Cataracts are a partial or complete opacity of the lens of the eye. They occur when protein clumps together in the lens, clouding areas and blocking light from reaching the retina. The three main types are nuclear, cortical, and subcapsular. Cataracts are often age-related but can be caused by conditions like diabetes. Symptoms include blurry vision, sensitivity to light, and difficulty seeing at night. Treatment is usually cataract surgery to remove the clouded lens and replace it with an artificial lens implant. Modern techniques like phacoemulsification use ultrasound and small incisions for removal. Surgery often results in excellent restored vision.

1. Cataract.Cataract.

2. Cataract.Cataract.
 Definition.Definition.
 Complete or partialComplete or partial
opacity of the ocularopacity of the ocular
lens.lens.
 Stedman’s MedicalStedman’s Medical
Dictionary 27Dictionary 27thth
EditionEdition

3. CataractCataract
 The lens is made mostly of water and protein. ProteinThe lens is made mostly of water and protein. Protein
arranges itself to allow light rays to pass through and toarranges itself to allow light rays to pass through and to
focus the rays onto the retina.focus the rays onto the retina.
 Sometimes, protein clumps together, clouding smallSometimes, protein clumps together, clouding small
areas of the lens and blocking some light from reachingareas of the lens and blocking some light from reaching
the retina. This clouding is called a cataract.the retina. This clouding is called a cataract.

4. Cataracts are classified as one of three types:Cataracts are classified as one of three types:
 AA nuclear cataractnuclear cataract is most commonly seen as itis most commonly seen as it
forms. This cataract forms in the nucleus, theforms. This cataract forms in the nucleus, the
center of the lens, and is due to natural agingcenter of the lens, and is due to natural aging
changes.changes.
 AA cortical cataractcortical cataract, which forms in the lens, which forms in the lens
cortex, gradually extends its spokes from thecortex, gradually extends its spokes from the
outside of the lens to the center. Many diabeticsoutside of the lens to the center. Many diabetics
develop cortical cataracts.develop cortical cataracts.
 AA subcapsular cataractsubcapsular cataract begins at the back of thebegins at the back of the
lens. People withlens. People with diabetesdiabetes,, high myopiahigh myopia, retinitis, retinitis
pigmentosa or those taking high doses ofpigmentosa or those taking high doses of steroidssteroids
may develop a subcapsular cataract.may develop a subcapsular cataract.

6.  In many cases, the cause of cataracts is unknown.In many cases, the cause of cataracts is unknown.
Factors that may contribute to cataract developmentFactors that may contribute to cataract development
include include diabetesdiabetes, long-term use of corticosteroids, and, long-term use of corticosteroids, and
other inflammatory and metabolic disorders.other inflammatory and metabolic disorders.

7. Other contributory factors include the following:Other contributory factors include the following:
 Age related: Most cataracts are related to aging.Age related: Most cataracts are related to aging.
 Childhood: Some cataracts develop at birth or inChildhood: Some cataracts develop at birth or in
childhood, often in both eyes. These may or may notchildhood, often in both eyes. These may or may not
affect vision.affect vision.
 Hereditary: A family may have a history of developingHereditary: A family may have a history of developing
cataracts.cataracts.

8.  During development: A mother may transmit cataracts to herDuring development: A mother may transmit cataracts to her
baby duringbaby during pregnancypregnancy if the mother has an infection, such asif the mother has an infection, such as
rubella. rubella.
 Secondary cataract: Cataracts may be linked to certain otherSecondary cataract: Cataracts may be linked to certain other
health problems, such as diabetes or steroid use.health problems, such as diabetes or steroid use.
 Traumatic: Cataracts may follow an injury to the eye, eitherTraumatic: Cataracts may follow an injury to the eye, either
quickly or years later.quickly or years later.
 Other causes: Cataracts may follow radiation exposure andOther causes: Cataracts may follow radiation exposure and
excessive exposure to UV light (sunlight), smoke, or alcohol.excessive exposure to UV light (sunlight), smoke, or alcohol.

