion was defined as no more than the median
weekly beer consumption (two beers per week
or fewer for women; four beers per week or
fewer for men). Moderate consumption was
defined as more than the median consumption
but fewer than four beers per day. Heavy con¬
sumption was defined as in the previous para-
graph. Light, moderate, and heavy beer drink¬
ers were compared with those who had not
consumed beer in the last year. The number of
pack-years of smoking was calculated as the
number of packs of cigarettes smoked per day
times the total number of years the partici¬
pant smoked.
The type and degree of lens opacities were
assessed from lens photographs taken during
the study. The protocol has been described in
detail in previous publications.""11' In brief, pho¬
tographs were taken of the lens with two cam¬
eras. A slit-lamp camera (SL5, Topcon, Para-
mus, NJ) was used for assessing nuclear scle¬
rosis.8 Cortical and posterior subcapsular
opacities were photographed with a retroillu-
mination camera (CR-T, Neitz, Torrance, Calif)
specially modified for this study.8 Photographs
were graded for severity of lens opacities ac¬
cording to standard protocols.8 Graders were
masked to subject characteristics. Photo¬
graphs of each eye for each subject were sep¬
arated and graded independently. Quality con¬
trol procedures were employed to minimize
variability in grading.9
Nuclear sclerosis was graded on a five-
step scale by comparing each photograph
with a set of standard photographs. For
analyses, levels 4 and 5 were combined due
to low numbers of level 5 cases. For cortical
and posterior subcapsular opacities, the
grader estimated the percentage of area
with opacities in each of nine segments."
Cortical opacities were categorized into
three levels of involvement for analyses:
none (less than 5% of the cortical area
involved); early (5% to 24% of the cortical
area involved); and late (25% or more of the
cortical area involved). Posterior subcapsu¬
lar opacities were categorized into two lev¬
els: absent (less than 5% of the lens area in¬
volved) and present (5% or more of the lens
area involved).
For some purposes, it is useful to categorize
eyes by the presence and severity of cataract
(including any or all of these lesions). For such
analyses, any opacity was described as no cat¬
aract, early cataract, or late cataract based on
combinations ofthe specific cataract types.1" A
subject's classification reflected the most se¬
vere level of any type of cataract observed. The
severity of cataract in the worst eye was used
for analyses of the specific cataract types and
of cataracts in general. History of cataract sur¬
gery was determined from the questionnaire.
STATISTICAL METHODS
A software system (Wisconsin Informa¬
tion Storage and Retrieval System, Univer¬
sity of Wisconsin Clinical Cancer Center,
Madison) was used for processing all subject
files. Because cortical and nuclear sclerotic
opacities were graded on ordinal scales
(none, early, and late [corresponding to 0, 1,
 Table 1.—Alcohol Consumption in the Beaver Dam Eye Study*
Lifetime Abstainers Moderate Drinkers Heavy Drinkers Total
Variable_(n=161)_(n=3908)_(n=844)_(N=4913)
Sex
Female_135(83.9)t_2462 (63.0)_160(19.0)t_2757(56.1)
Male 26(16.1)t 1446(37.0) 684(81.0)t 2156(43.9)
Age, y
43-54_31 (19.2)_1176(30.1)_312 (37.0)_1519(30.9)
55-64_35(21.7)_1004(25.7)_277 (32.8)_1316 (26.8)
65-74_44 (27.3)_1054(27.0)_178(21.1)_1276 (26.0)
75-84 51(31.7)i 674(17.2) 77(9.1) 802(16.3")
Cigarette smoker
Never_143(88.8)t_1919(49.1)_137(16.2)t_2199(44.8)
Past_9 (5.6)t_1310(33.5)_426 (50.5)t_1745(35.5)
Current_9 (5.6)t_678(17.4)_281 (33,3)t_968(19.7)
Education, y
<12_59 (36.6)t_1080(27.7)_294 (34.8)t_1433(29.2)
12 52(32.3)t 1711(43.8) 369(43.7) 2132(43.4)
>12_49 (30.4)_1112(28.5)_181 (21.5)t_1342(27.4)
or not
'Values are number (percentage) of subjects. When asked If they were had ever been a heavy drinker, 13 subjects did respond.
tSigniflcantly different from moderate drinkers (P<.01).
<.01 for trend.

