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Age Related Cataract and its Management

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Age Related Cataract and its Management

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Age-related cataract is the most common cause of blindness that can be prevented. Learn about its causes and treatment options.

Medically reviewed by

Dr. Infanteena Marily F.

Published At December 3, 2014
Reviewed AtAugust 4, 2023

Introduction

A cataract is a decrease in transparency of the natural crystalline lens present in the eye. The lens of the eye is normally clear and helps focus light onto the retina at the back of the eye. However, with age the lens can become less flexible and more opaque, leading to the development of a cataract. This can cause vision to become blurry, hazy, or distorted, and can make it difficult to see in dim light.

What Is an Age-Related Cataract?

Age-related cataract is a condition that affects the lens of the eye causing it to become cloudy or opaque. It is a common cause of vision loss among older individuals and is gradual and progressive. It affects both eyes and may not develop at the same time and rate in both eyes. Age-related cataract is also known as senile cataract.

What Are the Causes of Age-Related Cataracts?

Age-related cataracts are caused by changes in the protein structure within the lens of the eye. These changes can cause the lens to become less transparent and can result in the development of cloudy areas. Factors that contribute to the development of age-related cataracts include:

  • Aging causes the protein in the lens of the eye to clump together and cause cloudy areas.

  • Exposure to ultraviolet radiation from sunlight or a tanning bed can damage the cells in the eye and increase the risk of cataract formation.

  • Smoking.

  • Diabetes changes the metabolism of glucose in the lens of the eye increasing the risk of cataract formation.

  • People who are genetically predisposed or have a family history.

  • Long-term medications like corticosteroids or statins increase the risk of cataracts.

  • Eye injury or inflammation.

  • Other medical conditions like high blood pressure or obesity, may increase the risk of developing cataracts.

What Are the Signs and Symptoms of Age-Related Cataracts?

  • Blurred or Hazy Vision - Vision may be cloudy or blurry, making it difficult to see clearly. The haziness develops gradually.

  • Sensitivity to Light - Bright lights may appear overly intense, causing glare or halos around lights.

  • Poor Night Vision - Night vision may be particularly affected, making it difficult to see in dimly lit environments.

  • Double Vision - Images may appear to be doubled or overlapped.

  • Fading or Yellowing of Colors - Colors may appear faded or yellowed, and maybe less vibrant than they once were.

  • Need for Frequent Prescription Changes - Changes in vision may require frequent changes to eyeglasses or contact lens prescriptions.

  • Difficulty Reading or Performing Close-up Tasks - It may be difficult to read or perform tasks that require close-up vision, such as sewing or reading.

How Are Age-Related Cataracts Diagnosed?

The diagnosis of age-related cataracts typically involves a comprehensive eye exam which may include the following:

  • Visual Acuity Test - This test measures how well a person can see at various distances using an eye chart.

  • Dilated Eye Exam - Eye drops are used to dilate the pupils, allowing the doctor to examine the lens and other parts of the eye more closely. After dilation nuclear size and brunescence (discoloration of the nucleus) are examined. The ocular adnexa and intraocular structures are also examined.

  • Slit-Lamp Exam - This exam uses a special microscope and a slit of light to examine the structures of the eye, including the lens. The cataract can be staged based on the appearance of the lens during this examination as follows

    • Hypermature cataract.

    • Mature cataract.

    • Immature cataract.

    • Incipient cataract.

  • Swinging Flashlight Test - This is done to detect a relative afferent pupillary defect (RAPD) or a Marcus Gunn pupil. This indicates the presence of optic nerve lesions or severe retinal involvement.

  • Tonometry - This test measures the pressure inside the eye, which can help detect signs of glaucoma.

  • Retinal Exam - This is done to look at the back of the eye, including the retina, to check for any signs of damage or disease.

If cataracts are detected, the doctor may perform additional tests to determine the severity and location of the cataract and help determine the best course of treatment.

How Are Age-Related Cataracts Managed?

  • If the cataract is not yet mature it can be managed temporarily using better reading glasses and increased lighting.

  • Preventive measures like sunglasses, managing medical conditions, and limiting alcohol and smoking can be done to slow down or prevent its progression.

  • If the cataract has become mature there is no other option but surgical management.

  • The surgical management is called lens extraction, in which the cloudy lens is removed and replaced with a clear artificial lens called the intraocular lens. The following are the various surgical methods that are done

    • Extracapsular Cataract Extraction - This is the procedure of choice and involves the extraction of the lens through an opening in the anterior capsule. The integrity of the posterior capsule is retained. This procedure is rarely done in recent times.

    • Intracapsular Cataract Extraction - This technique is not used in recent days since it is associated with many complications. In this technique, the entire lens along with the posterior capsule and the zonules are removed.

    • Phacoemulsification - This is a type of cataract surgery that is commonly used to remove age-related cataracts. It involves using ultrasonic waves to break up the cloudy lens into small pieces, which are then suctioned out through a tiny incision in the eye. This procedure is performed using local anesthesia and as an outpatient surgery. The patient is monitored for a short period and then discharged.