9. The following symptoms can beThe following symptoms can be
signs:signs:
 Cloudy or blurry visionCloudy or blurry vision
 Problems with light,Problems with light,
including headlights thatincluding headlights that
seem too bright, glare fromseem too bright, glare from
lamps or bright sunlight, or alamps or bright sunlight, or a
halo around lightshalo around lights
 Difficulty readingDifficulty reading
 Faded colorsFaded colors
 Poor night visionPoor night vision
 Double or multiple visionDouble or multiple vision
(often goes away as a cataract(often goes away as a cataract
grows)grows)
 Frequent changes inFrequent changes in
prescription for eyeglasses orprescription for eyeglasses or
contact lensescontact lenses

11.  For anFor an early cataractearly cataract, vision may improve by changing, vision may improve by changing
eyeglasses, using a magnifying lens, or increasingeyeglasses, using a magnifying lens, or increasing
lighting. Beyond these measures, surgery is the onlylighting. Beyond these measures, surgery is the only
effective treatment.effective treatment.

12. A comprehensive eye examination usually includes the following:A comprehensive eye examination usually includes the following:
 Visual acuity testVisual acuity test - An eye chart test that measures your sight- An eye chart test that measures your sight
at various distancesat various distances
 Pupil dilationPupil dilation - Widening of the pupil with eyedrops to allow- Widening of the pupil with eyedrops to allow
your ophthalmologist to examine more of the lens and theyour ophthalmologist to examine more of the lens and the
retina as well as to look for other eye problemsretina as well as to look for other eye problems
 TonometryTonometry - A standard test to measure fluid pressure inside- A standard test to measure fluid pressure inside
the eye (Increased pressure may be a sign ofthe eye (Increased pressure may be a sign of glaucomaglaucoma.).)

13. Three different types of surgery can be used.Three different types of surgery can be used.
 Extracapsular surgeryExtracapsular surgery: This procedure consists of: This procedure consists of
surgically removing the lens but leaving intact the backsurgically removing the lens but leaving intact the back
half of the capsule (the outer covering of the lens). Thehalf of the capsule (the outer covering of the lens). The
ophthalmologist makes a slightly longer incision on theophthalmologist makes a slightly longer incision on the
side of the cornea (the clear, dome-shaped surface thatside of the cornea (the clear, dome-shaped surface that
covers the front of the eye) and removes the hardcovers the front of the eye) and removes the hard
center of the lens. Then, the ophthalmologist removescenter of the lens. Then, the ophthalmologist removes
the remainder of the lens by suction.the remainder of the lens by suction.

15.  PhacoemulsificationPhacoemulsification: Today, most: Today, most
ophthalmologists use this technique, alsoophthalmologists use this technique, also
called small-incision cataract surgery orcalled small-incision cataract surgery or
"phaco" surgery. The ophthalmologist makes"phaco" surgery. The ophthalmologist makes
a small incision on the side of the cornea.a small incision on the side of the cornea.
Then, the ophthalmologist inserts a tinyThen, the ophthalmologist inserts a tiny
probe into the eye. The probe emitsprobe into the eye. The probe emits
ultrasoundultrasound waves that soften and break upwaves that soften and break up
the cloudy center of the lens so it can bethe cloudy center of the lens so it can be
removed by suction. The back half of the lensremoved by suction. The back half of the lens
capsule is left behind.capsule is left behind.

17.  Intracapsular surgeryIntracapsular surgery: Consists of removing the lens with the: Consists of removing the lens with the
capsule intact. This requires the breakage of the zonules. capsule intact. This requires the breakage of the zonules.
Different methods to break the zonules were described, but only Different methods to break the zonules were described, but only
the cryoprobe survived. The cryoprobe is a probe which isthe cryoprobe survived. The cryoprobe is a probe which is
frozen onto the surface of the crystalline lens. With gentlefrozen onto the surface of the crystalline lens. With gentle
teasing, the lens could be delivered without any pushing on theteasing, the lens could be delivered without any pushing on the
eyeeye

18. History of Cataract SurgeryHistory of Cataract Surgery
 For more than 20 centuries, couching was the primary methodFor more than 20 centuries, couching was the primary method
for dislodging the cataract away from the pupil. The first writtenfor dislodging the cataract away from the pupil. The first written
description of couching came from Susruta (also spelleddescription of couching came from Susruta (also spelled
Sushruta), an ancient Indian surgeon (circa 600 BC)Sushruta), an ancient Indian surgeon (circa 600 BC)
 Couching was the procedure célèbre, and it was practiced fromCouching was the procedure célèbre, and it was practiced from
ancient time, through the Middle Ages, up until the early 1900s.ancient time, through the Middle Ages, up until the early 1900s.
Although the father of modern cataract surgery, Jacques Daviel,Although the father of modern cataract surgery, Jacques Daviel,
introduced the incisional extraction of the cataract in 1753,introduced the incisional extraction of the cataract in 1753,
surgeons still extolled the virtues of couching for another 150surgeons still extolled the virtues of couching for another 150
years.years.