and 2, respectively] for cortical opacities and

levels 1 through 5 for sclerotic opacities), cu¬
Table 2.—Number of Subjects Consuming Each Type of Alcohol in the Last Year* mulative logistic models were used to ana¬
Non-Beer Drinkers Beer Drinkers
lyze these types of opacities.1112 This model
assumes proportional odds for each level,
(n=1814) (n=3094) and the odds ratios (ORs) as calculated rep¬
I
Non-Hard- Non-Hard- resent the odds of being at or above a given
Liquor Hard-Liquor Liquor Hard-Liquor level compared with being below that level.
Drinkers Drinkers Drinkers Drinkers Total The proportional odds assumption was
Non-wine drinkers 782 273 253 614 1922 tested for each model and was not significant
231 2986 at P=.05. Posterior subcapsular opacities
Wine drinkers 262 497 1996
Total 1044 770 484 2610 4908
were analyzed using binary logistic regres¬
sion. Statistical Analysis System (SAS) was
»Eighteen subjects did not answer one or more alcohol-related questions. used for calculating 2 statistics and the
logistic regressions.13

Table 3.—Characteristics of Alcohol Drinkers*

Hard-Liquor Drinkers of Any

Beer Drinkers Wine Drinkers Drinkers Type of Alcohol Total
(n=3103) (n=2989) (n=3384) (n=4135) (N=4917)
Sex
Male 1689(54.4) 1263(42.2) 1580(46.7) 2253 (54.4) 2755 (56.0)
Female 1414 (45.Ì 1726(57.8) 1804(53.3) 1882(45.6) 2162(44.0)
Age, y
43-54 1093(35.2) 1038(34.7) 1165(34.4) 1356(32.8) 1519(30.9)
55-64 873(28.1) 810(27.1) 963 (28.5) 1137(27.5) 1315(26.7)
65-74 758 (24.4) 740 (24.8) 840 (24.8) 1045(25.3) 1281 (26.1)
75-84 379(12.2) 401 (13.4) 416(12.3) 597(14.4) 802(16.3)
Cigarette smoker
Never 1201 (38.7) 1394(46.6) 1383(40.9) 1776(43.0) 2201 (44.8)
Past 1239(39.9) 1086(36.4) 1294(38.2) 1527(36.9) 1745(35.5)
Current 662(21.3) 508(17.0) 706 (20.9) 831 (20.1) 970(19.7)
Education, y
<12 808(26.1) 632(21.1) 814(24.1) 1090(26.4) 1435(29.2)
12 1415(45.6) 1357(45.5) 1549(45.8) 1853(44.! 2133(43.4)
>12 879 (28.3) 999 (33.4) 1020(30.1) 1190(28.8) 1343(27.3)
Heavy drinking
Ever 590(19.0) 396(13.3) 536(15.9) 663(16.0) 822(16.7)
Never 2508(80.1) 2590 (86.7) 2844(84.1) (84.0)
3472 4088(83.1)
*Values are number (percentage) of patients. When asked about use of specific types of alcohol, nine people did not respond.

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 Variables that could confound the relation¬
ship between alcohol use and lens opacities
were considered for inclusion in the model.
Variables considered were those that were
significantly (P=s.05) related to both the
prevalence of at least one cataract type and
alcohol use in this population. These in¬
cluded age, sex, number of pack-years of
smoking, presence of diabetes, education
level, and past multivitamin use.
The final logistic regression models in¬
cluded variables significantly related to the
cataract type being studied, with two excep¬
tions. Education and past multivitamin use
were significantly related to nuclear sclerosis
(P<.05). However, they were not included in
the final model because neither of these vari¬
ables changed the ß by more than 10%.

RESULTS

Table 1 shows the distribution of alco¬

hol use in this population. There were
161 lifetime abstainers. Lifetime ab¬
stainers were more likely (P<.01) to be
women (83.9%) and nonsmokers (88.8%)
than were moderate drinkers. Past or
current heavy drinkers (n=844) were Fig 1.—Percentage of subjects with nuclear sclerosis (level 4 or worse) by drinking category,
more often men (81.0%) and past or cur¬ age, and sex.

