KUSUM,MSc.

Nursing,1st
Year
 DEFINITION

OPACITY OF LENS.

CLOUDING OR OPACITY OF
CRYSTALLINE LENS THAT IMPAIRS
VISION
Epidemiology
Cataracts are the leading cause of
blindness in the world
More than 1.3 million cataract
procedures are performed in the INDIA
each year.
Visual disability associated with
cataracts account for 8 million physician
office visits each year.
 Cataract is the leading cause of
blindness in last 40 years or older in the
worldwide.
History
The earliest reference to cataracts can be
found in Hindu writings from the 5th century
BC
The word Cataract comes from the Greek
word meaning Waterfall
Until the mid 1700s, it was thought that
cataract was formed by opaque material
flowing, like a waterfall into the eye
Etiology

Why age-related changes happen to the lens

is not known

One possibility is damage caused by unstable

molecules known as free radicals

Smoking and exposure to 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
Etiology

Age-related changes in the lens are not the

only cause of cataracts

Some infants are born with cataracts or

develop them during childhood

Such cataracts may be the result of the

mother having contracted rubella during
pregnancy

Metabolic disorders
PATHOPHYSIOLOGICAL
CHANGES
 Lens
The human lens is a
naturally clear
structure located
behind the iris and
supported by the
zonules
The lens is
avascular-It does
not have a vascular
supply
Structure
The basic lens
consists of a central
nucleus surrounded
by the cortex
contained within the
lens capsule
Optics
When light passes
through the pupil, it is
focused by the lens to
produce clear, sharp
images on the retina,
the light-sensitive
membrane on the back
of the eye that
functions like the film of
a camera
Optics
When this
arrangement is
disturbed in any
way, the
transparency is lost
This results in
scattering of light,
blurring, and
blocking of the
image
Structure

The lens is made mostly of water and protein

fibers.

The protein fibers are arranged in a precise

manner that makes the lens clear and allows
light to pass through without interference.

With aging, the composition of the lens

undergoes changes and the structure of the
protein fibers breaks down.

Some of the fibers begin to clump together,

clouding areas of the lens, and leading to the
loss of transparency.
 This loss of
transparency, or
opacity formation is
called Cataract

Clouding of the lens is a normal part of aging

About half of Indians older than 65 have

some degree of clouding of the lens.

According to one study, after age 75, 39% of

men, and 46% percent of women in the India
have visually significant cataracts.

Cataracts produce a gradual, painless,
progressive loss of vision, and many
patients are unaware of vision problems

Generally do not cause pain, or

abnormal tearing

But as the clouding progresses, the

cataract eventually interferes with your
vision

Commonly affect distance vision

Cause problems with glare

In the early stages, stronger lighting

and eyeglasses can help deal with the
vision problems
If impaired vision jeopardizes your
normal lifestyle, you might need
surgery

Patients often
describe trying to
look through a
fogged-up window

Clouded vision can

make it more
difficult to drive a
car, read, or see
details
Symptoms

Blurred vision

Increasing difficulty with vision at night

Glare, especially at night

Halos around lights

The need for brighter light for reading

Double vision in a single eye

Fading or yellowing of colors

 Due to increase of
yellow-brown
pigment in the lens,
color perception also
is affected
 Pain, redness, discharge, or irritation in
the eye are usually not signs or
symptoms of a cataract, but may be
signs and symptoms of other eye
disorders
 Hypermature Cataract

A cataract isn't
dangerous to the eye
unless the cataract
becomes completely
white, a condition
known as an overripe
(hypermature) cataract

This can cause

inflammation, eye pain
and headache

A hypermature cataract
is extremely rare and
needs removal
 Types of Cataract(according to site)
The lens consists of
three layers
The outer layer is a
thin, clear membrane
It surrounds a soft,
clear material (cortex)
The hard center of the
lens is the nucleus
A cataract can form in
any part of the lens
Nuclear Cataract

Occurs in the center of the lens

In its early stages, the patient may become

more nearsighted or even experience a
temporary improvement in reading vision

This so-called second sight disappears as

the lens gradually turns yellow and begins to
cloud the vision

Seeing in dim light and driving at night may

be especially troublesome
Cortical Cataract

Begins as whitish, wedge-shaped 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 nucleus

Both distance and near vision can be

impaired

Patients also have problems with glare and

loss of contrast
Subcapsular Cataract

Starts as a small, opaque area just under the

capsule shell, usually at the back of the lens,
right in the path of light on its way to the
retina

This type of cataract may occur in both eyes

but tends to be more advanced in one eye
than the other

Often interferes with reading vision, reduces

your vision in bright light and causes glare or
halos around lights at night
 CLASSIFICATIONS :
ETIOLOGICAL

