Relationship between altered levels of

serum electrolytes and risk of senile

cataract
Ch. Chandana Chowdary​1​, V. Sunanda​2​, Jayapal Reddy​3​. 1​ ​III MBBS Student, 2​ ​Professor & Head,
Department of Biochemistry, 3​​ Professor & Head, Department of Ophthalmology, Kamineni
Academy of Medical Sciences and Research Centre, L.B. Nagar, Hyderabad, Telangana State.

ABSTRACT:
Background: cataract is one of the age related eye disorder due to the opacity in the lens and
accounts for 50% of blindness in India. Many factors such as ageing, changes in blood
electrolytes, diabetes, family history are involved in senile cataract formation. Changes in the
serum electrolyte levels can induce changes in aqueous electrolyte levels and effect the lens
metabolism and probably cataract formation. ​Aims of the study: ​To assess the relationship
between the altered levels of serum electrolytes and risk of senile cataract. ​Materials and
Methods: ​The present study was a case control study and included 40 senile cataract patients
scheduled for cataract surgery in the control group and 40 normal individuals of same age
group in control group. Three ml of Random venous blood sample was collected in test and
control group. Serum electrolytes were measured by Ion Selective Electrode method. Statistical
analysis was done by Graph Pad online software. The mean±SD of electrolytes were calculated
and compared by paired t-test and ‘p’ – was elicited. ‘p’- value of <0.05 was considered as
significant. ​Results: ​Mean±SD of serum Na+, Cl- in the test group were 143.5 ± 3.6, 102 ± 3.2
respectively. Mean ± SD of serum Na+, Cl- in control group were 139 ± 2.4, 100 ± 2.3
respectively. The test group had significantly higher Na+ , Cl- levels (‘p’ - <0.001, ‘p’ - <0.05 )
as compared to control group. Mean±SD of serum K+ in test and control group were 3.9 ± 0.4 ,
4.1 ± 0.2 respectively. The test group had significantly lower serum K+ (‘p’ - <0.001) as
compared to control group. ​Conclusion: ​This study ​might suggest that diets with high sodium ,
chloride and low potassium remain significant risk factor in development of senile cataract. Salt
restricted diet and consumption of diet rich in potassium should be advised in cataract
individuals so as to maintain normal electrolyte balance in order to prevent further progression of
the disease.

Keywords: ​Serum electrolytes, senile cataract, Na+ - K+ ATPase, Na+ - K+ - Cl- pump
INTRODUCTION:

Senile cataract is one of the commonest consequences of the ageing process and it affects the
normal vision. In India, cataract accounts for 50% of blindness[4]. Many factors such as ageing,
altered serum electrolyte levels, diabetes, hypertension, nutrition and family history are involved
in the development of cataract.
Lens has a high content of potassium and low content of sodium. These two cations are in
balance with each other due to Na+-K+-ATPase pump and the lens capsular permeability. Hence
alteration in cation concentration of acqueous humour can be attributed to changes in serum
electrolytes, these ultimately affect lens metabolism leading to cataract formation.[1]
The permeability of chloride is high in lens. The Na+K+2Cl- co transporter
has been identified by dependence of cation flow on anion concentration. A disturbance in the
chloride concentration or chloride handling by the lens will jeopardize the ability of the lens to
maintain its hydrated state and threaten a loss of osmotic equilibrium that may result in
cataract.[1]
In this study, an attempt is made to see the effect of serum electrolyte
levels in development of cataract.

MATERIALS AND METHODS:

A case control study was carried out on the outpatients attending ophthalmology department,
Kamineni Academy Of Medical Sciences and Reseach Centre, LB Nagar, Hyderabad. The total
study population consisted of 80 individuals: Group – I consisted of 40 senile cataract patients of
age 50- 80 years and Group – II consisted of 40 normal individuals of same age group were
included in our study. The study was approved by the Institutional Ethical Committee. Informed
Consent is taken from all the participants.

INCLUSION CRITERIA:
1) Patients diagnosed by slit lamp examination as a case of senile cataract
2) Normal healthy individuals
3) Age group in between 50-80yrs.

EXCLUSION CRITERIA:
1) Not willing to participate in the study
2) Cataract due to any other etiology like trauma, radiation, diabetes
3) Patients with asthma, acute or chronic renal failure, any history of drug intake like
antipyschotics, chemotherapy etc.

