Cataracts: Causes, Symptoms, and Treatment

Cataracts occur when the lens of the eye becomes cloudy, reducing the amount of light that passes through to the retina. In some cases, this cloudiness may also cause abnormal refraction of light, resulting in incorrect focus. Consequently, the retina receives inadequate light, leading to blurred vision. Cataracts develop without inflammation or pain, and as the lens becomes progressively cloudier, vision deteriorates further. Symptoms can vary in severity but typically worsen gradually. It may take months or even years for patients to notice significant vision impairment.

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Symptoms of Cataracts

• Double vision
• Seeing halos around lights
• Cloudy or white opacity in the center of the pupil
• Blurred vision, requiring bright light for reading

Risk Factors for Cataracts

The primary risk factor is age, particularly in individuals over 60 years old. Additional factors include:

• Diabetes
• Alcohol consumption
• Prolonged sun exposure
• Smoking
• Chronic eye infections
• Eye injuries

Treatment Options for Cataracts

In the early stages, when symptoms are mild, physicians monitor the condition periodically. However, surgery is recommended when vision significantly deteriorates.

Types of Cataract Surgery

1. Phacoemulsification (Small Incision Surgery):
   This procedure uses ultrasound to break the cataract into small fragments, which are then removed. The incision is approximately 2.5–3 mm, requiring no stitches. Recovery is quick, and the procedure typically lasts 15–30 minutes. It is suitable for soft to moderately hard cataracts.
2. Large Incision Surgery:
   This involves making a larger incision to remove the entire lens in one piece, followed by suturing. The procedure lasts 30 minutes to 1 hour and is appropriate for hard or very mature cataracts.

Both techniques involve local anaesthesia, either through eye drops or an injection near the eyelid. For patients who are anxious or uncooperative, general anaesthesia may be recommended.

Additional Recommendations

• For elderly patients (≥ 60 years) or those with chronic conditions, consult an internist before surgery.
• If taking blood-thinning medication, consult a doctor to discontinue use at least seven days prior to surgery.

Types of Intraocular Lenses (IOLs)

1. Monofocal IOL:
   A standard single-focus lens that provides clear distance vision but requires reading glasses for near vision.
2. Multifocal IOL:
   Designed for presbyopia, these lenses use advanced technology such as apodized diffractive or refractive designs to balance near and distance vision. Approximately 80% of users can perform daily tasks like reading or driving without glasses. However, these lenses are unsuitable for patients with retinal diseases, diabetes, or glaucoma.
3. Toric IOL:
   These lenses correct astigmatism caused by uneven corneal curvature, improving distance vision. Near vision still requires glasses.
4. Multifocal Toric IOL:
   A cutting-edge innovation that combines astigmatism correction with multifocal functionality, providing clear near and distance vision while addressing cataract-related issues.

Postoperative Care

• Use an eye shield to protect the operated eye from rubbing or accidental impact. Wear it while sleeping.
• Avoid bending, coughing, or sneezing forcefully after surgery, as these actions may displace the intraocular lens.
• Keep the eye dry and avoid exposure to dust for at least one month to prevent infections.
• Sleep on your back and avoid pressure on the operated eye for the first day.
• Follow all prescribed medications and attend follow-up appointments as scheduled.
• Protect the eyes from bright sunlight and environmental pollutants by wearing sunglasses.
• Maintain control of chronic conditions like diabetes and adhere to your doctor’s instructions.

Benefits of Cataract Surgery

• Improved vision and quality of life.
• Easier management of retinal diseases, as clear lenses allow better visualization of the retina.

Risks of Delaying Cataract Surgery

• Progressive vision loss and reduced quality of life.
• Inability to treat underlying retinal conditions, such as retinal detachment, macular scarring, bleeding in the eye, or diabetic retinopathy.

Potential Complications During and After Surgery

1. Infection (<1%):
   Proper hygiene and avoiding dusty environments can minimize the risk.
2. Lens Dislocation (<1%):
   Caused by weak lens attachments, very hard cataracts, or patient movement during surgery. If this occurs, a second surgery may be required, incurring additional costs.
3. Severe Bleeding (1 in 1,000):
   This rare complication can result in permanent vision loss and is typically irreversible.

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