C A T A R A C T

People with cataracts often have other eye conditions as well. This is because many eye conditions affect older people. For example, many people with macular degeneration, glaucoma or diabetic eye problems also develop cataracts. Removing cataracts when you have other eye conditions is possible, but there may be other things to consider.

EPIDEMIOLOGY OF AGE-RELATED CATARACTAge-related cataract (senile cataract)This is by far the most common type and affects older people. It becomes more common with increasing age. Men and women are equally affected. Often both eyes are affected, but one eye may be worse than the other.

Typically, an age-related cataract forms gradually over many years. Many people with an early cataract do not realise they have it. This is because the cloudiness caused by an early cataract is not too bad and the vision is only mildly affected. In some people, the cataract does not become too severe. However, in many cases, vision becomes gradually worse over the years.

Blindness From CataractCataracts are the leading cause of blindness worldwide, accounting for visual loss in about half of the world's estimated 23 million persons with best corrected acuities of 3/60 or worse.

Cataract PrevalenceData from the Framingham Eye Study (FES) indicated that age-related lens changes, ranging from mild early changes (vacuoles, water clefts, spokes and lamellar separations) to later changes (cortical cuneiform opacities, nuclear sclerosis, posterior subcapsular opacities, aphakia), were present in 42 percent of persons aged 52-64.5 The prevalence of these changes increased to 91percent for persons aged 75-85.EPIDEMIOLOGY OF AGE-RELATED MACULAR DEGENERATIONAMD is a leading cause of visual loss in the United States, England, and probably many other industrialized countries. The clinical manifestations of this disease include drusen, atrophy of the retinal pigment epithelium, serous detachment of the retinal pigment epithelium, subretinal neovascularization, and disciform scars. Standardized techniques for defining the manifestations of AMD are necessary for epidemiologic study of this disease. Such standardization is facilitated by the use of fundus photographs.

The Framingham Eye Study provides the best prevalence data on AMD. The rapid increase in prevalence of this disease after the fifth decade of life is demonstrated in this study and is consistent with other studies. In fact, increasing age has the strongest association with AMD of any of the risk factors considered to date. Many other possible risk factors have been identified, but further investigation is necessary to verify these associations.

Congenital cataracts (present at birth)

These are uncommon but important to diagnose early. This is because vision and seeing have to be learnt very early in infancy. A cataract that is present at birth stops the eye from learning to see and can cause blindness which may persist even if the cataract is removed later in life. A congenital cataract must be removed as early as possible after birth. This is why doctors examine the eyes of babies as part of routine baby checks.

CRITIQUE

Activities

After surgery, you can usually go back to your everyday activities as soon as you feel able. Apart from taking eye drops, you can usually carry on as normal but you may need to avoid the following for the first week to ten days:

rubbing your eye. You may have to wear an eye shield (patch) when you are sleeping to avoid rubbing your eye

swimming (until your ophthalmologist says you can) to avoid contact with dirty water while your eye is healing

strenuous exercise, contact sports and heavy lifting. Everyday lifting like light shopping is usually fine, but heavy lifting like moving furniture is best avoided

wearing eye makeup until the hospital are happy with your recovery

You also need to take extra care:

when it is windy or dusty outdoors, in case something blows in your eye, but you don't need to stay indoors

washing your hair - avoid soapy water in your eye.

Complications

Cataract surgery is generally very successful. Only about three per cent of people who have cataracts experience complications. The most common complications can be dealt with and usually don't affect sight in the long term.

One of the most cmmon complications is a thickening of the lens capsule which holds the lens in place. This may occur a couple of months or even years after the original operation. If this happens, your sight will become cloudy again, as though the cataract has come back. Doctors call this complication posterior capsule opacification or posterior capsule thickening and it is usually easily dealt with by a small laser operation done through an outpatient appointment. There is information available on posterior capsule opacification if you contact our Helpline on 0303 123 9999.

More serious complications are much rarer and include:

retinal detachment

problems with the lens implant, the wrong lens implant or problems with its position

a break in the lens capsule

infectionThese complications are much rarer and treatments are available which will minimise their effects on your vision. Before being offered a cataract operation the ophthalmologist will talk you through the potential risks specific to your situation.

Post-operative complications Eyes are very delicate and complex organs and problems can occur after surgery has taken place. We have listed below a number of problems that can occur, but your babys ophthalmic doctor will discuss then in greater detail if they do occur. In order to pick up any post operative problems your babys eyes will be regularly checked.

Glaucoma (raised pressure within the eye). Fluid in the eye is unable to drain away causing a build up of pressure. This increased pressure can eventually cause some degree of visual loss. It is seen in up to 25% of children undergoing congenital cataract surgery. Often it can be controlled with medicine and eye drops but may, in some infants, require further surgery.

Amblyopia (Lazy eye). This can occur if the vision in one eye is stronger than in the other. The brain learns to ignore the vision it receives from the weak eye, causing varying degrees of visual loss in that eye. Occlusion therapy (patching) will be started this involves your child wearing a patch over the strong eye to try and improve the weak one.

Strabismus (Squint). A squint may develop as a result of a lazy eye. Treatment of the squint will depend upon its severity and further surgery may be required.

Pupil abnormalities. Sometimes the pupil may become oval or off centre after surgery this is quite common and will not affect your babys vision.

Endophthalmitis. This is an extremely rare bacterial infection which can have devastating consequences for the operated eye. Most cases are diagnoses and treated in the immediate post-operative period.

Cataract

From Wikipedia Last modified on 25 January 2012, at 19:43From Wikipedia

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For other uses, see Cataract (disambiguation).

Cataract

Classification and external resources

Magnified view of cataract in human eye, seen on examination with a slit lamp using diffuse illumination

ICD-10 H25-H26, H28, Q12.0

ICD-9 366

DiseasesDB 2179

MedlinePlus 001001

eMedicine article/1210914

Sperduto RD, Seigel D: Senile lens and senile macular changes in a populationbased

sample. Am J Ophthalmol 90:86-91, 1980.Leske MC, Sperduto RD: The epidemiology of senile cataracts: A review. Am J

Epidemiol 118:152, 1983.

Podgor MJ, Leske MC, Ederer F: Incidence estimates for lens changes, macular

changes, open-angle glaucoma and diabetic retinopathy. Am J Epidemiol 118:208-

212, 1983.

Milton RC, Sperduto RD, the Framingham Study Group: Incidence of age-related

cataract: 13.6 year followup in the Framingham Eye Study. Invest Ophthalmol Vis

Sci 32:2817, 1991.