20. History of Cataract SurgeryHistory of Cataract Surgery
 The final significant improvement arrived when T. Krawawicz inThe final significant improvement arrived when T. Krawawicz in
Poland (1961) introduced the cryoextractor. A small, cold probePoland (1961) introduced the cryoextractor. A small, cold probe
could be frozen to the surface of the lens. With gentle teasing,could be frozen to the surface of the lens. With gentle teasing,
the lens could be delivered without any pushing on the eyethe lens could be delivered without any pushing on the eye
whatsoeverwhatsoever
 The intracapsular cataract extraction (ICCE) was in its heyday inThe intracapsular cataract extraction (ICCE) was in its heyday in
the early 1970s, but its demise was rapidly approaching.the early 1970s, but its demise was rapidly approaching.

21. History of Cataract SurgeryHistory of Cataract Surgery
 Surgeons needed a safe scaffolding to hold theirSurgeons needed a safe scaffolding to hold their
posterior chamber IOLs. The intact zonular-capsularposterior chamber IOLs. The intact zonular-capsular
diaphragm was what they were looking for.diaphragm was what they were looking for.
 Two secondary motivating forces also influenced theTwo secondary motivating forces also influenced the
swing back to extracapsular cataract extraction (ECCE):swing back to extracapsular cataract extraction (ECCE):
 the quest for small incisional cataract woundsthe quest for small incisional cataract wounds
 and the quest for decreased postoperative complications.and the quest for decreased postoperative complications.

22. History of Cataract SurgeryHistory of Cataract Surgery
 Charles Kelman (1967) dramatically altered the ophthalmicCharles Kelman (1967) dramatically altered the ophthalmic
surgical world by introducing phacoemulsification of the cataractsurgical world by introducing phacoemulsification of the cataract
through a small wound.through a small wound.
 Coonan and colleagues, Wetzig and coworkers, and othersCoonan and colleagues, Wetzig and coworkers, and others
proved to the world that the postoperative complications ofproved to the world that the postoperative complications of
aphakic retinal detachmentaphakic retinal detachment andand cystoid macular oedemacystoid macular oedema could becould be
reduced by keeping the posterior capsule intact.reduced by keeping the posterior capsule intact.

23.  Surgical treatment for cataracts usually results inSurgical treatment for cataracts usually results in
excellent vision. Frequently, glasses still must be wornexcellent vision. Frequently, glasses still must be worn
after surgery.after surgery.
 If you have other problems besides the cataract, such asIf you have other problems besides the cataract, such as
degeneration in the retina or the optic nerve, results willdegeneration in the retina or the optic nerve, results will
not be as favorable.not be as favorable.

24.  In spite of the progress made in surgical techniques in manyIn spite of the progress made in surgical techniques in many
countries during the last ten years, cataract (47.9%) remainscountries during the last ten years, cataract (47.9%) remains
the leading cause of visual impairment in all areas of the world,the leading cause of visual impairment in all areas of the world,
except for developed countries.except for developed countries.
 WHO (Nov 2004).WHO (Nov 2004).

26. COMPLICATIONS OF CATARACTCOMPLICATIONS OF CATARACT
SURGERYSURGERY..
 INTRA-OPERATIVEINTRA-OPERATIVE
 Posterior Capsular RupturePosterior Capsular Rupture
 Expulsive hemorrhageExpulsive hemorrhage
 EARLY POST-OPERATIVEEARLY POST-OPERATIVE
 Acute Bacterial EndophthalmitisAcute Bacterial Endophthalmitis
 Iris prolapseIris prolapse
 Wound leakWound leak
 High intra-ocular pressureHigh intra-ocular pressure
 Corneal edema (Striate KeratopathyCorneal edema (Striate Keratopathy))

27. COMPLICATIONS OF CATARACTCOMPLICATIONS OF CATARACT
SURGERYSURGERY..
 LATE POST-OPERATIVELATE POST-OPERATIVE
 Posterior Capsule Opacification (PCO)Posterior Capsule Opacification (PCO)
 Retinal DetachmentRetinal Detachment
 Cystoid Macular Edema (CME)Cystoid Macular Edema (CME)
 Suture-related problemsSuture-related problems
 Malposition of the IOLMalposition of the IOL
 Corneal DecompensationCorneal Decompensation

28.  Thank you.Thank you.

29. Questions???Questions???