Cataracts: Causes, Symptoms & Treatment

A cataract, lens opacity or cataract is an eye disease that can appear in humans, especially in old age. It involves clouding of the lens of the eye. If left untreated, cataracts usually lead to blindness or severe vision problems. Typical first signs of a cataract are spongy and foggy vision and a strong sensitivity to light.

What is cataract?

Cataracts, also known as cataracts, are eye diseases in which the lens of the eye becomes cloudy and grayish in color. If left untreated, cataracts lead to blindness. In the past, it was believed that a gray fluid ran over the lens of the eye. For this reason, the disease was given the name cataract (waterfall).

Causes

Schematic diagram of eye surgery for cataracts. Click to enlarge. In the vast majority of cases (approximately 90%), cataracts are a disease of old age, occurring mainly beyond the age of 65. However, due to various causes, the disease can occasionally occur at a younger age. These include diabetes mellitus or side effects of certain medications such as cortisone. Exposure of unprotected eyes to harmful UV rays over many years is also a possible cause. A hereditary predisposition can also promote the development of cataracts. In a few cases, cataracts are congenital. The causes are diseases of the mother during pregnancy, such as rubella.

Symptoms, complaints and signs

At the beginning, cataracts cause a noticeable deterioration of vision. Accompanying this is the characteristic fog in the center of the visual field, which becomes denser over time and blurs perception. As the disease progresses, this fog spreads to the entire visual field, causing colors, contrasts, and contours to fade. This is accompanied by a deterioration in spatial perception and thus also in the orientation ability of the affected person. As the disease progresses, increased sensitivity to bright light usually sets in. Activities such as reading or watching television are perceived as strenuous and often cause headaches and dizziness. The type and severity of symptoms vary from patient to patient. In the late stages, almost all affected individuals experience severely limited vision, eventually leading to partial or complete blindness. The signs of cataracts are not only apparent to the patient, but often to family members and friends as well. For example, patients become increasingly unsteady when driving or performing physical activities. A strained facial expression with narrowed eyes is typical. Those affected also frequently miss their hand when they want to pick something up.

Course

The first symptoms of cataracts are increasingly blurred, blurred vision. Severe glare and reduced contrast vision also set in as the clouding of the eye’s lens increases. The clouding process often takes years. For this reason, many sufferers do not see a doctor until the late stages of the disease. If the disease is already very advanced, the pupil appears almost white. In the final stage, liquefaction of the pupil can also occur, leading to blindness.

Complications

An untreated cataract leads to a continuous deterioration of vision and thus to massive limitations of the affected person in everyday life. Cloudiness of vision, blurred images, and refraction of light in the field of vision become more frequent. The treatment of a cataract is quite low-risk. In less than one percent of cases, serious complications occur during laser surgery. These include, for example, the subsequent blindness of those affected (in less than 1:1000 cases) or infections of the eye. In approximately four percent of cases, a so-called after-cataract occurs, which manifests itself in symptoms similar to those of the cataract itself. However, it can also be removed. Lens transplantation is also unlikely to cause complications. Only the loss of the eye’s ability to accommodate is lost with the use of an artificial lens. After all, this cannot perform any active muscle work. Affected patients therefore have a fixed distance at which they can see sharply after a lens transplant. Depending on the situation, this must be supplemented by suitable glasses.Minor complications, such as fluctuations in eye pressure or retinal swelling, can occur in about five percent of all eye surgeries. However, they can be treated with medication. The risk of cataract surgery is very low. These operations represent the most common surgical procedures performed on humans.

When should you see a doctor?

When it comes to cataracts, it is always advisable to see a doctor. In the worst case, and especially without treatment, the disease can lead to complete blindness of the affected person and should always be treated by a doctor. Usually, early diagnosis and treatment can completely prevent possible vision problems or blindness. The visit to a doctor is necessary when the affected person suffers from visual disturbances that occur without a particular reason and relatively suddenly. Usually, the vision decreases and double vision or even veil vision occurs. However, high sensitivity to light may also indicate the disease and should be investigated. Diagnosis and treatment is performed by an ophthalmologist. In acute emergencies, the hospital may also be visited. Since in some cases the disease can also lead to psychological complaints or depression, a psychologist should also be consulted. Especially in cases of complete blindness or severe visual complaints, psychological treatment is highly advisable.

