Cataracts – Uncover The Causes, Symptoms, And Modern Cataract Surgery

What is Cataract?

Cataract is a common eye condition characterized by the clouding of the eye’s natural lens, which is responsible for focusing light on the retina to produce clear vision. This clouding effect is similar to looking through a foggy or frosted window and can significantly impair one’s ability to see clearly. Cataracts typically develop slowly over time, and they can occur in one or both eyes. While most cataracts are related to the aging process, they can also develop in younger individuals due to various causes, such as trauma, medications, or certain medical conditions

What Are The Types of Cataracts?

Age-related Cataracts:

The majority of cataracts are caused by advanced age due to degeneration of cell structure. Age-related cataract is further categorized by their location in the lens as follows:

• Nuclear cataract: Nuclear cataracts can make images appear dull or yellow. It advances quite slowly. Distance vision (inability to see far objects clearly) is usually far more impacted than near vision (inability to see near objects clearly).
• Cortical cataract: It has little effect on eyesight. Cortical cataracts can arise rapidly following trauma, but they usually proceed slowly.
• Posterior subcapsular cataract: Even if visual acuity is only slightly reduced, posterior subcapsular cataracts can create blinding glare in intense sunshine and from headlights. In most cases, both distance and close vision are impacted equally. Posterior subcapsular cataract progresses faster than nuclear cataracts.

Non-age-related Cataracts:

• They are caused by trauma, uveitis, scleritis, especially necrotizing scleritis, radiation of an intraocular tumor, or the metabolic influence of systemic disease.

What Are The Risk Factors of Cataract?

Cataracts can develop due to various risk factors. While aging is the primary factor associated with the development of cataracts, several other factors can increase the likelihood of their formation. Here are some key risk factors:

• Age: Aging is the most significant risk factor for cataracts. As we age, the proteins in the eye’s lens can deteriorate, leading to cloudiness and reduced transparency.
• Ultraviolet (UV) Radiation: Long-term and unprotected exposure to sunlight and UV radiation is known to increase the risk of cataracts. Wearing sunglasses that block UV rays can help reduce this risk.
• Smoking: Smoking is a modifiable risk factor associated with cataract development. Various chemicals in tobacco smoke can cause oxidative damage to the lens, accelerating cataract formation.
• Diabetes: Individuals with diabetes are more prone to developing cataracts, likely due to elevated levels of glucose in the eye’s lens.
• Family History: Genetic factors play a role in cataract development. If cataracts run in your family, you may have an increased risk.
• Eye Injuries: Trauma to the eye, including injuries and surgeries, can increase the risk of cataracts, especially if they damage the eye’s lens.
• Prolonged Use of Corticosteroids: Long-term use of corticosteroid medications, whether in the form of eye drops, oral medications, or inhalers, can elevate the risk of cataracts.
• Obesity: Obesity is associated with various health conditions, including diabetes, which can increase the risk of cataracts.
• High Blood Pressure: Hypertension may contribute to cataract development by affecting blood flow to the eye and the overall health of the eye’s structures.
• Excessive Alcohol Consumption: Heavy alcohol consumption over an extended period may contribute to cataracts by promoting oxidative stress in the eye.
• Previous Eye Inflammation or Infections: Conditions such as uveitis or other eye infections can increase the risk of cataracts.

What Are The Symptoms of Cataract?

Cataract development is a painless and progressive process that varies significantly between individuals. Many individuals experience increased nearsightedness before developing lens opacity. Some of the common symptoms of the development of cataracts are as follows:

• Blurred vision
• Extra Sensitivity toward light
• Difficulty to see at night or in low light
• Seeing a double image
• Difficulties distinguishing between different color hues or recognizing forms against backgrounds
• Observing halos surrounding lights
• Frequent changes in the prescription of lenses

Diagnosis of Cataract - How is it made?

Diagnosing cataracts is a crucial first step in managing this common eye condition, as early detection and evaluation are essential for timely treatment. Here’s an overview of the diagnostic process for cataracts:

