Factors Associated with Cataract Occurrence at the Eye Polyclinic of FMC Hospital Bogor in 2019

The purpose of this study was to determine the factors associated with the incidence of cataracts at the Eye Polyclinic of FMC Hospital. The method used in this research is quantitative research with analytical descriptive. This research uses a cross sectional study approach. The population of this study were all patients who visited the Eye Polyclinic of FMC Hospital Bogor. The sampling method used in this research is purposive sampling. The sample in this study was determined based on the type of cross sectional research. The incidence of cataracts is 70.6%, age 45 years is 83.8%, gender is female, which is 60.3%, work in buildings is 58.8%, history of diabetes mellitus is 66.2% , smoking habits < 20 cigarettes / day that is 40.9%. The results of statistical tests using chi-square, it can be concluded that there is a relationship between age and the incidence of cataracts (p-value 0.01; OR 5.923). There was a significant relationship between gender and the incidence of cataracts (p-value 0.002; OR 6.282). There was no significant relationship between occupation and the incidence of cataracts (p-value 0.421; OR 0.600). There was a significant relationship between a history of diabetes mellitus and the incidence of cataracts (p-value 0.005; OR 5.045). There is no significant relationship between smoking and the incidence of cataracts (p-value 0.056; OR 0.337).


Introduction
The eye is a tool for the sense of sight formed to receive stimuli, light rays on the retina by intermediary divert these stimuli to the center of vision in the brain, the part of the eye that functions to focus light stimuli on the retina is the lens.
Cataract is a condition in which the normally clear and clear lens of the eye becomes cloudy. Cataracts are generally a cloudy condition in the eye lens which is usually clear and transparent, the lens located behind the eyeball is refracting and focusing light on the retina or the retina on the yellow spot, if the lens becomes cloudy or light cannot be focused on the yellow spot properly so vision will become blurred, in this condition the relatively small cloudiness of the lens does not interfere much with vision, but if the level of cloudiness is thick it will interfere with vision.
Cataract is still the most dominant disease in the eye and is the main cause of blindness worldwide. At least 50% of all blindness is caused by cataracts, and 90% of them are in developing countries, including Indonesia.
Blindness due to cataracts or clouding of the eye lens is a global health problem that must be addressed immediately, because blindness can lead to reduced quality of human resources and loss of productivity and requires large costs for treatment.
The etiology of cataracts is still unclear and is related to many factors. Meanwhile, several risk factors associated with cataracts include gender, diabetes mellitus (DM), exposure to ultraviolet light, smoking, and occupation.
The number of cataract sufferers is directly proportional to the number of elderly population. It is estimated that 12 people go blind every minute in the world. In Indonesia, it is estimated that every minute one person becomes blind. This number will double by 2020, this is related to the increased life expectancy.
The incidence of cataract itself can not be separated due to the existing risk factors.
Factors causing cataracts themselves can come from within the body itself (intrinsic factors) and factors from outside the body (extrinsic factors). Intrinsic factors include age, gender, ethnicity and genetics. Extrinsic factors include chronic exposure to ultra violet, infrared or sunlight, smoking, nutrition, myopia, alcohol, socioeconomic status, educational status and multivitamins.
Based on a preliminary study conducted by the author at the Eye Polyclinic of FMC Hospital, Bogor in October 2018, data obtained from medical records showed that in 2015 there were 195 cases, in 2016 there were 276 cases, in 2017 there were 420 cases and in 2018 from January to In October, there were 448 cases of cataracts.
The purpose of this study was to determine the factors associated with the incidence of cataracts at the Eye Polyclinic of FMC Hospital.

Method
The method used in this research is quantitative research with analytical descriptive. This research uses a cross sectional study approach, which aims to determine the relationship between variables where the independent and dependent variables are identified in one unit of time. The population of this study were all patients who visited the Eye Polyclinic of FMC Hospital Bogor. The sample is part or representative of the population under study. The sampling method used in this research is purposive sampling. The sample in this study was determined based on the type of cross sectional research.   Table 5 shows that most of the respondents had a history of diabetes mellitus, namely 45 respondents (66.2%) while respondents who did not have a history of diabetes mellitus were 23 respondents (33.8%).   *Meaningful (P-value < 0.05 and OR 1) Based on Table 8 above, it can be seen that most of the respondents who experienced cataracts were female, namely 35 respondents. The results of statistical tests using chi square showed (p-value 0.002; OR 6.282), which means that there is a significant relationship between gender and cataracts, and female respondents have a 6.28 times risk of developing cataracts.

