Cataract. Slit lamp photograph reveals marked lens opacity of the left eye.

The patient complained of a slowly progressive, painless loss of vision.

Cataract. Slit lamp photograph following successful cataract surgery. The intraocular lens implant is positioned within the capsule of the natural lens. The blue haptics stabilize the lens, keeping it in place

Figures provided by Tim Bennett, C.R.A

Cataract
Cataract is a common cause of vision impairment in the elderly and the most common cause of blindness worldwide. In the United States, the potentially blinding effect of cataract among the elderly is
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dramatically reduced because cataract surgery is readily available, effective and safe. The prevalence of cataract increases with age from less than 5 percent in persons under 65 years of age to approximately 50 percent in those 75 years of age and older. Exposure to ultraviolet light may contribute to the progression
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of cataract formation.

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Although there is no universally accepted definition, "cataract" generally refers to lens opacities that interfere with vision function. Patients with visually significant cataracts may complain of blurred vision or glare. Cataract progression is typically slow, with gradual loss of vision over months to years. However, some types of cataract progress more rapidly. Slit-lamp examination reveals varying degrees of opacification in one or several regions of the lens (Figure 7). Nuclear cataracts are associated with central lens opacification. The nucleus loses its transparency and may develop a yellow or brown discoloration. Cortical cataracts often consist of "radial spokes" extending from the periphery of the lens. Their effect on vision varies greatly depending on the location of the opacification relative to the visual axis. Posterior subcapsular cataracts are located in the posterior cortical layer and usually involve the central visual axis. They have a granular, plaque-like appearance. Posterior subcapsular cataracts may be associated with aging, trauma, systemic or topical corticosteroid use, intraocular inflammation or radiation exposure. Cataract surgery is the most common surgical procedure
Formal visual field testing may be necessary if glaucoma is suspected.

covered by Medicare, with over 1 million procedures performed annually. This surgery should be considered when the cataract reduces vision function to a level that interferes with everyday activities. The mere presence of lens opacities--i.e., lens opacities not associated with decreased visual function--is not an indication for surgery in most instances. Cataract surgery is an outpatient procedure performed under local or topical anesthesia. Most cataract surgeries today are performed using phacoemulsification techniques. Phacoemulsification involves ultrasonic fragmentation of the lens into fine pieces, which are
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then aspirated from the eye. The small incision size afforded by phacoemulsification facilitates more rapid vision rehabilitation than traditional cataract surgery. A lens implant is usually placed within the lens capsule but may be placed in
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front of the capsule or the iris if there is not enough capsular support (Figure 8). Opacification of the posterior capsule may develop in up to 50 percent of eyes with intraocular lens implants within three to

five years. In these cases, Nd: YAG laser capsulotomy is a safe and effective procedure to clear the visual axis and restore visual function. Over 90 percent of patients undergoing cataract surgery experience visual improvement and improved quality of life if there is no ocular comorbidity. Complications of cataract surgery are unusual and occur in less than 1 percent of surgeries. Potentially serious complications include glaucoma, bleeding, infection, vitreous loss, retinal detachment and loss of vision.

REFERENCES 1. Ganley JP, Roberts J, eds. Eye conditions and related need for medical care among persons 1-74 years
of age, United States, 1971-72. Hyattsville, Md.: U.S. Dept. of Health and Human Services, Public Health Service, National Center for Health Statistics, 1983; DHHS publication no. 83-1678.

2. Allen D. Cataract. BMJ Clinical Evidence. Web publication date: 01 April 2007 (based on October 2006 search). Accessed July 1, 2008.
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Introduction: A cataract is an opacity, or clouding, of the lens of the eye.

The lens of an eye is normally clear. If the lens becomes cloudy or is opacified, it is called a cataract.

The prevalence of cataracts increases dramatically with age. It typically occurs in the following way:

The lens is an elliptical structure that sits behind the pupil and is normally transparent. The function of the lens is to focus light rays into images on the retina (the light-sensitive tissue at the back of the eye). In young people, the lens is elastic and changes shape easily, allowing the eyes to focus clearly on both near and distant objects. As people reach their mid-40s, biochemical changes occur in the proteins within the lens, causing them to harden and lose elasticity. This causes a number of vision problems. For example, loss of elasticity causes

presbyopia, or far-sightedness, requiring reading glasses in almost everyone as they age. In some people, the proteins in the lens, notably those called alpha crystallins, may also clump together, forming cloudy (opaque) areas called cataracts. They usually develop slowly over several years and are related to aging. In some cases, depending on the cause of the cataracts, loss of vision progresses rapidly. Depending on how dense they are and where they are located, cataracts can block the passage of light through the lens and interfere with the formation of images on the retina, causing vision to become cloudy.

Nuclear cataracts. These form in the nucleus (the inner core) of the lens. This is the most common variety of cataract associated with the aging process. Cortical cataracts. These form in the cortex (the outer section of the lens). Posterior subcapsular cataracts. These form toward the back of a cellophane-like capsule that surrounds the lens. They are more frequent in people with diabetes, who are overweight, or those taking steroids