cataract document file

8/13/2019 Cataract Document File

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1 INTRODUCTIONHaving a cataract is like trying to see through a cloud and unfortunately,

most of us will develop this condition as we age.

A cataractis a clouding of thelens inside theeye which leads to a decreasein vision. It is the most common cause of blindness and is conventionally

treated with surgery. Visual loss occurs becauseopacification of the lens

obstructs light from passing and being focused on to theretina at the back of

the eye.

It is most commonly due tobiological aging but there are a wide variety of

other causes. Over time, yellow-brown pigment is deposited within the lens

and this, together with disruption of the normal architecture of the lens fibers,

leads to reduced transmission of light, which in turn leads to visual problems.

Those with cataract commonly experience difficulty appreciating colors and

changes in contrast, driving, reading, recognizing faces, and experience

problems coping with glare from bright lights.

Cataract is the leading cause of blindness, accounting for 50% of blindness

worldwide. Although significant progress has been made toward identifying

risk factors for cataract, there is no proven primary prevention or medical

treatment. Surgical removal of cataract remains the only therapy.

Cataract is opacity of the natural, crystalline lens of the eye and remains the

most frequent cause of blindness in the world today. The World Health
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Organization (WHO) estimates that 50% (17 million) of persons currently blind

worldwide are blind from cataract.

Cataracts typically develop in one eye, but people who have had a

cataract in one eye are more likely to develop one in the other eye at somepoint. Sometimes cataracts develop in both eyes at the same time.

In a normal eye, light enters the eye and passes through the lens. Colors are

vibrant, images are clear, and the eyes are able to adjust to changes in

lighting. When a cataract is present, images are distorted or blocked

altogether, and colors seem dull and more yellow. Most people notice that

their vision becomes blurry when they begin to develop cataracts.

The prevalence of cataracts increases dramatically with age. It typically

occurs in the following way:

The lens is an elliptical structure that sits behind the pupil and is normallytransparent. The function of the lens is to focus light rays into images on

the retina (the light-sensitive tissue at the back of the eye).

In young people, the lens is elastic and changes shape easily, allowingthe eyes to focus clearly on both near and distant objects.

As people reach their mid-40s, biochemical changes occur in theproteins within the lens, causing them to harden and lose elasticity. This

causes a number of vision problems. For example, loss of elasticity


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causes presbyopia, or far-sightedness, requiring reading glasses in

almost everyone as they age.

In some people, the proteins in the lens, notably those called alphacrystallins, may also clump together, forming cloudy (opaque) areas

called cataracts. They usually develop slowly over several years andare related to aging. In some cases, depending on the cause of the

cataracts, loss of vision progresses rapidly.

Depending on how dense they are and where they are located,cataracts can block the passage of light through the lens and interfere

with the formation of images on the retina, causing vision to become

cloudy.

ANATOMY OF HUMAN EYE

Sclerotic Sclerotic is the outer coating of the eye which is white in

colour that protects the interior of the eye and provides

the shape to the eye.

Cornea The front part of sclerotic is transparent to light and istermed as cornea. The light coming from an object

enters the eye through cornea

Iris Iris is just at the back of cornea. This controls the size of

the pupil. It acts like a shutter of a photographic camer

and allows the regulated amount of light to enter the

eye.

Eye Lens Eye lens is a double convex lens with the help of whichimage is formed at retina by refraction of light.


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Ciliary Muscles The eye lens is held by ciliary muscles. Ciliary muscles help

the eye lens to change its focal length.

Pupil At the centre of the iris there is a hole through which lightfalls on the lens, which is called pupil.

Aqueous Humour The space between cornea and eye lens is filled with a

transparent fluid called aqueous humour.

Vitreous Humour The space between eye lens and retina is filled with a

jelly like transparent fluid called vitreous humour.

Retina Retina serves the purpose of a screen in the eye,

wherethe images of the objects are formed. Retina is at

the back of the eye lens. Retins is made of light sensitive

cells, which are connected to the optical nerve.

Optic Nerve Optic nerve carries the information to brain.

Blind Spot The region of eye containing the optic nerve is not at all

sensitive to light and is called blind spot. If the image of

an object is formed in the blind spot, it is not visible.

Yellow Spot The central part of retina lying on the optic axis of eye is

most sensitive to light and is called yellow spot

Eye Lids Eye lids are provided to control the amount of light falling

on the eye. They also protect the eye from dust particles

etc


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2 TYPES OF EYE CATARACTSCataracts may be partial or complete, stationary or progressive, or hard or

soft. The main types of age-related cataracts are nuclear sclerosis, cortical,

and posterior subcapsular.

