CATARACt

Dr. Delfi, Mked (Oph), Sp. M (K)

Departemen Ilmu Kesehatan Mata
Fakultas Kedokteran Universitas
Sumatera Utara

VISION 2020 : The right to

sight
Global initiative for the elimination of avoidable
blindness

A world in which no one is needlessly

blind and where those with
unavoidable vision loss can achieve
their full potential
A joint programme of :
The World Health Organization (WHO)
International Agency for the Prevention of Blindness (IAPB)

Visual impairment and

blindness
WHO 2014

285 million people are estimated to be

visually impairment worldwide
39 million are blind
246 have low vision

Globally the major causes of visual

impairment are :
uncorrected refractive error 43%
unoperated cataract 33%
glaucoma 2%

Indonesia : Survei kesehatan Indera

Penglihatan dan Pendengaran 19931996
Angka kebutaan 1.5%
Penyebab utama kebutaan :
Katarak (0.78%)
Glaukoma (0.20%)
Kelainan refraksi (0.14%)
Penyakit-penyakit yang berhubungan dgn
usia lanjut (0.38%)

Vision 2020 : cataract

chalenge

There are over 3 million

cataract-blind in Indonesia
CSR = 400 surgeries/year
It would take 30 years to do
all the patients with
existing cataracts
Backlog
Number of cataract
cases not operated
Backlog can be defined
for blindness, or an
agreed operable visual
acuity cutoff

Lens

The human lens is a

naturally clear
structure located
behind the iris.

The lens is
avascularIt does not have a
vascular supply

Some of the fibers begin

to clump together,
clouding areas of the lens,
and leading to the loss of
transparency

This loss of transparency,

or opacity formation is
called Cataract

Structure
The basic lens consists
of a central nucleus
surrounded by the
cortex contained
within the lens
capsule

The lens is made

mostly of water and
protein fibers

Opti
c

The lens focuses on the retina

When light passes through the pupil, it is focused by the lens to
produce clear, sharp images on the retina, the light-sensitive
membrane on the back of the eye that functions like the film of a
camera

Opti
c

As a cataract forms, the lens becomes opaque and light

cannot easily be transmitted to the retina
This results in scattering of light, blurring, and blocking of
the image

What Are the Symptoms of Cataracts?

u have a cataract, you may be experiencing any of these sympto
Painless blurring
or dimming of
your vision

Sensitivity to light and glare,

especially in bright sunlight or
while driving at night

What Are the Symptoms of Cataracts? (contd)

Increased nearsightedness,
requiring frequent changes in
your eyeglass prescription

Distortion or ghost images in either eye

Patients often
describe trying to
look through a
fogged-up window

Clouded vision can

make it more difficult to
drive a car, read, or see
details

Pen light

shadow test

Pathology

Cataract classification
Age
1. Cataract congenital ; onset before 2-3 months
of age
2. Cataract juvenile
o

Acquired

Advanced of cataract congenital

3. Cataract senile; onset 40 yo

Stadium of cataract
1. Insipien; vacuoles and water clefts in the
anterior and posterior cortex
2. Immature; the wedge shapes opacities spread
to adjacent fiber cell along the length of
affected fibers, causing the degree of opacity to
increase and extend toward the visual axis
3. Mature; entire cortex from the capsule to
nucleus becomes white and opaque. If the lens
takes up water, swelling become an
intumescent

4. Hypermature Cataract

Material lens through the

lens capsule, leaving
capsule wrinkled and
shrunken
This can cause
inflammation, eye pain
and headache
It needs removal

Surgery for cataract

1. Intracapsular Cataract Extraction (ICCE)
2. Extracapsular Cataract Extraction
A. Manual ECCE
B. Small Incision Cataract Surgery ( SICS )
C. Phacoemulsification

Phacoemulsification
During
phacoemulsification,
phaco for short, the
surgeon makes a small
incision, where the
cornea meets the
conjunctiva

The surgeon then uses the probe, which

vibrates with ultrasound waves, to break
up (emulsify) the cataract and suction
out the fragments

Once the cataract is

removed, a clear
artificial lens is
implanted to replace
the original clouded
lens
This lens implant is
made of plastic,
acrylic or silicone
and becomes a
permanent part of
the eye

Follow-up:
Patients are usually examined
1st, 2nd, 3rd day,
1 week, and
1 month after the surgery date

Conjunctivitis
(Red Eye)
Dr. Delfi, Mked (Oph), Sp. M (K)
Departemen Ilmu Kesehatan Mata
Fakultas Kedokteran Universitas
Sumatera Utara

Tarsal
conjunctiv
a

Fornix
conjunctiv
a
Bulbar
conjunctiv
a

Conjunctivitis is an inflammation or
infection of the transparent membrane
(conjunctiva) that lines the eyeball that
causes the eye to be swollen and makes
small blood vessels in the eye become more
prominent resulting in red eye.

