Cataracts
Cataracts occur when the lens in the eye becomes cloudy, either completely or partially. Cataracts occur most commonly due to age, inflammation, or steroid use.
In this article you will find information about the following:
What is Cataract?
Cataract is a condition when the natural lens of the eye becomes cloudy. Cataracts occur when the proteins in the lens start to break down and clump together, causing the lens to become opaque or cloudy.
Why do Natural lens go cloudy (aka: form a Cataract)?
The exact reasons why this process happens are not fully understood, but there are several factors that can contribute to the development of cataracts:
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Aging: As we get older, the proteins in the lens can gradually break down and lose their transparency, leading to the formation of cataracts.
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Exposure to Ultraviolet (UV) Radiation: Prolonged exposure to UV radiation from sunlight or other sources can increase the risk of cataract formation because UV radiation can cause damage to the proteins in the lens over time.
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Diabetes: People with diabetes are at a higher risk of developing cataracts. Elevated blood sugar levels can lead to changes in the lens structure and contribute to cataract formation.
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Smoking and Alcohol Consumption: Smoking and excessive alcohol consumption have been linked to an increased risk of cataracts. These habits can introduce harmful substances into the body that can accelerate the breakdown of proteins in the lens.
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Trauma or Eye Injury: Physical trauma or injury to the eye can cause cataracts to form. The damage can disrupt the normal structure and clarity of the lens.
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Genetic Factors: Certain genetic disorders or conditions can make individuals more susceptible to developing cataracts at an earlier age.
It's important to note that cataracts are a natural part of the aging process, and most people will develop them to some degree as they get older. However, the progression and impact on vision can vary from person to person. If cataracts significantly affect your vision and quality of life, cataract surgery can be performed to remove the cloudy lens and replace it with an artificial intraocular lens, restoring clear vision.
What are the symptoms of Cataract?
When you develop cataracts, which are cloudy or opaque areas in the lens of your eye, it can lead to various vision problems. The specific symptoms and their severity can vary from person to person. Some common problems associated with cataracts include:
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Blurred Vision: The most common symptom of cataracts is blurred vision. You may notice that your vision becomes cloudy, hazy, or foggy. It can be similar to looking through a dirty or frosted window.
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Reduced Colour Perception: Cataracts can affect your ability to perceive colours accurately. Colours may appear faded or less vibrant, and you might have difficulty distinguishing between certain shades.
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Sensitivity to Glare: Cataracts can make your eyes more sensitive to bright lights and glare. You may find it uncomfortable or challenging to see clearly in bright sunlight, or experience difficulty with oncoming headlights or streetlights at night.
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Poor Night Vision: Cataracts can impair your vision in low-light conditions, making it harder to see in the dark. You might notice increased difficulty navigating in dimly lit environments or experiencing reduced contrast and clarity at night.
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Double Vision: Cataracts can cause double vision or seeing multiple images of a single object. This effect can occur in one eye or both eyes and may interfere with depth perception.
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Frequent Changes in Eyeglass Prescription: As cataracts progress, the shape of the lens can change, leading to frequent changes in your eyeglass prescription. You may find that your glasses no longer provide clear vision, and updating the prescription may only provide temporary improvement.
It's important to note that cataracts typically progress slowly over time, and the extent of vision problems can vary. If you experience any of these symptoms or notice a decline in your vision, it's recommended to have a comprehensive eye examination with an eye care professional to determine if cataracts are the cause and discuss appropriate treatment options.
How do you treat a Cataract?
The primary treatment for cataracts is surgical intervention. Cataract surgery is a safe and effective procedure that involves removing the cloudy lens and replacing it with an artificial intraocular lens (IOL). Here are the steps involved in treating cataracts through surgery:
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Preoperative Evaluation: Before the surgery, you will undergo a comprehensive eye examination. This includes measurements of your eye's dimensions and calculations to determine the appropriate power of the IOL that will be implanted during the surgery.
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Anaesthesia: Cataract surgery is typically performed under topical or local anaesthesia, which means you will be awake, but your eye will be numbed so you don't feel any pain. In some cases, general anaesthesia may be used.
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Incision: The surgeon will make a small incision in the cornea, the clear front part of the eye, to access the lens.
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Lens Removal: There are different techniques used to remove the cloudy lens. The most common method is called phacoemulsification. In this technique, the surgeon uses an ultrasonic probe to break up the cataract into small pieces and then gently suction them out through the incision. Alternatively, in some cases, the lens may be removed in one piece through a larger incision (extracapsular cataract extraction).
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IOL Implantation: Once the natural lens is removed, an artificial IOL is inserted into the eye. The IOL is carefully positioned within the lens capsule, where the natural lens used to be. The IOL serves as a permanent replacement for the natural lens, helping to restore clear vision.
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Incision Closure: The small incision made in the cornea is usually self-sealing and does not require stitches. It will typically heal on its own.
Cataract surgery is usually an outpatient procedure, meaning you can go home on the same day. After the surgery, you may be prescribed eye drops to prevent infection and promote healing. It's essential to follow your surgeon's instructions regarding postoperative care and attend follow-up visits for monitoring and evaluation of your vision.
It's important to note that cataract surgery is one of the most common and successful surgical procedures, with a high rate of positive outcomes and improved vision for the majority of patients.
What are the various types of intraocular lenses available in the market?
There are several types of intraocular lenses (IOLs) available in the market. Here are some of the common types:
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Monofocal IOLs: These are the most basic type of IOLs. They provide a fixed focus at a single distance, usually for distance vision. They can correct vision for either near or distance, but not both. Most people still require glasses for certain activities, such as reading or driving.