Nuclear cataractsThese form in the nucleus (the inner core) of the lens. This is the most

common variety of cataract associated with the aging process. Over

time, this becomes hard or 'sclerotic' due to condensation of lens

nucleus and deposition of brown pigment within the lens. In advanced

stages it is called brunescent cataract. This type of cataract can

present with a shift to nearsightedness and causes problems with

distance vision while reading is less affected.

Cortical cataractsThese form in the cortex (the outer section of the lens). They occur

when changes in the water content of the periphery of the lens causes

fissuring. When these cataracts are viewed through

anophthalmoscope or other magnification system, the appearance is

similar to white spokes of a wheel pointing inwards. Symptoms often

include problems with glare and light scatter at night.

Posterior subcapsular cataractsThese form toward the back of a cellophane-like capsule that

surrounds the lens. They are more frequent in people with diabetes,

who are overweight, or those taking steroids. ecause light becomes

more focused toward the back of the lens, they can cause

disproportionate symptoms for their size.

Age-Related cataractsProtein builds up in the lens and causes cloudiness of the lens.

Secondary cataractForms after surgery for other eye disease like glaucoma ordiabetic

retinopathy.

Traumatic cataractForms after eye injury.

Congenital cataractPresent at birth due to birth defects, diseases, or other problems.

Radiation cataract
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Forms after severe radiation exposure.

3 CAUSES OF EYE CATARACTSThe lens of an eye is made up of water and protein. The protein is arranged ina way that keeps the lens clear and allows light to pass through. A cataract

forms when some of the protein clumps together and begins to cloud a

portion of the lens. Over time it grows larger and affects your vision. Although

the exact cause of cataracts remains a mystery, many experts believe it has

to do with the aging process. In the United States, 20 percent of people

between the ages of 65 and 74 develop cataracts severe enough to reduce

their vision, and almost half of all people over 75 have cataracts. Cataracts

seem to be more common when coupled with the following:

AgeNearly everyone who lives long enough will develop cataracts to some

extent. Some people develop cataracts during their middle-aged

years (40s and 50s), but these cataracts tend to be very small. It is after

age 60 that cataracts are most likely to affect vision. Nearly half of

people age 75 and older have cataracts.

GenderWomen face a higher risk than men.

Family HistoryCataracts tend to run in families.

Race And EthnicityAfrican-Americans seem to have nearly twice the risk of developing

cataracts than do Caucasians. This difference may be due to other

medical illnesses, particularly diabetes. African-Americans are much

more likely to become blind from cataracts and glaucoma than

Caucasians, mostly due to lack of treatment. Hispanic Americans are

also at increased risk for cataracts. In fact, cataracts are the leading

cause of visual impairment among Hispanics.

Diabetes And Other Medical Conditions Overexposure To Sunlight

Exposure to even low-level UVB radiation from sunlight increases the risk

for cataracts, especially nuclear cataracts. The risk may be highest

among those who have significant sun exposure at a young age.

People whose jobs expose them to sunlight for prolonged periods are

also at increased risk.

Smoking And Alcohol Use


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Smoking-Smoking a pack a day of cigarettes may double the

risk of developing cataracts. Smokers are at particular risk for

cataracts located in the nuclear portion of the lens, which limit

vision more severely than cataracts in other sites.

Alcohol-Chronic heavy drinkers are at high risk for a number ofeye disorders, including cataracts.

Environmental FactorsLong-term environmental lead exposure may increase the risk of

developing cataracts. Gold and copper accumulation may also

cause cataracts. Prolonged exposure to ionizing radiation (such as x-

rays) can increase cataract risk.

DiseasesThere are also several diseases that can cause cataracts or increase

the risk of developing them. People with certain medical conditions,

notably diabetes, are at high risk for cataracts, either because of a

direct effect of the disease, its treatments, or both.

Diabetes-People with diabetes type 1 or 2 are at very high risk for

cataracts and are much more likely to develop them at a

younger age. They also have a higher risk for nuclear cataracts

than non diabetics. Cataract development is significantly related

to high levels of blood sugar (hyperglycemia), and cataracts in

people with diabetes are sometimes referred to as so-called

sugar cataracts.

