The Correlation Between Diabetes Mellitus and Cataract

FACULTY OF MEDICINE TRISAKTI UNIVERSITY

JAKARTA 2011

NAME : FERIO JOELIAN

Student Number : 030 05 095

PREFACE This paper, titled The Correlation Between Diabetes Mellitus and Cataract . The writer made this paper to complete the English assignment for 3 rd Medical English subject in Faculty of Medicine, Trisakti University. The writer arranged this paper by searching the information from textbook and internet. The Writer managed the structure for this topic to be simple and easier for all the readers to understand. The writer hopes this papers topic is compatible and can give the information which needed by anyone, such as medical student and physicians, both here and abroad. The writer realized that this paper probably need to be corrected. For that reason, critics and suggestions will be accepted as long as it improves the writer. The writer hopes all the readers who had read this paper will continue to find out deeply about this topic. As the result, their knowledge will develop not only from this paper, but also from other sources. The writer would like to say thanks to dr. Alvina as the lecturer, who had been very kind and patient to taught and helped in finishing this paper. Furthermore, a big thanks also delivered to the writers parents, friends and everybody who have helped and inspired the writer during the process of making this paper. Finally, The writer hopes this paper will be useble for the us. Thank you.

Jakarta, July 2011

Ferio Joelian CONTENTS Cover Preface Contents Abstract Chapter I : Introduction 1.1 1.2 1.3 1.4 1.5 1.6 Chapter II Chapter III Chapter IV Chapter V References Backgrounds Problems Limitations of Problems Objectives Method of Writing Frame of Writing

: Diabetes Mellitus : Cataract : Cervical Cancer and Human Papillomavirus : Conclusion

ABSTRACT Diabetes mellitus is a disease that can increase the blood glucose levels. As a metabolic disease, diabetes mellitus can damage and influence other organ in the body. Cataract is a a clouding of the lens in eyes and can affects the vision. Cataract is very common in older people, but it can be a complication from other diseases. In many cases, people may not realize about their abnormality glucose levels in blood. Diabetes affects approximately 17 million people (about 8% of the population) in the United States. In addition, an estimated additional more than 12 million people have diabetes and don't even know it. And they realize it after the complications of this disease appears.

CHAPTER I INTRODUCTION

I.1

Background(1), (2) Diabetes Mellitus is a set of related diseases in which the body cannot regulate

the amount of sugar (specifically, glucose) in the blood that can make the normal blood vessels become abnormal and can damage other organs.(1) Cataract is a abnormallity of the lens eyes, it can be normal in older people or can be the complication from other diseases, such as diabetes mellitus. Over time, diabetes can lead to blindness, kidney failure, and nerve damage. These types of damage are the result of damage to small vessels, referred to as microvascular disease. Diabetes is also an important factor in accelerating the hardening and narrowing of the arteries (atherosclerosis), leading to strokes, coronary heart disease, other large blood vessel diseases, and eyes specially cataract.(2) For that reason, I choose this topic as my title in English paper. So I can acknowledge about it. I. 2 Problems The main problem that will be discussed in this paper is about the connection between Diabetes Mellitus and Cataract. And hopefully, the writer can figure it out about the connection for both of them. I. 3 Limitations of Problems The writer makes the limitation about what kind of sub-subject should The writer discuss here to prevent the discussion to be over detail. The limitations of the problems are definition, types, etiology, symptoms, diagnose, preventions and the treatments. The writer also add some extra information needed, but the aim of the explanation is the correlation between the problems.

