Cataract

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What is a Cataract?

A Cataract is defined as a thick, cloudy area that develops in the lens of the eye and is one of the most common conditions affecting the eye. A Cataract develops slowly and can affect either one or both the eyes and as it progresses, it interferes with normal vision.

Is Cataract a Medical emergency?

A Cataract is not a medical emergency.

Types

Cataracts are classified depending on the part of the lens they affect. The different types of Cataracts are:

  • Nuclear Cataracts: This is the most common type, it affects the central part of the lens. As the nuclear Cataract advances, it is called a brunescent Cataract.
  • Cortical Cataracts: It affects the edges of the lens. They form wedge-shaped streaks at the edges. These streaks gradually progress towards the center.
  • Posterior Subcapsular Cataracts: This type of Cataract affects the back of the lens. It grows faster and causes early vision impairments.
  • Congenital Cataracts: These are present at birth and gradually develop in early childhood. They may be due to genetic reasons, intrauterine infections, or any trauma.

Causes

The following are the causes:

  • Advanced age
  • Trauma to the eye
  • Prior eye surgery
  • Radiation exposure
  • Other underlying medical conditions like diabetes, glaucoma, etc
  • Long-term use of corticosteroids or other medications
  • Smoking tobacco
  • Genetic factors

Risk factors

Factors that influence the development of Cataract include the following:

  • Smoking tobacco
  • Alcohol consumption
  • Prolonged exposure to sunlight
  • High blood pressure
  • Eye injury or trauma
  • Prior eye surgery
  • Long-term use of corticosteroids or other medications
  • Exposure to radiation

Signs & symptoms

Signs and symptoms include the following:

  • Blurred or double vision
  • Difficulty seeing at night
  • Difficulty seeing bright lights
  • Seeing halos around the light
  • Fading of colors

Investigations

Investigation tests that are performed to rule out Cataracts include the following:

  • Visual acuity test: An eye chart consists of a series of letters that are placed size-wise. An individual is made to read the letters with one eye closed. This test detects any vision impairments.
  • Slit-lamp examination: A slit-lamp is an instrument that provides a magnifying view of the eye structures such as the eyelid, sclera, conjunctiva, iris, and cornea. It is used to detect abnormalities.
  • Tonometry: This is a procedure performed to measure the pressure inside the eye.
  • An ophthalmoscope is used to observe the internal parts of the eye, the retina, and the optic nerve. Tests are also performed to check the sensitivity to glare and perception of colours.

Diagnosis

A diagnosis is made based on medical history, clinical evaluation, and results of the investigations done.

Stages

Cataracts are divided into four stages depending upon the severity of the condition. They are as follows:

  • Early Cataract: This is the initial stage of Cataract disease. Slight blurring and foggy vision begin.
  • Immature Cataract: Yellow-colour deposits start to accumulate in the lens. The clouding of the lens begins to develop in the center.
  • Mature Cataract: The cloudy area increases gradually giving a milky white appearance. It spreads to the edges of the lens and interferes with the vision.
  • Hypermature Cataract: The Cataract becomes very dense and hard with significant vision impairment

Treatment options

Medical treatment

Apart from surgery, the treatment of Cataracts may include prescribing magnifying lenses or stronger eyeglasses.

Interventional treatment including surgery and indications for surgery/ Surgical treatment

Surgery is the primary treatment for Cataracts. The cloudy lens is replaced with an artificial lens. Surgery is performed when Cataracts interfere with daily activities of life. Surgery can be performed at any stage of the Cataract.

Different methods of Cataract surgery are as follows:

  • Phacoemulsification: This is a widely used Cataract procedure. Ultrasound waves are used to break down the Cataract into tiny fragments and then remove it from the eye.
  • Extracapsular Cataract Extraction (ECCE): In this procedure, the Cataract is removed manually through a long incision in the cornea and followed by stitches.
  • Manual small incision Cataract surgery (MSICS): This is a form of ECCE surgery, but is done with a small incision.
  • Intracapsular Cataract Extraction (ICCE): In this surgery, lens and lens capsule are removed in one piece. This surgery is rarely performed due to its high rate of complications.

Cataract surgery is very safe and gives good outcomes. Surgery is done on an outpatient basis.

Role of diet/ Exercise/ Lifestyle changes/ Preventive measures

The following measures can prevent the development of Cataracts:

  • Wearing sunglasses to protect against ultraviolet rays from the sun
  • Smoking cessation
  • Maintaining adequate weight
  • A healthy diet with vitamins A, C, and E.
  • Regular eye checkups
  • Keeping diabetes in control and managing other health problems
  • Limiting alcohol consumption

Complications

Though Cataracts may not be problematic initially, they can cause complications as they progress. Some of them include the following:

  • Visual impairments like blurred and foggy vision
  • Having trouble with reading and driving

Complications after Cataract surgery include an increased risk of retinal detachment, endophthalmitis, corneal edema, and posterior capsular opacification.

Prognosis

The overall prognosis of Cataracts is good.

When to contact the doctor? / How to identify the complications?

A medical consultation is warranted if vision changes, eye pain, headaches, and sensitivity to light are noticed.

Indications for hospitalization if required

Hospitalization is not required for the management of Cataracts or surgeries in a majority of the cases.

Suggested clinical specialists/ Department to consult for this condition

  • Ophthalmology
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