Autoimmune Diseases and Conditions Requiring Steroid Use-

Medical conditions requiring high use of corticosteroids

(commonly called steroids) pose a particularly high risk. Many of

these medical conditions are autoimmune diseases, including

rheumatoid arthritis, psoriasis, multiple sclerosis, systemic lupus

erythematosus, Behcet's disease, and others.

Eye Conditions-People who are nearsighted (myopia) are at

increased risk of developing cataracts. Physical injuries to the

eye (such as a hard blow, cut, or puncture) or eye inflammation

can also increase risk. Previous intraocular eye surgery increases

cataract risk.

Obesity-Obesity may be a risk factor for cataracts

Occult tumors-(e.g., choroidal melanoma in adults and

retinoblastoma in children)


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Precipitating/ Modifiable Factors

Smoking Excessive Drinking of Alcohol Unhealthy Diet Sedentary Lifestyle Lack of Exercise Long Term-Ultra Violet Exposure Exposure to Radiation Job/Work Usage of Corticosteroids & Ezetimibe Secondary to other Diseases like Uveitis or

Inflammation of the Inner La er of the E e.

Progressive Oxidative Damage to the Lens

Antioxidants, Vitamins, & Enzymes

H2O Content Destruction &

Breakdown of CHON

Sodium (Na)

Opacity/Clouding of the Lens

Density of Lens

Disrupts the Normal Fibers in the Eyes

Loss of Transparency Vision

Mature] Cataract Schematic Diagram

CATARACT FORMATION

BLINDNESS


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4 DIAGNOSISEither an ophthalmologist or an optometrist can examine patients for

cataracts, but only ophthalmologists are qualified to treat cataracts.

An ophthalmologist is a doctor who specializes in the medical andsurgical care of the eye.

An optometrist practices eye care, but does not perform surgery.DIAGNOSTIC TESTS

The eye professional can observe cloudy areas on the lenses with a direct

physical examination, even before the cataracts begin to interfere with

vision. Cameras can measure the cataract density. Various vision tests arealso performed.

Snellen Eye Chart

To determine how clearly a person can actually see, the Snellen eye chart is

used, with rows of letters decreasing in size. The eye doctor will place drops in

your eyes to dilate your pupils and perform a thorough eye exam. He or she

will study the crystalline lens of your eye and check the optic nerves and

retina for changes that may be contributing to your vision problems. This istypically done with an ophthalmoscope, which is a handheld tool used to

look inside the eye. Using an instrument called a slit lamp, your eye doctor

can identify the location of the cataract and determine its severity. The eye

doctor may also perform a tonometry test in order to measure the pressure

inside your eye. This is one of the diagnostic tools for glaucoma.

From a specified distance, usually 20 feet, a person reads the lettersusing one eye at a time.

If a person can read down to the small letters on the line marked 20feet, then vision is 20/20 (normal vision).

If a person can read only down through the line marked 40 feet, visionis 20/40; that is, from 20 feet the patient can read what someone with

normal vision can read from 40 feet.

If the large letters on the line marked 200 feet cannot be read with thebetter eye, even with glasses, the patient is considered legally blind.


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The visual acuity test can be performed in many different ways. It is a quick

way to detect vision problems and is frequently used in schools or for mass

screening. Driver license bureaus often use a small device that can test the

eyes individually and then together.

Other Tests

A number of other tests are used to diagnose cataracts or to determine if

surgery is needed.

A chart similar to the Snellen chart, which has the same size letters, butin different contrasts with background, is used to test contrast sensitivity.

Glare sensitivity is tested by having the patient read a chart twice, withand without bright lights.

Tests of macular function, which evaluate the eye's acute vision center,can help the ophthalmologist determine the expected improvement

from surgery.

The corneal endothelium, a layer of cells lining the cornea, is sensitiveto surgical trauma and should be evaluated before any intraocular

operation.

Patients with other eye disorders may need other pre-operative tests.


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Although eye tests help confirm a diagnosis of cataracts, results do not

always reflect the quality of life and how effectively people function at

home:

Some people with cataracts perform poorly on the tests yet appear tohave no trouble with daily function. Others perform well on the tests but insist that their eyesight is bad

enough to interfere with ordinary activities, such as driving.


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5 TREATMENTAlthough surgery is the only remedy for cataracts, it is almost never an

emergency. Most cataracts cause no problem other than reducing a

person's ability to see, so there is no harm in delaying surgery.

Early cataracts may be managed with the following measures: Stronger eyeglasses or contact lenses Use of a magnifying glass during reading Strong lighting Medication that dilates the pupil. (This may help some people with

capsular cataracts, although glare can be a problem with this

treatment.)