I.4

Objectives The objective of this paper is to inform the reader more information about the

correlation between Diabetes Mellitus and Cataract. For that, the writer hopes the readers awareness to make it develop. Further purpose is the prevention of these diseases can be done perfectly. I. 5 Method of Writing The method that The writer uses to make this paper based on the rules which given from the institude. The writer got the information by collecting data from many kinds of sources, there are books, journals and internet. 1.1 Frame of Writing Chapter 1: Introduction 1.1 Backgrounds 1.2 Problems 1.3 Limitations of Problems 1.4 Objectives 1.5 Method of Writing 1.6 Frame of Writing Chapter 2: The Correlation between Diabetes Mellitus and Cataract Chapter 3: Conclusion References

CHAPTER II DIABETES MELLITUS Diabetes mellitus is a group of metabolic diseases characterized by high blood glucose levels, that result from defects in insulin secretion, or action, or both. Diabetes mellitus, commonly referred to as diabetes was first identified as a disease associated with "sweet urine," and excessive muscle loss in the ancient world. Elevated levels of blood glucose (hyperglycemia) lead to spillage of glucose into the urine, hence the term sweet urine. Normally, blood glucose levels are tightly is regulated by several hormones, including insulin. Insulin is produced by the pancreas, a small organ between the stomach and liver. The pancreas secretes other important enzymes that help to digest food. Insulin lowers the blood glucose level. When the blood glucose elevates (for example, after eating food), insulin is released from the pancreas to normalize the glucose level. (2) In patients with diabetes, do not produce enough insulin (type 1 diabetes) or cannot use insulin properly (type 2 diabetes), or both (which occurs with several forms of diabetes). In diabetes, glucose in the blood cannot move into cells, so it stays in the blood. This not only harms the cells that need the glucose for fuel, but also harms certain organs and tissues exposed to the high glucose levels.the absence or insufficient production of insulin causes hyperglycemia. Diabetes is a chronic medical condition, meaning that although it can be controlled, it lasts a lifetime. (2), (3) II. Types of Diabetes Mellitus (1), (2), (3) Type 1 diabetes, in this type the body stops producing insulin or produces too little insulin to regulate blood glucose level. This type is typically recognized in childhood or adolescence. It used to be known as juvenile-onset diabetes or insulindependent diabetes mellitus.Type 1 diabetes can occur in an older individual due to destruction of pancreas by alcohol, disease, or removal by surgery. It also results from progressive failure of the pancreatic beta cells, which produce insulin. People with type 1 diabetes require daily insulin treatment to sustain life.(1), (2)

Type 2 diabetes, in this type the pancreas secretes insulin, but the body is partially or completely unable to use the insulin. This is sometimes referred to as insulin resistance. The body tries to overcome this resistance by secreting more and more insulin. People with insulin resistance develop type 2 diabetes when they do not continue to secrete enough insulin to cope with the higher demands. At least 90% of patients with diabetes have type 2 diabetes. Type 2 diabetes is typically recognized in adulthood, usually after age 45 years. It used to be called adult-onset diabetes mellitus, or non-insulin-dependent diabetes mellitus. These names are no longer used because type 2 diabetes does occur in younger people, and some people with type 2 diabetes need to use insulin.Type 2 diabetes is usually controlled with diet, weight loss, exercise, and oral medications. More than half of all people with type 2 diabetes require insulin to control their blood sugar levels at some point in the course of their illness. (1), (2), (3) Gestational diabetes is a form of diabetes that occurs during the second half of pregnancy.Although gestational diabetes typically goes away after delivery of the baby. Women who have gestational diabetes are more likely than other women to develop type 2 diabetes later in life.Women with gestational diabetes are more likely to have large babies. (1) III. The Signs and Symptoms (1), (2) There are some common signs and symptoms that can be found in patient with diabetes mellitus, such as:

Unexplained weight loss: People with diabetes are unable to process many of the calories in the foods they eat. Thus, they may lose weight even though they eat an apparently appropriate or even excessive amount of food. Losing sugar and water in the urine and the accompanying dehydration also contributes to weight loss.

Excessive thirst (polydipsia): A person with diabetes develops high blood sugar levels, which overwhelms the kidney's ability to reabsorb the sugar as the blood is filtered to make urine. Excessive urine is made as the kidney spills the excess sugar. The body tries to counteract this by sending a signal to the

brain to dilute the blood, which translates into thirst. The body encourages more water consumption to dilute the high blood sugar back to normal levels and to compensate for the water lost by excessive urination.