Treatment and therapy

Cataracts cannot be cured with medication. There is only the possibility of surgical replacement of the eye lens with an artificial lens. The surgical procedure is now one of the routine operations and carries only limited risks. The surgical procedure is performed under local anesthesia and takes about 20-30 minutes per eye. There are two surgical techniques. In the majority of cases, the extracapsular method is used. In this method, the lens capsule is opened, the diseased lens is shattered by means of a laser beam and then aspirated. In the intracapsular method, the entire lens capsule is removed. This method is rarely used nowadays because it carries more risks than the extracapsular method. After removal of the opacified lens, there are several options. The most optimal and in most cases applied option is the insertion of an artificial lens, which is made of plexiglass, silicone or hydrogel. For some time now, modern multifocal lenses have been used so that patients no longer need glasses after the operation. Slight glare and reduced contrast vision, especially at night, may nevertheless remain. Another advantage of the artificial lens is that it never needs to be replaced, but remains in the eye for life. An alternative to the use of an artificial lens is the wearing of contact lenses. This option is now only used in medically justified cases. The method of choice is the insertion of an artificial lens. After surgery, the eye needs about one to two months to heal. During this time, no heavy physical work or sports should be performed, which increases the pressure in the eye. Swimming and saunas are also not appropriate during this time. Prognosis:

In most cases, the results of cataract surgery are so good that individuals achieve near full visual acuity after surgery. However, if other eye conditions are present, it may be necessary to continue wearing glasses or contact lenses after surgery.

Outlook and prognosis

The prognosis for existing cataracts can vary widely. Due to the fact that the metabolic processes in the eye are very individual, an exact prognosis is not possible. It can only be assumed in any case that visual acuity will continue to deteriorate if the condition is not treated. Also, it cannot be assumed that spontaneous healing of the eyes will occur. Blindness will occur after an indefinite period of time. On the other hand, the prognosis with treatment is good. About 50 to 100 percent of visual acuity can be restored in patients who have only a cataract. If other eye diseases, such as glaucoma, are also present, the prognosis is somewhat worse. In the presence of degenerative eye diseases that first led to cataract, the prognosis is also worse. In addition, a so-called after-cataract can occur after successful treatment. This can occur months or years after treatment, but is easily treatable.The occurrence of an after-star can never be ruled out. No discomfort is expected after the treatment of a cataract. The artificial lens lasts a lifetime and does not cause any discomfort. No foreign body sensation in the eye is expected either.

Aftercare

After surgery to cure cataracts (cataract or laser surgery), a bandage is placed over the eye to prevent irritation. Still, no cosmetics or the like should get into the area of the bandage. However, the eye should be protected from possible irritation even after the bandage is removed. Therefore, physical exertion such as sports or physical work should be avoided at the beginning. This can increase the pressure in the eye, which can lead to risks for the recently operated eye. Likewise, no activities should be performed where dirt or dust can collect in the eye. Wound healing after the operation is supported by appropriate eye drops. However, regular follow-up visits to the ophthalmologist with appropriate checks and measurements are particularly important. Measurements of vision can also be performed by the optometrist, but only the doctor can control the healing process and tell you when you can resume all physical activities as usual. In addition, an ophthalmologist can detect possible risks such as a “posterior cataract”. You can also usually order new glasses four to six weeks after surgery, when the eye has become accustomed to the new artificial lens.

Here’s what you can do yourself

The interim period until cataract surgery can be bridged with some measures to facilitate everyday life. Wearing a peaked cap, baseball cap or wide-brimmed hat will reduce glare when outdoors. Sunglasses can be worn instead of or in addition to headgear. It is very likely that visual acuity will decrease somewhat by the time cataracts are ready for surgery. Therefore, it is important to structure the home and workplace and to provide contrasts. For example, the table can be set with a high contrast. High-contrast tableware is suitable as a contrast to the table. Another variant is contrasting coasters to the tableware. Colored tinted drinking glasses are available in stores. They help to better identify the glass and avoid accidental toppling. Another method to avoid knocking over glasses is to move the palm of your hand sideways, touching the table, forward to feel for the glass at the bottom. The angle at which the shoulder joint, elbow and wrist handle can be well memorized. For cooking, the required amount of spice can be tipped into the hollow hand. The level of liquids in a container can be heard well: The higher the level of liquid in the container, the higher the sound. In addition, the time that elapses with the turning on of the tap can be noticed. Temporary magnifying vision aids may be necessary. The myopic cataract patient sees better if he approaches the object strongly and removes his glasses.