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Cataracts in the Elderly

What is a cataract?

A cataract is a condition where there is clouding of the naturally clear lens of the eye leading to blurred vision. Cataract usually occurs with aging but sometimes certain drugs (steroids), trauma and other associated disease like diabetes may lead to cataracts in early life. A cataract is one of the main cause of age-related vision problems. Surgery is done to restore vision where the opaque lens is replaced with an artificial one.

Cataract Symptoms

The symptoms tend to develop gradually and progress over time. Usually after 60 years, a cataract starts to develop in most seniors and by the age of 75 years the symptoms become prominent. These symptoms include :

  • Blurred and diminished vision.
  • Intolerance to light and glare.
  • Seeing rainbow colored “halo” around light source.
  • Double vision.
  • Problem in seeing different shapes and distinguishing between shapes.
  • Problem in seeing in dim light and at night.

Causes of Cataracts

The colored portion of the eye covered by the transparent cornea consists of the iris (colored) and the tiny aperture in the iris (pupil). The natural lens is present behind the pupil suspended by fibers (zonules) in correct position. The lens, consisting of transparent lens proteins, focuses the light on the retina (light sensitive layer on the back of the eye ball) and produces a sharp image for visual acuity. Th cataract scatters the light and prevents formation of sharp images on the retina thereby blurring the vision. Sometimes a cataract can affect both the eyes simultaneously. Risk factors associated with cataracts include :

  • Old age
  • Diabetes
  • Alcoholism
  • Smoking
  • High blood pressure
  • Long term exposure to UV light (astronauts, pilots are more prone to develop early cataract), ionizing radiation, infra-red radiation (glassblowers) and even microwave radiation.
  • Trauma.
  • Simultaneous allergic condition may hasten the development of cataract especially in children.
  • Drug induced cataracts may develop with long-term steroid and antipsychotic drugs (like quetiapine).
  • Prior eye surgery.
  • Family history.

Types of Cataracts

There are various types of cataract.

  • Nuclear cataract affects the middle (central) portion of the lens. With this type of cataract the person becomes nearsighted. With time the opacity of the lens become denser with brown or yellowish discoloration. Multiple images and double vision are usually associated with a nuclear cataract.
  • Cortical cataract affects the outer part of the lens (edges). It begins with whitish streaks of opacity starting at the border and slowly progressing towards the center. Sensitivity to glare is commonly associated with this type of cataract.
  • Posterior subcapsular cataract affects the posterior (back) portion of the lens obstructing the passage of light through the lens to the retina. Poor reading vision, difficult vision in bright light are the common symptoms of this type of cataract.
  • Congenital cataract are cataracts that are present since birth or develop during early childhood.

Cataract Treatment

Surgery is the only effective treatment for a cataract. In the past,  surgery was done only for a matured cataract but these days with improved technology surgery is recommended earlier usually by the time when the cataract affects daily activities. The surgery is done in an out-patient setting and usually a patient is released from the hospital immediately after operation provided that there are no complications during surgery.

Two types are cataract surgery are performed to remove the lens and an artificial lens is then inserted.

  • Phacoemulsification (most preferred) is where sound waves are used to break the lens into tiny pieces.
  • Extra-capsular cataract extraction (ECCE) is where the lens is removed manually.

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