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What is Cataract?
g ‘ 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.

g Cataracts are classified as one of three types:

M ‘ „
„   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.
M ‘ ñ   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.
M ‘  
 , which forms in the lens cortex, gradually extends its spokes
from the outside of the lens to the center. Many diabetics develop cortical cataract

What are the clinical manifestations of Cataract?

M Clouded, blurred or dim vision
M ncreasing difficulty with vision at night
M 0ensitivity to light and glare
M 0eeing "halos" around lights
M ^requent changes in eyeglass or contact lens prescription
M ^ading or yellowing of colors
M Œouble vision in a single eye
g ‘t first, the cloudiness in your vision caused by a cataract may affect only a small part of
the eye's lens and you may be unaware of any vision loss. ‘s the cataract grows larger, it
clouds more of your lens and distorts the light passing through the lens. This may lead to
signs and symptoms you're more likely to notice.

Risk ^actors for Cataract ^ormation:

‘ging
M £oss of lens transparency
M Clumping or aggregation of lens protein
M ‘ccumulation of a yellow-brown pigment due to the breakdown of lens protein
M Œecreased oxygen uptake
M ncrease in sodium and calcium
M Œecrease in levels of vitamin C, protein, and glutathione
‘ssociation Ocular Conditions
M Retinitis pigmentosa
M Myopia
M Retinal detachment and retinal surgery
M nfection
Toxic ^actors
M Corticosteroids, especially at high doses and in long-term use
M ‘lkaline chemical eye burns, poisoning
M Cigarette smoking
M Calcium, copper, iron, gold, silver and mercury which tend to deposit in the papillary
area of the lens
Nutritional ^actors
M Reduced levels of antioxidants
M Poor nutrition
M Obesity
Physical ^actors
M Œehydration associated with chronic diarrhea, use of purgatives in anorexia nervosa, and
use of hyper-baric oxygenation
M Blunt trauma, perforation of the lens with a sharp object or foreign body, electric shock
M Ñltraviolet radiation in sunlight and x-ray
0ystemic Œiseases and 0yndromes
M Œiabetes mellitus
M Œown syndrome
M Œisorders related to lipid metabolism
M Renal disorders
M Musculoskeletal disorders

Pathophysiology of Cataract:

Cataracts can develop in one or both eyes at any age for a variety of causes. Recent
studies have linked cataract risk to lower income and educational level, smoking history for 35 or
more pack-years, and high triglyceride levels in men. Visual impairment normally progresses at
the same rate in both eyes over many years or in a matter of months. The three most common
types of senile cataracts are defined by their location in the lens: nuclear, cortical and posterior
subcapsular. The extent of visual impairment depends on their size, density and location in the
lens. More than one type can be present in one eye.

‘ nuclear cataract is caused by central opacity in the lens and has a substantial genetic
component. t is associated with myopia, which worsens when the cataract progresses. f dense,
the cataract severely blurs vision. Periodic changes in prescription eyeglasses help manage this
condition.

‘ cortical cataract involves the anterior, posterior or equatorial cortex of the lens. ‘
cataract in the equator or periphery of the cortex does not interfere with the passage of light
through the center of the lens and has little effect on vision. Cortical cataracts progress at a
highly variable rate. Vision is worse in very bright light. 0tudies show that people with the
highest levels of sunlight exposure have twice the risk of developing cortical cataracts as those
with low-level sunlight exposure.

Posterior subcapsular cataracts occur in front of the posterior capsule. This type typically
develops in younger people and in some cases is associated with prolonged corticosteroid use,
diabetes or ocular trauma. Near vision is diminished, and the eye is increasingly sensitive to
glare from bright light. 0tudies in the Ñnited 0tates have shown that Caucasians are more likely
to develop nuclear and posterior subcapsular cataracts whereas cortical cataracts are more
prevalent among ‘frican ‘mericans. 0ome studies have found that occupational sun exposure in
people between 20-29 years old is associated with nuclear cataract formation.

Œiagnostic 0tudies:
M 0nelllen chart
M Opthalmoscopy
M 0lit-lamp biomicroscopic examination
¬ Ñsed to establish the degree of cataract formation

Treatment ± Medical Management:

Non-surgical
M Medications
M ·yedrops
M ·yeglasses
¬ n early stages of cataract develop, glasses, contact lenses, strong bifocals or
magnifying lenses may improve vision

0urgical
M ntracapsular Cataract ·xtraction
¬ The entire lens (nucleus, cortex and capsule) is removed and fine sutures are used
to close the incision
M ·xtracapsular Cataract ·xtraction
¬ nvolves smaller incisional wounds, less trauma to the eye and maintains the
posterior capsule of the lens, reducing postoperative complications. ‘ portion of
the anterior capsule is removed, allowing extraction of the lens nucleus and cortex
M Phacoemulsification
¬ This method of extra capsular surgery uses an ultrasonic device that liquefies the
nucleus and cortex, which are then suctioned out through a tube
M £ens Replacement
¬ ‘fter removal of the crystalline lens, the patient is referred to as asphakic (without
lens). The lens, which focuses the light on the retina, must be replaced for the
patient to see clearly.
¬ Three lens replacement options:
å ‘phakic glasses
M ·ffective and rarely used. Objects are magnified by 25%, making
them appear closer than they actually are
 å Contact lenses
M Provides patient with almost normal vision, but because contact
lenses need to remove occasionally, the patient also needs a pair of
aphakic glasses. Not advised for patient who have difficulty
inserting, removing and cleaning them. ^requent handling and
improper disinfection can increase risk for infection
å nsertion of O£
M Œuring cataract surgery, it is the usual approach to lens
replacement. ‘fter cataract extraction or phacoemulsification, the
surgeon implants an O£. t is contraindicated in patient with
recurring uveitus, proliterative diabetic retinopathy, neovascular
glaucoma or rebeosis iridis

Patient-teaching:
M Wear glasses or metal eye shield at all times following surgery
M ‘lways wash hands before touching or cleaning the post-operative eye
M Clean post-operative eye with a clean tissue, wipe the closed eye with a single gesture
from the inner canthus outward
M Bathe or shower, shampoo hair continuously or seek assistance
M ‘void lying on the side of the affected eye the night after surgery
M eep activity light. Resume the following activities as directed by the physician
M Remember not to lift, push or pull objects heavier than 15 lbs
M ‘void bending or stooping for an extended period
M Be careful when climbing or descending stairs
M now when to contact the physician

Nursing Œiagnosis:
M Risk for infection
M Risk for visual impairment