Cataract Awareness Symptoms, Diagnosis, and Treatment

Understanding what is cataract

A cataract is a clouding of the eye’s natural lens, which lies behind the iris and the pupil. This clouding can cause vision to become blurry, dim, or less colourful, making it difficult to see clearly. Cataracts often develop slowly and are more common as people age. Over time, they can interfere with daily activities like reading, driving, or recognizing faces. Treatment usually involves surgery to remove the cloudy lens and replace it with an artificial one, restoring clear vision.
Recognize the symptoms of Cataracts

• Blurry or cloudy vision
• Fading or yellowing of colours
• Increased sensitivity to light and glare
• Difficulty seeing at night
• Double vision in one eye
• Frequent changes in eyeglass or contact lens prescription

What causes cataracts?

Cataracts occur when proteins in the eye’s lens clump together, leading to clouding and vision impairment. Factors contributing to this process include aging, injury, and medical conditions such as diabetes.

How cataracts form?

The lens of the eye is mostly water and proteins arranged in a precise way to keep the lens clear and let light pass through. With age, these proteins may break down and clump together, forming a cataract that clouds small areas of the lens. Over time, the cataract may grow larger and cloud more of the lens, making it harder to see.
Types of cataracts

1. Nuclear Cataracts: Form in the centre of the lens and often cause the lens to yellow or brown.
2. Cortical Cataracts: Begin at the edges of the lens and move toward the centre, creating a spoke-like appearance.
3. Posterior Subcapsular Cataracts: Form at the back of the lens, often affecting reading vision and causing glare.
4. Congenital Cataracts: Present at birth or develop during childhood, possibly due to genetic factors or infections during pregnancy.

Risk factors for cataracts
Several factors increase the risk of developing cataracts:
• Age: Most common in older adults.
• Diabetes: Higher risk due to changes in blood sugar levels.
• Smoking and alcohol use: Both increase the likelihood of cataract formation.
• Prolonged sun exposure: UV radiation can contribute to cataract development.
• Family history: Genetics play a role in cataract susceptibility.
• Previous eye injury or surgery: Can lead to cataract formation.

How to prevent cataracts

While some risk factors like age cannot be avoided, there are steps you can take to reduce your risk of cataracts:
• Regular eye exams: Early detection and monitoring can help manage cataract development.
• Healthy diet: Consuming fruits and vegetables rich in antioxidants can support eye health.
• Wear sunglasses: Protect your eyes from harmful UV rays.
• Quit smoking: Reduces your risk of cataracts and other health issues.
• Limit alcohol consumption: Moderate your intake to lower the risk.
• Manage health conditions: Keep conditions like diabetes under control to prevent cataract formation.
Diagnosis of cataracts

Cataracts are typically diagnosed through a comprehensive eye exam. Here’s what you can expect during the diagnostic process:

1.Visual acuity test: This test measures how well you can see at various distances, using an eye chart to check for vision impairment.
2. Dilated eye exam: Your eye doctor will use special drops to widen your pupils. This allows a closer examination of the lens and retina to check for signs of cataracts and other eye conditions.
3. Slit-Lamp examination: A specialized microscope illuminates and magnifies the structures at the front of your eye, making it easier to detect abnormalities.
4. Retinal exam: Using the slit lamp or an ophthalmoscope, your doctor examines the back of your eye (retina) to assess for any cataract formation or other issues.
5. Tonometry: This measures the pressure inside your eye, which can be affected by cataracts or other eye conditions.

Treatment and management of cataracts

The treatment approach for cataracts depends on the severity of the condition and how much it affects your vision and daily activities.

Non-surgical management
In the early stages, when cataracts cause only minor vision problems, the following strategies can help manage symptoms:

• Updated eyeglasses or contact Lenses: Improved prescriptions can help you see better.
• Magnifying glasses: Useful for reading small print.
• Better lighting: Brighter lights can help reduce vision problems.
• Anti-Glare sunglasses: Can reduce sensitivity to bright lights and glare.

