Post by on Sunday, February 7, 2021

Cataracts can be congenital or acquired.  They are the most common cause of diminution of vision

The word cataract comes from the Latin Word ‘cataracta’ which means waterfall. A cataract is formed when there is loss of transparency in the crystalline lens of the eye. Cataracts can be congenital or acquired.  They are the most common cause of diminution of vision. Cataracts are very common as you get older. In fact, more than half of all Americans age 80 or older either have cataracts or have undergone surgeries for cataract extraction.

What are the symptoms of cataracts?

Cataracts lead to blurring of vision over time.  Other symptoms are Glare and intolerance of bright light, fading of colors, diplopia which is double image of a single object or polyopia which means multiple images. These may also be associated with frequent change in glasses and other intraocular pathologies and systemic co morbidities.

What are the causes of cataracts?

Most common form of visually impairing cataracts are Senile or age-related. These occur due to normal physiological changes in the eye called cataract genesis. Other types are congenital cataracts, traumatic, cataracts due to exposure to sunlight and UV radiations, cataracts associated with systemic diseases like diabetes mellitus, myotonic dystrophy and atopic dermatitis, cataracts associated with ocular conditions like intraocular inflammation, glaucoma, high myopia etc

Am I at risk for cataracts?

Your risk for cataracts goes up as you get older. You ’ re also at higher risk if you:

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          <!--[endif]-->Alcoholism.

        <!--[endif]-->Dehydration.

        <!--[endif]-->Malnutrition.

        <!--[endif]-->Family history of cataracts .

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       <!--[endif]-->If you ’ re worried you might be at risk for cataracts, talk with your doctor. Ask if there is anything you can do to lower your risk.

Congenital cataracts occur in about 3 in 10,000 live births. Causes include metabolic disorders, chromosomal abnormalities, maternal malnutrition and intra uterine infections.

How can I prevent cataracts?

You can take steps to protect your eyes and delay cataracts.

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        <!--[endif]-->Eat healthy. Eat plenty of fruits and vegetables — especially dark, leafy greens like spinach, kale, and collard greens.

       <!--[endif]-->Get a dilated eye exam. If you ’ re age 60 or older, get a dilated eye exam at least once every 2 years.

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How will my eye doctor check for cataracts?

An eye doctor can check for cataracts as part of a detailed and dilated ocular examination. The examination is simple and painless.  After evaluation of visual acuity and refractive error, the ophthalmologist dilates the pupil of the eye with eye drops   and then examines the anterior segment of the eye on a slit lamp and posterior segment with the help of an indirect ophthalmoscope.

What ’ s the treatment for cataracts?

A new prescription for eyeglasses or contact lenses can help you see better with early cataracts.

  Cataract extraction along with an intraocular lens (IOL) implantation   is the only way to treat a cataract effectively. In most cases it is an elective procedure.  The cataract surgery can be done manually - which is known as the  small incision cataract surgery (SICS) or  phacoemulsification which uses  the ultrasound energy and is the standard of cataract extraction in developed countries and at higher centres in the developing countries Femto lasers which have been used for refractive procedures for years now, are being used by many ophthalmic surgeons for performing the manual steps in phacoemulsification, but due to higher cost and  substantial learning curve it is still not a very preferred method.

Sometimes the cataract is associated with other ocular conditions like raised intraocular pressure or an intumescent cataract which may lead to endothelial damage of the cornea, in such scenarios the cataract extraction is an emergency. There are a variety of IOLs available in the market based on the material, design and refractive properties. The patient and the ophthalmologist can choose the IOL based on the needs of the patient. The IOL can be monofocal - wherein post surgery the patient will require glasses for near work, bifocal - wherein the patient will not need glasses and multifocal - the patient will have clear vision for near, intermediate and distance work.

 Although it is the most commonly performed surgery, as with any other surgery, the cataract surgery also has complications associated with it.  The complications range from mild - moderate to serious and vision threatening problems. Intra operative (during the operation) there can be a

 Rupture of the posterior lens capsule, nucleus drop, posterior migration of lens matter and vitreous haemorrhage. Post operative complications include cystoid macular edema which is the most common cause of diminution of vision after a cataract surgery, raised intraocular pressure, intraocular inflammation and infection which is known as endophthalmitis. Posterior capsular opacification (PCO) is the most common late complication of an uncomplicated cataract surgery.

Talk about your options with your doctor. Most people don ’ t need to rush into surgery. Waiting to undergo surgery usually doesn’t harm the eyes. Remember these tips:

        Tell your doctor if cataracts are getting in the way of your everyday activities         See your doctor for regular check-ups         Ask your doctor about the benefits and risks of cataract surgery         Encourage family members to get checked for cataracts, since these can run in families

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(Author is a Resident, Aditya Birla Sankara Nethralaya, Kolkata and can be contacted on purnanangia@gmail.com )