Cataract

Symptoms Of Cataract

The symptoms of cataract include:

• Blurred vision
• Cloudy, foggy, or filmy vision
• Double vision or ghosted image out of the eye with cataract
• Need for brighter light to read
• Glare (Seeing a halo around lights), especially when you drive at night with oncoming headlights).
• Poor night vision (difficulty seeing at night)
• Colors don't look as bright as they used to

Causes Of Cataract

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

Crystallins are the main proteins that make the lens and the lens surfaces. They are responsible for the lens's refractive function. These proteins are arranged in a particular fashion that keeps the lens clear and allows light to pass through it. This helps the lens to focus a clear image onto the back of the eye or retinal surface.

Changes in the arrangement and alterations in the character of the lens proteins result first in increasing rigidity of the lens and eventually causing cataract.

Types of Cataract

Age-related cataract

It is the most common form of cataract. It usually develops in individuals > 50 years of age. Ageing can cause natural changes in the lens of your eye. 

Secondary cataract

These cataracts are associated with diseases like diabetes or an eye problem (like glaucoma (increased pressure in the eye), eye infection, etc.). In some cases, medications such as steroids can cause this cataract.

Childhood cataract

Although cataracts are rare in children, your child may be at greater risk if you have a family history of childhood cataracts. It can affect one or both eyes (bilateral). In some cases, these cataracts are small and don't cause any trouble with vision. 

Risk Factors For Cataract

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

Age

Age-related (or senile) cataract is defined as a cataract occurring in people >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, probably due to a lack of estrogen (reproductive hormone) in post menopausal years.

Racial or ethnic groups

In comparison to Europeans, white people and persons with Asian ancestry have higher prevalence rates. 

Genetics

Genes play an important role in the development of cataract. If your parents had cataract then there is a chance that you might also get cataract.

Traumatic injury

Damage to your lens because of serious injury to the eye can lead to cataract. This cataract can form quickly after the injury or take many years.

Certain Medications

Studies suggest that long term use of  corticosteroids can lead to cataracts.

Smoking

The ill effects of smoking on the lungs are known to all. It is a known major risk factor for cataract as well.

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, like ultraviolet (UV) rays from the sun and radiation therapy for cancer, may predispose to cataract. 

Systemic diseases

Disorders that increase the risk of the development of cataract include:

Diabetes: Poor control of diabetes mellitus (DM) is linked to several eye complications, including cataracts.

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Hypocalcemia: Decreased amount of calcium in the blood can cause eye changes, leading to cataracts.

Hypothyroidism: It 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 cataract. The risk also increases with serious episodes of diarrhea.

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Diet lacking proper nutrition

Malnutrition and a diet deficient in antioxidants and vitamins increase the risk of the development of cataract.

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Maternal and fetal factors

Malnutrition and infections like rubella, toxoplasmosis, etc. have been associated with cataracts during pregnancy or early infancy. 

Other factors

Some of the lesser-known factors include:

• Certain skin disorders and allergies
• Oxidative stress (imbalance in antioxidants in your body)
• High cholesterol levels
• Errors in copper metabolism
• Hormone replacement therapy
• Drug abuse
• Ingestions of toxins

Diagnosis Of Cataract

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

1. History taking

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

• Your chief complaint, i.e. a decrease in vision, any family history of cataract a

• 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 a faulty vision caused by cataract can lead to a squint. 

• Slit-lamp test: This exam is used to detect issues such as cataracts, eye injuries, and a lens clouding.

3. Other eye investigations

• Visual acuity test: The test measures how well your distant vision is.

• Pupil dilation test: This test is done to purposefully 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: It is based on the fact that vision in different light settings may be altered in cataracts.

• Color vision testing: This helps detect acquired color vision defects.

• Potential acuity testing: This gives an idea of vision after cataract removal.

• Spectacular photographic microscopy: This is done before cataract surgery to see the health of the endothelium.

Prevention Of Cataract

There is no prevention for cataract. However, a few tips that can help to lower the risk of developing cataract and slow down its progression are as follows:

Eat a healthy, well balanced diet

The diet should include the following- 

• Vitamins C: Good sources of vitamin C include citrus fruits, lemon, tomatoes, kiwifruit, broccoli, potatoes, strawberries, kale, bell peppers, guava, etc.
  
  

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• Beta-carotene- Beta-carotene is a rich source of vitamin A, which is indispensable for eye health. Good sources include carrots, sweet potatoes, and apricots.

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• Vitamin E: It protects the eyes from harmful chemicals. Food items rich in vitamin E include tree nuts, peanuts, sunflower seeds, vegetable oils, green leafy vegetables, etc.

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• Antioxidants: They are best recognised for shielding your eyes from UV rays and dangerous blue light. Foods high in antioxidants good for the eye include sweet corn, red grapes, spinach.