• Visual Acuity Test: A visual acuity test using an eye chart is one of the initial steps. This test measures your ability to see clearly at various distances and helps determine the extent of your visual impairment.
• Slit-Lamp Examination: A slit-lamp examination is a specialized microscope that allows the eye specialist to examine the structures of your eye, including the cornea, lens, and retina. This close-up examination can reveal the presence and extent of cataracts. To get a better view of the lens and its condition, the eye specialist may use dilating eye drops to enlarge your pupils. This allows for a more thorough examination of the lens and its opacities.
• Tonometry: Tonometry is a diagnostic procedure often used in the evaluation of cataracts. While tonometry primarily serves as a tool for measuring intraocular pressure, it plays a more indirect role in cataract assessment. Elevated intraocular pressure can be a secondary concern in advanced cataract cases, as the clouded lens may obstruct the normal flow of eye fluids, affecting pressure. In such instances, tonometry helps to gauge the extent of pressure changes and determine if they contribute to any additional complications or discomfort. It’s important to note that tonometry is not a primary method for diagnosing cataracts; rather, it is often part of a comprehensive eye examination, where its results are considered alongside other clinical findings and imaging techniques for a more accurate evaluation of ocular health, particularly in patients with coexisting cataracts and other eye conditions.
• Retinal Evaluation: A retinal examination, also known as funduscopy, is a vital component of a comprehensive eye check-up. This specialized procedure thoroughly assesses the retina, the light-sensitive tissue at the back of the eye. Its primary purpose is to detect and diagnose various eye conditions and diseases that may affect the retina, such as diabetic retinopathy, macular degeneration, and retinal detachment.
  To perform a retinal examination, the eye specialist typically begins by dilating the pupils with special eye drops to allow for a more detailed view. Then, various tools and techniques, including slit-lamp biomicroscopy, direct and indirect ophthalmoscopy, fundus photography, and even advanced imaging technologies like optical coherence tomography (OCT), are used to evaluate the health and condition of the retina.

Surgical Management of Cataract

There are no medical treatments that have been proven to work for cataracts. The only way to effectively treat a cataract is to surgically remove and replace the eye’s clouded lens in order to restore the transparency of the lens.

Cataract Removal Surgery Explained In 1 Minute

Cataract removal surgery is a common procedure performed to restore vision impaired by cataracts. It involves the removal of the cloudy lens in the eye and replacing it with an artificial lens, known as an intraocular lens (IOL). This surgery is typically performed by an ophthalmologist and is considered safe and effective in improving vision.

• Anesthesia: Cataract surgery is typically performed using local anesthesia, such as eye drops or a regional block, to numb the eye. This means you would remain awake but won’t feel any pain during the procedure.
• Incision: After anesthesia, you will get an incision in your cornea, and depending on the type of incision, there are two main techniques for cataract surgery: phacoemulsification and extracapsular extraction. Phacoemulsification is the most common and involves creating a small incision (about 2-3 mm) in the cornea. Extracapsular extraction requires a larger incision and is used in more advanced cases.
• Lens Removal: In phacoemulsification, an ultrasonic probe is used to break up the cloudy lens into small pieces, which are then suctioned out. With extracapsular extraction, the lens is removed in one piece.
• Intraocular Lens Implantation: After removing the cataract, an artificial lens called Intraocular lens (IOL) is inserted into the eye to replace the natural lens. The type of IOL used (monofocal, multifocal, or toric) is determined based on the patient’s individual needs and preferences.
• Wound Closure: The small incision in the cornea is typically self-sealing, eliminating the need for sutures in most cases.

What Are The Most Common Problems After Cataract Surgery?

After cataract surgery, patients are monitored briefly in the recovery area. You may experience temporary discomfort, usually mild and manageable, with prescribed eye drops. On the first postoperative day, your doctor will examine your eyes. You are usually advised to rest for a day or two and avoid strenuous activities. Visual improvement is often noticeable within a day or two, with further improvement over several weeks. Following surgery, you must visit your doctor again a week and a month later to ensure routine healing and monitor for any issues. It is important to note that you may acquire cataracts again even if you have the surgery years later. This is due to the clouding of the capsule that holds the IOL that your doctor has placed. For this condition, you might have to go for a surgery called capsulotomy that will help to restore clarity in your vision.

How Can We Prevent Cataracts?

Cataracts are a common age-related eye condition, but several preventive measures can help decrease the risk of developing cataracts or slow their progression. Here is what you can do:

• Protect your eyes from UV radiation with sunglasses.
• Quit smoking to reduce cataract risk.
• Maintain a diet rich in antioxidants and vitamins.
• Control diabetes through diet and medication.
• Manage high blood pressure.
• Limit alcohol consumption.
• Stay well-hydrated.
• Use proper eye protection in high-risk environments.
• Schedule regular eye check-ups for early detection.

Questions For Your Doctor

1. Are there any alternative treatments or remedies to consider before surgery?
2. Is cataract surgery the only solution, or can I delay it?
3. How will cataract surgery improve my vision?
4. What are the risks and potential complications associated with cataract surgery?
5. What anesthesia will be used during the surgery?
6. Will I be awake during the procedure, and will I feel any pain?
7. Will I still need to wear glasses or contact lenses after cataract surgery?
8. Are there any restrictions or lifestyle changes I should consider after the surgery?
9. How long can I wait before having the surgery if I choose to delay it?
10. Can both eyes be operated on simultaneously, or should they be done separately?
11. Are there any specific contraindications or conditions that may affect my eligibility for cataract surgery?

References

• https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/cataracts
• https://www.aao.org/eye-health/diseases/what-are-cataracts