rent smokers (83.8%) than were moder¬

ate drinkers. Lifetime abstainers were
older and heavy drinkers were younger
than moderate drinkers (the reference
group). Moderate drinkers were more
likely to have completed high school
(72.3%) than were heavy drinkers
(65.2%) or lifetime abstainers (63.1%).
Among current drinkers, women con¬
sumed a mean of 12.02 g and men a mean
of 58.20 g of ethanol per week. Only 10
women and 106 men reported currently
consuming four or more drinks per day.
Of 728 past heavy drinkers, 150 were
women and 578, men. Heavy drinking
was coded as "never," "past," or "cur¬
rent" for the following analyses.
Participants were divided into users
and nonusers for each alcohol type.
There was considerable overlap among
the three categories, with 40.7% of cur¬
rent drinkers consuming all three alco¬
hol types and another 27.3% drinking
two of the three types (Table 2). There
were differences among the alcohol
groups as well (Table 3). Beer drinkers
were most likely to be men (54.4%), past Fig 2.—Percentage of subjects with cortical opacities by drinking category, age, and sex.

or current smokers (61.2%), less edu¬

cated (26.1% did not complete high
school), and past heavy drinkers (19%).
Wine drinkers were most often women
(57.8%), nonsmokers (46.6%), better ed¬
ucated (21.1% did not complete high
school), and not heavy drinkers (86.7%).
Drinkers of hard liquor fell in between
the other two categories with respect to
gender, smoking, and education. No
tests of significance are appropriate, as
the groups are not mutually exclusive.
A history of heavy drinking was asso¬
ciated with the three types of lens opac-
ities. Figure 1 shows the distribution of
nuclear sclerosis by drinking category.
Lifetime abstainers and moderate drink¬
ers were combined for these figures be¬
cause there were no significant differenc¬
es between them with respect to preva¬
lence of cataract. In both sexes and every
age group, a higher percentage of heavy
drinkers had late nuclear sclerotic
changes (level 4 or worse). Similar re¬
sults were seen for cortical (Fig 2) and
posterior subcapsular opacities (Fig 3).
Smoking has been related to the sever-
ity of cataract2'4·6 and differed by alcohol
use in the current study (Table 1). There¬
fore, the number of pack-years of smok¬
ing was included as a variable in all logis¬
tic regressions. As shown in Table 4, past
heavy drinkers were found to have in¬
creased odds of nuclear sclerosis OR, 1.34;
95% confidence interval [CI], 1.12 to 1.59)
in logistic regressions adjusted for age,
sex, and number of pack-years of smok¬
ing. Diabetes mellitus was related in
univariate analyses to cortical opacities
(data not shown). Including this variable,

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 there was an additional significant effect
of past heavy drinking on the severity of
cortical opacity (OR, 1.36; 95% CI, 1.04 to
1.77). The presence of posterior subcap¬
sular opacity was also significantly asso¬
ciated with past heavy drinking (OR, 1.57;
95% CI, 1.10 to 2.25). When using the di¬
agnostic classification of none, early, or
Fig 3.—Percentage of subjects with posterior subcapsular opacities by drinking category, age,
and sex.
Table 4.—Odds Ratios (ORs) and 95% Confidence Intervals (CIs) for Lens
Associated With History of Heavy Drining
late cataract, past heavy drinking was as¬
sociated with a significantly increased
OR of 1.40 (95% CI, 1.16 to 1.68). Previous
cataract surgery in one or both eyes was
reported by 270 participants. This end
point was also related to past heavy
drinking (OR, 1.78; 95% CI, 1.24 to 2.57).
There were no significant relationships
Opacities
between these variables and current
heavy drinking (Table 4).
The relationship between types of
lens opacities and intake of specific
types of alcohol was also explored. Table
5 shows the ORs for these analyses. The
relationships between alcohol and lens
opacity differed by type of alcohol con¬
sumed. Wine was associated with less
severe nuclear sclerosis (OR, 0.84; 95%
CI, 0.74 to 0.94) and less severe cataract
(OR, 0.83; 95% CI, 0.73 to 0.95) in gen¬
eral. Participants who drank liquor
were less likely to have severe nuclear
sclerosis than those who did not (OR,
0.81; 95% CI, 0.72 to 0.95). Liquor use
was also associated with lower fre¬
quencies of any cataract (OR, 0.83;
95% CI, 0.72 to 0.94) and fewer past
cataract surgeries (OR, 0.75; 95% CI,
0.57 to 0.98). No significant differ¬
ences were found between those who
drank beer in the last year and those
who did not.
To examine whether the amount of al¬
cohol currently consumed was important,
data were analyzed two ways. First, a lin¬
ear relationship was examined looking at
the square root transformation of the
amount of ethanol consumed. A signifi¬
cant relationship was found between beer
consumption and cortical cataract. Those
who drank larger amounts of beer were
more likely to have cortical cataract than
those who drank smaller amounts ofbeer.
To better quantify this result, beer con¬
sumption was classified as none, light,
moderate, or heavy, as described in the
"Subjects, Materials, and Methods" sec¬
tion. An increased risk of cortical cataract
was associated with increased beer con¬