Description of Respondents Based on Smoking Habits
The Relationship of the Independent Variable (Occupation) with the Dependent Variable (Cataract Incidence)   *Meaningful (P-value < 0.05 and OR 1) From Table 11 above, it can be seen that most of the respondents have a smoking habit of <20 cigarettes/day. The results of statistical tests using chi square showed (p-value 0.056; OR 0.337) which means that there is no significant relationship between smoking and cataracts.

Overview of Cataract Events at FMC Hospital Bogor
From the results of the study on January 7, 2019 to February 5, 2019, the distribution of the frequency of cataract occurrence at FMC Bogor Hospital was 70.6% while those who did not have cataracts were 29.4%.
According to the theory, cataracts are clouding of the lens. Cataracts vary widely in density and can be caused by many things, but are usually associated with aging. Meanwhile, according to Ilyas (2008) Cataract is a condition where the eye lens which is usually clear and clear becomes cloudy. The origin of the word cataract is from the Greek word cataracta which means waterfall. This is because cataract patients seem to see something like a waterfall is covered in front of their eyes.

Relationship Between Age and Cataract
At FMC Hospital, Bogor, the age with cataract incidence was 45 years in 57 respondents with a percentage of 83.8%. The result of statistical test using chisquare is (p-value 0.01 OR 5.923) which means that there is a significant relationship between age and cataract incidence and age ≥ 45 years has a 5.92 times risk of developing cataracts.
According to Miranty Aditya H, et al's research (2016) with the title "Analysis of Risk Factors Associated with the Incidence of Synilic Cataract at Bahteramas General Hospital in 2016". The number of respondents from this study was 140 respondents consisting of 70 cases or cataract patients and 70 controls or non-cataract patients who had been diagnosed by an ophthalmologist and recorded in the medical record book. Respondents by age group in the most cases were at the age of ≥ 45 years as many as 59 respondents (84.3%), then the age group <45 years as many as 11 respondents (15.7%). Meanwhile, in the control group, the majority were in the age group <45 years as many as 51 respondents (72.9%), then aged 45 years as many as 11 respondents (15.7%).

Sex Relationship with Cataract
At FMC Hospital, Bogor, the gender with cataract incidence was female in 41 respondents with a percentage of 60.3%. The results of statistical tests using chisquare are (p-value 0.002 OR 6.282), which means that there is a significant relationship between gender and the incidence of cataracts in women and has a risk of 6.28 times having cataracts.
According to Miranty Aditya H, et al's research (2016) with the title "Analysis of Risk Factors Associated with Senile Cataract Incidence at Bahteramas General Hospital in 2016". According to gender, the majority of cases were female as many as 38 people (54.3%), then male as many as 32 people (45.7%). The results of statistical tests show that the risk of developing cataracts for female respondents is 4.354 times greater than that of male respondents.

Occupational Relationship with Cataract
At FMC Hospital Bogor, the incidence of cataracts in those who work outside the building is 28 respondents with a percentage of 41.2% while those in the building are 40 respondents 58.8%. The result of statistical test using chi-square is (p-value 0.421 OR 0.600) which means that there is no significant relationship between work and cataracts.
According to research by Alfi Laila, et al (2017) "Analysis of Risk Factors for Cataract Occurrence in the Kendari Coastal Area" with a total of 62 respondents. The statistical test results obtained an Odd Ratios value of 2,908 (CI: 1,031 8,201) which indicates that there is a significant relationship between work and the incidence of cataracts and it can be concluded that respondents who work outside the building are at risk of cataracts by 2,908 times compared to those who work inside the building.
According to occupational theory, this is related to exposure to ultraviolet light, where UV light is a risk for cataracts. Ultraviolet rays from sunlight will be absorbed by lens proteins and then will cause photochemical reactions to form free radicals or oxygen species that are highly reactive. This reaction will affect the protein structure of the lens, which in turn causes cloudiness of the lens called cataract. In a study by Neale et al reported a strong positive association between work exposed to sunlight at the age between 20-29 years and nuclear cataracts. Exposure that occurs in the elderly has a weak relationship.
From the results of the study above, it can be concluded that there is no significant relationship between occupation and the incidence of cataracts in this study. Because most of the respondents' daily work is inside the building, which is 40 respondents out of a total of 68 respondents. So that the results of statistical test data processing using chi-square on the work variable, when compared with the results of other studies and compared with theory, the research on the work variable is not appropriate.

