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What are eye cataracts?

What causes cataracts?
What are the symptoms of cataract?
Classification of cataracts
Risk factors
How are cataracts diagnosed?
How are cataracts treated?
Risks of cataract surgery
Interview with an Ophthalmologist
Case study on eye cataract

What Are Eye Cataracts?

A cataract is a clouding of the lens inside the eye which leads to a
decrease in vision. Cataracts are one of the most common
causes of vision loss and are conventionally treated with surgery.
Visual loss occurs because opacification of the eye lens obstructs
light from passing and being focused on the retina at the back of
the eye.
It is most commonly due to aging, but has many other causes.
Over time, yellow-brown pigment is deposited in the lens, and
this, together with disruption of the lens fibers, reduces the
transmission of light and leads to visual problems.
Cataracts can develop in one or both eyes. If they develop in both
eyes, one will be more severely affected than the other. A
normally clear lens allows light to pass through to the back of the
eye, so that the patient can see well-defined images. If a part of
the lens becomes opaque light does not pass through easily and
the patient's vision becomes blurry - like looking through cloudy
water or a fogged-up window. The more opaque the lens
becomes, the worse the person's vision will be.
Those with cataracts often experience difficulty in appreciating
colors and changes in contrast, driving, reading, recognizing
faces, and coping with glare from bright lights.

In the above depicted picture, the eye circled with red colour is
occupied by an early staged cataract.

What Causes Cataracts?

The eye functions much like a camera. Light rays enter the eye,
passing through the cornea, the aqueous humor and then the
pupil and into the lens. The lens bends the light rays to focus
objects onto the retina lining the back of the eye. From there, the
image passes through the retinal cells, into the optic nerve, and
finally to the back of the brain which process the images.
Cataracts occur when there is a buildup of protein in the lens that
makes it cloudy. This prevents light from passing clearly through
the lens, causing some loss of vision. Since new lens cells form
on the outside of the lens, all the older cells are compacted into
the center of the lens resulting in the cataract.
Types of cataracts include:
Age-related cataracts. This type of cataract develops as a result of
Congenital cataracts. Babies are sometimes born with cataracts as a
result of an infection, injury, or poor development before they
were born, or they may develop during childhood.
Secondary cataracts. These develop as a result of other medical
conditions, like diabetes, or exposure to toxic substances, certain
drugs such as corticosteroids or diuretics, ultraviolet light, or
Traumatic cataracts. These form after injury to the eye.
Other factors that can increase a person's risk of developing
cataracts include cigarette smoke, air pollution, and heavy alcohol

What Are the Symptoms of Cataracts?

Cataracts usually form slowly and cause few symptoms until they
noticeably block light. When symptoms are present, they can
Vision that is cloudy, blurry, foggy, or filmy
Progressive nearsightedness in older people often called "second
sight" because they may no longer need reading glasses.
Changes in the way you see color because the discolored lens
acts as a filter.
Problems driving at night such as glare from oncoming headlights.
Problems with glare during the day.
Double vision (like a superimposed image).
Sudden changes in glasses prescription.
When a cataract is small, the cloudiness affects only a small part of
the lens. Cataracts tend to grow slowly, so vision gets worse
gradually. Over time, the cloudy area in the lens may get larger, and
the cataract may increase in size. Seeing may become more difficult
and a persons vision may get duller or blurrier.

