CATARACTS

Described as a natural clouding of the eye lens, cataracts are pretty common, affecting about 20 million people worldwide. Cataracts are actually considered an inevitable part of aging and are widespread among people ages 55 years and older. In fact, half of all Americans have themor have had cataract surgeryby age 80. In other words, if you live long enough, you will likely develop cataracts. What's worse, if left untreated, cataracts can lead to blindness. Cataracts are already the leading cause of vision loss in adults over age 55 and the most common cause behind blindness worldwide.
The good news, however, is that treatment for cataracts is successful; more than 97 percent of the 3 million-plus cataract surgeries performed each year in the United States are considered successful.

n fact, about 95 percent of patients are able to restore their full pre-cataract distance vision after undergoing the standard intraocular lens (IOL) procedure.

CAUSES OF CATARACTS

Many things can cause a cataract to form, including diabetes, but it is believed that natural aging is the main culpritat least for 99 percent of cataract sufferers (the other 1 percent are born with congenital cataracts, sometimes due to metabolic disorders or

intrauterine infections). For the majority of people with age-related cataracts, or acquired cataracts, these develop very slowly and painlessly over the years and are often initially discovered by an eye doctor during routine exams, but may not be treated until your cataract impedes upon daily activities.

TYPES OF CATARACTS
To understand exactly how and why a cataract forms, you first need to know what kind of cataract it is. Following is a breakdown of the 3 most common. Nuclear cataracts

The most common type, nuclear cataracts are associated with nearsightedness, blurry vision, and faded colors. As a nuclear cataract develops, the eye's lens becomes more curved and worsens nearsightedness, sometimes temporarily improving farsightedness but not for long. Attributed as a consequence of natural aging, there are several reasons why nuclear cataracts form. Just as skin sheds, so does the eye. But since cells cant be lost into the air inside the eye, they deposit into the lens, causing it to thicken and yellow. Likewise, with aging, fewer nutrients reach the inner eye, contributing to the formation of an opaque nucleus. Overexposure to ultraviolet light can also contribute, especially as the lens becomes harder, less resilient, and more opaque over time. Several studies have also linked alcohol and exposure to cigarette smoke as cataract contributors. Some systemic disorders, such as hypothyroidism (an underactive thyroid disease), diabetes, and in rare cases, glaucoma, can lead to cataracts as well.

Cortical cataracts

Often associated with farsightedness and natural aging, cortical cataracts are less common and tend to develop in their own unique way.

They form when the shell, or cortex, of the lens becomes hard after developing postbirth and grows, usually till around age 60, when nearly 16 percent of the lens has become cortex. Cortical production makes the lens more compact and hard, or sclerotic. Posterior subcapsular cataracts

Posterior subcapsular cataracts are even less common but affect vision more than any other type and tend to affect people under age 40 more often. Since light converges at the back of the lens, extreme sensitivity to bright lights normally develops and reading can be extremely difficult. Causes include: Chronic intraocular inflammation due to overuse of medications such as corticosteroids. Corticosteroids: A class of steroid hormones used to treat a variety of conditions. Chronic use may lead to the formation of posterior subcapsular cataracts. A penetrating injury to the lens, eye surgery, concussion, or the use of irradiation to treat an eye tumor, which can cause any type of cataract but typically result in posterior subcapsular cataracts.

CATARACT PREVENTION
While many doctors believe that nothing prevents most cataracts from forming, there is some promising research and things you can start doing now for possible cataract prevention (if you dont have them already) or to slow down the development of a cataract. Such as:

Wear sunglasses to block out the harmful ultraviolet (UV) rays from sunlight. Too much exposure has been shown to contribute to the development of cataracts. Look for a label from the American National Standards Institute (ANSI) that says that the lenses block both UVA and UVB rays. Eat foods containing high amounts of antioxidants, meaning fruits and vegetables. People who eat large amounts of green, leafy vegetables, such as kale and spinach, which are rich in the nutrients lutein and zeaxanthin, show lower risk for cataracts. Have your cholesterol checked by your doctor. It could be that there is a link between high cholesterol levels and cataracts, as some studies suggest that the use of statins, a class of cholesterol-lowering drugs, may help prevent the formation of nuclear cataracts. Anyway, it doesnt hurt to get your cholesterol levels tested by a doctor at least every 5 years, or more often if you have had high levels in the past or are a man over age 45 or a women over age 50.