Progression of Cataracts

Patients and their families usually have plenty of time to carefully consider

options and discuss them with an ophthalmologist. There is no constant rate

at which cataracts progress:

Some cataracts develop to a certain point and then stop. Even if a cataract does progress, it may be years before it interferes

with vision.

Very rarely do people need immediate cataract surgery.CATARACT SURGERYCataract removal is the one of the most common type of eye surgeries

performed in the United States, especially for people over age 65. In the past,

cataract surgery was not performed until the cataract had become well

developed. Newer techniques, however, have made it safer and even more

efficient to operate in earlier stages. Cataract surgery improves vision in up to

95% of patients and prevents millions of Americans from going blind.

Nevertheless, cataract surgery may be performed more often than needed.

In general, even if cataracts are diagnosed, the decision to remove them

should be based on the patient's own perception of vision difficulties and

needs and the effect of vision loss on normal activity. The patient should also

be aware of all the risks and costs of surgery.

Surgery is almost always performed under local anesthesia, and only the

eyes surface is numbed, either by injection or eye drops. If the patient

cannot hold still for the surgeryas young children often cannotgeneralanesthesia may be used, but these situations are rare.


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Cataract surgery usually requires the replacement of the natural lens with an

intraocular lens (IOL). The cloudy natural lens is replaced with a clear IOL,

thereby giving you better vision. Todays ophthalmologists can actually

replace the cloudy lens with a technologically advanced intraocular lens

such as Crystalens or ReSTOR, which will correct not only your distance visionbut your near and arms-length vision as well. These are more similar to your

natural lenses when you were younger, and can give you back the ability to

see things up close that you lost in your 40s, when you became presbyopic.

There are two types of cataract surgery used today. They are called

phacoemulsificationand extracapsularsurgery.

In Phacoemulsification, or Phaco for short, a tiny incision is made into the

cornea and a computer-assisted device emits ultrasound waves to break thelens into tiny pieces. The pieces are then removed and replaced with an IOL.

In extracapsular surgery, a longer incision is made and the cloudy core of the

lens is removed as a whole piece while any leftover parts of the lens are

sucked up. Complications of cataract surgery are unusual, but may include

infection, bleeding, pain, swelling, and sometimes something called an

after-cataract. This is a condition in which tissue surrounding the IOL

becomes cloudy. Fortunately, an eye surgeon can easily eliminate the after

cataract by using a laser, and without any additional surgery. This procedure,

called a YAG Laser Capsulotomy, is extremely effective and relatively quickand simple.

In the vast majority of cases, cataract surgery and lens implantation is

performed in an outpatient setting, meaning that you will be able to have

your cataract removed and a new lens implanted and be able to go home

within a few hours. You can generally expect to be able to resume your

normal work and recreational activities within a few days.

INDICATIONS FOR SURGERY

In general, surgery is indicated for people with cataracts under the following

circumstances:

The Snellen eye test reports 20/40 or worse, with a cataract beingresponsible for vision loss that cannot be corrected by glasses.

Performing everyday activities has become difficult to perform to thepoint that independence is threatened, or the patient is at risk for

accident or injury.


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These guidelines are general, however. Whether surgery is appropriateor not further depends on the cataract patient's specific condition and

needs. Some examples include:

Even if the criteria for surgery are met, a very sick, elderly person in anursing home may have less need for sharp vision than an activeyounger adult. Among very elderly patients (85 years and older),

especially those with serious health problems, there are also higher risks

for complications during surgery and poor outcomes afterward.

Nevertheless, these cautions should not prevent the elderly from having

this procedure; vision improvement rates are still over 85%.

Even if the criteria for surgery are notmet, some people with eye testsof 20/40 or bettermight want surgery because of problems with glare,

double vision, or the need to have an unrestricted driver's license.

Even if the criteria for surgery are notmet, if retinal disease is alsosuspected (usually a complication of diabetes), the doctor may

perform cataract surgery in order to have a clear view of the eye.

Because of the risks, albeit small ones, of poorer vision or blindness, no one

should be forced to have cataract surgery if they don't want it or are not

strong enough to have the procedure. If there are any doubts about whether

or not to have cataract surgery, consider a second opinion.

Treatment Decisions for Cataracts in the Second Eye.

If a person has a cataract in a second eye, the issues for decision making are

the same as for the first eye. The timing of the procedure in the case of two

cataracts is unclear. Doctors have long recommended postponing surgery

on the second eye until the first eye has healed and the results are known.

