Cataract is an eye disease, the main symptom of which is clouding of the main substance or capsule of the lens (a decrease in their transparency), accompanied by a decrease in visual acuity. The lens is one of the most important components of the optical system of the eye, the main function of which is to conduct light and focus images of objects on the retina. Cataract is one of the most common eye diseases.
Cataracts are distinguished into congenital and acquired
Congenital cataract- may be a consequence of intrauterine developmental disorders, for example, an infection in the mother (rubella, etc.), as well as a genetic predisposition.
Acquired cataract- most often the natural aging process of the body, but it can also occur as a result of metabolic disorders of the body, can be caused by toxic, radiation or radiation effects on the lens of the eye, trauma or as a result of diseases of the inner membranes of the eye. Cataract often occurs in people after 40-50 years, and it is called age-related. Age-related cataracts differ in stages - initial, immature, mature and overripe. The initial stage of cataract is characterized by a slight decrease in vision and the presence of streaky opacities in the lens (detected when viewed with an ophthalmoscope), going from its periphery to the center.
Stages of cataract development and symptoms:
- The initial stage of cataract- characterized by clouding of the lens of the eye along the periphery - outside the optical zone and is accompanied by a slight drop in vision.
- Immature cataract- the spread of lens opacities into the central optical zone. Clouding of the lens at this stage of cataract leads to a noticeable decrease in vision. The patient can see spots and strokes in front of the eyes, things and objects look blurry
- Mature cataract- the entire lens of the eye is affected by opacities, which is characterized by a decrease in visual acuity to the level of light perception.
- Overripe cataract- further development of the disease is accompanied by the disintegration of the lens fibers, the substance of the lens affected by cataract liquefies, it becomes milky white.
Maturation rate of cataracts
- Have 12 % patients happens rapidly progressive maturation of cataracts... From the moment of the development of the disease to the extensive opacity of the lens, requiring immediate surgical intervention, there are 4-6 years.
- Have 15 % patients are observed slowly progressive cataracts that develop over the course of 10-15 years.
- Have 70 % patients cataract progression occurs in 6-10 years... Required compulsory surgery.
Conservative cataract treatment
Conservative treatment is carried out at the initial stages of age-related cataract and is based on the use of various drugs, mainly in the form of eye drops, such as: quinax, katachrom, vitaiodurol, vitafakol, vicein and a number of others.
Cataract is the most common eye disease occurring at any age, starting from birth. But most often the disease develops in people after 50 years - this is an age-related (senile) cataract.
Cataract is the clouding of the lens of the eye and the loss of its natural transparency. Pathology is accompanied by various visual disturbances - the appearance of sensitivity to bright daylight, deterioration of twilight vision, diplopia, up to the complete loss of the ability to see.
Symptoms of the disease
In a normal seeing person, the lens is a transparent natural lens that can quickly change its shape in order to always focus the light entering the eye on the retina. Then a person sees equally well both in the distance and near. Due to a change in the chemical composition of cataract, the lens becomes cloudy, thickened and loses its transparency, letting less and less light into the eye. A person sees everything indistinctly and blurry, like through a veil of water or fogged glass. This phenomenon can be considered the main symptom of cataracts. In addition to blurred vision, patient complaints include:
- deterioration in night vision;
- distortion of the contours of objects;
- poor color perception;
- flickering before the eyes of spots, stripes and strokes;
- halos around objects that occur in bright light;
- photophobia;
- double vision of the objects in question;
- difficulty reading, sewing;
- inability to pick up glasses.
For an outside observer, the development of a cataract in a patient is accompanied by a change in the color of his pupil from black to gray, grayish white and milky white. Accordingly, his visual acuity also decreases.
Causes
Medicine calls the following causes of cataract development:
- the natural aging process of the body;
- endocrine disorders: vitamin deficiency, diabetes mellitus, metabolic disorders;
- eye injuries (mechanical, chemical, radiation);
- unfavorable ecology;
- hereditary predisposition;
- some medications;
- poisoning (with naphthalene, mercury, dinitrophenol, ergot, thallium);
Stages
Untreated age-related cataracts go away 4 stages of development:
- initial cataract- characterized by peripheral opacity of the lens, which does not significantly affect vision;
- immature cataract- clouding of the lens captures the central optical zone, visual acuity is markedly reduced;
- mature cataract- the lens is completely clouded, vision is reduced to the level of light perception;
- overripe cataract- due to the disintegration and liquefaction of the fibers, the lens absolutely does not transmit light, complete blindness.