CATARACT TECHNOLOGY
In the early stages, cataracts might simply require a stronger eyeglass or lens prescription, force you to turn on brighter lights, or use a magnifying glass. You might also reduce glare by repositioning lights indoors or by wearing polarized sunglasses outside. For patients with posterior subcapsular cataracts, the use of dilating eye drops can help keep their pupils large, thus allowing more light into the eyes. Depending on the severity of your vision loss, you may be able to delay surgery for a while, but eventually, surgery may be inevitable, as lenses and glasses will never reverse the process. Talk to your doctor about when surgery may no longer be avoidable for your own safety and quality of life.

CATARACT SURGERY PROCEDURE

The cataract surgery procedure is very common throughout most of the world. The surgeon makes a tiny incision on the side of the cornea, removes the eye's clouded natural lens (using a procedure known asphacoemulsification), and then replaces it with an artificial intraocular lens (IOL). Phacoemulsification is the most common technique used today. Because the incision is less than an eighth of an inch, stitches are not typically required and the eye heals quickly. In 97 percent of cases, no complications occur.Innovative new tools, like the LenSx Laser may help increase surgeons precision for even better outcomes. Fortunately, modern procedures are outpatient, lasting only 15 to 30 minutes, and cause little to no pain. They even allow you to return to work the same day, if you choose. If you have cataracts in both eyes, your doctor may recommend surgery on the weaker eye first, and then complete the second round after the first eye has healed.

INTRAOCULAR LENSES (IOLS)

How IOLs Work? An intraocular lens (IOL) is the artificial lens surgeons implant to replace the eye's crystalline lens that must be removed once it becomes cloudy. The main job of the IOL is to focus light onto the back of the eye (or retina), just as a natural, healthy eye lens would. From here, the light rays are converted into electrical impulses that travel to the brain, where they are then converted into images. If the light isn't focused correctly on the retina, then the brain can't process the images accurately.

IOLs share the same basic construction as earlier versionsa round, corrective central portion of the lens with 2 arms, or haptics, to keep it in place in the eyebut other than these shared characteristics, modern IOLs can vary widely in design, being made of plastic, silicone, or acrylic. Most of today's IOLs are about a quarter of an inch or less in diameter and soft enough to be folded so they can be placed into the eye through a very small incision.

TYPES OF IOLS
The most common type of IOL is called a posterior chamber lens, meaning it is placed behind the iriswithin the capsule where the natural lens used to be. When it is placed in front of the iris, as might happen when the lens capsule is damaged, it is called an anterior chamber lens.

Here we focus on the most common type of IOL and the different lenses that have evolved from this technique: Monofocal IOLs, such as the AcrySof IQ IOL, provide a set focal point, usually for distance vision. This allows cataract surgery patients to see clearly within a range. About 95 percent of people who receive a standard IOL have their vision restored to its pre-cataract state. However, most patients still require glasses for reading or distance vision. Monovision is a technique the surgeon may choose to perform that involves inserting an IOL in one eye for near vision and an IOL in the other eye for distance vision. This technique requires adaptation, since each eye will then be oriented towards different needs. Advanced Technology IOLs Multifocal IOLs, or advanced technology IOLs, is a newer type of lens that treats multiple focal points and reduces or eliminates the need for eyeglasses or contact lenses after cataract surgery. Part of the rapid evolution in IOL innovations, these newer lenses are made from cutting-edge materials with unique features. This is made possible through highly specialized optics that divide light and focus it on more than one point to provide a range from near to far eyesight. Accommodative IOLs are considered monofocal, meaning they have a fixed focal point. This type of lens is designed to move in response to your eye's own muscle, which translates into the ability to see multiple focal points While there are several advanced technology IOLs on the market today, the newer and most popular ones are made by Alcon such as the AcrySof IQ ReSTOR IOL. Astigmatism Correcting IOLs In addition to treating the cataract, some IOLs can also correct astigmatism at the time of surgery. These lenses will minimize the need for distance vision glasses after surgery. One such IOL that has gained widespread popularity is the Alcon AcrySof IQ Toric IOL (made specifically to address cataracts with astigmatism).

CATARACT SURGERY
Safety and Risks Cataract Surgery Risks The fact that millions of people have gone before you and come out of the procedures pleased, healthy, and able to see clearly again should be of comfort. Nonetheless, there are always special cases and certain situations when complications can arise. No surgical procedure is without risks. The following list, while not comprehensive, provides some of the potential complications which could occur. These may develop during or after cataract surgery while you are still under your doctor's care and would be addressed immediately.

