JMIR Publications

ABSTRACT

Background:

Emerging evidence suggests shared pathophysiological mechanisms between cataracts and cardiovascular disease (CVD), indicating a potential link between these two prevalent non-communicable diseases. Oxidative stress, resulting from an imbalance between reactive oxygen species production and the body's antioxidant defenses, contributes to lens protein aggregation in cataracts and lipid oxidation in atherosclerosis, a key feature of several CVD subtypes. This shared pathophysiology implies that systemic vascular health may influence cataractogenesis. However, the epidemiological evidence supporting this relationship remains inconclusive.

Objective:

The main objective of this systematic review aims to synthesize existing evidence on the risk of developing cataracts in adults with underlying CVD.

Methods:

This systematic review follows the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and its extension for protocols (PRISMA-P) guidelines. Using the Population, Exposure, Comparator, Outcome (PECO) framework, this review attempts to identify the association between established CVD and the risk of cataract development or the need for cataract surgery. Systematic literature searches are conducted in PubMed, Scopus, Web of Science, and Embase using Medical Subject Headings terms, from database inception to 31 December 2024. Original research articles involving adults (≥18 years) that assess the statistical relationship between CVD and cataracts are included. Two independent reviewers screen studies, extract data, and appraise studies’ quality using the Newcastle-Ottawa Scale. Meta-analyses are conducted using random-effects models to calculate pooled effect estimates, with heterogeneity assessed using the I² statistic.

Results:

By October 2025, the systematic review had been successfully completed in accordance with PRISMA guidelines. Comprehensive database searches identified relevant studies examining the association between cardiovascular disease (CVD) and cataract development or the need for cataract surgery.

Conclusions:

This systematic review provides a consolidated and up-to-date evaluation of the relationship between CVD and cataracts. The findings highlight the potential importance of integrating cardiovascular risk assessment into routine ophthalmologic care. Continued refinement of study methodologies and standardisation of outcome measures are needed to address observed heterogeneity and strengthen future evidence, ultimately supporting more holistic management of patients with coexisting cardiovascular and ocular conditions. Clinical Trial: This systematic review has been registered with PROSPERO (CRD42025629907) and the Ministry of Health Malaysia (NMRR ID-24-03414-99G).