    • Laser Phacolysis - This is a newer technique that is also known as laser-assisted cataract surgery. It involves using a laser to create an incision in the eye and soften the cloudy lens, making it easier to remove.

    • Intraocular Lens Implantation - All these above-said procedures are used in combination with intraocular lens implantation. This refers to the placement of a clear artificial lens in place of the cloudy lens that was extracted.

What Are the Complications of Cataract Surgery?

  • Swelling and redness in the eye.

  • Swelling of the retina (cystoid macular edema).

  • Swelling of the cornea which usually clears itself and is characterized by the fluid buildup in the cornea at the front of the eye.

  • Retinal detachment is a rare but serious complication in which the retina may separate from the inner wall of the eye.

  • Infections in the eye (endophthalmitis).

  • Secondary cataract.

  • Glaucoma.

  • Posterior capsule opacification is a condition in which the thin membrane that surrounds the artificial lens becomes cloudy, causing vision to become blurry.

Conclusion

If a cataract is neglected, apart from vision loss, the patient can develop complications like lens-induced glaucoma which can further lead to corneal edema, severe pain, and irreversible optic nerve damage. As cataract gets older it can lead to poor surgical outcome due to a high rate of surgical complications and the visual outcome may not be satisfactory. So it is advisable to seek the ophthalmologist at the earliest to get the best outcome with minimal complications.

Frequently Asked Questions

1.

What Are the Different Types of Cataracts?

The different types of cataract are:
- Nuclear cataracts.
- Posterior subcapsular cataracts.
- Cortical cataracts.
- Congenital cataracts.

2.

Is It Possible to Cure Cataract Without Surgery?

There is no proper way to cure cataracts without any surgical intervention. The progression of the condition can be fast or slow, and it is often unpredictable. Maintaining a healthy lifestyle by performing eye exercises can help overcome the condition of cataracts to a certain extent.

3.

Is Permanent Cure Possible for Cataract?

Yes, cataracts can be cured. Cataracts require some treatment options for recovery. It cannot be reversed on its own. Surgical options and lasers are the most recommended treatment options.

4.

When Is the Right Time to Go for Cataract Surgery?

When an individual experiences blurring of the vision, then it is an indication that the patient might require surgery in the near future. The daily activities of the individual might get affected due to impairment of the vision, and that might be the right time to seek medical help. If the patient has a cataract in both eyes, the eye that is having more severity is treated first.

5.

How Fast Will a Cataract Progress?

The progression of the cataract depends on the type. A few types of cataract have the tendency to progress rapidly and causes blurring of the vision within a short period of time. Other types of cataracts progress very slowly, and the patient requires treatment only after one or two years.

6.

Is Cataract Surgery a Painful Procedure?

Cataract surgery is not a painful procedure. The patient will be given anesthesia before the initiation of the surgical procedure. After a few hours, the effect of anesthesia will subside, and the patient will not feel any numbness. The discomfort experienced by the patient will stop after one or two days.

7.

Is It Advisable to Treat Cataract in an Earlier Stage?

If the cataract develops into a more advanced stage, then the time taken for recovery is also prolonged. So, if the condition is treated early, the complications of visual impairment can be prevented. It is always a better option to treat the condition of cataracts in the initial stages itself.

8.

What Are the Tips to Be Followed After Cataract Surgery?

- After cataract surgery, you are advised not to lift heavy weight. You should also avoid creating pressure on your eyes by watching television and playing video games. Try to avoid sneezing.
- You are advised to take sufficient rest after the surgery. Do not wear makeup or use shampoo products. It is also good to avoid activities like swimming and driving.

9.

Which Is the Correct Age for Cataract Surgery?

Most of the patients require cataract surgery only after the age of 40. The occurrence of cataracts in young patients is very rare. Cataract surgery is not performed depending on the age but on the extent of the severity of that condition. If younger patients are affected by cataracts, then there are no specific complications for cataract surgery.

10.

What Is the Recent Treatment Option for Cataracts?

The latest treatment for cataracts is intraoperative wavefront aberrometry. After the removal of the cataract, the refractive errors in the eye can be treated in the later stages. The appropriate power of the lens is adjusted so that the individual can correct their vision after the completion of the surgery.

11.

What Are the Preventive Measures for Cataract?

Preventive measures for cataracts are not much difficult to incorporate into a lifestyle.
- Avoid steroid eye drops.
- Live a healthy lifestyle.
- Prolonged exposure to UV light must be avoided.
- Consider cataract surgery.
- Check side effects of the medications provided.

12.

What Happens if a Cataract Is Left Untreated?

If the cataract is not treated properly, it might result in blindness in some patients. The blurring of the vision will prolong until the patient undergoes proper treatment for it. The pressure in the eyes also keeps increasing. It can also result in infection, bleeding, and inflammation of the eyes.
Dr. Anand Yattinamani
Dr. Anand Yattinamani

Ophthalmology (Eye Care)

Tags:

blurred visionphacoemulsification cataract extraction
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