Cataract

Introduction

Cataract is derived from a Latin word that means large waterfall. Clouding of the clear lens causes blurred vision. Most Cataracts slowly develop over the course of some years. A Cataract begins when proteins within the eye form clumps that prevent the lens from sending clear images to the retina, which is liable for vision.

Etiological causes of Cataract

• Age-related Cataracts are common in older adults or the elderly.
• Congenital Cataracts are present at birth or develop shortly after some time. They can be inherited or due to infections during pregnancy.
• Traumatic Cataract occurs following an eye injury or electric shock.

Anatomical classification of Cataract

• Nuclear Cataract is found within the centre of the lens. The lens starts to become darker as a person grows older, changing from clear to yellowish and finally brown.
• Cortical Cataract affects the layer of the lens surrounding the nucleus. The Cataract seems like a wedge or a spoke.
• Posterior capsular Cataract is found within the back outer layer of the lens.
• Posterior polar Cataract is found within the centre of the lens.

Causes and risk factors

• Diabetes
• Steroids
• Phenothiazine drugs like chlorpromazine
• Eye surgery or eye injuries
• Radiation

Symptoms

• Vision disturbances like – cloudy, blurry vision.
• Sensitivity to bright sunlight, lamps or headlights.
• Glare (seeing a halo around lights), especially after you drive in the hours of darkness with oncoming headlights.
• Change in glass prescription, including sudden nearsightedness.
• Seeing in double vision.
• Need for brighter light to read.
• Difficulty seeing in the dead of night (poor night vision).
• Changes within the way you see colour.

When to operate?

Cataract treatment relies on the extent of visual defect they cause. If a Cataract minimally affects vision or not the least amount, no treatment could also be needed. Patients are also advised to observe for increased visual symptoms and follow a daily check-up schedule. When a Cataract progresses to the purpose that it affects an individual’s ability to do normal everyday tasks, surgery could also be needed. Cataract surgery involves removing the Cataractous lens and replacing it with an intraocular lens.

Types of Cataract surgery

Small incision Cataract surgery

An incision of about 5.5 mm to 7.0 mm is created within the eye, the Cataractous lens is removed, and the intraocular lens is placed inside.

Phacoemulsification

This procedure involves making an incision within the side of the cornea and inserting a small probe into the eye. The probe emits ultrasound waves that soften and wedge the lens suctioned out, and the intraocular lens is placed inside.

Femtosecond lasers in Cataract surgery

Femtosecond lasers initially employed in refractive surgeries are now being adopted by many surgeons replacing the several manual steps of phacoemulsification with an automatic process.

Advantages of Femtosecond laser-assisted Cataract surgery

• Precise incisions
• Integrity of incisions
• Better refractive outcomes

However, the price factor is one of the most important disadvantages in femtosecond-assisted surgeries.

Operative complications

• Rupture of the posterior membrane
• Posterior loss of lens fragments
• Posterior dislocation of IOL
• Suprachoroidal haemorrhage

Posterior capsular opacification

’After Cataract’ is nothing but a typical late complication of Cataract surgery. It is caused due to the cells that have been left behind after the procedure, and these cells start to grow in size, finally causing a Cataract. This opacification is treated by Yag laser capsulotomy.

While there are not any clinically proven approaches to preventing Cataracts, simple preventive strategies include:

• Reducing exposure to sunlight through UV-blocking lenses.
• Quit smoking
• Increasing antioxidant vitamin consumption by eating more leafy green vegetables and taking nutritional supplements.
• Taking supplements like lutein and zeaxanthin, vitamin C and E, along with zinc.

Conclusion

Cataract is a commonly occurring condition in most adults and tends to develop over time.

Even though there are no medicinal cures for this disease, it can be managed through surgery to improve vision and restore eyesight. Taking some level of precautions can help to prevent Cataract formation to an extent.