Past Heavy Drinking Current Heavy Drinking sumption (Table 6). An increased risk of
-1 - cortical cataract was not associated with
Lens Opacity OR OR 95% CI
95% CI consumption of wine, hard liquor, or a
Nuclear sclerosis* 1.34f 1.36 1.12-1.59
0.92-2.02 combination of alcohol types when con¬
Cortical opacity^ 1.36f 1.00 1.04-1.77
0.49-2.08 sidered as continuous variables (data not
Posterior subcapsular opacity^_1.57f_1.10-2.25_O90_0.32-2.54 shown).
Any cataractj_1.40f_1.16-1.68_^37_0.90-2.07 All ofthe logistic regressions described
Cataract surgery* 1.78 1.24-2.57 1.09 0.38-3.17 were performed with stratification for
sex. There were very few differences be¬
Adjusted for age, sex, and pack-years of smoking. See "Subjects, Materials, and Methods" section for
definition of pack-years. tween men and women. For example, for
tP<.05. nuclear sclerosis and current wine con¬
^Adjustedfor age, sex, pack-years of smoking, and presence of diabetes. See "Subjects, Materials, and
sumption, women had an OR of 0.84 (95%
Methods" section for definition of pack-years.
CI, 0.72 to 0.99) and men, 0.83 (95% CI,

Table 5.—Odds Ratios (ORs) and Confidence Intervals (CIs) for Lens Opacities Associated With Current Alcohol Consumption
Any Alcohol Beer Wine Hard Liquor
I I I I I I I I
_OR_95% CI_OR_95% CI_OR_95% CI_OR_95% CI
Nuclear sclerosis*_086_0.73-1.01_095_0.84-1.08 0.84t 0.74-0.94 0.811 0.72-0.93
Cortical opacity*_086_0.70-1.07_^03_0.86-1.24 0.85_0.71-1.01 0.86_0.72-1.03
Posterior subcapsular opacity*_0JÎ0_0.65-1.23_L07_0.72-1.40 0.97_0.75-1.25 0.94_0.72-1.23
Any cataract*_0.80* 0.68-0.95_(19*1_0.83-1.08 0.83* 0.73-0.95 0.83* 0.72-0.95
Cataract surgery* 0.90 0.66-1.23 0.81 0.61-1.06 1.02 0.78-1.32 0.75* 0.57-0.98
Adjusted for age, sex, and pack-years of smoking. See "Subjects, Materials, and Methods" section for definition of pack-years.
*P<.05.
*Adjusted for age, sex, pack-years of smoking, and presence of diabetes. See "Subjects, Materials, and Methods" section for definition of pack-years.

