Cataracts

Cataract represents a medical condition that causes the formation of a cloudy and opaque area in the eye’s natural lens, which contains protein and water. Practically, the protein molecules found in the crystalline lens clump together forming a cloudy barrier and blocking the light. Depending on the type of cataract and its progress, some people notice slight changes in their vision while others might experience drastic effects that could leave them blind. This condition is quite common in elders and even though at the beginning glasses might help, if the affected vision interferes with daily activities then surgery represents the next logical step. Fortunately, the procedure is safe and efficient. Even though it is painless, this condition may lead to vision loss if left untreated, which means that seeking medical advice becomes imperative.

 

Types of Cataracts by Location

Cataract can affect three areas of the eye: the center portion, the outer part and the back surface of the lens.

  • Nuclear sclerotic cataract is the most common type and develops in the central zone or nucleus of the lens. The vision deteriorates gradually. More exactly, at the beginning of the process, this type of cataract may cause nearsightedness. Over time, the vision becomes more clouded because the lens turns yellow and ultimately, the yellow turns into brown and the person affected may encounter difficulties in distinguishing colors.
  • Cortical cataract, which is a less common form, causes whitish, wedge-like opacities or streaks in the cortex of the eye, also known as the peripheral area. Because it gradually extends to the centre, it impedes the light from passing though.
  • Posterior capsular cataract presents a faster progress in comparison to the other types and forms in the back of the lens causing light sensitivity, glare and interfering with reading vision. People who already have medical conditions like diabetes or take corticosteroids over large periods in high doses are more prone to developing posterior capsular cataract.
  • Congenital cataract represents the proof that people can develop it during childhood, destroying the belief that only older adults can experience blurry or cloudy vision. Even more, some people are born with this condition.

 

Cataracts location

 

Cataracts Causes and Risk Factors

  • Aging represents the main factor that leads to the appearance of cataract, which needs time to develop, thus clouding the lens. When cataract affects young people, some of the logical explanations include eye trauma, chronic medical conditions or prescription drugs.
  • Medical conditions like Wilson’s disease, diabetes and Down syndrome can stimulate cataract development at any age.
  • Medications for heart diseases, inflammation, cholesterol, epilepsy and chronic illnesses as well as sedatives can significantly increase the chances for cataract.
  • The risk for developing this condition is even higher in tobacco fiends and people who abuse alcohol.
  • Specialists link vitamin deficiencies to the appearance of cataract because the body no longer benefits from the necessary protection against free radicals, which damage cell walls and structures.
  • Other factors that may lead to cataract development are obesity, prolonged exposure to sunlight, eye injuries, infections or diseases.

 

Symptoms and Signs of Cataracts

Symptoms of cataracts usually vary according to the location and the clouding intensity. Because this condition is painless and the progress is very slow, the person affected might notice that something is wrong and seek medical attention years later or probably never if the cataract develops to just one eye. The most common symptoms include blurry vision, glare, diplopia or double vision and sensitivity to bright sunlight, poor night vision, seeing halos around lights and fading of colors, among others.

Generally, people with cataracts see cloudy images, regardless of the distance. Practically, they feel like staring through a foggy window. With the passage of time, because the condition does not allow the light to strike the retina, the brain receives less signals and the vision becomes poorer so people encounter difficulties seeing or driving during the night due to glare from streetlights and oncoming headlights. Another sign that people experience is diplopia and they should not mistake it for diplopia caused by improper alignment of both eyes because the first case may occur even when looking through one eye. In terms of colors, they may appear more yellowish or more faded. At the beginning, it is not a drastic difference but making a clear distinction between similar shades like blue and purple becomes almost impossible. Furthermore, people with cataracts might feel the need to change their glasses more frequently because obviously, the vision starts to deteriorate.

A stranger characteristic of this condition is a phenomenon known as “second sight”. In this case, the cataract has an opposite effect, namely improves vision at close distances. People who used to wear glasses during reading or other activities may discover that they are no longer necessary. Nevertheless, this joy does not last because this miracle improvement disappears as the condition worsens.

 

Prevention Methods for Cataracts

Unfortunately, specialists have not found a certain way to prevent or slow the progression of cataracts for patients to evade the need of undergoing surgery. However, they advise using several useful strategies.

  • A healthy and well-balanced diet with fruits and vegetables will help the body receive the nutrients and vitamins needed. In addition, they have many antioxidants, which are extremely beneficial for the eyes. Undoubtedly, this represents a natural and safe method of remaining healthy and reduces the possibility of developing cataract.
  • For people with other health problems, following the treatment strictly is very important for decreasing the risk of cataracts. Those with harmful vices like smoking should immediately ask for help and try various ways of quitting including counseling and medications. Excessive alcohol use is another enemy that can lead to cataract development.
  • Regular eye examinations can help doctors detect potential issues that might affect vision including cataract. Discovering this condition in the early stage will prevent permanent vision loss.
  • Ultraviolet light contributes significantly to the appearance of this condition. For this reason, people should wear glasses in order to protect their eyes from the strong sunlight every time they spend time outdoors.

