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What is a Cataract

A cataract is a clouding of the lens, which lies behind the iris and the pupil. The lens works like a camera by focusing the incoming light onto the retina and it also adjusts the eye's focus, letting us see things clearly both up close and far away.

The protein  in a lens is arranged in a precise way that keeps the lens clear and lets light pass through it.
In case of a cataract some of the protein has clumped together and has formed a cloud in a small area of the lens.
Over time, it may grow larger and cloud more of the lens, making it harder to see.

There are three types of cataracts:

A nuclear cataract, which is located in the center of the lens, the nucleus,  is most commonly seen as it forms. It is said that the cause of this cataract is due to changes in the protein structure as we age.

A cortical cataract starts of on the outside of the lens and slowly extends to the center. This cataract is common for people with diabetics.

A subcapsular cataract begins at the back of the lens. People who have a higher risk of developig this form of cataract are:  people with diabetes, high farsightedness, retinitis pigmentosa or those taking high doses of steroids.

The term "age-related" is a little misleading because people can have an age-related cataract in their 40s and 50s. But during middle age, most cataracts are small and do not affect vision. It is after age 60 that most cataracts have a serious impact on ones vision.

What are the symptoms

Each type of cataract has its own symptoms. With a nuclear cataract you may notice an improvement in your near vision. This is called 'second sight'. However when the cataract gets worse this will disappear.
A subcapsular cataract may not give any symptoms in the beginning, but only in a later stage when it is more developed.

The most common symptoms of a cataract are:

• Cloudy or blurry vision.
• Colors seem faded.
• Glare. Headlights, lamps, or sunlight may appear too bright. A halo may appear around lights.
• Poor night vision.
• Double vision or multiple images in one eye. (This symptom may clear as the cataract gets larger.)
• Frequent prescription changes in your eyeglasses or contact lenses.
• These symptoms also can be a sign of other eye problems. If you have any of these symptoms, check with your eye care professional.
  

When a cataract is small you will not notice it much. You may find that your vision is a little blurry, like looking through a cloudy piece of glass. 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. Your vision may get duller or blurrier.

Another way that cataracts can affect your vision is that the clear lens slowly changes to a yellowish/brownish color, adding a brownish tint to vision.

At first, the amount of tinting may be small and may not cause a vision problem. Over time, increased tinting may make it more difficult to read and perform other routine activities. This gradual change in the amount of tinting does however not affect the sharpness of the image transmitted to the retina.

If you have advanced lens discoloration, you may not be able to identify blues and purples. You may be seeing black instead of purple or blue.

What causes Cataract

Much research has been done and is still happening to determine what the cause is of cataracts. So far it is unclear why, as we grow older, the protein starts to clump. Of course not everyone experiences having cataracts, so to just write it down to age is not correct.

Many studies suggest that exposure to ultraviolet light is associated with the development of cataracts. This is one of the reasons why many eyecare specialists recommend wearing sunglasses and a wide brimmed hat. A 2005 study conducted in Iceland suggests that airline pilots have a higher risk of developing nuclear cataract than non-pilots, and that the cause may be exposure to cosmic radiation. A similar theory suggests that astronauts, too, are at risk from cosmic radiation.

It has also been suggested that people with diabetes or people who use steroids, diuretics and major tranquilizers are at risk for developing a cataract.

Other risk factors are: cigarette smoke, air pollution and heavy alcohol consumption. Several studies found lead exposure to be a risk factor. However this research was not extensive enough to determine whether lead can definitely put you at risk, and if so, whether the risk is from a one-time dose at a particular time in life or from chronic exposure over years.

How is Cataract diagnosed

By doing a comprehensive eye examination, an ophthalmologist can diagnose a cataract and monitor its development.

A comprehensive eye examination usually includes:

Visual acuity test: This is an eye chart test where the doctor will ask the individual to read a letter chart to see how sharp your sight is at various distances.

Pupil dilation: In this test, the pupil (the round black centre of your eye) is widened with eye drops to allow the doctor to see more of the lens and retina and look for other eye problems.

Other eye tests:

• Glare test


• Contrast sensitivity test

How can a Cataract be treated

When symptoms begin to appear, you may be able to improve your vision for a while using new glasses, strong bifocals, magnification, appropriate lighting or other visual aids.

We advocate natural means to treat and forestall cataracts.
A diet high in antioxidants, such as beta-carotene (vitamin A), selenium and vitamins C and E, may forestall cataract development. Meanwhile, eating a lot of salt may increase your risk. You should only consider surgery when your cataracts have progressed so far that they seriously impair your vision.

An option for the treatment of cataracts is surgery whereby the clouded lens is removed and replaced by a  clear, plastic intraocular lens (IOL). There are many new kinds of IOLs available. One example is an IOL that lets patients see at all distances, not just one. Another new IOL blocks both ultraviolet and blue light rays, which research indicates may damage the retina.

Sometimes a cataract should be removed even if it does not cause problems with your vision. For example, a cataract should be removed if it prevents examination or treatment of another eye problem, such as age-related macular degeneration or diabetic retinopathy. If your eye care professional finds a cataract, you may not need cataract surgery for several years. In fact, you might never need cataract surgery. By having your vision tested regularly, you and your eye care professional can discuss if and when you might need treatment.

Cataract surgery is successful in restoring vision. In fact, it is the most frequently performed surgery in the United States, with over 1.5 million cataract surgeries done each year. Most people who have cataract surgery regain very good vision, somewhere between 20/20 and 20/40.

After the operation you can return to many everyday activities, but your vision may be blurry. The healing eye needs time to adjust so that it can focus properly with the other eye, especially if the other eye has a cataract. Ask your doctor when you can resume driving.

If you received an IOL, you may notice that colors are very bright. The IOL is clear, unlike your natural lens that may have had a yellowish/brownish tint. Within a few months after receiving an IOL, you will become used to improved color vision.

What are the risks of surgery

Some common problems can occur after surgery. These may include increased pressure, blurring from swelling, inflammation (pain, redness, swelling), and sometimes bleeding. More rare and serious problems include infection, loss of vision, or light flashes. If you experience increasing pain or a worsening of vision after surgery, you should contact your eye doctor. With prompt medical attention, almost all problems can be treated successfully.

Cataract surgery slightly increases your risk of retinal detachment. Other eye disorders, such as high myopia (nearsightedness), can further increase your risk of retinal detachment after cataract surgery.

Sometimes the eye tissue that encloses the IOL becomes cloudy after the operation and may blur your vision. This condition, called an after-cataract, can develop months or years after cataract surgery.

An after-cataract is usually treated with a laser. Your doctor uses a laser to make a tiny hole in the eye tissue behind the lens to let light pass through. This outpatient procedure is called a YAG laser capsulotomy. It is painless and rarely results in increased eye pressure or other eye problems. As a precaution, your doctor may give you eyedrops to lower your eye pressure before or after the procedure.