Classification of Cataracts

Cataracts may be partial or complete, stationary or progressive,

or hard or soft. The main types of age-related cataracts are
nuclear sclerosis, cortical, and posterior subcapsular.
Nuclear sclerosis, the most common type of cataract, involves the
central or nuclear part of the lens. Over time, this becomes hard
or sclerotic due to condensation of lens nucleus and deposition of
brown pigment within the lens. In advanced stages, it is called
brunescent cataract. This type of cataract can present with a shift
to nearsightedness and causes problems with distance vision,
while reading is less affected.
Cortical cataracts are due to the lens cortex becoming opaque.
They occur when changes in the water content of the periphery of
the lens causes fissuring. When these cataracts are viewed
through an ophthalmoscope or other magnification system, the
appearance is similar to white spokes of a wheel pointing inwards.
Symptoms often include problems with glare and light scatter at
Posterior subcapsular cataracts are cloudy at back of the lens
adjacent to the capsule in which the lens sits. Because light
becomes more focused toward the back of the lens, they can
cause disproportionate symptoms for their size.
An immature cataract has some transparent protein, but with a
mature cataract, all the lens protein is opaque. In a hypermature
or Morgagnian cataract, the lens proteins have become liquid.
Congenital cataract, which may be detected in adulthood, has a
different classification and includes lamellar, polar, and sutural

Nuclear Cataract

Cortical Cataract

Posterior Subcapsular Cataract

Risk Factors

Increasing age
Drinking excessive amounts of alcohol
Excessive exposure to sunlight
Exposure to ionizing radiation, such as that used in X-rays and
cancer radiation therapy
Family history of cataracts
High blood pressure
Previous eye injury or inflammation
Previous eye surgery
Prolonged use of corticosteroid medications

How Are Cataracts Diagnosed?

Diagnosis of eye cataracts can be performed by an optometrist,

ophthalmologist, or by a general practitioner, but only an
ophthalmologist - a physician who specializes in eye care - can
perform cataract surgery. The provider will want to determine
whether you have a cataract or cataracts, confirm whether or how
much the condition is impairing your vision, rule out other eye
diseases that could account for low vision, and check for any
conditions that might make surgery risky.
Cataracts can be diagnosed from the patients description of signs
and symptoms, a visual acuity test using an eye chart, and a
physical examination of the eyes. Specialized tests can be used
to evaluate particular problems.
During diagnosis Visual acuity should be tested with the patient's
best-corrected spectacle correction. Distance vision should be
checked using the best-corrected spectacle prescription for
distance and a formal eye chart. A slit-lamp examination is also
performed to evaluate the lens following pupillary dilation. In
cases of significant cataract, opacification of the lens will be
noted. In children, and in adults unable to cooperate with slit-lamp
examination, observation and comparison of the red reflex using
direct ophthalmoscopy can help quantify the severity of the
Glare stress is induced using the brightness acuity tester, a handheld instrument with an illuminated field pierced with a viewing
aperture. This instrument allows the examiner to measure the
patient's visual acuity under the type of glare conditions that the

patient might experience in the real world. An initial

ophthalmology assessment also includes measurement of intraocular pressure. No other tests are performed to make the
diagnosis of cataract other than a physical examination of the

An acuity tester

How Are Cataracts Treated?

A cataract does not have to be removed just because it is there.

Surgery will be considered when a cataract causes enough vision
loss to interfere with daily activities, such as; work, driving,
reading or watching TV.
It is a misconception that a cataract needs to be ripe before it
can be removed. Surgery is performed when a persons visual
needs require it. An ophthalmologist can decide when surgery is
Surgery is the only effective way to remove a cataract and is
usually performed in a hospitals operating theatre under a local
anaesthetic. The cataract is removed using a microscope and
miniature instruments. In most cases, an intraocular lens implant
is placed in the eye to restore the focusing power of the natural
lens. If an intraocular lens is not implanted, cataract glasses or a
contact lens will be needed after surgery.
Most patients go home from the hospital on the day of surgery.
If a cataract has developed in both eyes, treatment will not be
given to both at the same time. It is common for a cataract to
develop quicker in one eye than the other, therefore the more
seriously affected eye will be treated first.
There are no known medications or dietary supplements that will
prevent or cure a cataract, and it is a common misconception that
lasers are used to remove a cataract.