However, many patients have trouble reading and performing ordinary tasks

while waiting for a second surgery. Patients with double cataracts should

discuss all options with their surgeon.

PREPARATION FOR SURGERY

Cataract surgery is usually done as an outpatient procedure under local

anesthesia and takes less than an hour. Preoperative preparations may

include:

Having a general physical examination is important for patients withmedical problems such as diabetes. Diabetes can cause damage to

the blood vessels of the eyes retina, a condition called diabeticretinopathy. Recent research suggests that patients who have diabetic


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retinopathy and poor blood sugar control should not have their blood

sugar rapidly corrected before cataract surgery. Correcting blood

sugar too quickly before surgery may cause vision problems after

surgery.

The ophthalmologist will use a painless ultrasound test to measure thelength of the eye and determine the type of replacement lens that will

be needed after the operation.

Topical antibiotics (such as ofloxacin or ciprofloxacin) may be appliedpreoperatively to protect against postoperative infection.

Most healthy patients receive either a local injection or topicalanesthetic. They may also receive a sedative. Some patients may

need general anesthesia.

SURGICAL PROCEDURES

All cataract procedures involve removal of the cataract-affected lens and

replacing it with an artificial lens.

Phacoemulsification. Phacoemulsification (phaco means lens; emulsification

means to liquefy) is the most common cataract procedure performed in the

United States.

The procedure generally involves:

The surgeon makes a small incision. A thin probe that transmits ultrasound is then used to break up the

clouded lens into small fragments. The tiny pieces are sucked out with a vacuum-like device.


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A replacement lens is then inserted into the capsular bag where thenatural lens used to be. In most cases, this is an intraocular lens (IOL),

which is foldable and slips in through the tiny incision.

Because the incision is so small, it is often watertight and does notrequire a suture afterward, particularly if a foldable lens has been used.A suture may be needed if a tear or break occurs during the

procedure or the surgeon inserts a rigid lens that requires a wider

incision.

REPLACEMENT LENSES AND GLASSES

With the clouded lens removed, the eye cannot focus a sharp image on the

retina. A replacement lens or eyeglasses are therefore needed:

Intraocular Lenses (IOLs)

In about 90% of cataract operations, an artificial lens, known as an

intraocular lens (IOLs), is inserted. Most IOLs are made out of acrylic, although

other materials, such as silicon, are also used.

IOLs are designed to improve specific aspects of vision. The choices include:

Lenses that address a single fixed focal point. Such lenses are suitableeither for reading or distance vision, but not both. If a distance lens is

implanted, the surgeon prescribes glasses or contact lenses for reading.

If a reading lens is implanted, lenses for seeing distances will be

prescribed.

Lenses that address multifocal points. Multifocal lenses can focus atdifferent points for both reading and distance vision. However, contrast

may be reduced, and some patients experience glare and halos,

particularly at night.


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Lenses are available that will correct astigmatism after cataractsurgery.

The patients and the doctor must make these decisions based on specific

visual needs. Many patients also need eyeglasses after cataract surgery forreading or to correct astigmatism.

COMPLICATIONS OF CATARACT SURGERY

Modern cataract surgery is one of the safest of all surgical procedures. Most

complications, even if they occur, are not serious. They can include:

Swelling and inflammationRisk is about 1%. This complication is particularly harmful for patients

with existing uveitis (chronic inflammation in the eye, which can be due

to various medical conditions).

GlarePatients may experience glare after surgery from light scattering at the

edges of the new lens, particularly with square-edged IOLs, which are

typically used with posterior capsular cataracts. In most cases, this is a

temporary problem that resolves after a few weeks. Sometimes, the

problem lasts, and the patient needs another operation.

Materials used in some lenses trigger an immune response in somepatients. This causes inflammation and tiny deposits of tissue in the eye

that lead to secondary cataracts -- called posterior capsule

opacification.

Retinal detachmentIn rare cases, the retina at the rear of the eye can become detached.

Risk is very low (0.1%), and phacoemulsification poses less of a risk for

this than older standard surgery.

Atonia (loss of muscle tone that results in a disturbing glare).(Phacoemulsification poses less of a risk than standard surgery.)

GlaucomaThis is an eye condition in which the pressure of fluids inside the eye rises

dangerously. Risk is very low, but patients should be sure to avoid

activities after surgery that increase pressure.

InfectionThis is very rare (0.2%) but may be significant if it does develop.

