Cataract

• Blurred vision
• Cloudy, foggy, or filmy vision
• Double vision or ghosted images from the eye with cataract
• Need for brighter light to read
• Glare (seeing a halo around lights), especially when driving at night with oncoming headlights
• Poor night vision (difficulty seeing at night)
• Colors appear less vibrant than before

A cataract is a lens abnormality characterized by decreased transparency and increased cloudiness. The eye's lens is usually clear and composed mainly of water and protein.

Crystallins are the primary proteins that constitute the lens and its surfaces. They are responsible for the lens's refractive function. These proteins are arranged in a specific manner that maintains the lens's clarity and allows light to pass through, enabling the lens to focus a clear image onto the back of the eye or retinal surface.

Changes in the arrangement and alterations in the properties of the lens proteins lead to increased rigidity of the lens, ultimately resulting in the formation of a cataract.

Risk Factors For Cataract

There are several risk factors for cataract development that can be classified as follows:

• Age: Age-related (or senile) cataract is defined as a cataract occurring in people over 50 years of age. It becomes progressively more severe and frequent in the elderly and is responsible for 48% of world blindness.
• Gender: Women are at a higher risk for most cataracts than men, likely due to a lack of estrogen (reproductive hormone) in postmenopausal years.
• Racial or Ethnic Groups: In comparison to Europeans, white individuals and those with Asian ancestry have higher prevalence rates.
• Genetics: Genes play an important role in the development of cataracts. If your parents had cataracts, there is a chance that you might also develop them.
• Traumatic Injury: Damage to the lens due to serious injury to the eye can lead to cataracts. These cataracts can form quickly after the injury or take many years to develop.
• Certain Medications: Studies suggest that long-term use of corticosteroids can lead to cataracts.
• Smoking: The detrimental effects of smoking on the lungs are well-known, and it is also a major risk factor for cataracts.
• Alcohol Consumption: Alcohol increases the risk of cataracts as the lens is sensitive to the direct toxic effects of alcohol.
• Radiation: Certain types of radiation, such as ultraviolet (UV) rays from the sun and radiation therapy for cancer, may predispose individuals to cataracts.
• Systemic Diseases: Disorders that increase the risk of cataract development include:
  • Diabetes: Poor control of diabetes mellitus (DM) is linked to several eye complications, including cataracts.
  • Hypocalcemia: A decreased amount of calcium in the blood can cause eye changes, leading to cataracts.
  • Hypothyroidism: This condition refers to a decrease in thyroid hormone production. Though very rare, evidence suggests that hypothyroidism can cause cataracts.
• Severe Dehydration and Diarrhea: Severe dehydration, especially at a young age, can lead to cataracts. The risk also increases with serious episodes of diarrhea.
• Diet Lacking Proper Nutrition: Malnutrition and a diet deficient in antioxidants and vitamins increase the risk of cataract development.
• Maternal and Fetal Factors: Malnutrition and infections such as rubella and toxoplasmosis have been associated with cataracts during pregnancy or early infancy.
• Other Factors: Some lesser-known factors include:
  • Certain skin disorders and allergies
  • Oxidative stress (imbalance in antioxidants in the body)
  • High cholesterol levels
  • Errors in copper metabolism
  • Hormone replacement therapy
  • Drug abuse
  • Ingestion of toxins

Cataracts are visible during clinical evaluation of the eye. The following steps are used to evaluate cataracts:

1. History Taking

Your healthcare provider will ask about your health history, which includes the following:

• Your chief complaint, i.e., a decrease in vision, and any family history of cataracts.
• Past eye history.
• Any systemic disease causing or aggravating the symptoms.
• Your current medications.

2. Comprehensive Eye Examination

The comprehensive eye exam will include dilation (eye drops will widen your pupils) to examine the eye. Tests include:

• Visual Acuity Test: This is the eye chart test. It checks for the ability to see from different distances.
• Refraction Test: This test assesses the sharpness and clarity of vision. Both eyes are tested individually for their ability to see letters of varying sizes.
• Cover Test: This test is used to determine if you have a squint, as faulty vision caused by cataracts can lead to a squint.
• Slit-Lamp Test: This exam is used to detect issues such as cataracts, eye injuries, and lens clouding.

3. Other Eye Investigations

• Visual Acuity Test: This test measures how well your distant vision is.
• Pupil Dilation Test: This test is done to intentionally widen the pupils so that the eye doctor can examine the eyes thoroughly.
• Tonometry Test: This test measures the fluid pressure in the eye.
• Contrast Sensitivity Testing: This test is similar to the visual acuity test and is based on differentiating between shades of grey.
• Glare Testing: This test evaluates how vision may be altered in different light settings due to cataracts.
• Color Vision Testing: This helps detect acquired color vision defects.
• Potential Acuity Testing: This provides an estimate of vision after cataract removal.
• Specular Photographic Microscopy: This is performed before cataract surgery to assess the health of the endothelium.

