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Cataract

Cataract

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Published by: carls burg a. resurreccion on Dec 26, 2009
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07/23/2013

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CATARACTS

DEFINITION A cataract is a clouding of the eye's natural lens, which lies behind the iris and the pupil. The lens works much like a camera lens, focusing light onto the retina at the back of the eye. The lens also adjusts the eye's focus, letting us see things clearly both up close and far away. The lens is mostly made of water and protein. The protein is arranged in a precise way that keeps the lens clear and lets light pass through it. But as we age, some of the protein may clump together and start to cloud a small area of the lens. This is a cataract, and over time, it may grow larger and cloud more of the lens, making it harder to see. Researchers are gaining additional insights about what causes these specific types of proteins (crystallins) to cluster in abnormal ways to cause lens cloudiness and cataracts. One recent finding suggests that fragmented versions of these proteins bind with normal proteins, disrupting normal function. Cataracts are classified as one of three types:

A subcapsular cataract begins at the back of the lens. People with diabetes, high farsightedness or retinitis pigmentosa, or those taking high doses of steroids, may develop a subcapsular cataract. A nuclear cataract is most commonly seen as it forms. This cataract forms in the nucleus, the center of the lens, and is due to natural aging changes. A cortical cataract, which forms in the lens cortex, gradually extends its spokes from the outside of the lens to the center. Many diabetics develop cortical cataracts.

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SIGNS AND SYMPTOMS As a cataract becomes more opaque, clear vision is compromised. A loss of visual acuity is noted. Contrast sensitivity is also lost, so that contours, shadows and color vision are less vivid. Veiling glare can be a problem as light is scattered by the cataract into the eye. A contrast sensitivity test should be performed and if a loss in contrast sensitivity is demonstrated an eye specialist consultation is recommended. In the developed world, particularly in high-risk groups such as diabetics, it may be advisable to seek medical opinion if a 'halo' is observed around street lights at night, especially if this phenomenon appears to be confined to one eye only.

CAUSES Cataracts develop from a variety of reasons, including long-term exposure to ultraviolet light, exposure to radiation, secondary effects of diseases such as diabetes, hypertension and advanced age, or trauma (possibly much earlier); they are usually a result of denaturation of lens protein. Genetic factors are often a cause of congenital cataracts and positive family history may also play a role in predisposing someone to cataracts at an earlier age, a phenomenon of "anticipation" in pre-senile cataracts.

Cataracts may also be produced by eye injury or physical trauma. A study among Icelandair pilots showed commercial airline pilots are three times more likely to develop cataracts than people with non-flying jobs. This is thought to be caused by excessive exposure to radiation coming from outer space. Cataracts are also unusually common in persons exposed to infrared radiation, such as glassblowers who suffer from "exfoliation syndrome". Exposure to microwave radiation can cause cataracts. Atopic or allergic conditions are also known to quicken the progression of cataracts, especially in children. Cataracts may be partial or complete, stationary or progressive, hard or soft. Some drugs can induce cataract development, such as corticosteroids and Ezetimibe and Seroquel. There are various types of cataracts, e.g. nuclear, cortical, mature, and hypermature. Cataracts are also classified by their location, e.g. posterior (classically due to steroid use) and anterior (common (senile) cataract related to aging). PATHOPHYSIOLOGY Among the transparent tissues of the eye, the lens is a rather bradytrophic compartment having a relatively xenobiotic metabolism. It is composed of specialized proteins, whose optical properties are dependent on the fine arrangement of their threedimensional structure and hydration. Protein-bound SH-groups of the crystallins are protected against oxidation and cross-linking by high concentrations of reduced glutathione. Their molecular composition as well tertiary and quaternary structures provide a high spatial and timely stability (heat-shock proteins) especially of the larger crystallins, who are able to absorbed radiation energy (shortwave visible light, ultraviolet and infrared radiation) over longer time periods without basically changing their optical qualities. This provides considerable protective function also for the activity of various enzymes of the carbohydrate metabolism. The glucose metabolic pathway is functioning rather anaerobically with low energetic efficiency; nevertheless it has to provide the metabolic energy for protein synthesis, transport and membrane synthesis. In addition, the syncytial metabolic function of the denucleated fiber cells has to be maintained by the epithelium and the small group of fiber cells, which still have their metabolic machinery. This results in a steep inside-out metabolic gradient, which is complicated by the fact that the lens has a kind of repair system shutting of damaged groups of fiber cells (wedge- or sectorial cataracts). All epithelial cells of the lens are subjected to light and radiation stress leading to alterations of the genetic code. Because defective cells cannot be extruded, these are either degraded (apoptosis, necrosis), or they are moved to the posterior capsular area, where they contribute to the formation of posterior subcapsular cataracts. Ageing generally reduces the metabolic efficiency of the lens thus increasing its susceptibility to noxious factors. Ageing provides the grounds where cataract noxae can act and interact to induce the formation of a variety of cataracts, many of them being associated with high protein-related light scattering and discoloration. TREATMENT

Cataract surgery, using a temporal approach phacoemulsification probe (in right hand) and "chopper" (in left hand) being done under operating microscope. When a cataract is sufficiently developed to be removed by surgery, the most effective and common treatment is to make an incision (capsulotomy) into the capsule of the cloudy lens in order to surgically remove the lens. There are two types of eye surgery that can be used to remove cataracts: extra-capsular (extracapsular cataract extraction, or ECCE) and intra-capsular (intracapsular cataract extraction, or ICCE). Extra-capsular (ECCE) surgery consists of removing the lens but leaving the majority of the lens capsule intact. High frequency sound waves (phacoemulsification) are sometimes used to break up the lens before extraction. Intra-capsular (ICCE) surgery involves removing the entire lens of the eye, including the lens capsule, but it is rarely performed in modern practice. In either extra-capsular surgery or intra-capsular surgery, the cataractous lens is removed and replaced with a plastic lens (an intraocular lens implant) which stays in the eye permanently. Cataract operations are usually performed using a local anaesthetic and the patient is allowed to go home the same day. Recent improvements in intraocular technology now allow cataract patients to choose a multifocal lens to create a visual environment in which they are less dependent on glasses. Under some medical systems multifocal lenses cost extra. Traditional intraocular lenses are monofocal. Complications are possible after cataract surgery, including endophthalmitis, posterior capsular opacification and retinal detachment. In ICCE there is the issue of the Jack in the box phenomenon [14] where the patient has to wear aphakic glasses—alternatives include contact lenses but these can prove to be high maintenance, particularly in dusty areas.

Hazy or blurred vision may mean you have a cataract.

Magnified view of cataract in human eye, seen on examination with a slit lamp using diffuse illumination

Bilateral cataracts in an infant due to Congenital rubella syndrome

Slit lamp photo of anterior capsular opacification visible a few months after implantation of Intraocular lens in eye, magnified view

Slit lamp photo of posterior capsular opacification visible a few months after implantation of Intraocular lens in eye, seen on retroillumination

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