Excessive urination (polyuria): Another way the body tries to get rid of the extra sugar in the blood is to excrete it in the urine. This can also lead to dehydration because excreting the sugar carries a large amount of water out of the body along with it.

Excessive eating (polyphagia): If the body is able, it will secrete more insulin in order to try to deal with the excessive blood sugar levels. Moreover, the body is resistant to the action of insulin in type 2 diabetes. One of the functions of insulin is to stimulate hunger. Therefore, higher insulin levels lead to increased hunger and eating. Despite increased caloric intake, the person may gain very little weight and may even lose weight.

Poor wound healing: High blood sugar levels prevent white blood cells, which are important in defending the body against bacteria and also in cleaning up dead tissue and cells, from functioning normally. When these cells do not function properly, wounds take much longer to heal and become infected more frequently. Also, long-standing diabetes is associated with thickening of blood vessels, which prevents good circulation including the delivery of enough oxygen and other nutrients to body tissues.

Infections: Certain infection syndromes, such as frequent yeast infections of the genitals, skin infections, and frequent urinary tract infections, may result from suppression of the immune system by diabetes and by the presence of glucose in the tissues, which allows bacteria to grow well. It can also be an indicator of poor blood sugar control in a person known to have diabetes.

Altered mental status: Agitation, unexplained irritability, inattention, extreme lethargy, or confusion can all be signs of very high blood sugar, ketoacidosis, hyperosmolar hyperglycemia nonketotic syndrome, or hypoglycemia (low sugar).

Blurry vision: Blurry vision is not specific for diabetes but is frequently present with high blood sugar levels. Symptoms of type 1 diabetes are often dramatic and come on very suddenly.

Type I diabetes is usually recognized in childhood or early adolescence, often in association with an illness (such as a virus or urinary tract infection) or injury.The extra stress can cause diabetic ketoacidosis.Symptoms of ketoacidosis include nausea and vomiting. Dehydration and often-serious disturbances in blood levels of potassium follow. Symptoms of type 2 diabetes are often subtle and may be attributed to aging or obesity.A person may have type 2 diabetes for many years without knowing it.People with type II diabetes can develop hyperglycemic hyperosmolar nonketotic syndrome. Type II diabetes can be precipitated by steroids and stress.If not properly treated, type 2 diabetes can lead to complications like blindness, kidney failure, heart disease, and nerve damage. IV. The Exams and Tests (1) There are some method to diagnose diabetes mellitus, such as Finger stick blood glucose. This is a rapid screening test that may be performed anywhere, including community-based screening programs. A fingerstick blood glucose test is not as accurate as testing the patient's blood in the laboratory but is easy to perform, and the result is available right away. The test involves sticking the patient's finger for a blood sample, which is then placed on a strip. The strip goes into a machine that reads the blood sugar level. These machines are only accurate to within about 10% of true actual laboratory values. Fingerstick blood glucose values may be inaccurate at very high or very low levels, so this test is only a preliminary screening study. This is the way most people with diabetes monitor their blood sugar levels at home. A random blood glucose test can also be used to diagnose diabetes, but the fasting blood glucose test is more accurate than a random blodd glucose test.. A blood glucose level of 200 mg/dl or higher indicates diabetes.