CONGENITAL ACQUIRED

1. SENILE
2. TRAUMATIC
3. COMPLICATED
4. PATHOLOGICAL
5. DEFICIENCY
6. OCCUPATIONAL
7. RADIATION
8. TOXIC
Congenital Cataracts
Responsible for nearly 10% of all visual loss
in children worldwide
Approximately 0.03% of newborns have
some form of congenital cataract
Most are not associated with additional
developmental problems
Around one fifth of these patients have a
family history of congenital cataract but in up
to half of all cases there is no family history
 In the case of a newborn infant, a cataract
causes the immature visual system to be
deprived of the stimulation needed for normal
development
If left untreated, permanent visual loss may
occur
Unilateral cataracts are more likely to cause
visual loss because of the competition
between the two eyes
 If the cataract is small there may be only
slight blurring of vision with near normal
visual development
If the cataract is larger, or located more
posteriorly, it can effect visual development
In some cases this can lead to permanent
amblyopia (lazy eye)
Without adequate stimulation central vision
can be permanently effected
 Outcome is very much dependent on the type
of cataract
Some congenital cataracts impair visual
development only to a small degree and may
never require surgery
If the cataract is only in one eye, there is a
strong tendency for the child to prefer the
healthy eye
The eye affected by the cataract rarely achieves
normal vision, therefore removal of the cataract is
indicated
Etiology of Pediatric Cataracts
Hereditary
Autosomal dominant form most common
Genetic and Metabolic Diseases
Down syndrome
Maternal Infections
Rubella, Syphilis, Toxoplasmosis, Varicella
 Ocular Anomalies
Aniridia-Absence of iris at birth
Toxic
Corticosteroids, Radiation
Trauma
Risk Factors In Adults
Exposure to sunlight (UV light)
Smoking
Diabetes
Trauma (blunt or penetrating)
Family history of cataracts
Corticosteroid therapy
Radiation exposure
Electrical injury
Myotonic dystrophy
Uveitis- Ocular inflammation
Risk Factors

Everyone is at risk of developing

cataracts simply because age is the
single greatest risk factor

By age 65 about half of all population

have developed some degree of lens
clouding.
 Cataracts develop sooner in diabetic
patients than in non-diabetic patients
This is caused by shifts in the glucose,
electrolyte, and water balance within
the lens
Fluctuating vision and rapid shift to
near sightedness are symptoms of
diabetes
ACQUIRED CATARACT
SENILE CATARACT
DEFINITION- Bilateral progressive
lens opacity affecting the old people
not suffering from local or general
diseases.
 ETIOLOGY (senile cataract)

Disturbance of lens capsule

permeability.
Disturbance in lens metabolism.
Ultraviolet rays.
Hereditary.
SIGN/SYMPTOMS(Senile cataract)

1. Gradual painless diminution of vision.

2. Fixed black spots.
3. Uniocular diplopia or polyopia.
4. Change in colour.
Clinical Findings
The most common
objective finding
associated with
cataracts is
decreased visual
acuity
This is measured
with an office wall
chart or near-vision
card
Visual Acuity

Acuity refers to the sharpness of vision or

how clearly you see an object

In this test, your eye doctor checks to see

how well you read letters from across the
room

Eyes are tested one at a time, while the other

eye is covered.

Using the chart with progressively smaller

letters from top to bottom, to determine the
level of vision
Refraction
This is performed by
your doctor to see if
the decrease in
vision is simply due
for need for new
glasses, or if there is
another process at
work that accounts
for the decrease in
visual acuity
Slit Lamp Exam (SLE)
SLE allows the
ophthalmologist to see
the structures of the
eye under magnification
The microscope is called
a slit lamp because it
uses an intense slit of
light to illuminate your
cornea, iris, and lens
These structures are
viewed in small sections
to detect any small
abnormalities
Dilated Exam

Dilating drops are

placed in the eyes to
dilate the pupils wide
and provide a better
view to the back of the
eyes

It allows the
ophthalmologist to
examine the lens for
signs of a cataract and,
if needed, determine
how dense the
clouding is
Dilated Exam
It also allows for
examination of the
retina and the optic
nerve.
Dilating drops
usually keep your
pupils open for a
few hours before
their effect gradually
wears off
Treatment

Make sure that eyeglasses or contact

lenses are the most accurate
prescription possible

Improve the lighting in your home with

more or brighter lamps

When outside during the day, wear

sunglasses to reduce glare

Limit night driving


Think about how the cataract affects
your daily life

Can you see to do your job and drive safely ?

