Have you ever heard the word CATARACT??? For most people it strikes fear, for some, it simply means blindness, while others refer to it as the old man’s disease of the eye.
Recently, I came across a young patient who walked into the clinic claiming he had cataract. After examination, I found out what he was referring to as ‘cataract’ was actually pterygium (a fleshy, transparent and triangle-shaped membrane that grows on the conjunctiva with no serious effects on vision).
Since a lot of people either do not know what cataract is or what it looks like and how seriously it should be taken, let’s discuss it.
What is Cataract?
Simply put, a cataract is an opacity of the natural lens of the eye.
This lens in its normal and natural state is a transparent clear medium for the transmission and refraction of light which results in vision. To understand cataract, we must first understand the crystalline lens. The lens is the 2nd most important contributor to the refractive power of the eye after the cornea. It is made up of water, proteins, lipids, carbohydrates and other trace elements. It has an epithelium (outer layer of cells) and a capsule (transparent collagenous basement membrane). The epithelium produces the capsule and is responsible for transportation of nutrients to the lens fibres. These lens fibres are in turn responsible for lens transparency (the organized arrangement of the fibres).
Types of Cataract
There are different types of cataract. They are grouped according to what caused it.
- Developmental cataract (Partial and stationary): This occurs at birth (congenital) and could be due to a disruption or disturbance at a particular stage of development (abnormal lens fibres formed caused by maternal or infantile malnutrition), infections (rubella), deficient oxygen, e.t.c. These could manifest as an abnormally shaped lens, dislocated or dislodged lens, or an opacity.
- Acquired Cataract (progressive until entire lens is involved): This is usually senile (age-related).
Causes of Cataract
While there may be no direct and specific explanation as to how and why cataract develops, a few reasons are stated below.
• Degeneration of lens fibres
• Abnormally formed lens fibres
• Deposition of other materials in place of these lens fibres
• Loss of transparency due to disarrangement and disorganization of lens fibres.
• Sometimes fluid may gather under the capsule causing tissue swelling (intumescence) and resultant opacity.
• Trauma can cause the lens capsule to rupture.
• Denaturing of proteins may cause a dense opacity to be formed.
Certain factors could put a person at a higher risk of developing or acquiring cataract
- Increasing Age: Usually at about 40 years of age, changes begin to occur. But research has proven that majority of cataract cases caused by the natural ageing process begin to show at about 60 years of age.
- Uncontrolled Diabetes: Diabetic Cataract may occur in young people in acute cases that disturbs the water balance of the body. Control of the blood sugar may slow progression to mature cataract.
- Deficiency of Amino acids, Vitamin B2.
- Toxic Substances (Insecticides, Cyanate from Cigarette smoking): Smoking and long exposure to insect-killing chemicals have been shown to increase the risk of acquiring cataract.
- Prolonged Drug Use (Miotics, Corticosteroids)
- Radiation (infrared) Heat: Glass factory workers and certain iron industry workers are most affected
- Irradiation (X-rays, Gamma rays, and UV light) sometimes found in atomic energy plant workers
- Mechanical Trauma: this could range from accidents as serious as road traffic accidents to mild incidents such as a slap in the face.
- Electrical Trauma –Electric shock especially high voltage current or lightning strikes.
The most common symptom associated with almost all types of cataracts is blurred vision. Some people describe it as cloudy vision, as though one is looking through smeared glass or most commonly described as “foggy view during the day”. In advanced cases, a visible white opacity may be seen through the pupil.
Difficulty seeing under bright sunlight is also an early complaint. Indoor lights that once didn’t bother you now may seem too bright. Driving at night may become a problem because of the glare caused by street lights and oncoming headlights
One may complain of doubling or tripling of objects due to irregular refraction by different parts of the lens. This is noticed more when viewing objects at far and when the pupil is dilated in dim illumination.
Depending on where the opacity is and how dense it is, vision may be reduced. For opacities at the edges of the lens, vision will be better in bright illumination or in the day. However, if the opacities are central, the patient sees better in dim illumination or at night.
Cataract is known as the primary cause of reversible blindness in the world. Where there is no other underlying eye disease, the outcome of management is generally positive.
Non- Surgical Cataract Treatment
- Cataract symptoms may be improved with new eyeglasses, anti-glare sunglasses, or magnifying lenses.
- Certain tints and coatings also can be added to lenses to reduce symptoms.
- Your eye doctor may recommend that you wear a hat when outdoors in addition to quality sunglasses to help prevent further cataract development.
- Certain eye medications commonly termed “cataract-dissolving” eye drops exist. While there are a few people who claim these drops actually improved their cataracts, no scientific research has confirmed their effectiveness.
Surgical Cataract Treatment
If non-surgical measures do not help, surgery is the only effective treatment. It is considered when a cataract progresses and decreases vision to a point that it interferes with lifestyle and daily activities.
Things to note:
Certain habits may help slow down cataract development.
- Shade your eyes from the sun
- Quit Smoking
- Reduce Alcohol intake
- Eat healthy for your eyes
- Manage other health problems like Diabetes and Hypertension
- Visit your eye doctor regularly
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Well done, Dr Uduak.