 

When to Seek Medical Attention for Cataracts

During a routine eye examination, any doctor can instantly notice signs of cataract development even if the patient does not experience the symptoms mentioned above. Generally, the appearance of this condition is quite uncommon in individuals under 40 but it is possible for cataract to develop at any age. Regardless of the patient’s age, the symptoms will not kick in until years after. Even though cataract development does not cause long-term damage, doctors will recommend surgery when the patient starts to notice particular signs including poor color and blurry vision, questionable changes in eyeglasses prescription and difficulties with glare. Scheduling an exam becomes imperative and the person affected has the opportunity to receive accurate and professional answers to her questions. Moreover, a conversation with the doctor will determine if surgery could improve her vision.

 

Example of a cataract

 

Diagnosis for Cataracts

In order to establish an accurate diagnosis for cataracts, the doctor must clear any doubt regarding the condition of the patient. Thus, after examining the medical history and symptoms, he will proceed to perform a thorough eye examination, which includes various tests.

  • Retinal exam: During this procedure, the doctor uses eye drops in order to dilate the pupils of the patient, which facilitates the examination of the retina. He also makes use of a special device known as ophthalmoscope or a slit lamp.
  • Visual acuity test: Following this test, the doctor can assess if the patient’s vision presents signs of impairment by asking him to read a series of letters aloud from a certain distance and determine his precision. However, the doctor tests one eye at a time while covering the other to discover possible differences between them.
  • Slit-lamp examination: This procedure helps the doctor view the structures of the eye under magnification with a microscope called slit lamp of course, which provides intense light to illuminate the lens, iris and cornea. Thus, he will be able to detect even the smallest abnormalities and confirm the diagnosis.
  • Contrast sensitivity testing and tonometry: This procedure is very useful for verifying the patient’s capability to make a distinction between various shades of gray. Most times, a cataract limits this ability. Tonometry represents a standard test that provides information regarding the fluid pressure inside the eye, which is useful for excluding other possible eye diseases like glaucoma.

 

Surgery for Cataracts

If glasses or contact lenses cannot correct vision loss, then surgery represents the next step, which has the goal to improve the patient’s quality of life and his ability to perform daily activities, including reading and driving. The patient can delay the procedure in order to analyze carefully the risks and the benefits of this step. Meanwhile, the doctor will recommend periodic eye exams to observe the progression of the cataracts and the patient can use various methods to deal with the condition such as:

  • limit or avoid as much as possible driving during the night
  • examine the eyeglasses or contact lenses prescription to make sure it is accurate
  • wear sunglasses or a big hat when going outside to reduce glare
  • replace the lamps inside the home for light improvement
  • use a magnifying glass to read when encountering difficulties

These self-care measures are useful for a certain period, but the patient must take into account the progression of the cataract and serious vision deterioration. When performing daily activities become harder, cataract surgery might become the only solution. The surgery consists in using a clear artificial lens to replace permanently the affected lens. The doctor numbs the eye area with local anesthetic but the patient remains awake during the entire procedure. Furthermore, the patient can leave the hospital freely after the surgery. Even though this type of surgery is generally safe, there are chances of bleeding and infection as well as retinal detachment. Following the intervention, the patient might experience slight discomfort for the next days and the healing may last several weeks. Some patients need cataract surgery for both eyes but the doctor will solve each problem in turn meaning that he will wait for the first eye to heal before moving to the second. He can perform the surgery using three basic techniques:

  1. Phacoemulsification represents the most common form that surgeons use for cataracts removal. The procedure requires a small incision in or near the cornea and the insertion of a thin probe with ultrasonic vibrations that will dissolve the blurry lens and then suction out the pieces. After the complete removal of the cataract, the surgeon places an artificial lens also known as intraocular lens that helps the eye focus after the surgery.
  2. Extracapsular cataract surgery: Surgeons use this procedure when dissolving the cataract is not possible due to the advance stage. Thus, the surgeon needs to perform a larger incision to remove the cataract in one piece and finish with multiple sutures to close the wound. The patient will most likely wear an eye patch after the surgery and will experience a slower recovery.
  3. Intracapsular cataract surgery: This technique consists in the removal of the entire lens and the surrounding envelope or capsule. The surgeon places the artificial lens in a different location. Even though this method is not very popular nowadays, it may prove to be quite efficient in cases of significant trauma.

For several days or weeks after the surgery, the patient must strictly observe the doctor’s instructions, which include using eye drops, preventing water or soap entering the eye, rubbing or pressing the eye. The ophthalmologist may ask the patient to wear glasses or something else to protect the eye area, a shield during sleep and inform him regarding the moment he can regain his active life and perform various tasks or hobbies. It is possible for the vision to become blurry or cloudy even years after the intervention and this type of situation demands a laser procedure, which will help restore clear vision.

The most common risks of cataract surgery are ongoing swelling, bleeding and eye infection, detached retina, pain, damage to certain parts of the eye and even vision loss.

 

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