Risks of Cataract Surgery

Any surgical procedure carries potential risks. Cataract extraction
may be followed by complications. Risks of cataract extraction
include, but are not limited to, infection, bleeding, retinal
detachment, dislocation of the cataract or lens implant, corneal
clouding or scarring, macular swelling, worsening of diabetic
retinopathy or macular degeneration, glaucoma, inflammation,
reduced or complete loss of vision or eye, corneal abrasion,
astigmatism, need for laser after cataract extraction, need for
additional surgical procedures, bruising from injection, irregular
pupil, drooping of eyelid, glare or reflections from lens implant,
and need for glasses after surgery. Complications due to
anesthetic injection or sedation are possible, due to drug
reactions or other problems. These complications may involve
other parts of the body, including the possibility of brain damage
or even death. Rarely, the optic nerve may be damaged which
can result in loss of sight. There is a possibility of hemorrhage or
bleeding. In some cases, complications may occur weeks, months
or even years later. Some complications could result in the need
for more surgical procedures. One situation that is fairly common
is for a secondary cataract to form, sometimes months but usually
years after even perfectly performed surgery. This requires a
laser treatment to correct.

Interview With An Ophthalmologist

(Dr. Muralidharan, ophthalmologist)
What exactly is a cataract?
A cataract is a cloudiness of the eye's natural lens, which
lies between the front and back areas of the eye.
Are cataracts found only in older people?
About half of the population has a cataract by age 65,
and nearly everyone over 75 has at least one. But in rare
cases, infants can have congenital cataracts. These are
usually related to the mother having German measles,
chickenpox, or another infectious disease during
pregnancy, but sometimes they are inherited.
Why is it important to wait a while before removing
A cataract usually starts very small and practically
unnoticeable but grows gradually larger and cloudier. It is
important to wait until the cataract interferes significantly
with your vision and your lifestyle. You need to continue
to visit an eye doctor regularly so the cataract's progress
is monitored. Some cataracts never really reach the
stage where they should be removed. If your cataract is
interfering with your vision to the point where it is unsafe
to drive, or doing everyday tasks is difficult, then it's time
to discuss surgery with your doctor.

Is cataract surgery serious?

All surgery involves some risk, so yes, it is serious.
However, cataract surgery is the most commonly
performed type of surgery in India. Many cataract
surgeons have several thousand procedures under their
belt. Choosing a surgeon with this much experience will
reduce the risk of something going wrong.
How is a cataract removed?
A small incision is made into the eye. The surgeon will
either remove the lens as is, or use ultrasound, a laser or
surgical solution to break it up, and then remove it. The
back membrane of the lens called the posterior capsule is
left in place. Usually, a replacement lens called
an intraocular lens is inserted. Occasionally, a doctor will
perform intracapsular extraction; this is when both the
lens and the membrane are removed, to ensure that the
membrane itself won't eventually grow cloudy and
interfere with vision. When the membrane becomes
cloudy, or if any bits of remaining natural lens become
cloudy, this is called a secondary cataract. The problem
with intracapsular extraction is that the membrane is no
longer there to receive a replacement lens.
I've heard that lasers are sometimes involved?
YAG lasers are used in a later procedure to create a clear
opening in the lens-containing membrane, if the
membrane becomes cloudy in the months following the
original cataract removal.

My grandmother had cataract surgery a few years

ago, and she had to wear thick glasses afterward.
Is this still necessary?
Nowadays, cataract patients who have intraocular lenses
implanted during surgery may need reading glasses for
close vision, but that's about it. In fact, with the newer
multifocal and accommodating intraocular lenses, even
reading glasses are unnecessary. People who don't
receive intraocular lenses wear contact lenses for
distance vision, with reading glasses for close up. Or they
may wear multifocal contact lenses for all distances.
Rarely does anyone have to wear thick eyeglasses now.
How much does cataract surgery cost?
The cost of cataract surgery varies from one doctor to the
next; it also depends on the eyewear that is prescribed
and the type of artificial lens used as a replacement.
Medicare and most health insurance plans will cover
cataract surgery and ordinary intraocular lenses, but not
the cost of premium artificial lenses that simultaneously
correct vision at near, intermediate and distant ranges.
These types of lenses can cost as much as Rs.250000 or
more out-of-pocket for both eyes.
What are possible side effects of cataract surgery?
As with any surgery, pain, infection, swelling and
bleeding are possible, but very few patients have serious
problems or cataract surgery complications. The surgeon
may prescribe medications for these effects. Retinal
detachment also occurs in a few people.