• Omega-3 fatty acids: These are key for maintaining healthy eyes. They also slow the progress of cataracts. Fatty fish, fish oils, flax seeds, chia seeds, flaxseed oil, and walnuts are bountiful sources of omega-3 fatty acids. Supplements can also be consumed to meet your daily requirement of omega 3s.

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• Carbohydrates: It is advised to have a low-carb diet. Because a high-carbohydrate diet may hasten cataract progression.
  
  

Quit smoking

Smoking is known to increase your risk of developing cataracts. The sooner you get rid of this habit, the more your body will thank you.

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Wear sunglasses

Prolonged exposure to the sun's harmful UV rays can damage the proteins in the lens of your eye.  Wearing sunglasses not only accentuates your fashion game but also 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 level under control

Cataracts are more prone to occur in diabetics, especially if blood sugar levels are uncontrolled.

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Use steroid medications only under medical supervision

Prolonged use of prednisone and other steroid medications prescribed for many medical conditions can increase the chance of developing cataracts. 

Read about dos and don'ts to follow if you are on steroids.

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Get regular eye checkups

To preserve eye health, it is better to go for frequent eye exams. An ophthalmologist can see any changes in your eyesight or ocular health even before any noticeable signs or symptoms occur.

Specialist To Visit

For proper diagnosis and treatment of cataract, you can visit the following specialists:

• Ophthalmologist

• Optometrist

An ophthalmologist is a specialist in the branch of medicine concerned with studying and treating disorders and diseases of the eye. Optometrists are trained to examine and detect defects of eyes.

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When to see a doctor?

It is of important to visit your doctor at the earliest in case you experience the following:

• Blurry vision

• Seeing double or a ghosted images 

• Extra sensitivity to light 

• Having trouble seeing properly at night 

• Needing more light to read

• Seeing bright colors as faded or yellow.

If you notice any such symptoms, seek medical advice immediately, and consult our trusted team of doctors.

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Treatment Of Cataract

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

Prescription glasses

Prescription glasses along with sun shades to reduce the sensitivity to light, and magnifying lenses can help the vision to some extent.  

While prescription glasses cannot directly treat cataracts, they can aid in correcting blurry vision and other problems caused by cataracts.

Surgery

Surgery is almost always required if visual acuity is less or if there is a medical reason like glaucoma or retinal detachment that negatively affects the eye's health.

Cataract surgery is a permanent solution that successfully enables the patient to see again normally. It involves the removal of the affected lens, which is replaced with an artificial lens.

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

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Complications Of Cataract

Cataract cause multiple complications discussed as follows:

Disease-related complications

• Corneal ulceration: It is an open sore on your cornea (the transparent part of the eye that allows light to enter the inside)

• Corneal perforations: It is a potentially devastating complication that can lead to corneal melting

• Iritis: It is swelling and irritation in the colored ring around your 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 in which there is 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: It refers to eye inflammation of the uvea, which is the middle layer of the eye wall, between the retina and the sclera (white of the eye).

• Posterior capsular thickening: It occurs when a cloudy layer of scar tissue forms behind the lens implant. It is common within the first 6 months after surgery.

• Aphakia: It means not having a lens inside your eye. Absence of lens can make the eye out of focus, and vision blurry. It can be caused by surgery for cataracts. 

• Glaucoma: Cataract surgery can increase the eye's pressure. This can damage the eye's optic nerve, leading to glaucoma. 

• Retinal detachment: Retinal detachment is a condition that develops when the retina, a light-sensitive tissue in the back of the eye, is yanked away from its normal location.

• Hyphema: It is the accumulation of red blood cells (RBC) in the anterior chamber of the eye.

• Corneal burn: Also known as eye burn, it can result when certain chemicals used during the procedure come into contact with your eyes.

• Opacification: Often referred to as "secondary cataract," it is the most common postoperative complication of cataract.

Alternative Therapies For Cataract

Non-surgical cataract treatment options can successfully minimise the impact of cataracts and slow their progression. However, they cannot make cataracts go away. 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 and, thus, preventing the protein clumping resulting in clouding.

6 homeopathy facts you must Know

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Living With Cataract

Cataracts tend to develop gradually as you age and aren’t usually painful. They won't usually cause vision loss initially, but you'll probably start to notice clouding in your sight, which can be concerning. 

Regular eye tests are the best way to detect any eye health problem, 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 reasonably small lifestyle changes you can make to help you manage cataracts, such as:  

• Stronger prescription eyeglasses.

• Use brighter lights at home and work.

• Wear anti-glare sunglasses.

• Use magnifying lenses for reading and other activities that require up-close vision.

• 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 harder. So it would be best if you were more careful when driving.

Cataract surgery successfully restores vision in most people. Corrected vision will positively impact life's social and emotional spheres. 

Home-care For Cataract

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, anti-inflammatory eye drops or other medications precisely as advised by ophthalmologists.

• 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 the ophthalmologist.

• Follow up with your doctor as scheduled on day 1, week 1, and week 3