Tuesday, September 22, 2020

Types of Cataracts, Symptoms, Surgery & Treatments

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What are Cataracts?

Cataracts are a condition where the lens of the eye becomes clouded and vision is impaired. This happens when the protein component in the lens begins clumping together. It usually occurs progressively where a portion of the lens develops a slightly opaque film that becomes denser over time, leading to increased opacity and vision problems. If left untreated, Cataracts can cause dislocation of the lens in some cases and also lead to partial or full blindness.

Cataracts are one of several conditions that can affect the eye as it ages, primarily affecting adults over forty. However, Cataracts can also be found in children and babies and currently affect over 20 million people in the United States. More than half of the US population will have had some experience with Cataracts by the age of 80. However there are effective treatments for removing Cataracts in both children and adults.

How the Eye Works

The eye is comprised of a number of synergistic parts that work in tandem to deliver vision. The various parts of the eye include:

The Sclera is the component that covers most of the eye, which is often called the “whites of the eye”. The Sclera is covered with tiny blood vessels which deliver blood to the eye. This part of the eye is tough and protective and helps the eye keep its shape.

The Cornea is the clear outer area of the eye, often calls the eye’s window. The cornea filters and bends light toward the retina for the processing of images. It is possible for the cornea to become scratched or damaged and even replaced. Tears are a primary means of keeping the cornea clean.

The Lens takes the light filtered through the Cornea and filters it more effectively into the retina. The lens is able to expand and contract to finely focus the light based on what is being viewed at the time. In the case of Cataracts, the lens is covered with a film, which scatters light instead of focusing it. This leads to blurry and eventually severely impaired vision as the disease progresses.

The Iris is the colored area of the eye that defines whether a person is classified as having blue, brown or green eyes. The Iris is has a muscular component which allows it to change shape to effectively filter light. The iris protects the pupil and its expansion and contraction mechanism allows it to control how much light is filtered through.

The Pupil is the black dot in the center of the Iris and like a camera shutter, it controls the amount of light that is allowed to filter through to the back of the eye. If bright lights are directed towards the eye, the pupil will contract to shield the eye and it will expand again when the light is removed.

The Retina is the processing center of the eye. It changes filtered light into electrical nerve impulses which are then sent to the brain for processing into images. The retina is responsible for both direct vision, as well as peripheral vision.

The Macula is a small central portion of the Retina that is responsible for central, forward vision.

The Optic Nerve is actually a conglomeration of many nerve cells that feed signals from the eye to the brain for processing into images.

Types of Cataracts

There are four main classifications of Cataracts, in addition to other subcategories. The main types of Cataracts are:

  • Senile Cataracts, as the name implies affect the eye as it ages. This is by far the largest group of Cataract sufferers.
  • Congenital Cataracts occur either in babies at birth, or in very young children. Congenital Cataracts most often affect both eyes and can be partial or fully obstructing. This type of Cataract may be the result of a maternal infection or of inherited genetic traits.
  • Secondary Cataracts are ones that develop as a side affect or secondary ailment of another illness. This can occur in patients with Diabetes, Glaucoma or heavy steroid use.
  • Traumatic Cataracts occur as a result of trauma to the eye and may not develop right away. Often times the results are not detectable until years In the future.
  • Radiation Cataracts occur after exposure to certain types of radiation, such as working in a nuclear facility or heavy microwave use.

In addition to the above classifications, Cataracts can also be classified by the portion of the lens that they obstruct. These classifications are as follows:

  • Subcapsular Cataracts are found at the back portion of the lens and are also usually secondary cataracts- resulting from another condition such as Diabetes, steroid use or inflammation of the eye. This type of Cataract directly blocks the flow of light into the retina and is characterized by difficulty seeing in bright light or sunlight, but better vision in the dusk or dark. However, it can cause a glare to emit from lamps or bright lights that shine at night. In addition, a person with a Subcapslar Cataract may have problems reading.
  • Nuclear Cataracts initially form in the center or “nucleus” of the lens. Because of its position, a Nuclear Cataract may at first make an individual more nearsighted, but as the Cataract thickens and spreads, overall vision is impaired. Nuclear Cataracts can cause problems with color identification and cause double vision.
  • Cortical Cataracts develop as thin streaks on the outer ring of the lens and slowly progress inwards. Eventually Cortical Cataracts can cause glare, as the light is sent to the retina in a fractured manner.