Blisters on the corneaThere is a higher risk of rupture with phacoemulsification, but the risk is

extremely low, particularly for experienced eye surgeons.


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Bleeding can develop inside the eye. Risk is about 1% for minorbleeding and 1 in 10,000 for severe bleeding.

An implanted IOL can become damaged or dislocated. Risk is verylow.

The surgery itself can produce vision loss or impairment. The risk for this is1 in 1,000. (Phacoemulsification poses less of a risk than standard

surgery.)

Phacoemulsification does have some specific complications, although they

are rare, particularly with experienced eye surgeons. They include:

Rupture of the lens capsule. Loss of the lens nucleus into the eye fluid. (This will require removal by a

specialist and may result in poorer vision.)

Flying fragments of the lens can damage the cornea or threaten theretina.

Pre- and postoperative changes in blood pressure, which are generallynot a problem, should be observed carefully, since in some cases the

changes may be extreme.

In about 30% of cases patients develop secondary cataracts within 1 - 5

years after either procedure. Therefore, these patients need different

treatment choices.

Preventing Infection and Reducing Swelling

The ophthalmologist may prescribe the following medications after surgery:

A topical antibiotic may protect against infection.


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Corticosteroid eyedrops or ointments are often used to reduceswelling, but they can pose a risk for increased pressure in the eye.

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as diclofenac,ketorolac, naproxen, and voltaren, also reduce swelling and do not

have the same risks as steroids. Newer NSAIDS approved to treat painand swelling after cataract surgery include bromfenac (Xibrom) and

nepafenac (Nevanac).

Factors that Increase Risk for Complications

The risks of complications are greater for the following people:

Patients who have other eye diseases.

People with diabetes. Intracapsular and extracapsular cataractextraction can pose a high risk for the development or worsening of

retinopathy, a known eye complication of diabetes. The amount of

experience a surgeon has plays a role in whether or not a patient has

this complication.

People who have taken tamsulosin (Flomax) or other alpha-1 blockerdrugs. Tamsulosin is a muscle relaxant prescribed for treatment of

several urinary conditions, including benign prostatic hyperplasia (BPH).

Tamsulosin may cause intraoperative floppy iris syndrome (IFIS), a loss of

muscle tone in the iris that can cause complications during eye surgery.Problems have been reported both for patients who were taking the

drug during surgery as well as those who had stopped taking the drug

weeks or months before surgery. Men who have taken tamsulosin or

similar drugs should inform their eye surgeon. The surgeon may need to

use different techniques to minimize the risk of IFIS and other

complications.

POSTOPERATIVE CARE

Returning Home and Follow-up Visits

Patients usually leave the surgical site within an hour of surgery.Cataract surgery almost never requires an overnight hospital stay.

Patients need someone to drive them home and stay with them for afew days until their vision acclimates.

The patient is usually examined the day after surgery and then duringthe following month. Additional visits occur as necessary.

Vision usually remains blurred for a while but gradually clears, usuallyover 2 - 6 weeks. (It can take longer.)


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When the doctor decides the condition has stabilized, the patient willreceive a final prescription for glasses or contacts.

Protecting the Eye

Postoperative protection of the eye typically involves:

The ophthalmologist usually tapes a bandage over the eye to protectit during the healing process.

When changing the bandage, the eye can be cleaned gently using awashcloth dipped in warm water without soap. A new bandage can

then be positioned and taped.

It is very important not to press or rub the eye during this procedure.

An eye shield may be placed over the bandage at night.

Avoiding Glaucoma

Cataract surgery can cause glaucoma, a condition in which the pressure of

fluids inside the eye rises dangerously. It is very important to minimize any

activity that increases internal eye pressure. Postoperative cataract patients

take the following precautions:

Minimize vigorous exercise. Put on shoes while sitting and without lifting up the feet. Kneel instead of bending over to pick something up. Avoid lifting. Limit reading since it requires eye movement (watching television is all

right).

Sleep on the back or on the unoperated side.TREATMENT FOR PATIENTS WITH ACCOMPANYING EYE CONDITIONS

Cataracts and Glaucoma

For patients with both glaucoma and cataracts, doctors recommend:

In patients with cataracts and poorly controlled glaucoma, a two-stepprocedure for both eye conditions may be used. The patient first

receives a trabeculectomy for glaucoma, followed by cataract

surgery. Fluid leakage and the presence of blood in the back chamber

of the eye are potential complications of this combined procedure.