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 Table 6.—Odds Ratios (ORs) and 95% Confidence Intervals
Light Consumption
_Lens Opacity_OR_95% CI_OR_95% CI_OF?_95% CI
Nuclear
Cortical
sclerosis*_092_0.78-1.09_098_0.81-1.17_ _2ß_0.73-1.98
opacity*_^28_1.00-1.64_^37_1.01-1.85_1J46_0.63-3.38
Posteriorsubcapsular opacity*_VIS)_0.84-1.68_068_0.41-1.14_095_0.29-3.16
Any cataract* 1.00
*Odds compared with non-beer drinkers.
*Adjusted for age, sex, and pack-years of smoking.
^Adjusted for age, sex, pack-years of smoking, and
0.69 to 0.99). Similar results were seen
with other cataract and alcohol types
(data not shown). By logistic regression,
there were also no significant differences
between sex and heavy drinking. The OR
ofhaving nuclear sclerosis for women was
1.10 (95% CI, 0.78 to 1.55), and for men,
1.42 (CI, 1.16 to 1.74). There were no sig¬
nificant interactions between sex and
type of alcohol consumed or between sex
and history of heavy drinking.
COMMENT
Past heavy drinking was related to
more severe lens opacities in this popu¬
lation, but no significant relationship was
found between more severe lens opaci¬
ties and current heavy drinking. There
were many more past heavy drinkers
(n=728) than current heavy drinkers
(n=126), defined by the number of serv¬
ings of alcohol currently consumed per
week. People may be more likely to re¬
port past heavy drinking than current
heavy drinking,14 or drinking patterns
may have changed because of age or tem¬
poraltrends so that older participants
who were at higher risk for cataract
drank less. Also, cataract develops over
1. Clayton RM, Cuthbert J, Phillips CI, et al.
Analysis of individual cataract patients and their
lenses: a progress report. Exp Eye Res. 1980;31:
553-556.
2. Harding JJ, van Heyningen R. Beer, ciga-
rettes and military work as risk factors for cata-
ract. Dev Ophthalmol. 1989;17:13-16.
3. Clayton RM, Cuthbert J, Duffy J, et al. Some
risk factors associated with cataract in SE Scot-
land: a pilot study. Trans Ophthal Soc U K. 1982;
102:331-336.
4. Harding JJ, van Heyningen R. Drugs, includ-
ing alcohol, that act as risk factors for cataract, and
possible protection against cataract by aspirin-like
analgesics and cyclopenthiazide. Br J Ophthalmol.
1988;72:809-814.
5. Taylor HR. The environment and the lens. Br
J Ophthalmol. 1980;64:303-310.
6. Flaye DE, Sullivan KN, Cullinan TR, Silver
JH, Whitelocke RAF. Cataracts and cigarette
smoking: the city eye study. Eye. 1989;3:379-384.
7. Klein R, Klein BEK, Linton KLP, DeMets
DL. The Beaver Dam Eye Study: visual acuity.
Ophthalmology. 1991;98:1310-1315.
8. Klein BEK, Magli YL, Neider MW, Klein R.
Wisconsin System for Classification of Cataract
From Photographs. Washington, DC: US Dept of
Commerce; 1990. National Technical Information
Service accession No. PB 90-138306.
Downloaded From: http://archopht.jamanetwork.com/ by a New York University User on 06/05/2015
(CIs) for Lens Opacities Associated With Beer Consumption*
Moderate Consumption
-1
0.83-1.19 0.92
See "Subjects, Materials, and Methods" section for definition of pack-years.
presence of diabetes. See "Subjects, Materials, and Methods" section for definition of
a long period, so exposure in the past may
be more likely to affect cataract develop¬
ment than current behavior. In addition,
it is plausible that vulnerability of the
lens to noxious stimuli may differ
throughout life, so exposure at a more
sensitive age may be an important factor.
The CIs for current heavy drinking were
quite wide, so the lack of association
could also have been due to the small
number of current heavy drinkers.
Different relationships were found for
the different types of alcohol. Wine and
hard-liquor consumption was generally
associated with ORs of less than 1, while
beer consumption was associated
with ORs of more than 1. Other
investigators15"18 have reported differ¬
ences in risk estimates among different
types of alcohol for cancers of the esoph¬
agus and rectum. It is plausible that oth¬
er components of wine or hard liquor con¬
fer protective effects on cataract devel¬
opment. However, no such theoretical
links have yet been established.
Table 3 shows that participants con¬
suming different types of alcohol differ
in other characteristics. It could be that
these differences explain in part the
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Kaaks R, Casagrande C. Cancer and polyps of the
Heavy Consumption
-1
0.76-1.13 1.49 0.88-2.52
pack-years.
varying relationships to cataract that
were found. For example, those who
drank beer were more likely to report a
history of heavy drinking than were
those who drank wine or hard liquor.
These two effects are very difficult to
separate in cross-sectional analyses. In
addition, correlates of these parame¬
ters, or other exposures related to life¬
style or dietary differences, may influ¬
ence the frequency of cataract.2·19 This
could also explain why the relationships
found for wine and hard-liquor con¬
sumption did not remain when consid¬
ered as continuous variables.
Alcohol has many metabolic ef¬
fects20"22 and modifies the absorption of
drugs23,24 and dietary components.25
These effects may be important in the
alcohol-cataract relationship. However,
one cannot exclude the possibility that
alcohol itself, especially when consumed
in high volume, may be a direct toxin.
Further research is needed to evaluate
potential causal relationships.
This research was supported by grants Y06594 and
EY08012 from the National Institutes of Health.
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19. Leske MC, Chylack LT Jr, Wu SY. The Lens
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aract. Arch Ophthalmol. 1991;109:224-251.
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