Surgical treatment
When cataracts significantly impair vision and interfere with daily activities, surgery is often the recommended treatment. Cataract surgery is a common and generally safe procedure. There are two main types of cataract surgery:
1. Phacoemulsification (Phaco): A small incision is made in the eye, and an ultrasound device breaks up the cloudy lens. The pieces are then removed, and an artificial intraocular lens (IOL) is implanted.
2. Extracapsular cataract extraction: A larger incision is made to remove the cloudy lens in one piece. An IOL is then implanted. This method is less common and typically used for advanced cataracts.

Post-surgery care
• Follow-up visits: Regular check-ups with your eye doctor to monitor healing and address any complications.
• Medications: Prescribed eye drops to prevent infection and reduce inflammation.
• Avoiding strenuous activities: Protecting your eyes from injury and strain during the healing process.

Research insights from Sri Lanka

Prevalence and risk factors

The Kandy Eye Study by Athanasiov, et al. (2010) looked closely at how common cataracts are in central Sri Lanka. They surveyed 1,375 people aged 40 and older and found that 33.1% had some form of cataract, including those who had surgery. The study showed no strong link between cataracts and gender, smoking, or outdoor work. However, it found that people with lower education levels and shorter height were more likely to develop cataracts.
Another study by Nishad, et al. (2019) focused on older people and found that 80.6% of those over 60 had cataracts. It also noted that younger women were more likely to have cataracts, highlighting the need for special screening programs for women to catch and treat cataracts early.

Barriers to treatment

Even though free cataract treatment is available in Sri Lanka, many people don’t use these services, leading to ongoing vision problems or blindness. Nishad et al. (2019) found that barriers to treatment among the elderly include a lack of awareness, financial difficulties, and misunderstandings about cataracts and their treatment. Overcoming these barriers is essential to increase the number of people getting cataract surgery and reduce blindness.

Impact on quality of life

Cataracts greatly affect the quality of life, especially for older people. Nanayakkara (2009) studied the quality of life related to vision in elderly people in the Gampaha District. The study found a 56% cataract prevalence, with major risk factors being age, gender, job exposure, lower social class, chronic illnesses, and smoking. It validated the National Eye Institute Visual Functioning Questionnaire (NEI-VFQ) for use in Sri Lanka and found that elders with cataracts had a much lower quality of life. These results highlight the need for effective public health strategies to manage and prevent cataracts, improving the well-being of older people.

Outcomes of cataract surgery

Cataract surgery coverage and visual outcomes are important measures of the success of treatment programs. Murthy et al. (2018) conducted a national survey and found that out of 5,779 participants, 345 had undergone cataract surgery, with a high coverage rate of 85.4% for severe vision impairment (vision <3/60). The results were mostly positive, with 59.7% of eyes achieving good visual outcomes at the first check-up, improving to 75.1% with correction. However, there were disparities in surgical coverage, with lower rates in underserved provinces and among poorer groups. This shows the need for targeted actions to ensure everyone in the country has fair access to cataract surgery.

If you notice any of these symptoms or experience sudden changes in your vision, consult an eye care professional. Early detection can help manage the condition more effectively.
Stay proactive about your eye health and keep your vision clear!

References

Athanasiov, P. et al., 2010. Cataract in Central Sri Lanka: Prevalence and Risk Factors from the Kandy Eye Study. Ophthalmic epidemiology, Volume 17, pp. 34-40.
Murthy, G. V. S. et al., 2018. Prevalence and visual outcomes of cataract surgery and cataract surgical coverage in Sri Lanka: findings from the National Blindness and Visual Impairment Survey. Ceylon Medical Journal, 63(5), pp. 18-25.
Nanayakkara , S. D., 2009. Vision-Related Quality of Life Among Elders With Cataract in Sri Lanka: Findings From a Study in Gampaha District. Asia Pacific Journal of Public Health, 21(3), pp. 303-311.
Nilanga Nishad, A. et al., 2019. Cataract among elderly in Sri Lanka. bioRxiv.