Symptoms of Cataracts

Cataract symptoms vary depending on the type and stage of progression. For many individuals, symptoms will not be evident for months or years because of the ways and speed that many Cataracts form. However, below are the most common types of symptoms for initial and progressive Cataracts:

  • Feeling as if you are looking through dirty eyeglasses
  • Blurred or cloudy vision
  • Poor night vision
  • Frequent changes in glasses prescription
  • Sudden improvement in sight, followed by a decline
  • Problems reading small print in books on the computer screen
  • Problems seeing colors crisply and clearly
  • Colors have a yellowish or brownish tint
  • Angles and shadows of objects are blurred
  • A glare when looking directly at light, including the sun, lamps and headlights
  • Difference in sight in one eye, as opposed to the other

Causes of Cataracts

The lens of the eye contains protein. When the protein molecules begin to clump together and form a coating, it is classified as a Cataract. Over time, this coating can become thicker and spread across the entire lens, causing partial or full vision impairment.

Depending on the circumstance of the patient, there are a number of possible causes of Cataracts, including:

  • Aging
  • Diabetes
  • Hypertension
  • Eye Injury
  • Family Genetics
  • Exposure to radiation
  • Excessive ultra violate light
  • Cosmic radiation as experienced by airplane pilots and astronauts or other radiation exposure
  • Steroid use
  • Smoking
  • Heavy alcohol consumption
  • Longtime use of tranquilizers

If you are experiencing vision impairment, make sure to inform your doctor of any other health issues you may have. This can often provide much needed insight and speed treatment and recovery.

Diagnosing Cataracts

There are a number of means to diagnose Cataracts. The most common tests are:

A Visual Acuity test is a standard eye exam which measures the effectiveness of your sight from different distances. The standard Snellen chart is used and is approximately fifteen to twenty feet away from the patient. The doctor may ask you to cover one eye while reading the chart or have you read the letters through a series of lenses designed to simulate different types of vision.

In a Retinal Dilation exam, special drops are placed in the eyes that cause the retina to dilate considerably. The doctor can then examine the retina for signs of Cataract formation or other damage. In addition, the doctor examines the optic nerve, which sends signals to the brain that become images. A conclusive diagnosis may be made after a retinal dilation exam, or point to the need for additional testing.

For a Slit Lamp test, the eyes are also dilated, however the doctor will use a special tool called an Ophthalmoscope to view the eye. The Ophthalmoscope projects a beam of light in a vertical slit upon the eye. This tool provides a 3D picture of the eye and aids in Cataract detection.

Tonometry, also known as the Intraocular Pressure uses various means to test fluid pressure around the eye. One means is by injecting air into the eye, while other methods involve a prism or electrical indention. Tonometry testing aids in the diagnosis of Cataracts, as well as other eye conditions such as Glaucoma.

A Glare test is almost identical to a standard visual acuity test, except that a light is shone into the eye while trying to decipher the letters on the wall. This test evaluates whether your vision is impaired at night or when faced with objects that can cause a glare, such as oncoming headlights. A problem with glare is often the first complaint in someone with developing Cataracts.

A Contrast Sensitivity test measures an individuals “contrast sensitivity function”, which is the ability to see objects at different shapes and levels of contrast. Requiring a high level of contrast in order to see an image or letter clearly may be indicative of Cataracts.

Once a definitive diagnosis is made, as well as the type of Cataract identified, a treatment plan can be developed.

Treatment of Cataracts

Mainstream medicine states that there is no cure for Cataracts other than surgery to remove the clouded lens. However, as Cataracts are not dangerous to your health, most practitioners will advise the patient to delay surgery until and if the Cataracts have begun to affect their vision dramatically. This may mean having trouble reading, feeling unsafe driving and objects becoming blurry, causing possible falls and accidents. It is important to discuss your vision with your doctor and come to a decision regarding surgery that both you and he are comfortable with.

Cataract surgery is performed on over 3million people annually in the US, with a 98% success rate, with over 99% of patients reporting no serious side affects. The surgery is relatively routine and takes approximately 30 minutes to perform.

Cataract Surgery Video:

Before Surgery

Immediately before the operation, which is performed by an Ophthalmologist, the patient will undergo a series of tests to confirm the level of vision, measure the surface of the eye and select the correct lens. Note that if the patient has Cataracts in both eyes, only one eye will be operated on at time, with a second procedure scheduled within 3-4 weeks.