Bleeding. Bleeding inside the eye during cataract surgery is extremely rare, because the incision is placed on the edge of the cornea, which contains no blood vessels. If it does occur, it will likely occur on the surface of the eye. In this case, the surgeon will usually cauterize the area and the bleeding stops. Bruising or black eye. If your doctor used an injection to numb your eye, it is possible that you may experience some bruising around your eye. This is temporary and will go away on its own. Incision leak. Sometimes a small leak in the incision in the cornea can occur. Such a leak increases the chances of infection, and your doctor may apply a contact lens or pressure bandage over your eye to decrease the chance of infection. In some cases, the incision must be closed with a stitch. Intraocular Infection. Developing an infection after cataract surgery is extremely rare, occurring only once in several thousand surgeries. Most cataract surgeons administer antibiotic drops before, during, and after surgery to minimize the risk. Endophthalmitis, an inflammation of the eye triggered by infection, is also very rare and more common in people with compromised immune systems, which includes patients with diabetes. Inflammation. Swelling inside the eye that is unrelated to infection is usually minor and can easily be treated with anti-inflammatory drops after surgery. Glaucoma. An extremely small number of cataract surgery patients develop secondary glaucoma after cataract surgery. Secondary glaucoma is usually temporary and can develop when inflammation or bleeding occurs during the surgery. In most cases, glaucoma medications can be used to help control the increased intraocular pressure, but sometimes, laser or other surgery is required.

Pronounced astigmatism. Sometimes swelling of the cornea or tight stitches (if stitches are used) can distort the shape of the cornea, causing astigmatism. Swelling will reduce during healing, and the astigmatism will generally go away on its own. Or if stitches were used, once they are removed, the cornea will usually relax back to its natural shape. Retinal detachment. If you are extremely nearsighted, you may be more prone to retinal detachment during cataract or any other eye surgery. Symptoms include flashing lights, new floaters, gradual shading of vision as though a curtain was being drawn, and quick detachment of your sharp, central vision. If you experience any of these symptoms, call your doctor immediately. Tearing of the posterior capsule. During cataract surgery, the natural lens is removed from the posterior capsule and replaced with an artificial IOL. The capsule can sometimes tear during this process. When this happens, the physician will repair the vitreous body that has leaked into the capsular bag Capsular bag: A thin membrane that holds the eye's natural lens and seal it off. Decentered intraocular lens. Rarely, the IOL placed in the eye can become displaced a week to a month later. If this happens, you would experience blurred vision, glare, double vision, or fluctuating vision (when the eye sees the edge of the IOL, causing focused and unfocused images). This is sometimes due to torn zonules during surgery or through an accident involving the eye. Your doctor will either reposition the lens or remove and replace it with another. Cystoid macular edema. As long as 3 months after cataract surgery, or as soon as a few weeks, the tissues of the macula may swell. If this happens, your central vision will be blurry, and your doctor will most likely give you a non-steroidal antiinflammatory drug.

Secondary cataract. By far the most common complication, occurring after about 30 percent of surgeries,a secondary cataract happens when cells have grown under the lens and the posterior capsule holding the IOL has become cloudy, blurring your vision. Your doctor will then use a YAG laser to create a small hole in the membrane for light to pass through. This is a painless outpatient procedure your doctor can perform quickly. Other adverse reactions that have been associated with the implantation of intraocular lenses are: hypopyon, acute corneal decompensation, pupillary block, and secondary surgical intervention (including but not limited to lens repositioning, biometry error, visual disturbances or patient dissatisfaction). As a result of the multifocality, some visual effects (halos or radial lines around point sources of light at night) may also be expected due to the superposition of focused and unfocused multiple images. A reduction in contrast sensitivity may also be experienced by some patients, especially in low lighting conditions such as driving at night.

WESLEYAN UNIVERSITY- PHILIPPINES MABINI EXTENSION, CABANATUAN CITY

RELATED LEARNING EXPERIENCE CASE STUDY

CATARACT AND PHACOEMULSIFICATION WITH IOL

SUBMITTED TO: MR MARK MENDEZ SUBMITTED BY: MARIA LOURDES RAMOS BSN IV BLOCK IV