What is cataract?

/uploads/images/pathologies/vision-with-cataract-63bd26d10e9cf888901650.png
/uploads/images/pathologies/cataract-nomal-vision-63bd26d10e88a405966849.png

Understanding Cataracts: A Comprehensive Guide for Patients
 

Cataracts are a common eye condition that affects millions of people worldwide, especially as they age. Despite their prevalence, many people are unaware of what cataracts are, how they develop, and the treatment options available. This article aims to provide a thorough understanding of cataracts, helping patients recognize the symptoms, comprehend the causes, and explore the treatments to restore their vision.

Primary cataract is an opacification of the naturally crystalline lens that focuses the light entering the eye onto the retina. This clouding of the lens develops either in the totality of the lens, the anterior capsule, the posterior capsule or the lens nucleus.

Primary cataract often develops gradually and painlessly, so vision can be affected with-out a person realizing it. It is the first cause of legal blindness worldwide and is responsible for the loss of vision of 20 million people. It can be treated by replacing the cloudy lens with an artificial one. Secondary cataract (opacification of the posterior capsule of the lens) may appear after a few months or years of having undergone a cataract extraction.

What are Cataracts?


What does vision look like with cataracts?

A cataract is a clouding of the eye's natural lens, which lies behind the iris and the pupil. This clouding can cause vision problems, as the lens is essential for focusing light onto the retina, enabling clear vision. Cataracts can develop in one or both eyes, but they do not spread from one eye to the other.


What are the Types of Cataracts?

Cataracts can be broadly categorized into two main types: primary and secondary. Each category encompasses different underlying causes and characteristics.

PRIMARY CATARACTS

Primary cataracts develop primarily due to the natural aging process and other intrinsic factors. These are the most common types of cataracts and include:

  • Nuclear Cataracts: These form in the center of the lens and are commonly associated with aging. They can cause the lens to turn yellow or brown and lead to significant vision impairment. People with nuclear cataracts may initially experience a temporary improvement in their reading vision, known as "second sight," but this effect diminishes as the cataract progresses.
  • Cortical Cataracts: These begin as white, wedge-like opacities or streaks on the outer edge of the lens cortex and gradually extend to the center, interfering with light passing through the lens. They can cause glare and difficulty with night vision due to the scattering of light.
  • Posterior Subcapsular Cataracts: These form at the back of the lens and often progress faster than other types. They can cause glare and halos around lights, especially at night, and affect reading vision. Posterior subcapsular cataracts are more common in younger people compared to nuclear and cortical cataracts.

SECONDARY CATARACTS

Secondary cataracts develop as a result of other medical conditions, medications, or environmental factors. They can also occur after cataract surgery. Key types of secondary cataracts include:

  • Congenital Cataracts: Some people are born with cataracts or develop them during childhood. These can be genetic or caused by infections or trauma during pregnancy. Congenital cataracts may require early intervention to prevent vision impairment and developmental delays.
  • Traumatic Cataracts: These result from an injury to the eye. Trauma can cause immediate damage to the lens or lead to cataract formation years later. Any sharp blow or penetrating injury to the eye can result in a traumatic cataract.
  • Radiation Cataracts: Exposure to certain types of radiation, such as from cancer treatments or excessive exposure to UV radiation, can lead to cataract formation. Protecting the eyes from UV rays with sunglasses can help mitigate this risk.
  • Medications: Long-term use of corticosteroids and certain other medications can cause cataracts. These medications can alter the biochemical processes within the lens, leading to its opacification. Patients on such medications should have regular eye examinations to monitor for cataract development.
  • Systemic Diseases: Conditions such as diabetes can accelerate the development of cataracts. Diabetic cataracts tend to progress more rapidly and may occur at a younger age compared to cataracts in non-diabetic individuals.
  • After Cataract Surgery (Posterior Capsule Opacification): Sometimes, cells can grow on the back of the new lens implanted during cataract surgery, causing cloudy vision. This condition, also known as secondary cataract or posterior capsule opacification (PCO), can be treated with a painless laser procedure called YAG laser capsulotomy.

What causes eye cataracts?


