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A cataract is a clouding of the eye's natural lens, which lies behind the iris and the pupil. Inside our eyes, we have a natural lens. The lens bends (refracts) light rays that come into the eye to help us see. The lens should be clear. If you have a cataract, your lens has become cloudy. Things look blurry, hazy or less colorful with a cataract. Cataracts are the most common cause of vision loss in people over age 40 and is the principal cause of blindness in the world.
Though there are other risk factors for cataracts, aging is the most common cause. This is due to normal eye changes that happen after the age 40. The lens is mostly made of water and protein. The protein is arranged in a precise way that keeps the lens clear and lets the light pass through it. But as we age, normal proteins in the lens start to break down and some of the protein may clump together and start to cloud a small area of the lens. This keeps light from passing through clearly. This is a cataract, and over time, it may grow larger and cloud more of the lens, making it harder to see.
Most age-related cataracts develop gradually. Other cataracts can develop more quickly, such as those in younger people or those in people with diabetes.
Besides aging, other cataract risk factors include:
· Family history - having parents, brothers, sisters or other family members who have cataracts
· having certain medical problems, such as diabetes, Hypertension, Obesity
· having had an eye injury, eye surgery, or radiation treatments on your upper body
· having spent a lot of time in the sun, especially without sunglasses that protect your eyes from damaging ultraviolet (UV) rays
· Prolonged use of corticosteroid medications
· Statin medicines used to reduce cholesterol
· Hormone replacement therapy
· Significant alcohol consumption
· High myopia
· Age-related. These form as you get older.
· Congenital. This is what doctors call it when babies are born with cataracts. They may be caused by infection, injury, or poor development in the womb. Or, they can form in childhood.
· Secondary. These happen as a result of other medical conditions, like diabetes. They can also result from being around toxic substances, ultraviolet light, or radiation, or from taking medicines such as corticosteroids or diuretics.
· Traumatic. These form after an injury to the eye.
· Other things that can raise your chances of getting cataracts include cigarette smoke, air pollution and heavy drinking.
Cataracts usually form slowly. You may not know you have them until they start to block light. Then you might notice:
Doctors don’t know exactly what causes cataracts, so there’s no proven way to prevent them. But since cataracts and other conditions, such as glaucoma, are common in older adults, it’s important to get your eyes checked regularly. This is really important if you have a family history of eye problems or have been exposed to things that could cause trouble with your eyes.
Adults should see an eye doctor at least every 2 years until age 50, and then every year after that.
Many people think cataracts only happen to older people, but children can get cataracts too. Both pediatric cataracts and cataracts from aging are a clouding in the lens of the eye that can cause blurry vision or blindness.
In adults, cataracts occur after the eyes and vision are developed and stable. Most adults can have good vision again after the cataracts are removed. Because children's eyes are still developing until they're 8-10 years old, untreated cataracts can have serious long-term effects on their vision. But early detection and prompt treatment can prevent permanent vision loss in children with cataracts.
Understanding pediatric cataract:
Most pediatric cataracts are detected when the child is examined at birth, before they even leave the hospital. Many more are detected by pediatricians at well-baby exams and some are noticed by parents. Acquired cataracts are most often diagnosed at vision screenings by the pediatrician or after an eye injury.
For children, whose eyes and brain are still learning to see, distortion can lead to lazy eye (amblyopia). Without proper treatment, pediatric cataracts can cause abnormal connections between the brain and the eye. Once made, these connections are irreversible.
Treatment for pediatric cataracts can vary depending on the type and severity. But the vast majority of children need surgery to remove the cataracts. Children who receive timely treatment and follow-up have a good prognosis.
Successful outcomes may require years of individualized visual rehabilitation. For most children, surgery is just the first step to rehabilitate the eyes. Ongoing treatment must repair eye-brain connections. This involves teaching the eyes how to focus properly.
Unlike adults with full-sized eyes, children require specialized surgical instrumentation and techniques. When performed by an experienced surgeon, cataract removal is generally safe. The most common risks include glaucoma, retinal detachment, infection and the need for more surgeries.
After surgery, children often need some combination of contact lenses, intraocular lenses implanted in the eye or glasses. If amblyopia has developed, the child may need patching. This treatment involves covering the stronger eye to stimulate vision in the weaker eye.
Foldable vs. Non-foldable Lenses -
In conventional cataract surgery & in SICS (Small Incision suture less Cataract Surgery) a large cut or incision is made in the eye to remove the cataract. This is followed by insertion of a rigid non flexible 6.0/6.5 mm lens through the incision into the eye. These lenses are rarely used these days.
In phacoemulsification the entire operation done through a small hole of 3.0 mm or less. It is not possible to implant a rigid lens. The doctors use very flexible lenses which can be folded and loaded in special injectors and inserted through the small hole into the eye. These are currently the preferred lens to be used.
There Are Two Methods Of Cataract Surgery :-
In this technique, incisions are made and the cataract is broken into smaller pieces and aspirated, and then the intraocular lens is implanted. The surgery is done under topical anesthesia, only drops are used.
Cataract surgery is done using this femtosecond laser. It makes -bladeless, laser- made incisions, perfect circular opening and also to break the cataract into smaller pieces. It is followed up with lens removal and intraocular lens implantation. It significantly reduces the risk of complications, makes the surgery simpler, more precise, and gives more predictable visual results and faster recovery.
In cataract surgery the natural lens of the eye is removed. This leads a significant decrease in the optical convergence power of the eye or hypermetropia. Intraocular lenses are small lenses made of polymers and implanted into the eye in place of natural lens to help focus the light on to retina. When it comes to intraocular lenses (IOLs) for cataract surgery, there are number of different types of materials that eye surgeons can select from.
Foldable lenses are made of two types of material – hydrophilic and hydrophobic acrylic – the latter being better in terms of long term results and least possibility of posterior capsule opacity. Both hydrophilic and hydrophobic lenses incorporate UV filters, but hydrophilic IOLs are constructed from aliphatic materials: the UV filter is less efficient when compared with aromatic-based hydrophobic materials.
Lens Material - Silicone, Hydrophilic & Hydrophobic Acrylic :
The optical design of the intraocular lenses are :