A bibliometric and visualized analysis of the pathogenesis of cataracts from 1999 to 2023

**Background:** Cataract, characterized by lens opacification, is the leading cause of visual impairment and blindness worldwide. In 2020, an estimated 15.2 million individuals aged 50 and above were blind due to cataracts, and 78.8 million had moderate and severe vision impairment. Although cataract surgery is widely used, it has drawbacks including lack of bioactivity of implanted intraocular lenses, poorer visual quality, long training time, and high socioeconomic costs. Therefore, research on cataract pathogenesis is ongoing and important. This study aims to provide an overview of research status, popular topics, and scholarly tendencies in cataract pathogenesis over recent decades using bibliometric analysis.

**Methods:** Publications from January 1, 1999, to December 20, 2023, were collected from the Web of Science Core Collection (WoSCC). The search strategy was: TS=(cataract*) AND TS=(pathogenesis OR mechanism* OR nosogeny OR nosogenesis), with document type limited to 'article' and 'Review Article'. A total of 4006 articles were evaluated. Data were analyzed using Microsoft Excel, VOSviewer (version 1.6.20), CiteSpace (version 6.2.R6), and Python (version 3.8.8). VOSviewer was used for co-authorship, co-citation, co-occurrence, and network visualization. CiteSpace was used to identify keywords with significant bursts of activity. Synthetic knowledge synthesis was performed to qualitatively analyze the relationships between keywords.

**Key Results:** The number of annual global publications climbed from 76 to 277 between 1999 and 2023, a 264.47% rise. The cumulative citation count was 121,841, with an h-index of 141. Experimental Eye Research published the most manuscripts (178 publications), while Investigative Ophthalmology & Visual Science received the most citations (6675 citations). The most influential and productive country was the United States (1244 publications, 54,456 citations), followed by China (995 publications, 15,453 citations). The University of California system was the most productive institution (136 publications, 5401 citations). Yao Ke published the most papers (49 publications, 838 citations), while Truscott RJW received the highest number of citations (1292 citations) and had the largest h-index (19). The top 100 ranked keywords were divided into four clusters through co-occurrence analysis: (1) secondary cataracts, (2) oxidative stress, (3) gene mutations and protein abnormalities, and (4) alteration of biological processes in lens epithelial cells. The top three keywords with the highest burst strength were 'age-related cataract' (strength:15.66), 'missense mutation' (strength:13.32), and 'lipid peroxidation' (strength:13.24). From 2017 to 2023, the strongest citation burst keywords included age-related cataract, risk, proliferation, glaucoma, management, growth, diabetic cataract, and epithelial mesenchymal transition.

**Clinical Implications:** This bibliometric analysis provides a comprehensive overview of cataract pathogenesis research, identifying key research hotspots and emerging frontiers. The findings highlight the importance of oxidative stress, gene mutations, and cellular biology alterations in cataract development. The study suggests that future research should focus on molecular pathways, drug action targets, and cellular biology changes. It also emphasizes the need for international collaboration and resource allocation to institutions and researchers with high productivity and impact. The analysis identifies underexplored areas such as the role of organelle degeneration, autophagy, and the gut microbiome in cataract pathogenesis. These insights can guide future research directions and optimize resource allocation, potentially accelerating the translation of research findings into clinical practice, particularly in the development of preventive drugs for cataracts.