Case Study on Eye Cataract

Case I
A 67 year-old lady presented with
complaints of gradual decrease in
vision in both the eyes since 2 years.
She was unable to carry out her
daily activities and could not
recognize people at some distance
till they came quite close. Watching
television and reading were
becoming increasingly difficult for her. On examination
her vision in the right eye was 6/60, while left eye had
6/36. Anterior segment examination showed normal
anterior chambers with normal pupils. Lens had cataract
in both the eyes, right eye more than left eye. Fundus
examination showed no abnormality and Intraocular
Pressure was 14 and 16.
She was diagnosed to have Immature senile cataract in
both eyes. Since she was having problem in doing her
daily work she was advised cataract surgery with
Intraocular Lens Implantation. She
underwent Phacoemulsification with foldable lens
implantation in the right eye first and on the second
day postoperatively her vision in the right eye was 6/9
without glasses. She had no significant postoperative
pain and was comfortable from first postoperative day.
The left eye was operated 3 months later for cataract
with similar results. The lady was very happy as she

could now read a lot and play cards, which she was
missing earlier.

Case II
A 43 year old gentleman came with
problem of blurred vision in the left
eye. He was a senior Executive in a
software company and his work
involved a lot of reading and computer
work. He had been having this problem
for the last 3- 4 months and it was
becoming increasingly difficult for him
to do his office work now. On
examination he had a visual acuity of 6/6 in the right eye
and 6/9 part in the left eye. Lens in the left eye showed a
small central cataract while right eye was normal. Retinal
examination was also normal in both the eyes.
Since the patients work involved a lot of fine work like
reading and computer work, which was being hampered,
he was advised to consider cataract surgery in the left
eye. He underwent phacoemulsification in the left eye 4
days later. His post postoperative vision in this eye was
6/5 and he could satisfactorily carry out his extensive
daily work.

Case III

A 72 year old lady had diminished vision in the right

eye for 4 years. On check up her vision in the right eye
was counting fingers 3 meters while left eye was 6/18.
Anterior segment examination showed some clouding of
the lens in both the eyes. Intraocular pressures were
normal. Fundus examination right eye showed a large
whitish scar in the macula while left eye showed small
pale yellowish dot like lesions in and around the macula.
The patient was diagnosed to have Age related macular
degeneration in the right eye and Drusen (age related
changes) in the left eye with Immature senile cataract
both eyes.
She was explained about the irreversible damage to the
central part in the left eye and the poor visual prognosis
even after cataract surgery. She was told that cataract
surgery may help her peripheral vision a little but central
vision is not likely to improve. She decided to go ahead
with cataract surgery right eye. Post operatively she felt
better as she could see the surrounding areas more
clearly that helped her in walking and moving around.

Cataract is a eye disease in which ones clear and
transparent eye lens may become opaque, causing hazy
vision and glare from bright lights. Cataracts have many
causes, including age, diabetes and steroid medications.
No treatment can prevent or reverse the formation of a
Cataracts cause deterioration of vision, but very rarely
cause other serious problems. As a result one would
normally consider treating a cataract only when vision
has deteriorated to an unacceptable level. This is a very
personal decision, because some people are quite happy
with a level of vision that others find disabling.
Treatment involves surgical removal of the lens and its
replacement with a new lens of clear synthetic material.
The lens can be removed in a number of ways, but the
most successful is by means of an ultrasound probe in a
procedure known as phaco-emulsification. This is done
through a small incision, usually just under the upper
eyelid. This is one of the most successful of all surgical
procedures, restoring vision in a very high percentage of

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