Relationship History of Diabetes Mellitus with Cataract
At FMC Hospital Bogor, there were 45 respondents with a history of diabetes mellitus with cataract incidence with a percentage of 66.2%. The result of statistical test using chi-square is (p-value 0.005 OR 5.045) which means that there is a significant relationship between a history of diabetes mellitus and the incidence of cataracts. Respondents with a history of diabetes mellitus have a 5.04 times risk of developing cataracts.
Factors Associated with Cataract Occurrence at the Eye Polyclinic of FMC Hospital Bogor According to research Meisye S, et al (2015) with the title "Factors Associated with Cataract Incidence at the Community Eye Health Center (Bkmm) of North Sulawesi Province in 2014" an analysis of the relationship between diabetes mellitus and the incidence of cataracts shows that there is a relationship between diabetes mellitus with the incidence of cataracts in patients receiving eye treatment at the Community Eye Health Center (BKMM) of North Sulawesi Province. The results of statistical analysis using Chi-square obtained p = 0.000 with OR = 9.88 (95% CI = 4.45-21.91), it can be said that people with diabetes mellitus have 9.88 times risk of developing cataracts.
According to theory, cataracts are generally a problem for the elderly, but in people with Diabetes Mellitus who are not well controlled, cataracts can occur at a younger age. It is estimated that the process of cataracts in people with Diabetes Mellitus is the result of the accumulation of sugar metabolism substances by eye cells. Under normal blood sugar conditions, the buildup of these wastes does not occur. When blood sugar levels increase, the conversion of glucose by aldose reductase to sarbitol increases. In addition, the conversion of sarbitol to fructose is relatively long and unbalanced, the levels of sarbitol and the eye lens increase. It is hypothesized that sarbitol increases intracellular osmotic pressure with a consequent increase in water uptake and subsequently, directly or indirectly, cataracts are formed. The longterm clinical effect will result in the occurrence of cataracts in patients with diabetes mellitus compared to nondiabetic patients.

The Relationship of Smoking with Cataracts
In FMC Hospital Bogor, smoking with cataract incidence is 20 cigarettes/day 25 respondents with a percentage of 36.8%, while <20 cigarettes/day 43 respondents with a percentage of 63.2%. The results of statistical tests using chi-square (p-value 0.056 OR 0.337) which means that there is no significant relationship between smoking and the incidence of cataracts.
According to research by Alfi Laila, et al (2017)  From the results of the study above, it can be concluded that smoking and the incidence of cataracts in this study did not have a significant relationship between smoking and the incidence of cataracts, because the majority of respondents were women where women rarely smoked. The majority of male respondents have a Factors Associated with Cataract Occurrence at the Eye Polyclinic of FMC Hospital Bogor smoking habit of <20 cigarettes/day. So that the results of statistical test data processing using chi-square on the smoking variable, when compared with the results of other studies and compared with theory, the research on the smoking variable is not appropriate.

Conclusion
The incidence of cataracts is 70.6%, age 45 years is 83.8%, gender is female, which is 60.3%, work in buildings is 58.8%, history of diabetes mellitus is 66.2% , smoking habits < 20 cigarettes / day that is 40.9%. The results of statistical tests using chi-square, it can be concluded that there is a relationship between age and the incidence of cataracts (p-value 0.01; OR 5.923). There was a significant relationship between gender and the incidence of cataracts (p-value 0.002; OR 6.282). There was no significant relationship between occupation and the incidence of cataracts (p-value 0.421; OR 0.600). There was a significant relationship between a history of diabetes mellitus and the incidence of cataracts (pvalue 0.005; OR 5.045). There is no significant relationship between smoking and the incidence of cataracts (p-value 0.056; OR 0.337).