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Now, the doctors prefer to choose fasting blood glucose (sugar) test because this test is more accurate than Finger stick test and random blood glucose. It is easy to perform and convenient. After the person has fasted overnight (at least 8 hours), a single sample of blood is drawn and sent to the laboratory for analysis. Normal fasting plasma glucose levels are less than 100 milligrams per deciliter (mg/dl). Fasting plasma glucose levels of more than 126 mg/dl on two or more tests on different days indicate diabetes. When fasting blood glucose stays above 100mg/dl, but in the range of 100126mg/dl, this is known as impaired fasting glucose (IFG). While patients with IFG do not have the diagnosis of diabetes, this condition carries with it its own risks and concerns, and is addressed elsewhere. Though not routinely used anymore, the oral glucose tolerance test (OGTT) is a gold standard for making the diagnosis of type 2 diabetes. It is still commonly used for diagnosing gestational diabetes and in conditions of pre-diabetes. With an oral glucose tolerance test, the person fasts overnight (at least eight but not more than 16 hours). Then first, the fasting plasma glucose is tested. After this test, the person receives 75 grams of glucose (100 grams for pregnant women). There are several methods employed by obstetricians to do this test, but the one described here is standard. Usually, the glucose is in a sweet-tasting liquid that the person drinks. Blood samples are taken at specific intervals to measure the blood glucose. For the test to give reliable results:

The person must be in good health (not have any other illnesses, not even a cold).

The person should be normally active (not lying down, for example, as an inpatient in a hospital), and

The person should not be taking medicines that could affect the blood glucose. For three days before the test, the person should have eaten a diet high in carbohydrates (200-300 grams per day).

The morning of the test, the person should not smoke or drink coffee.

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People with glucose levels between normal and diabetic have impaired glucose tolerance (IGT). People with impaired glucose tolerance do not have diabetes, but are at high risk for progressing to diabetes. Weight loss and exercise may help people with impaired glucose tolerance return their glucose levels to normal. In addition, some physicians advocate the use of medications, such as metformin (Glucophage), to help prevent/delay the onset of overt diabetes. Recent studies have shown that impaired glucose tolerance itself may be a risk factor for the development of heart disease. In the medical community, most physicians are now understanding that impaired glucose tolerance is not simply a precursor of diabetes, but is its own clinical disease entity that requires treatment and monitoring. Glucose tolerance tests may lead to one of the following diagnoses:

Normal response: A person is said to have a normal response when the 2-hour glucose level is less than 140 mg/dl, and all values between 0 and 2 hours are less than 200 mg/dl.

Impaired glucose tolerance: A person is said to have impaired glucose tolerance when the fasting plasma glucose is less than 126 mg/dl and the 2hour glucose level is between 140 and 199 mg/dl.

Diabetes: A person has diabetes when two diagnostic tests done on different days show that the blood glucose level is high.

Gestational diabetes: A woman has gestational diabetes when she has any two of the following: a 100g OGTT, a fasting plasma glucose of more than 95 mg/dl, a 1-hour glucose level of more than 180 mg/dl, a 2-hour glucose level of more than 155 mg/dl, or a 3-hour glucose level of more than 140 mg/dl.

V.

Complications (1), (2) There are two phase of diabetes complication, acute phase and chronic phase.

In the short run, diabetes can contribute to a number of acute (short-lived) medical problems.

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Many infections are associated with diabetes, and infections are frequently more dangerous in someone with diabetes because the body's normal ability to fight infections is impaired. To compound the problem, infections may worsen glucose control, which further delays recovery from infection.

Hypoglycemia, or low blood sugar, occurs from time to time in most people with diabetes. It results from taking too much diabetes medication or insulin (sometimes called an insulin reaction), missing a meal, doing more exercise than usual, drinking too much alcohol, or taking certain medications for other conditions. It is very important to recognize hypoglycemia and be prepared to treat it at all times. Headache, feeling dizzy, poor concentration, tremors of hands, and sweating are common symptoms of hypoglycemia. You can faint or have a seizure if blood sugar level gets too low.

Diabetic ketoacidosis is a serious condition in which uncontrolled hyperglycemia (usually due to complete lack of insulin or a relative deficiency of insulin) over time creates a buildup in the blood of acidic waste products called ketones. High levels of ketones can be very harmful. This typically happens to people with type 1 diabetes who do not have good blood glucose control. Diabetic ketoacidosis can be precipitated by infection, stress, trauma, missing medications like insulin, or medical emergencies like stroke and heart attack.

