Purpose: To evaluate the relationship between the presence
of cortical cataract and accommodation effort, using refractive
error as a proxy. Methods: Patients between 50 and 90
years, scheduled for cataract surgery, were selected with the
help of a photographic database. Nuclear and cortical cataract
were graded and patients grouped having no cataract,
pure cortical, mixed or pure nuclear cataract. Refraction data
at the time of the photograph was converted to estimated
spherical equivalent refractive error each patient would
have had at the age of 45 years. Results: From the initial 239
eyes from 239 patients, cases with myopia below –6.5 dpt
and hyperopia above 6.5 dpt were excluded, resulting in 199
cases for final analysis. Eyes with no cataract showed the
lowest median refractive error (–3.65 dpt), followed by the
pure nuclear group (–2.69 dpt). The median refractive error
for pure cortical (–0.23 dpt) and mixed cataracts (–0.87 dpt)
were close to emmetropia. Cortical cataracts were found in
37% of myopes, 82% of emmetropes, and 85% of hyperopes.
Conclusion: Emmetropes and hyperopes tend to develop
more cortical cataract than myopes. These cortical cataracts
might be caused by shear stress inside the crystalline lens
due to accommodation efforts at the time of onset of presbyopia