Phacoemulsification has improved success rates and reduced high


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complication rates of the double procedure compared with

extracapsular cataract extraction. New advances that replace

trabeculectomy with nonpenetrating glaucoma surgery may prove to

be beneficial.

In patients who have cataracts plus either closed-angle glaucoma oropen angle glaucoma that is stabilized with medication, the cataract

may be extracted and medication continued for the glaucoma.

Cataracts and Corneal Disease

Patients with both cataracts and corneal disease may have one of the

following procedures:

Combination Procedure. A single operation that combines threeprocedures, extracapsular cataract extraction and intraocular lens

insertion with corneal transplantation (called penetrating keratoplasty).

Sequential Procedure. An operation that uses two proceduressequentially. The sequential option performs the cataract procedures

and the corneal transplantation separately.

SECONDARY CATARACTS (POSTERIOR CAPSULAR OPACIFICATION)

AND THEIR TREATMENTS

Although less common than with phacoemulsification, about 30% of patients

who have extracapsular cataract surgery develop a secondary "after-

cataract" called posterior capsular opacification. Posterior capsular

opacification generally occurs because of the following events:

After surgery, there are still some natural lens cells left behind thatproliferate on the back of the capsule.

The capsule gradually becomes cloudy and interferes with clear visionthe same way the original cataract did.

Secondary cataracts are more likely to occur in younger patients, in those

with diabetes, or when cataract surgery is combined with vitrectomy

(clearance of debris from the fluid in the eye).

Treatment for Posterior Capsular Opacification

Researchers are investigating methods that may help prevent posterior

capsular opacification. The standard treatment is laser surgery known as

a YAG capsulotomy. (Capsulotomy means cutting into the capsule, and YAG


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is an abbreviation of yttrium aluminum garnet, the laser most often used for

this procedure.)

This is an outpatient procedure and involves no incision. Using the laser beam, the ophthalmologist makes an opening in theclouded capsule to let light through. After the procedure the patient should remain in the doctor's office for

an hour to be sure that pressure in the eye is not elevated.

An eye examination for any complications should follow within 2 weeks.Complications

Laser surgery has become so commonplace that some ophthalmologists use

it after cataract surgery to prevent later clouding. However, laser surgery hasits own risks and possible complications, similar to those of cataract surgery

itself, and can also lead to poorer vision or blindness. About 1% of laser

surgery patients develop a detached retina, a risk that is much higher than

the original cataract surgery.

In some people, particularly those with glaucoma or who are severely

nearsighted, the pressure in the eye may spike after laser surgery. Certain

drugs used for treating glaucoma, such as dorzolamide (Trusopt) or

apraclonidine (Iopidine), may help prevent this occurrence. It is stronglyrecommended, however, that this surgery be performed only if the lens

capsule clouds up again, notto prevent a secondary cataract.

TREATING CATARACTS IN CHILDREN

Infants

Treatment of infants first depends on whether one or both eyes are affected:

For infants born with cataracts in one eye, the American Academy ofOphthalmology recommends surgery as soon as possible, by 4 months

or ideally even earlier. The procedure is followed by contact lens

correction and patching of the unaffected eye. Although this

approach is successful in many cases, some children still become blind

in the affected eye. There is also a high risk for glaucoma after surgery.

In infants with cataracts in both eyes, surgery is not always an option.Sometimes surgery may be performed sequentially, with the second

eye operated on a few days after the first. Phacoemulsification


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appears to pose a much higher risk for secondary cataracts than

standard lens removal.

Toddlers and Older Children

Intraocular lens replacement is now standard treatment for children 2 years

and older.

TALKING TO YOUR EYE DOCTOR

Here are some questions to ask your eye doctor about cataracts:

If I notice subtle changes in my vision, how long should I wait tocontact you?

How often do you treat people with cataracts? What has caused my cataract to develop? What can I do to prevent cataracts from developing in my other eye? What foods should my family eat to prevent cataracts? Who will perform my cataract surgery? If you refer me to a surgeon, how closely will you work with him or her

before, during, and after surgery?

What treatments should I expect if I begin to feel pressure building up?


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6 PREVENTIONAlthough cataracts are not completely preventable, their occurrence can

be delayed. Quitting smoking, avoiding overexposure to sunlight, avoiding

excess amounts of alcohol are important protective measures, and eating

plenty of fresh fruits and vegetables may delay the formation of cataracts.

No existing evidence suggests that using eye drops or ointments or

performing eye exercises will stem the onset of cataracts.