Acute conjunctivitis

Symptoms
The most common symptoms of conjunctivitis
include:

Redness and itchiness

A gritty feeling or sandy sensation
A whitish/yellowish discharge
Watering

Common symptom is swelling of the eyelid,

either upper or lower.

Another Symptom is Excess Tears

The Itchy, Burning Associated with conjunctivitis

Sensation of a foreign object in the Eye,

rubbing and trying to remove from the eye.

Inflammation is seen as reddish change in the

periphery of the eye often accompanied by a puslike discharge. Yellow discharge, often causing
eyelids to stick together after sleeping.

Causes
Causes of red eye include:

Viruses
Bacteria
Allergies
Chemicals
A foreign object

Conjunctivitis is very contagious, and can be

transferred by close contact.

Prevention Good hygiene

If you have a red eye, the following measures will help:

Wash your hands thoroughly with soap frequently and

do not touch your eyes with your hands.
Change your towel, pillowcase and bed sheets often
and do not share them with others.
Discard eye cosmetics particularly mascara which you
have used.
Do not use someone else eye cosmetics or personal
eye-care items.
Follow instructions for proper contact lens care.
If a child is infected, avoid close contact with other
children.

Management

Administering eye drops to treat conjunctivitis

Diabetic
Retinopat
hy
Dr. Delfi, Mked (Oph), Sp. M (K)
Departemen Ilmu Kesehatan Mata
Fakultas Kedokteran Universitas
Sumatera Utara

Diabetic retinopathy is the leading

cause of blindness in patients aged 2064 years
Diabetic retinopathy (DR)
DM type 1(40%)
DM type 2 (20%)

Causes of global blindness in millions of people (WHO 2002)

20
18
16
14
12
10
8
6
4
2
0

Foster S.Resnikoff. The impact of vision 2020 on global blindness. Eye 2005; 19:1133-1135

Epidemiology
The prevalence of all types of diabetic
retinopathy in the diabetic population
increases with the duration of diabetes and
patient age.

Pathogenesis
Hyperglycemia over an extended period

Biochemical and physiologic changes

Endothelial damage

Retinal capillary changes

loss of pericytes and basement membrane thickening

Capillary occlusion

Retinal non perfusion

Decompensation of the endothelial barrier function

serum leakage and retinal edema

Symptoms

Asymptomatic in early stages of the disease

As the disease progresses symptoms may include :
Blurred vision
Floaters
Fluctuating vision
Distorted vision
Dark areas in the vision
Poor night vision
Impaired color vision
Partial or total loss of vision

Non proliferative diabetic

retinopathy
Microaneurys
ms
Intraretinal
hemorrhages
Hard exudates
Cotton wool
spot

Proliferative diabetic
retinopathy
Retinal
neovasculariza
tion

Fluorescein
angigraph : dye
leak
Typically sign
neovascularizatio
n

High risk proliferative diabetic

retinopathy
Vitreous
hemorhage

The patients will notice

deterioration of vision

PDR with
Clinically
significant macular
edema (CSME)

After laser
treatment
(laser burn
appears whitish
brown)

Diabetic macular
edema

Advanced diabetic eye disease

Preretinal fibrosis and tractional
retinal detachment

Rubeosis iridis

The Effect of Intensive Diabetes Treatment

On the Progression of Diabetic Retinopathy
In Insulin-Dependent Diabetes Mellitus
The Diabetes Control and Complications
Trial (DCCT)
76% reduced the risk of developing
retinopathy
54% slowed progression of retinopathy
60% reduced the risk of clinical neuropathy
54% reduced albuminuria
Arch Ophthalmol. 1995; 113:36-51

Screening for diabetic eye problems

Ophthalmoscopic examination through dilated pupils

Diagnosis

Slit-lamp biomicroscopy

Indirect ophthalmoscopy

Treatment

Laser photocoagulation surgery

Pars plana vitrectomy for vitreous

hemorrhage