Random venous blood sample of 2 ml was collected from all the participants included in this
study in plain vacutainer and allowed to clot for 30 minutes. Serum was separated by
centrifugation at 5000rpm for 5 minutes and electrolyte levels (Na+; K+ and Cl-) were analysed
by Ion Selective Electrode method using Sensacore Electrolyte Analyzer.
STATISTICAL ANALYSIS: ​The mean±SD values of all the electrolytes were calculated by
Graph Pad online software[4]. The comparison of serum electrolytes was done by paired ‘t’- test.
Interpretation was done according to ‘p’ - value. ‘p’ - value <0.05 was considered as statistically
significant[4].
RESULTS:

Table 1:
Results and data analysis of the present study shows that mean±SD of serum Na+ ……………..,
K+…………………., Cl- ……………………… in senile cataract patients were found to be
statistically higher(143.5+/-3.6, 102+/-3.2) and serum K+{3.9+/-0.4} was lower as compared to
control group{139+/-2.4,101.2+/-2.3,4.1+/-0.2}, though electrolyte levels did not cross the upper
level of reference limit.

DISCUSSION:

Cataract is the leading cause of poor vision and blindness in the world, with an estimated 17
million individuals are bilaterally blind[1]. The WHO and international agency for prevention of
blindness have developed a global initiative vision 2020 - the right to sight for elimination of
avoidable blindness by the year 2020.[1)

TABLE 1: ​[8]

The incidence of senile cataract is increasing with age, which accounts for more than 50% of all
cases of cataract[3]. Important risk factors for senile cataract include ageing, electrolyte
imbalance, diabetes, hypertension, nutrition and family history, exposure to UVB radiation[6].
Normally lens has high level of K+(114-130mmol/l) and low Na+(14-26mmol/l). These two are
in balance with each other due to Na+ - K+ ATPase pump, which in turn maintains permeability
of lens membrane. There is an increase in membrane permeability of the lens with age due to
reduced activity of Na+ - K+ ATPase pump, which leads to an increase in internal Na+. Higher
levels of extra cellular Na+ might make it more difficult for Na+ - K+ ATPase pump to maintain
the low levels of intra cellular Na+ required for lens transparency. In addition to this alteration in
Cl- levels also been suggested for the possible mechanism of cataract development by causing of
osmotic equilibrium[1].
Patience included in the present study were devoid of diseases like diabetes, acute
and chronic renal failure and conventional risk factors for cataractogenesis like high blood
glucose and urea were not present in these patients. Therefore role of serum electrolyte
imbalance can be justified in the process of cataractogenesis[4].
One of the studies has observed that is a remarkable difference in cation
{sodium}concentration of acqueous humour in turn a difference in serum cation
{sodium}concentration and it thus can be one of the risk factors for cataract[4,2]
From a clinical perspective, it has been suggested that after 50 years of age,
serum electrolytes measurement as a screening investigation can predict early development of
senile cataract. It is also critical issue because most of the electrolyte changes are silent and one
half of all cataract cases occur among individuals with normal serum electrolyte levels.

CONCLUSION:
We conclude from our study :
Biochemical parameters like serum electrolytes ( Na+,K+,Cl-) can act as modifiable risk factors
in age related cataract.[1] Hence diets rich in Na+ has to be avoided along with consumption of
diet rich in K+ has to be adviced in early cataract individuals to delay the progression of
cataract.[3]

LIMITATION OF STUDY:
Includes small sample size and setting of study in a tertiary care centre. Larger prospective
longitudinal population based studies are required to categorically ascertain this association of
altered levels of serum electrolytes with senile cataract.
REFERENCES:

[1] Jadav prashantkumar.M ,Sharma harim M, maniar meghna A, chaudary nithin kumar
G.comparitive study of Na+ K+ levels in senile cataract patients.SEAJCRR 2013;190-196

[2] Pravin N soni.Dhiraj S.sheetal U.wankhede ,seema P soni.serum electrolytes in senile

cataract patients at marathwada region. International journal of advances in medicine 2016.vol 3
287-289

[3] Rewatkar M muddeshwa lokhande , Ghosh K. electrolve imbalance in cataract patients.

Indian medical gazette 2012.89-91

[4] Ujwal Upadva B.sumana B.parveen D, pragathi gupta, iyshwarya U .study of electrolytes in
cataract individuals.

[5] INTERNATION JOURNAL OF CURRENT MEDICAL AND PHARMACEUTICAL

RESEARCH2016.1217

[6] Ramajit singh, Radhika tendon. PARSONS diseases of eye 22​nd​ edition 262-265

[7] Ak khurana, Arjun k khurana, Bhawana khurana. Comprehensive ophthalmology 6​th edition
179-184

[8] Vasudevan book of biochemistry latest edition for reference values.