Hyperosmolar hyperglycemic nonketotic syndrome is a serious condition in which the blood sugar level gets very high. The body tries to get rid of the excess blood sugar by eliminating it in the urine. This increases the amount of urine significantly and often leads to dehydration so severe that it can cause seizures, coma, and even death. This syndrome typically occurs in people with type 2 diabetes who are not controlling their blood sugar levels, who have become dehydrated, or who have stress, injury, stroke, or are taking certain medications, like steroids. In chronic phase, the blood glucose in diabetes influence the large vessel

disease involving the heart and blood vessels (macrovascular disease). Diabetes accelerates hardening of the arteries (atherosclerosis) of the larger blood vessels,

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leading to coronary heart disease (angina or heart attack), strokes, and pain in the lower extremities because of lack of blood supply (claudication). Beside attack the large blood vessels, the diabetes can attack the small one, too, that can be damaged the eyes, kidneys and nerves system The major eye complication of diabetes is called diabetic retinopathy. Diabetic retinopathy occurs in patients who have had diabetes for at least five years. Diseased small blood vessels in the back of the eye cause the leakage of protein and blood in the retina. Disease in these blood vessels also causes the formation of small aneurysms (microaneurysms), and new but brittle blood vessels (neovascularization). Spontaneous bleeding from the new and brittle blood vessels can lead to retinal scarring and retinal detachment, thus impairing vision. Cataracts and glaucoma are also more common among diabetics. It is also important to note that since the lens of the eye lets water through, if blood sugar concentrations vary a lot, the lens of the eye will shrink and swell with fluid accordingly. As a result, blurry vision is very common in poorly controlled diabetes. Patients are usually discouraged from getting a new eyeglass prescription until their blood sugar is controlled. This allows for a more accurate assessment of what kind of glasses prescription is required. Kidney damage from diabetes is called diabetic nephropathy. The onset of kidney disease and its progression is extremely variable. Initially, diseased small blood vessels in the kidneys cause the leakage of protein in the urine. Later on, the kidneys lose their ability to cleanse and filter blood. The accumulation of toxic waste products in the blood leads to the need for dialysis. Dialysis involves using a machine that serves the function of the kidney by filtering and cleaning the blood. In patients who do not want to undergo chronic dialysis, kidney transplantation can be considered. Nerve damage from diabetes is called diabetic neuropathy and is also caused by disease of small blood vessels. In essence, the blood flow to the nerves is limited, leaving the nerves without blood flow, and they get damaged or die as a result (a term known as ischemia). Symptoms of diabetic nerve damage include numbness, burning, and aching of the feet and lower extremities. When the nerve disease causes a complete loss of sensation in the feet, patients may not be aware of injuries to the feet, and fail to properly protect them. Shoes or other protection should be worn as much as
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possible. Seemingly minor skin injuries should be attended to promptly to avoid serious infections. Because of poor blood circulation, diabetic foot injuries may not heal. Sometimes, minor foot injuries can lead to serious infection, ulcers, and even gangrene, necessitating surgical amputation of toes, feet, and other infected parts. Diabetic nerve damage can affect the nerves that are important for penile erection, causing erectile dysfunction (ED, impotence). Erectile dysfunction can also be caused by poor blood flow to the penis from diabetic blood vessel disease. Diabetic neuropathy can also affect nerves to the stomach and intestines, causing nausea, weight loss, diarrhea, and other symptoms of gastroparesis (delayed emptying of food contents from the stomach into the intestines, due to ineffective contraction of the stomach muscles). VI. Prevention and Treatment (1), (2), (3) To prevet the diabetes mellitus, there is some way to modified the life-style. But until now, belum ditemuan cara to prevent type 1 diabetes mellitus. Type 2 diabetes, however, can be prevented in some cases.

Control weight to normal or near-normal levels by eating a healthy low-fat, high-fiber diet.

Regular exercise is crucial to the prevention of type 2 diabetes. Keep alcohol consumption low. Quit smoking. If the person have high blood fat levels (such as high cholesterol) or high blood pressure, take the medication as directed.