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Multifocal IOLs: These IOLs are designed to provide clear vision at multiple distances, such as near, intermediate, and distance. They have different zones or rings that allow the eye to focus on objects at different distances. Multifocal IOLs can reduce the need for glasses or contact lenses after cataract surgery.
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Accommodating IOLs: These IOLs are designed to mimic the natural focusing ability of the eye. They can move slightly within the eye, allowing the eye's muscles to adjust the focus and provide clear vision at different distances. Accommodating IOLs offer a range of vision but may not eliminate the need for glasses completely.
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Toric IOLs: Toric IOLs are specifically designed to correct astigmatism, which is a common refractive error. They have different powers in different meridians of the lens to compensate for the astigmatism. Toric IOLs can provide clearer vision for people with astigmatism, reducing the need for glasses or contact lenses for distance vision.
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Extended Depth of Focus (EDOF) IOLs: EDOF IOLs are designed to provide an extended range of clear vision, including near and intermediate distances. They use advanced optical technology to increase the depth of focus, allowing for a broader range of vision. EDOF IOLs may reduce the need for glasses for some activities but may not eliminate it entirely.
The choice of IOL depends on various factors, including the individual's vision needs, lifestyle, and overall eye health. Each of these lenses have their own adjustment problems and therefore may not be suitable for you. Your eye doctor will assess your specific requirements and recommend the most suitable type of IOL for you.
What Complications could someone get after cataract Surgery?
While cataract surgery is generally safe and has a high success rate of around 95-98%, like any surgical procedure, it carries some potential risks and complications. It's important to note that complications are relatively rare, and most people experience significant improvement in their vision after cataract surgery. However, here are some possible complications that can occur:
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Infection: Infections can occur after cataract surgery, although they are rare. Signs of infection may include increased pain, redness, swelling, discharge, or decreased vision. Prompt medical attention is necessary if you suspect an infection. A rare infection of very severe type and consequences is called Endophthalmitis and usually happens within the first 5-7 days after surgery. If the vision and pain get worse and eye starts to get congested, swollen with increased redness, please consult the operating consultant or your local eye emergency unit urgently.
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Inflammation: Inflammation within the eye, called intraocular inflammation or uveitis, can occur after surgery. It is usually treated with anti-inflammatory medications to prevent complications and promote healing but sometimes can linger for long periods and may require longer duration of anti-inflammatory eye drops.
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Swelling of the Cornea: The cornea, the clear front part of the eye, may become swollen or cloudy after cataract surgery, leading to decreased vision. This condition is called corneal edema and can usually be managed with medications or additional treatments. It’s usually common if the surgery has had complications, taken longer than usual, or due to an underlying genetic corneal disease.
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Retinal Detachment: In rare cases, the retina (the layer of tissue at the back of the eye responsible for vision) can detach after cataract surgery. Symptoms may include sudden onset of flashes of light, floaters, or a curtain-like shadow in the visual field. Immediate medical attention is necessary if you experience these symptoms. This is more common in people who are high myopes (Short-sighted) and risk increases multi-fold as the power of myopia goes higher.
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Secondary Cataract: In most cases (about 8 out of 10 people), a thickening and clouding of the capsule that holds the artificial lens can occur after cataract surgery. This is called posterior capsule opacification or a "secondary cataract." It can cause vision to become blurry again. A simple and painless laser procedure called YAG laser capsulotomy can easily and effectively treat this condition.
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Dislocated Intraocular Lens: The artificial lens (IOL) implanted during cataract surgery may rarely become dislocated or displaced, leading to changes in vision. This can sometimes require additional surgical intervention to reposition or replace the IOL.
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Glaucoma: Cataract surgery can rarely lead to an increase in eye pressure, resulting in a condition called glaucoma. Regular follow-up visits are important to monitor eye pressure and detect any signs of glaucoma.
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Visual Dysphotopsias – These are visual disturbances which can be transient or rarely permanent based on the type of IOL that is inserted in the eye or ability of the brain to adjust to the new lens after cataract surgery.
It's crucial to have a thorough discussion with your Ophthalmologist before cataract surgery to understand the potential risks and benefits that apply specifically to you. They can assess your specific situation, explain the likelihood of complications, and address any concerns you may have.
What are visual dysphotopsias?
Visual dysphotopsias refer to abnormal visual perceptions or disturbances that can occur after cataract surgery. These visual phenomena are typically subjective experiences reported by some individuals, and they can vary in type and intensity. Here are a few types of visual dysphotopsias:
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Halos: Halos are rings of light that surround a light source, such as a lamp or headlights. Some individuals may experience increased haloing around lights, particularly in low-light conditions, after cataract surgery. This can cause discomfort or difficulty with night driving.
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Glare: Glare refers to excessive brightness or dazzling of vision, often resulting from light sources. Following cataract surgery, some people may notice increased sensitivity to glare, especially when exposed to bright lights or sunlight.
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Starbursts: Starbursts are similar to halos but appear as radiating lines or spokes of light extending from a light source. They can make lights appear larger, more spread out, or distorted. Starbursts can be particularly noticeable around streetlights or headlights.
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Ghosting or Double Vision: Some individuals may experience ghosting or double vision after cataract surgery. This can manifest as seeing multiple images or a faint, shadow-like duplicate of an object.
It's important to note that not everyone experiences visual dysphotopsias after cataract surgery, and those who do may have varying degrees of severity. In many cases, these visual disturbances tend to diminish or improve over time as the eye adjusts to the intraocular lens and heals from the surgery. However, in some cases, visual dysphotopsias can persist or be bothersome.
If you experience significant or persistent visual dysphotopsias that interfere with your daily activities or quality of life, it's crucial to discuss your symptoms with your Ophthalmologist. They can evaluate your specific situation, assess the potential causes, and provide appropriate guidance or treatment options to help manage or alleviate the visual disturbances.
C
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