Avoiding Ultraviolet Radiation

The simplest and most effective way to protect against ultraviolet (UV)

radiation is to stay out of the sun. Wear a hat and cover-up outside,

particularly when the sun is most intense (10 a.m. - 3 p.m.). A wide-brimmed

hat can significantly reduce eye exposure to UVB radiation. Because the sun's

rays are highly reflective, sitting in the shade or under an umbrella by itself

does not guarantee protection.

Clothing that blocks or screens the harmful rays of the sun (UVA and UVB), in

combination with wide-brimmed hats, sunglasses, and sunscreen, all help


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prevent damage to the eyes and skin. Any one of these by itself, even the

sunscreen, may not be enough to prevent sun damage.

Note:Avoidance of the sun should not be taken to extremes. Some sunshine

is desirable. Moderate sun exposure provides an important source of vitaminD, which is essential for healthy bones and other health factors.

Sunglasses.Protective sunglasses do not have to be expensive. But it is

important to select sunglasses whose product labels state they block at least

99 percent of UVB rays and 95 percent of UVA rays.

Polarized and mirror-coated lenses do not offer any protection against UV

radiation. It is not clear if blue light-blocking lenses, which are usually amber

in color, provide UV protection.

Diet And Nutrition

It is not clear whether nutrition plays a significant role in cataract

development. Dark colored (green, red, purple, and yellow) fruits and

vegetables usually have high levels of important plant chemicals

(phytochemicals) and may be associated with a lower risk for cataracts.

In analyzing nutrients, researchers have focused on antioxidants and

carotenids. Studies have not demonstrated that antioxidant vitamin

supplements (such as vitamins C and E) help prevent cataracts. Still, fruits and

vegetables containing these vitamins are important for overall good health.

Lutein and zeaxanthin are the two carotenids that have been most studied

for cataract prevention. They are xanthophylis compounds, which are a

particular type of carotenid. Lutein and zeaxanthin are found in the lenses of

the eyes. Some evidence indicates that xanthophyll-rich foods (such as dark

green leafy vegetables) may help retard the aging process in the eye and

protect against cataracts. However, there is not enough evidence to suggest

that taking supplements with these carotenoids lowers the risk of cataract

formation.


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7 PATIENT HISTORYIn this Project the study is done on patient who has undergone Cataract

Surgery 3 months before.

BIOGRAPHIC DATA

Name: Saraswati

Address: Rohini, Delhi, 110089

Age: 47 Years

Civil Status: Married

Occupation: Lecturer

Religion: Hindu

PAST HEALTH HISTORY

Saraswati is a 47year old lady from Delhi. She has no history of hypertension,

asthma or any heart ailments. But she was suffering from Diabetes mellitus

since last 5 years. She was first diagnosed with Cataract in her both eyes last

July 27, 2012. It was difficult to do the Eye Surgery as maintaining the Glucose

level is major problem in Diabetic patients. And also this disease reduces the

healing power after surgery.

With the diagnosis of Cataract she undergone Phacoemulsification with

Intraocular lens implant for her right/left eye this March 20, 2013 at Centre for

Sight Eye Centre.

PRESENT HEALTH HISTORY

Currently her eye is perfectly fine and visibility is also good. Currently she is not

planning for Second surgery.

CHIEF COMPLAINT


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Itchy, painful and teary eyes. Partial loss of vision at later stage.

FAMILY HEALTH HISTORY

There is a family history of Cataract. Her father was suffering from the same

disease and had undergone Surgery in both their eyes. This was the realcause of disease in her.

8 SUMMARY

A cataract is clouding of the lens of the eye, which impedes the passage of

light. Most cataracts are related to ageing, although occasionally children

may be born with the condition, or cataract may develop after an injury,inflammation or disease.

Risk factors for age-related cataract include diabetes, prolonged exposure

to sunlight, tobacco use and alcohol drinking. Vision can be restored by

surgically removing the affected lens, and replacing it by an artificial one.

In this case we had studied that cause of Cataract was genetic, as she was

having a family history of this disease.


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9 BIBLOGRAPHYhttp://en.wikipedia.org/wiki/Cataract

http://www.eyehealthweb.com/cataracts/

http://health.nytimes.com/health/guides/disease/cataract/print.html

http://prezi.com/2h65y_ipzus2/cataract-case-study/

http://www.visitech.org/case-studies.html

http://www.webmd.com/eye-health/cataracts/health-cataracts-eyes

cataract document file

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