Lifestyle modification and/or certain medications can be used in people with prediabetes to prevent progression to diabetes. Pre-diabetes can be diagnosed by checking fasting glucose and two hours after ingesting 75 grams of glucose.

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If the person already have diabetes, the focus should be on preventing the complications, which can cause serious disabilities such as blindness, kidney failure requiring dialysis, amputation, or even death.

Tight glucose control: The single best thing the patient can do is to keep their blood sugar level within the suggested range every day. The only way to do this is through a combination of regular blood sugar checks, a balanced diet low in simple sugars and fat and high in complex carbohydrates and fiber, and appropriate medical treatment. Please consult a nutritionist or check with the doctor with questions in regard to diet.

Maintain a healthy weight and quit smoking. Increase physical activity levels. Aim for moderately vigorous physical activity for at least 30 minutes every day.

Drink an adequate amount of water and avoid taking too much salt. The skin should be taken care of; keep it supple and hydrated to avoid sores and cracks that can become severely infected.

Brush and floss the teeth every day. See a dentist regularly to prevent gum disease.

The feet should be washed and examined daily, looking for small cuts, sores, or blisters that may cause problems later. The toenails should be filed rather than cut to avoid damaging the surrounding skin. A specialist in foot care (podiatrist) may be necessary to help care for the feet.

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CHAPTER III CATARACT I. Definition(4), (5) Cataract 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. Most cataracts develop slowly and don't disturb the eyesight early on. But as the clouding progresses, the cataract eventually interferes with the vision. (4) Cataract are very common in older people as the process of normal aging. 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. But, sometimes it can be happened because of other diseases, for example diabetes mellitus. (5) II. Etiology (4) 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. (4)

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III.

Risk Factors (6) Everyone is at risk of developing cataracts simply because age is the greatest

risk factor. By age 65, persons have developed some degree of lens clouding, although it may not impair vision. After age 75, persons have cataracts that are significant enough to impair their vision. Factors that increase your risk of cataracts include:

Age Diabetes Family history of cataracts Previous eye injury or inflammation Previous eye surgery Prolonged use of corticosteroids Excessive exposure to sunlight Exposure to ionizing radiation
Smoking

IV.

Types of Cataract (6), (7)

Cataracts has three type, they are:

Nuclear. A nuclear cataract is the most cooomonly seen as it forms. It occurs in the center of the lens. In its early stages, as the lens changes the way it focuses light, you may become more nearsighted or even experience a temporary improvement in your reading vision. Some people actually stop needing their glasses. Unfortunately, this so-called second sight disappears as the lens gradually turns more densely yellow and further clouds your vision. As the cataract progresses, the lens may even turn brown. Seeing in dim light and driving at night may be especially troublesome. Advanced discoloration can lead to difficulty distinguishing between shades of blue and purple.

Cortical. A cortical cataract begins as whitish, wedge-shaped opacities or streaks on the outer edge of the lens cortex. As it slowly progresses, the streaks extend to the center and interfere with light passing through the center

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of the lens. Problems with glare are common for people with this type of cataract.

Subcapsular. A subcapsular cataract starts as a small, opaque area just under the capsule of the lens. It usually forms near the back of the lens, right in the path of light on its way to the retina. A subcapsular cataract often interferes with your reading vision, reduces your vision in bright light and causes glare or halos around lights at night. Scientists don't know exactly why a lens changes with age. One possibility is

damage caused by unstable molecules known as free radicals. Smoking and exposure to ultraviolet (UV) light are two sources of free radicals. General wear and tear on the lens over the years also may cause the changes in protein fibers. V. Signs and Symptoms (6), (8), (9) A cataract usually develops slowly and causes no pain. At first, the cloudiness may affect only a small part of the lens (a clear, elliptical structure near the front of each eye) and the person may be unaware of any vision loss. Over time, however, as the cataract grows larger, it clouds more of your lens and distorts the light passing through the lens. Eventually, this impairs your vision because of overall blur or image distortion. Signs and symptoms of cataracts include:

Clouded, blurred or dim vision Increasing difficulty with vision at night Sensitivity to light and glare Halos around lights The need for brighter light for reading and other activities Frequent changes in eyeglass or contact lens prescription Fading or yellowing of colors Double vision in a single eye If a person have cataract, light from the sun, lamps or oncoming headlights

may seem too bright. Glare and halos around lights can make driving uncomfortable and dangerous. The person may experience eyestrain or find yourself blinking more often to clear your vision.

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A cataract isn't dangerous to the physical health of the eye unless the cataract becomes completely white, a condition known as an overripe (hypermature) cataract. This can cause inflammation, pain and headache. A hypermature cataract requires removal if it's associated with inflammation or pain. VI. The Exams and Tests (4), To detect a cataract, the eye-care provider examines the lens. A comprehensive eye examination usually includes the following:

Visual acuity test: An eye chart test is used to measure the reading and distance vision.

Refraction: the eye doctor should determine if glasses would improve the vision.

Glare testing: Vision may be significantly altered in certain lighting conditions and normal in others; in these circumstances, the doctor may check the glare symptoms with a variety of different potential lighting sources.

Potential acuity testing: This helps the ophthalmologist get an idea of what the vision would be like after removal of the cataract. Think of this as the eye's vision potential if the cataract was not present.

Contrast sensitivity testing: This checks for the ability to differentiate different shades of gray, which is often this limited by cataracts.

Tonometry: a standard test to measure fluid pressure inside the eye (Increased pressure may be a sign of glaucoma.)

Pupil dilation: The pupil is enlarged with eye drops so that the ophthalmologist can further examine the lens and retina. This is important to determine if there are other conditions which may ultimately limit your vision besides cataracts.

VII.

Preventions and Treatments (4), (6), (7), (8)

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Regular eye exams remain the key to early detection. If the over age 65, schedule eye exams at least every other year. Although most cataracts occur with age and can't be avoided altogether. In early stages of a cataract when symptoms are mild, the person can take steps to help slow or possibly prevent the development of cataracts:

Don't smoke. Smoking produces free radicals, increasing your risk of cataracts. Eat a balanced diet. Include plenty of fruits and vegetables in your diet. Eating lots of fruits and vegetables may have a modest effect in preventing cataract development, though this hasn't been definitively proved.

Protect yourself from the sun. Ultraviolet light may contribute to the development of cataracts. Whenever possible, wear sunglasses that block ultraviolet B (UVB) rays when you're outdoors.

Take care of other health problems. Follow your treatment plan if you have diabetes or other medical conditions. If you have a chronic illness, it's especially important that you take other preventive steps, such as wearing UVB-blocking sunglasses when outdoors and not smoking.

Wearing sunglasses outside during the day might reduce your chances of developing cataracts or having problems with the retina. Some sunglasses can filter out UV light, reducing exposure to harmful UV radiation and might slow the progression of cataracts.

A healthy lifestyle might help, just as a healthy lifestyle helps prevent other diseases in the body. Eat a proper diet, get regular exercise and rest, and do not smoke.

Tight blood-sugar control can delay the otherwise accelerated development of cataracts for the person with diabetes mellitus. Cataracts can't be cured with medications, dietary supplements, exercise or

optical devices The only effective treatment for cataracts is surgery. It can remove the clouded lens, which usually includes replacing the lens with a clear lens implant. Sometimes cataracts are removed without reinserting implant lenses. In such cases,

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vision can be corrected with eyeglasses or contact lenses. Cataract surgery is successful in about 95 percent of all cases. (6), (8) Surgery is done on only one eye at a time. It's generally done on an outpatient basis, usually with local anesthesia. Recovery is fast. The patient can often resume the normal daily activities beginning the night of surgery and may be able to start driving again the day after surgery, after the postoperative checkup. There are three basic techniques for cataract surgery:

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.(4), (7)

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CHAPTER IV THE CORRELATION BETWEEN DIABETES MELLITUS AND CATARACT Diabete mellitus is a group of metabolic diseases characterized by high blood sugar (glucose) levels. Diabetes mellitus is one of the leading causes of irreversible blindness worldwide, and in the United States, it is the most common cause of blindness in people younger than 65 years of age. In addition to being a leading cause of blindness, diabetic eye disease encompasses a wide range of problems that can affect the eyes. Diabetes mellitus may cause a reversible, temporary blurring of the vision, or it can cause a severe, permanent loss of vision. Diabetes mellitus increases the risk of developing cataracts and glaucoma. Some people may not even realize they have had diabetes mellitus for several years until they begin to experience problems with their eyes or vision. Severe diabetic eye disease most commonly develops in people who have had diabetes mellitus for many years and who have had little or poor control of their blood sugars over that period of time. Over many years, high blood sugar and other abnormalities in metabolism found in people with diabetes mellitus may damage the blood vessels in the body. This damage to the blood vessels leads to poor circulation of the blood to various parts of the body. Since the function of the blood is to carry oxygen and other nutrients, this poor circulation causes decreased oxygen delivery to tissues in different parts of the body and subsequent damage to those tissues. Some of the most sensitive tissues to decreased blood flow and oxygen delivery include the brain, heart, kidneys, and the eyes. Lack of adequate oxygen delivery to these areas causes strokes, heart attacks, kidney failure, and vision loss.This blurring is because the sugar in the blood can diffuse into the lens of the eye and cause it to swell, thus changing the focal point of the eye and resulting in blurring of the vision. Over time, this repeated swelling of this type is thought to damage the lens and cause it to become cloudy, resulting in a cataract.

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CHAPTER V CONCLUSION Diabetes mellitus as a metabolic disorder that characterize with high blood glocose levels. It can influence the small and large blood vessels and damaging other organ in the body, such as kidneys, heart, nerves system, eyes, etc. In many people, they may not realize about their abnormal level of blood glucose. So, many people realize they have daibetes mellitus after they feel the complication of this disease. One of the common complication is cataract, this diabetes attack the lens of the eyes that makes the blurry vision on this person. This blurring is because the sugar in the blood can diffuse into the lens of the eye and cause it to swell, thus changing the focal point of the eye and resulting in blurring of the vision. Over time, this repeated swelling of this type is thought to damage the lens and cause it to become cloudy, resulting in a cataract. From that mechanisme of diabetes mellitus, this disease can increase the risk of developing eye diseases, especially cataract. To treat and prevent this diseases, the person must do some treatment and surgary to fix the lens and manage the blood glucose levels. And of course, must change the life-style.

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REFERENCES
1. http://www.emedicinehealth.com/diabetes/article_em.htm. Accesed on July

17th 2011 (internet)

2. http://www.medicinenet.com/diabetes_mellitus/htm#tocn. Accesed on July

17th 2011 (internet)

3. http://jcem.endojournals.org/cgi/reprint/84/4/1165. Accesed on July 17th 2011 (internet) 4. http://www.emedicinehealth.com/cataracts/article_em.htm. Accesed on July 17th

2011 (internet)
5. http://www.cataract.com/. Accesed on July 17th 2011 (internet) 6. http://www.mayoclinic.com/health/cataracts/DS00050/DSECTION=treatment

s-and-drugs. Accesed on July 17th 2011 (internet)

7. http://www.allaboutvision.com/conditions/cataracts.htm. Accesed on July 17th

2011 (internet)
8. http://www.nlm.nih.gov/medlineplus/cataract.html. Accesed on July 17th

2011 (internet)
9. http://adln.lib.unair.ac.id/files/disk1/35/gdlhub-gdl-s1-2006-fauzimasci-1745-

fkm.32-. Accesed on July 17th 2011 (internet)

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