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BiologyNotes
OphthalmologyArticles
Revision Notes
/ Biology Notes
/ Ophthalmology
Cataract
Written by: Tay Xue Chao, Brian Diaz from Manchester University,
Introduction
A cataract is opacity within the lens of the eye, and may affect either one or both eyes. The
opacity changes the transparency and refractive index of the lens, resulting in the blurring of a
persons vision. According to the World Health Organisation (WHO, 2007), cataracts account for
47.9% of blindness worldwide. The reported prevalence of childhood cataracts ranges from 115
per 10,000 children.
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TypesofCataract
Nuclear Cataract
Cortical Cataract
Subcapsular Cataract
Aetiology
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RiskFactors
The following are associated with acquired cataract in developed nations:
Pathogenesis
The lens of the eye is composed of specialised cells arranged in a highly ordered and complex
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manner. These cells are stratified epithelia and have a very high content of cytoplasmic protein
the crystallins. These proteins, along with the complex structure, impart transparency to the
lens.
Unlike other epithelia, the lens does not shed nonviable cells. As such, it is particularly
susceptible to the degenerative effects of aging on cell structure. The exact pathogenetic
mechanisms of this are not known. It has, however been observed that most of the risk factors
identified are environmental stressors that lead to the formation of toxins or the impairment of
antioxidants.
ClinicalPresentation:SymptomsandSigns
Cataracts detected in infants and young children must be referred to a specialist as soon
as possible in order to allow for normal visual development and to prevent blindness.
DifferentialDiagnosis
Macular degeneration
Presbyopia
Retinal disease
Retinoblastoma (in children)
Diagnosis
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Slitlampexamination
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including cataract
Posteriorcapsularopacificationonretroilluminationwithslitlamp
Prevention
There is no proven therapy to prevent either cataract formation or its progression once it
has developed. However, the following have been observed to be of benefit in decreasing
risk:
Eating a healthy diet
Eating a diet rich in lutein and zeaxanthin
Smoking cessation
Postmenopausal oestrogen use (longer than 10 years)
Vitamin supplementation
Management
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Phacoemulsion
Most effective
Safest
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Complicationsthatmayresultfromsurgery
Early complications
Late Complications
Postoperative thickening of the lens capsule frequently occurs over time causing gradual
deterioration of vision. This can be treated by splitting the capsule with a laser.
Prognosis
Postoperatively 95% of patients that have no other complications achieve a corrected acuity of
6/12.
The major risk factors that affect prognosis are diabetes and diabetic retinopathy. Diabetes
causes fluctuating blood glucose levels. Occasionally, high blood glucose levels cause
oedema and subsequent swelling of the lens. When the blood glucose diffuses, the swelling in
the lens also reduces. This repeated action causes cataracts.
In paediatric cataracts, visual acuities of 20/20 to 20/40 may be achieved if cataracts are
diagnosed and treated early.
Summary
Cataracts are lens opacities that can range in severity from unnoticed dots to total fogging of
vision. Cataracts are by far the commonest cause of preventable blindness worldwide.
Agerelated causes are most common, although there are also familial or congenital causes.
Gradual painless deterioration of vision is the most common symptom reported, with other
possible coexisting symptoms such as glare and problems with night driving dependent on the
type of cataract.
Early symptoms can be alleviated with spectacles, but to correct vision, surgery is required.
Surgery involves the insertion of an intraocular lens to replace the affected one. The exact
technique used is determined by the aetiology and density of the cataracts. Phacoemulsification
(a form of small incision surgery) is the most frequently used technique. Further investigations
such as blood glucose, serum calcium, and liver biochemistry should be considered in order to
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It is also worth noting that cataracts may not always be bilateral, and hence, eyes may be
managed and treated individually according to the severity of the cataract within each eye.
Usefulresources
Websites:
http://www.cataractdoctor.com/
Videos:
http://www.careflash.com/video/cataracts (http://www.careflash.com/video/cataracts) (Cataracts
explained in lay terms)
http://www.rootatlas.com/wordpress/video/866/cartooncataractsurgeryvideo/
(http://www.rootatlas.com/wordpress/video/866/cartooncataractsurgeryvideo/)
(Cataract surgery, Phacoemulsification) My favourite!
References
Kumar and Clark Clinical Medicine 7th edition
UpToDate articles "Cataract", "Cataract in children", and "Slit lamp examination"
http://www.patient.co.uk/doctor/CataractsandCataractSurgery.htm
(http://www.patient.co.uk/doctor/CataractsandCataractSurgery.htm)
Skills
Eye Examination & Vision Assessment
Identifying and Treating Eye Emerge
Ocular History Taking
Using an Ophthalmoscope
Conditions
Agerelated Macular Degeneration
Allergic Eye Diseases
Blindness: Global Epidemiology
Cataract
Corneal Disorders
Cranial Nerve III, IV and VI Palsies
Eyelid, Orbital and Lacrimal Disorders
Glaucoma
Intraocular Tumours
Ocular Inflammation
Ophthalmic Infections
Ophthalmic Involvement in Systemic Disease
Retinal Detachment
Retinitis Pigmentosa
Retinoblastoma
Retinopathy
Squint
Presentations
Diplopia
Dry Eye
Eyelid Lumps, Bumps and Rashes
Floaters, Flashers and Halos
Foreign Body
Loss of Vision
Ocular Pain and Headaches
Ophthalmic Trauma
Optic Disc Swelling and Optic Atrophy
Orbital Swellings
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