Understanding Cataract

Cataract is an opacity found in the eye, particularly in the crystalline lens. The lens is responsible for focusing light that enters the eye on the retina, enabling you to see clearly. The lens is made up of three parts, and each can be affected individually or at the same time.
 Capsule: This is the outer covering of the crystalline lens. This is where the suspensory ligaments are attached so your eye muscles can change the shape of the lens accordingly for far, intermediate, and near vision.
 Cortex: this is the layer just next to the capsule. This is responsible for giving you clear peripheral vision.
 Nucleus: this is the center of the crystalline lens, and the most power part. This is the most active part during central vision, and mostly responsible during reading and near-point activities.
Classification of Cataract According to Origin

 Primary: this is the type of cataract where the origin cannot be traced. Most of age-related cataract are considered along the primary types of cataract.
 Secondary: an underlying medical condition such as leprosy, psoriasis, or hyperthyroidism can be the cause of a person’s cataract.
 Traumatic: a blow to the eye due to a physical attack or accident can cause the lens to be dislodged or cause internal eye hemorrhage resulting to cataract.
 Congenital cataract: a developmental anomaly can cause the baby to be born with cataract. The most common cause of this type of cataract is congenital rubella syndrome.
Causes and Risk Factors of Cataract
The exact cause why a person suffers from cataract is not yet known. However, most cataracts are attributed to the following risk factors:
 Old age: as the person ages, the protein structure in the lens also denatures or degenerates. It is theorized that an increase in oxidants causes change in lenticular structure.
 Radiation: UVA, UVB, and UVC have been attributed to the change in the lens. The type of damage done by UV rays is termed as progressive, and accumulates in time. This means that once the lens is damaged, it does not disappear, rather it will stay that way and will still collect more and more damage as the eye is exposed to it. Other types of radiation that can cause cataract are cosmic radiations (suffered by pilots and space explorers) microwave radiations, and radiations experienced by welders.
 Medical conditions: as stated, diabetes and goiter are among the medical conditions that can cause cataract. Along with retinopathy, cataract is one of the most common complications of diabetes. The high sugar content inside the eye causes is to absorb more water. This in turn can cause swelling which will affect the clarity of the lens.
 Medications: Prolonged use of certain medications can cause the onset of cataract. These medications include but not exclusive of corticosteroids, tri-cyclic anti-depressants, anti-psychotic medications, miotics, and medications for psoriasis.

Signs and Symptoms of Cataract:

 Difficulty differentiating green, blue, and violet colors – this is due to the yellowish discoloration of the lens. This is mostly observed on nuclear cataracts, and also cataracts that are mature.

 Halos around lights, glare – this is because the opacity is diffusing light rays just before they hit the retina. This can pose a threat to your safety especially when driving.

 Hazy vision – the opacity of the lens is making the light unable to reach the retina. This is quite similar in looking through a pair of eye glasses with hazy marks or on it.

 Diplopia (double vision) – because the opacity is causing a change in the focusing ability of the eye it can result to having two different foci formed on the retina.

 “Second sight” – this is noted just before the cataract is about to mature. As stated, the opacity is causing a change in the focusing power of the crystalline lens. You may notice that you will not need to wear your eye glasses during reading. However, this clear vision will eventually fade once the opacity has become mature.

 Difficulty seeing either at day (nuclear cataract) or at night (cortical cataract) – to help your eyes adjust to different levels of lighting, your pupils will have constrict during day time and dilate during dim light conditions or at night. If the cataract is formed at the nucleus, a constricted pupil may cause difficulty in seeing which can only be relieved during the dim light conditions. If your cataract is located at the cortex your vision may be as it was during the day, and will deteriorate at night because your dilated pupils allow peripheral access of light to the eye.

 Constant changing of eye glasses – as the opacity gradually increase in size and severity, your vision will also change. This would result in the need of changing eye glasses more frequently than usual. A normal person with glasses needs only a change once every 2 to 3 years. A person with cataract will need to change glasses at least twice a year. Eventually, once the cataract is mature, glasses will be useless and an operation will be needed.

Treatment:

There is no definite treatment that can help solve cataract. The only way that you can see better again is through cataract surgery. There are two types of cataract surgery and they are extracapsular cataract extraction and intracapsular cataract extraction.

Extracapsular cataract extraction (ECCE) involves removal of cataract, leaving the subcapsule behind. This surgical procedure previously poses high risk for complications because of a large incision done on the cornea. The recovery is also quite long, requiring the patient to remain hospitalized for 3 to 5 days as the incision heals. The modern adaptation of this surgery is called phacoemulsifcation. This is an out-patient procedure, or the incision done is really quite small. It is so small it often does not require suturing and can heal itself in time, faster than standard ECCE. This involves application of subsonic sound waves to emulsify the cataract. The emulsified lens is removed by suction using the same machine, resulting to less ocular trauma.

Intracapsular cataract extraction (ICCE) involves removing the entire crystalline lens. This is more risky and rarely done. This is only done because the cataract has been left too long and has caused severe eye complications. This surgery is often done on congenital cataracts. The risk of this surgery includes iris prolapsed, dislocation of the vitreous humor, and retinal detachment.

After cataract removal, an intraocular lens or IOL is placed in lieu of the removed lens. Previously, IOL’s still require the need for reading glasses. Because of research and advancing technology, a new type of IOL has been introduced, and they are called progressive IOL’s. These types of IOL’s can help you see better in all distances: far, intermediate, and near. Depending on your eye condition, you can have a 20/20 to 20/40 vision.

It is important that you keep your eye patch on according to the instructions of your ophthalmologist or cataract surgeon. You are required to use a different eye patch at night. This eye patch is made up of aluminum and designed to protect your eye from trauma as you sleep. You need to wear dark glasses while outside for it can be quite painful for your eyes to adjust on intense lighting conditions. You will also need to refrain from lifting objects heavier than 15 lbs as well as straining during bowel movement. You may re-open your surgical wound or disturb your IOL, and that can be more difficult to treat compared to cataract removal.

As of now, there is now known way to prevent the onset of cataract. However, if you increase your intake of foods rich in anti-oxidant, refrain from smoking and drinking, lessen your intake of salt, and wear protective eye wear while going outside, you can delay its onset or slow its progression.


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