In preparation for the actual surgery the eye is dilated with a liquid solution and the patient may receive a local anesthetic injection to numb the eye area. Drops may also be used as an alternative anesthetic. The patient will be fully awake during surgery, but will not be able to clearly see what is going on around them due to the dilation and anesthesia. The doctor and surgical instruments will likely seem very blurred and only light will be visible.

Cataract Surgery

In Cataract surgery, the lens of the eye is removed and replaced with a synthetic lens made of plastic called an intraocular lens. The Ophthalmologist will work with a high resolution magnifying system to see all areas of the eye. During surgery, a small incision is made and the lens is usually removed by means of Phacoemulsification-using high frequency energy to break up the lens for removal. The lens is encased in a transparent envelope called the lens capsule, which is cut open to remove the lens. Once the shattered lens is suctioned out of the capsule the replacement lens is then inserted in its place.

Another rarely performed Cataract Surgery is Intracapsular Cataract Extraction, which removes the lens capsule, as well as the lens. However, due to the larger incision needed and the possible complications, this form has largely been replaced by Phacoemulsification.

Recovering from Surgery

After surgery the eye will be examined to ensure that it is functioning properly and vision is clear. The affected eye will then be covered by gauze to allow it to rest and allow the lens transplant to settle. The dressing can usually be removed by the next day. While the surgery is painless, as the anesthesia wears off the patient may experience some pain and discomfort. Some are able to tolerate the discomfort well, but others may require an over the counter pain killer. Rarely, a prescription strength pain medication may be necessary. The eye may be red or bruised right after surgery, but should recover quickly.

Because the eye has to heal and adjust, it may take a week or two to have the vision completely normalize. The doctor will likely prescribe eye drops which will reduce the risk of infection, as well as a solution to reduce swelling. During the healing period, avoid eye makeup, swimming, heavy lifting and rubbing your eye. You should sleep with an eye patch to avoid irritating the eye. Complete healing should be complete within a few weeks, but if a surgery is schedule for the opposite eye, vision will be uneven until the second operation.

Risks of Surgery

All surgery comes with potential risks. In the case of Cataract surgery, they are relatively few but do include:

  • Capsule Opacification, which is the thickening of the lens capsule (which holds the actual lens), which can cause cloudiness and a perception that the Cataract has returned. This can occur anytime after surgery and can be easily corrected by laser surgery.
  • Detachment of the Retina is a very serious condition and can result in blindness if not reattached quickly. Symptoms of a detached retina can include seeing flashes of lights, floaters and spots.
  • Incorrect positioning of the Lens can cause vision problems including double vision. Additional surgery is required to correct the positioning.
  • Rupture of the Lens Capsule, which requires additional surgery
  • Infection of the eye will require antibiotics
  • Eye Swelling can be treated with anti-inflammatory eye drops

Surgery Outcomes

Cataract surgery is one of the most successful and least complicated surgeries performed today. Less than three percent of patients experience any side affects and most individuals experience minor pain or discomfort, which is easily managed with over the counter pain medication. For individuals who have surgery, vision is usually completely corrected. Ninety percent of patients report improved vision and Cataracts do not return after surgery. However, if the patient has another eye condition, such as Glaucoma, they may still experience some symptoms.

Alternative Treatment for Cataracts

Cataracts identified in the early stages may be corrected by natural means. Anecdotal evidence has show the effectiveness of the following in arresting Cataract progression, or even reversing the condition:

  • Eliminate milk, as it promotes Cataract growth
  • Eliminate sugar in all of its forms, including very sweet fruits
  • Add vitamin C to the diet, as it attacks free radicals and has been shown to help dissolve Cataracts
  • Regulating blood sugar to avoid the progression of diabetes, which can stimulate Cataract formation
  • Adding Vitamin E and Selenium to your supplement regimen
  • Consume colorful vegetables high in antioxidants
  • Supplement with Glutathione, which has been seen to be deficient in those with senile Cataracts
  • Wear a hat and sunglasses that block UV light
  • Avoid radiation from microwave ovens and other sources
  • Traditional Chinese Medicine states that Cataracts are a result of liver and kidney imbalance and offers herbal blends to restimulate those organs

References

Photos

The eye & I
Jonathan
Medically trained in the UK. Writes on the subjects of injuries, healthcare and medicine. Contact me jonathan@cleanseplan.com

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