Cataracts are changes in clarity of the natural lens inside the eye that gradually degrade visual quality. The natural lens sits behind the colored part of the eye (iris) in the area of the pupil, and cannot be directly seen with the naked eye unless it becomes extremely cloudy. The lens plays a crucial role in focusing unimpeded light on the retina at the back of the eye. The retina transforms light to a neurologic signal that the brain interprets as vision. Significant cataracts block and distort light passing through the lens, causing visual symptoms and complaints.
The term cataract is derived from the Greek word cataractos, which describes rapidly running water. When water is turbulent, it is transformed from a clear medium to white and cloudy. Keen Greek observers noticed similar-appearing changes in the eye and attributed visual loss from "cataracts" as an accumulation of this turbulent fluid, having no knowledge of the anatomy of the eye or the status or importance of the lens.
Cataract development is usually a very gradual process of normal aging but can occasionally occur rapidly. Many people are in fact unaware that they have cataracts because the changes in their vision have been so gradual. Cataracts commonly affect both eyes, but it is not uncommon for cataracts in one eye to advance more rapidly. Cataracts are very common, affecting roughly 60% of people over the age of 60, and over 1.5 million cataract surgeries are performed in the United States each year.
Experts have estimated that visual disability associated with cataracts accounts for over 8 million physician office visits a year in the United States. This number will likely continue to increase as the proportion of people over the age of 60 rises. When people develop cataracts, they begin to have difficulty doing activities they need to do for daily living or for enjoyment. Some of the most common complaints include difficulty driving at night, reading, participating in sports such as golfing, or traveling to unfamiliar areas; these are all activities for which clear vision is essential.
The lens is made mostly of water and protein. Specific proteins within the lens are responsible for maintaining its clarity. Over many years, the structures of these lens proteins are altered, ultimately leading to a gradual clouding of the lens. Rarely, cataracts can present at birth or in early childhood as a result of hereditary enzyme defects, and severe trauma to the eye, eye surgery, or intraocular inflammation can also cause cataracts to occur earlier in life.
Other factors that may lead to development of cataracts at an earlier age include excessive ultraviolet-light exposure, diabetes, smoking, or the use of certain medications, such as oral, topical, or inhaled steroids. Other medications that are more weakly associated with cataracts include the long-term use of statins and phenothiazines.
Having cataracts is often compared to looking through a foggy windshield of a car or through the dirty lens of a camera. Cataracts may cause a variety of complaints and visual changes, including blurred vision, difficulty with glare (often with bright sun or automobile headlights while driving at night), dulled color vision, increased nearsightedness accompanied by frequent changes in eyeglass prescription, and occasionally double vision in one eye.
Some people notice a phenomenon called "second sight" in which one's reading vision improves as a result of their increased nearsightedness from swelling of the cataract. A change in glasses may help initially once vision begins to change from cataracts; however, as cataracts continue to progress and opacify, vision becomes cloudy and stronger glasses or contact lenses will no longer improve sight.
Cataracts are usually gradual and usually not painful or associated with any eye redness or other symptoms unless they become extremely advanced. Rapid and/or painful changes in vision are suspicious for other eye diseases and should be evaluated by an eye-care professional.
Types of Cataracts
All cataracts are fundamentally a change in the clarity of the overall lens structure; however, cataracts may result either early in life or as a result of aging, and different portions of the lens may be more affected than others. Cataracts that occur at birth or present very early in life (during the first year of life) are termed congenital or infantile cataracts. These cataracts require prompt surgical correction or they may prevent the vision in the affected eye from developing normally. When the central portion of the lens is most affected, which is the most common situation, these are termed nuclear cataracts.
The outside of the lens is called the lens cortex, and when opacities are most visible in this region, the cataracts are called cortical cataracts. There is an even more specific change that occasionally happens, when the opacity develops immediately next to the lens capsule, either by the anterior, or more commonly the posterior, portion of the capsule; these are called subcapsular cataracts. Unlike most cataracts, posterior subcapsular cataracts can develop rather quickly and affect vision more suddenly than either nuclear or cortical cataracts.
Treatment for Cataract:
Phacoemulsification: This is the most common form of cataract removal as explained above. In this most modern method, cataract surgery can usually be performed in less than 30 minutes and usually requires only minimal sedation and numbing drops, no stitches to close the wound, and no eye patch after surgery.
Extracapsular cataract surgery: This procedure is used mainly for very advanced cataracts where the lens is too dense to dissolve into fragments (phacoemulsify) or in facilities that do not have phacoemulsification technology. This technique requires a larger incision so that the cataract can be removed in one piece without being fragmented inside the eye. An artificial lens is placed in the same capsular bag as with the phacoemulsification technique. This surgical technique requires a various number of sutures to close the larger wound, and visual recovery is often slower. Extracapsular cataract extraction usually requires an injection of numbing medication around the eye and an eye patch after surgery.
Intracapsular cataract surgery: This surgical technique requires an even larger wound than extracapsular surgery, and the surgeon removes the entire lens and the surrounding capsule together. This technique requires the intraocular lens to be placed in a different location, in front of the iris. This method is rarely used today but can be still be useful in cases of significant trauma.
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