There is no prevention for cataract. However, a few tips can help lower the risk of developing cataracts and slow down their progression:

• Eat a healthy, well-balanced diet: The diet should include the following:
• Vitamins C: Good sources of vitamin C include citrus fruits, lemons, tomatoes, kiwifruit, broccoli, potatoes, strawberries, kale, bell peppers, and guava.
• Beta-carotene: Beta-carotene is a rich source of vitamin A, essential for eye health. Good sources include carrots, sweet potatoes, and apricots.
• Vitamin E: It protects the eyes from harmful chemicals. Foods rich in vitamin E include tree nuts, peanuts, sunflower seeds, vegetable oils, and green leafy vegetables.
• Antioxidants: They are recognized for shielding your eyes from UV rays and harmful blue light. Foods high in antioxidants beneficial for the eyes include sweet corn, red grapes, and spinach.
• Omega-3 fatty acids: These are key for maintaining healthy eyes and may slow the progression of cataracts. Sources include fatty fish, fish oils, flax seeds, chia seeds, flaxseed oil, and walnuts.
• Carbohydrates: It is advised to have a low-carb diet, as a high-carbohydrate diet may hasten cataract progression.
• Quit smoking: Smoking increases the risk of developing cataracts. The sooner you quit, the more your body will thank you.
• Wear sunglasses: Prolonged exposure to the sun's harmful UV rays can damage the proteins in the lens of your eye. Wearing sunglasses protects your eyes.
• Limit alcohol intake: Alcohol speeds up your body's inflammatory response and has dehydrating effects, which could harm the proteins in your eye's lens.
• Keep blood sugar levels under control: Cataracts are more prone to occur in diabetics, especially if blood sugar levels are uncontrolled.
• Use steroid medications only under medical supervision: Prolonged use of prednisone and other steroid medications can increase the chance of developing cataracts.
• Get regular eye checkups: To preserve eye health, it is advisable to have frequent eye exams. An ophthalmologist can detect changes in your eyesight or ocular health even before noticeable signs or symptoms occur.

The choice of treatment depends on the level of opacity that makes it difficult to perform basic everyday tasks. The available options include:

• Prescription Glasses: Prescription glasses, along with sun shades to reduce sensitivity to light and magnifying lenses, can help improve vision to some extent. While they cannot directly treat cataracts, they can aid in correcting blurry vision and other issues caused by cataracts.
• Surgery: Surgery is almost always required if visual acuity is reduced or if there is a medical reason, such as glaucoma or retinal detachment, that negatively affects the eye's health. Cataract surgery is a permanent solution that successfully restores normal vision by removing the affected lens and replacing it with an artificial lens.

Note: Many health conditions require optimization before surgery for better results, such as diabetes and high blood pressure (hypertension).

The majority of the time, cataract surgery effectively restores vision. To prevent infection, postoperative care is crucial during the healing process.

Here are a few tips for rapid recovery:

• Try to stay away from dirt and dusty areas.
• Avoid strenuous or heavy activities such as vigorous exercise or heavy lifting for the initial few days post-surgery.
• Avoid driving until your doctor examines you and permits you to resume driving.
• Take your medications, such as antibiotics and anti-inflammatory eye drops, precisely as advised by your ophthalmologist.
• Use protective eye shields or sunglasses outdoors.
• Do not rub your eyes.
• Avoid swimming or hot tubs for the initial weeks post-surgery.
• Avoid using eye makeup without consulting your ophthalmologist.
• Follow up with your doctor as scheduled on day 1, week 1, and week 3.

Cataract causes multiple complications discussed as follows:

Disease-related complications

• Corneal ulceration: An open sore on the cornea, the transparent part of the eye that allows light to enter.
• Corneal perforations: A potentially devastating complication that can lead to corneal melting.
• Iritis: Swelling and irritation in the colored ring around the eye's pupil.
• Subluxation of the lens: The lens is considered subluxed when it is partially displaced but remains within the lens space.
• Secondary glaucoma: Any form of glaucoma with an identifiable cause of increased eye pressure, resulting in optic nerve damage and vision loss.
• Blindness: Cataract is the leading cause of blindness, accounting for 50% of blindness worldwide.

Surgery-related complications

• Uveitis: Eye inflammation of the uvea, the middle layer of the eye wall, between the retina and the sclera.
• Posterior capsular thickening: Occurs when a cloudy layer of scar tissue forms behind the lens implant, common within the first 6 months after surgery.
• Aphakia: The absence of a lens inside the eye, which can cause the eye to be out of focus and vision to be blurry, often due to cataract surgery.
• Glaucoma: Cataract surgery can increase eye pressure, potentially damaging the optic nerve and leading to glaucoma.
• Retinal detachment: A condition that develops when the retina, a light-sensitive tissue in the back of the eye, is pulled away from its normal location.
• Hyphema: The accumulation of red blood cells in the anterior chamber of the eye.
• Corneal burn: Can result when certain chemicals used during the procedure come into contact with the eyes.
• Opacification: Often referred to as "secondary cataract," it is the most common postoperative complication of cataract.

Non-surgical cataract treatment options can successfully minimize the impact of cataracts and slow their progression. However, they cannot eliminate cataracts. These alternative therapies for cataracts may include:

• Homeopathy: This therapy can provide some symptomatic relief. Homeopathy medicines work by diluting the protein accumulation in the lens, thus preventing the protein clumping that results in clouding.

6 Homeopathy Facts You Must Know

Cataracts tend to develop gradually as you age and are not usually painful. They typically do not cause vision loss initially, but you may start to notice clouding in your sight, which can be concerning.

Regular eye tests are the best way to detect any eye health problems, as early symptoms might not be noticeable initially.

Cataracts may impact your day-to-day work, especially if your job involves a lot of screen time. There are some manageable lifestyle changes you can make to help you manage cataracts, such as:

• Stronger prescription eyeglasses
• Using brighter lights at home and work
• Wearing anti-glare sunglasses
• Using magnifying lenses for reading and other activities that require up-close vision
• Taking time off for appointments and checkups

Cataracts may also affect your driving ability. You might experience glare or halos around bright lights, such as headlights and street lights, making night driving more difficult. Therefore, it is advisable to exercise caution while driving.

Cataract surgery successfully restores vision in most individuals. Corrected vision will positively impact various aspects of life, including social and emotional well-being.