Cataracts primarily develop due to aging, but several other factors can contribute to their formation:

  • Age: The most significant risk factor. As people age, the proteins in the lens begin to break down and clump together, causing cloudiness.
  • Genetics: A family history of cataracts can increase the likelihood of developing them.
  • Diabetes: This condition can accelerate the development of cataracts.
  • Smoking and Alcohol: Both can increase the risk of cataracts. Smoking produces free radicals that damage the lens, while excessive alcohol consumption can lead to oxidative stress.
  • Sun Exposure: Prolonged exposure to ultraviolet (UV) rays can contribute to cataract formation. Wearing sunglasses that block UV rays can help reduce this risk.
  • Eye Injury or Surgery: Trauma to the eye or previous eye surgery can increase the risk of cataracts.
  • Medications: Long-term use of corticosteroids and certain other drugs can lead to cataracts.
  • Radiation Exposure: Exposure to certain types of radiation can also increase the risk.
/uploads/images/pathologies/explanation/cataract1-66d9ae0874896934853228.png

What are the signs of cataracts?


Cataracts develop slowly and initially may not affect vision significantly. However, as they progress, they can cause a variety of symptoms, including:

  • Blurry Vision: This is the most common symptom. It can feel like looking through a cloudy or foggy window.
  • Difficulty with Night Vision: Cataracts can cause significant problems seeing in low light, making night driving challenging.
  • Sensitivity to Light and Glare: Bright sunlight, headlights, or lamps may cause discomfort and glare.
  • Halos Around Lights: This is especially noticeable at night and can make driving difficult.
  • Color Changes: Colors may appear faded or yellowed.
  • Double Vision in One Eye: This can occur if the cataract affects the lens's ability to focus light properly.
  • Frequent Prescription Changes: A need for frequent changes in eyeglass or contact lens prescriptions can indicate cataracts.
/uploads/images/pathologies/explanation/cataract-diagnosis-66fe9a6ba38b3729069326.png

How cataract is diagnosed?


If you experience any of the symptoms mentioned, it's essential to consult an eye care professional. The diagnosis of cataracts typically involves:

Visual Acuity Test: This standard eye chart test measures how well you can read a series of letters from a distance.

Slit-Lamp Examination: This involves using a microscope to examine the structures at the front of the eye, including the cornea, iris, lens, and the space between the iris and cornea.

Retinal Exam: After dilating your pupils with eye drops, your doctor will examine the lens and retina for signs of cataracts and other eye conditions using a slit lamp or an ophthalmoscope.

Tonometry: This measures the pressure inside your eye. High pressure can indicate glaucoma, which can accompany cataracts.

/uploads/images/pathologies/explanation/cataract-treatment-66fe9a6ba5020460031481.png

How do you deal with cataracts?


While early-stage cataracts can be managed with prescription glasses, magnifying lenses, and stronger lighting, surgery is the only effective treatment for advanced cataracts. Here are the main surgical options:

  • Phacoemulsification: Also known as phaco, this is the most common cataract surgery. A tiny incision is made in the cornea, and an ultrasonic probe is used to break up the clouded lens into small pieces. These pieces are then removed, and an artificial intraocular lens (IOL) is implanted.
  • Extracapsular Cataract Surgery: In this procedure, a larger incision is made, and the clouded lens is removed in one piece. An IOL is then implanted. This method is typically used for advanced cataracts that are too dense for phacoemulsification.
  • Femtosecond Laser-Assisted Cataract Surgery: This advanced technique uses a laser to make precise incisions and soften the cataract for removal. It's often used in conjunction with phacoemulsification.

Intraocular Lens (IOL) Options: After the natural lens is removed, it is replaced with an artificial lens. There are several types of IOLs available:

  • Monofocal IOLs: Provide clear vision at one distance, usually distance vision, requiring reading glasses for close work.
  • Multifocal IOLs: Provide clear vision at multiple distances, reducing the need for glasses.
  • Toric IOLs: Correct astigmatism as well as providing clear vision at one or more distances.

Zoom on Posterior Capsule Opacification and YAG Laser Treatment


Posterior Capsule Opacification (PCO)

Posterior Capsule Opacification (PCO) is a common complication that can occur after cataract surgery. Although cataract surgery removes the cloudy lens and replaces it with an artificial intraocular lens (IOL), the lens capsule that holds the IOL in place is left intact. 