Do you have problems reading or watching

television?
Is it difficult to cook, shop, climb stairs or take

medications?
How active are you? Does lack of vision affect

your level of independence?

Are you afraid you'll trip or fall or bump into

something?
MANAGEMENT (GENERAL)

If you have cataracts in both eyes and

decide to have surgery, your eye doctor
typically removes the cataract in one
eye at a time

This allows time for the first eye to heal

before the second eye surgery

Advances in surgical technique and more
sophisticated technology have helped make
surgery a safe and effective treatment for
cataracts

Prior to surgery, your eye doctor measures

the size and shape of your eye to determine
the proper lens implant power

This measurement is made with a painless

ultrasound test

Cataract surgery is
typically an outpatient
procedure that takes
less than an hour

Most people are awake

and need only local
anesthesia

On rare occasions
some people may need
general anesthesia if
they have difficulty
laying flat or have
claustrophobia
 Two things happen
during cataract surgery
the clouded lens is
removed, and a clear
artificial lens is
implanted
 SURGICAL PROCEDURES

INTRACAPSULAR EXTRACTION :

The lens as well as the capsule are removed

through a small incision.
 EXTRACAPSULAR EXTRACTION :

Lens is incised & the nucleus,cortex,&

anterior capsule are extracted.

The posterior capsule is left in place & is

usually the base to which an IOL is
implanted.
1. CRYOSURGERY
A special technique in which a pencil
like instrument with a metal tip is
supercooled(-35C),then touched to
exposed lens, freeezing to it so the lens
is easily lifted out.
2. PHACOEMULSIFICATION

During
phacoemulsification,
phaco for short, the
surgeon makes a
small incision, where
the cornea meets
the conjunctiva
 The surgeon then
uses the probe,
which vibrates with
ultrasound waves, to
break up (emulsify)
the cataract and
suction out the
fragments

Once the cataract is
removed, a clear
artificial lens is
implanted to replace the
original clouded lens

This lens implant is

made of plastic, acrylic
or silicone and becomes
a permanent part of the
eye

Some IOLs are rigid
plastic and implanted
through an incision that
requires several stitches
(sutures) to close

However, many IOLs

are flexible, allowing a
smaller incision that
requires no stitches
 Patients usually go home the same day
Patients are seen in the office the next day,
the following week, and then again after a
month so that he or she can check the
healing progress

It's normal to feel mild discomfort for a

couple of days after surgery

You may wear an eye patch or protective

shield the day of surgery

Your doctor may prescribe medications to

prevent infection and control eye pressure
Post-op Course
Patients are usually examined 1 day, 1
week and then one month after the
surgery date.
Complications of Surgery
Vitreous Loss- 3.1%
Vitreous Hemorrhage-0.3%
Uveitis-1.8%
Increased Eye Pressure- 1.2%
Retinal Detachment- 0.7%
Endophthalmitis- 0.13%
Post Operative Period

Contact your doctor immediately if you

experience any of the following signs or
symptoms after cataract surgery:
Vision loss

Pain that persists despite the use of over-the-

counter pain medications

A definite increase in eye redness

Light flashes or multiple spots (floaters) in front of

the eye

Nausea, vomiting or excessive coughing
Posterior Subcapsular Opacity

This condition occurs

when the back of the
lens capsule eventually
becomes cloudy and
blurs vision

PCO can develop

months or years after
cataract surgery

Occurs approx. 20%

percent of the time

Treatment for PCO is simple and quick

Laser capsulotomy is a quick, painless

outpatient procedure that usually takes
less than five minutes

Capsulotomy means "cutting into the

capsule" and YAG is an abbreviation of
yttrium-aluminum-garnet, the type of
laser used for the procedure
 YAG Laser Capsulotomy

A technique in which
a laser beam is used
to make a small
opening in the
clouded capsule to
let light pass
through.
Post YAG

Afterward, patients typically stay in the

doctor's office for about an hour to make sure
the eye pressure is not elevated

In some people, particularly those who have

glaucoma or are extremely nearsighted, YAG
laser surgery can raise eye pressure

Other complications are rare but can include

swelling of the macula and a detached retina

Most cataracts occur with age and can't
be avoided altogether

Regular eye exams remain the key to

early detection

You can take steps to help slow or

prevent the development of cataracts
WHAT TO DO ?

Do not smoke
Smoking produces free radicals, increasing your

risk of cataracts.

Eat a balanced diet

Include plenty of fruits and vegetables.

Ultraviolet light protection since UV light may

contribute to the development of cataracts

Diabetes Control
COMPLICATION OF
CATARACT