臨床眼科71巻1号

2017年01月発行

特集 眼疾患の一次予防と二次予防—眼疾患はどこまで予防可能か？

白内障の一次予防と二次予防

著者： 佐々木洋¹

所属機関： ¹金沢医科大学眼科学講座

ページ範囲：P.52 - P.60

はじめに

　高齢化社会において白内障は誰しもが罹患する疾患であり，世界的にも高齢化が進むなか，患者数はいまだに増加しており，失明原因の第1位はいまだ白内障で，全体の33.4％を占めると報告されている^1）。発展途上国では白内障による失明率は著しく高く，眼科医や手術可能な施設の不足，また貧困により手術加療を受けられない患者が多い。途上国でも内科的医療は徐々に進歩しており，近い将来長寿化が進むことが予想される一方で，眼科医療は立ち遅れているため，今後急激に白内障による失明者が増加することが危惧される。白内障の発症年齢は環境要因により大きく異なり，赤道部付近の途上国では50歳代でも進行した白内障に罹患している患者も多く，失明予防には一次予防がきわめて重要である。近年大規模な疫学調査が数多く行われており，紫外線（ultraviolet：UV）や喫煙など一次予防が可能な危険因子の解明も徐々に進んでいる（表1）。白内障の最大の危険因子は加齢であるため完全な予防は難しいが，既知の危険因子対策による一次予防効果は大きい。一方，白内障の二次予防に有効な薬物治療に関する研究は最近まで遅々として進んでいなかったが，近年，混濁水晶体を再透明化する薬物に関する報告^2,3）もあり，今後白内障の二次予防が大きく変化する可能性もある（表2）。しかし，本稿ではこれまでに明らかになっている一次予防に関連する白内障危険因子および二次予防の可能性について解説する。

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