Over time, cells can proliferate on the posterior part of this capsule, causing it to become cloudy. This cloudiness can lead to symptoms similar to those of the original cataract, such as blurry vision, glare, and difficulty with night vision. PCO can develop months or even years after cataract surgery.


YAG Laser Capsulotomy

The treatment for PCO is a procedure called YAG laser capsulotomy, which is both safe and effective. Here’s how it works:

Preparation: The eye is numbed with anesthetic eye drops to ensure comfort during the procedure. The patient is positioned at a specialized laser machine, similar to the slit-lamp microscope used for eye examinations.

Procedure: The YAG laser is used to create a small opening in the center of the cloudy posterior capsule. This allows light to pass through to the retina unobstructed, restoring clear vision. The laser procedure itself is quick, typically taking only a few minutes.

Post-Procedure: Following the procedure, patients can usually return to normal activities immediately. Some may experience slight discomfort or see floaters temporarily, but these symptoms generally resolve within a few days.

Follow-Up: A follow-up visit is often scheduled to ensure that the eye is healing properly and that vision has improved as expected. It’s important to report any unusual symptoms, such as persistent floaters, flashes of light, or a significant decrease in vision, to the eye care professional.


Benefits and Risks of YAG Laser Capsulotomy

Benefits:

  • Non-Invasive: The procedure does not involve any incisions, making it less risky than traditional surgery.
  • Quick Recovery: Most patients experience rapid improvement in vision with minimal downtime.
  • Effective: YAG laser capsulotomy has a high success rate, with most patients experiencing significant improvement in vision.

Risks:

  • Increased Eye Pressure: Temporary increase in intraocular pressure (IOP) can occur, which is usually monitored and managed with medications if necessary.
  • Floaters: Some patients may see floaters after the procedure, though these typically resolve on their own.
  • Retinal Detachment: A rare risk, retinal detachment can occur if the laser inadvertently affects the retina. Immediate medical attention is required if symptoms of retinal detachment, such as flashes of light or a shadow over part of the vision, occur.

New techniques are emerging to treat secondary cataracts, such as the PROCAP™ procedure which delivers superior visual results by reducing the risk of damage to the intraocular lens (IOL) and limiting the appearance of post-treatment floaters.

Recovery and Aftercare


Recovery from cataract surgery is generally quick, but it requires careful adherence to post-operative instructions:

  • Protective Eyewear: Wear an eye shield, especially at night, to protect the eye as it heals.
  • Avoiding Certain Activities: Refrain from heavy lifting, bending over, or any strenuous activities that could increase eye pressure.
  • Medications: Use prescribed eye drops to prevent infection and reduce inflammation.
  • Follow-Up Appointments: Attend all follow-up appointments to ensure proper healing and address any complications.
  • Managing Symptoms: It's normal to experience mild discomfort, itching, or fluid discharge. However, severe pain or vision loss should be reported immediately.

Can cataracts be prevented?


While not all cataracts can be prevented, certain lifestyle changes can reduce the risk:

  • Regular Eye Exams: Early detection and monitoring can help manage cataracts before they become problematic.
  • Healthy Diet: Consuming a diet rich in fruits, vegetables, and antioxidants can support eye health.
  • Sun Protection: Wearing sunglasses that block UV rays can reduce the risk of cataract formation.
  • Quit Smoking: Avoiding smoking can significantly decrease the likelihood of developing cataracts.
  • Limit Alcohol Consumption: Reducing alcohol intake can also lower the risk.
  • Manage Health Conditions: Keeping conditions like diabetes under control can help prevent cataracts.


Conclusion


Cataracts are a common and treatable condition that can significantly impact vision and quality of life. Understanding the different types of cataracts, their symptoms, and the available treatment options can help patients make informed decisions about their eye health. Regular eye exams, protecting the eyes from UV exposure, and managing underlying health conditions can also help reduce the risk of developing cataracts. 

If cataract surgery is needed, advancements such as YAG laser capsulotomy offer effective solutions for complications like posterior capsule opacification, ensuring clear vision and improved quality of life.