Symptoms
Cataract manifests itself in painless visual disturbances such as blurred vision, sensitivity to light, glare, reduced vision, disturbances in color vision, seeing a veil of light, and double vision in one eye. It is the most common cause of blindness worldwide. The disease is usually characterized by a slow progression over several years. An advanced cataract is detectable by eye.
Causes
In most cases, the cause of cataracts is an age-related clouding of the lens of the eye, which in the following no longer focuses the light sharply, but scatters it. Affected are mainly older people, so in the 70th year of age, an estimated 25% of all people develop a significant cataract. Depending on the localization, a cortical cataract, a nuclear cataract and a capsular cataract are distinguished. In addition to age-related causes, cataracts can be congenital, caused by intrauterine viral infections, malnutrition, poisoning, medications (e.g., glucocorticoids), radiation, systemic diseases (e.g., diabetes), ocular disease, and injury. Several risk factors, such as smoking, alcohol, genetics, and female sex, are known.
Diagnosis
The diagnosis is made in ophthalmologic care. Other conditions that cause similar symptoms include myopia or hyperopia, glaucoma, age-related macular degeneration, and diabetic retinopathy.
Nonpharmacologic treatment
The diagnosis of a cataract is not yet an indication for surgery. Initially, better illumination, corrected glasses or magnifying glasses are still sufficient. Only if the visual disturbances restrict the daily activities too much, an operation is indicated. Cataract surgery is one of the most common operations, of which about 600,000 are performed annually in Germany, for example. The lens is usually replaced with an artificial lens on an outpatient basis under local anesthesia. The most common method is the so-called phacoemulsification, in which only a small incision of 2 mm is necessary, the lens is crushed by ultrasound and then aspirated. The artificial lens is rolled up and can be inserted through the small opening. Complications such as bleeding, infection, retinal detachment and loss of vision can occur, but are rare. The eyes are not operated on at the same time, but at intervals of a few weeks.
Drug treatment
As early as one day before as well as after surgery, NSAID eye drops such as bromfenac (Yellox), diclofenac eye drops (Voltaren Ophtha), indometacin (Indophtal), ketorolac (Acular), and nepafenac (Nevanac) are used to treat inflammation and pain. They are usually administered as needed for up to a maximum of 14 days postoperatively and have the added benefit of counteracting pupil constriction (miosis) during surgery. Mydriatics are also used to dilate the pupil. NSAIDs are also combined with the anti-inflammatory glucocorticoid eye drops, but these can increase intraocular pressure over time and are not without controversy. On the other hand, the synergistic effects are an advantage. Antibiotic eye drops, mainly quinolones such as ofloxacin, levofloxacin, and moxifloxacin, are administered before and after surgery to prevent infection and endophthalmitis. The use is off-label, as this indication is not officially approved by the authorities. Finally, drug treatment or prevention of cataracts would also be desirable. So far, however, there is no scientific proof of efficacy for the preparations used. Among others, vitamins, amino acids, minerals, antioxidants (e.g. lutein) and phytopharmaceuticals are used. In many countries, a corresponding preparation has even been approved by the authorities (Catarstat eye drops).