Cataract treatment
Observation of the above-described symptoms in oneself or in those close to them should force a person to consult a doctor to clarify the diagnosis and determine the stage of development of the disease. The diagnosis is made on the basis of the patient's complaints and the observed clinical picture. Modern equipment makes it possible to detect even insignificant opacities of the lens and start treatment on time.
To date, medicine does not have medicines that can radically cure eye diseases such as hyperopia, myopia, retinal detachment or cataracts. Medicines can only slow down the development of the disease or, at best, stop it at a level acceptable for normal life. This is possible if the initial stage of the disease is not missed. Modern ophthalmology mainly uses eye drops and ointments containing hormones, vitamins and various extracts of animal and plant origin. Their large number indicates that it is not always possible to normalize metabolic processes in the lens with medicines.
Operation
Conservative cataract treatment does not give the desired effect and can only slow down the progression of the disease. The only way to completely get rid of cataracts is to carry out a microsurgical operation.
Currently, the most effective method is replacement of a clouded lens with an artificial intraocular lens.
The stage of mature cataract is considered optimal for surgery. At this time, all the fibers of the lens are cloudy, and they can be easily separated from the capsule. But the current state of eye microsurgery makes it possible to successfully operate on immature cataracts, if circumstances so require. Vision after the operation is not only restored, but often it is even better than it was before the cataract disease.
The essence of the operation
In modern ophthalmology, cataract surgery is called ultrasonic phacoemulsification. It is the fragmentation of the lens using ultrasound, followed by its removal.
There are 2 ways to perform phacoemulsification - longitudinal and torsion... The second method is the most effective and safest, which made it widespread.
To gain access to the lens, 2 incisions are made at the edge of the cornea, and if necessary 3 incisions are made. The main one has a length of 1.8 to 2.2 mm, the additional one is 1.2 mm. Through the main incision, the tip of the phacoemulsifier is introduced into the ocular cavity and separates the lens into separate fragments, turning them into an emulsion and thus allowing its anterior capsule to be removed. The design of the device allows, simultaneously with defragmentation, to carry out aspiration of destroyed lens tissues, as well as to stabilize intraocular pressure with an isotonic solution.
Through additional incisions, less dense lens tissue is removed without prior destruction. Then in the capsule bag is placed intraocular lens (artificial lens). Implantation is performed using a special device through the main incision. No suture is required, as the incision is self-sealing after the lens is installed. The operation is performed under local anesthesia and takes 25 to 50 minutes. If more severe pain relief is needed, anesthetic injections and facial nerve block are given.
Preparation
With phacoemulsification, complications rarely appear, so no special measures are required before the operation. Recommended:
- limit physical and visual stress;
- categorically exclude alcohol;
- stop taking anticoagulants no later than 5 days before the operation.
In preparation for the operation, the ophthalmologist surgeon assesses the density of the lens nucleus to determine the safety of this method.
Contraindications
The low trauma of phacoemulsification makes this method suitable for most patients. And even old age is not a contraindication. However, the earlier treatment is started, the lower the risk of complications. Absolute contraindications are considered:
- dystrophic conditions of the cornea. These phenomena often accompany senile cataracts. The operation improves vision very slightly;
- oncological diseases of the organs of vision. The lack of knowledge of the disease makes the results of the operation unpredictable;
- decompensated glaucoma - accompanied by hardening of the eyeball, which excludes the use of a laser;
- subluxation of the lens. The condition interferes with the operation due to the inability to determine the degree of lens displacement.
Carrying out phacoemulsification not recommended if the patient has:
- violations of color perception;
- a narrow pupil with a diameter of less than 6 mm;
- brown cataract (in patients over 60 years old).
Doctors do not undertake to carry out surgery when a viral or bacterial infection is detected in a person until a complete cure.
Recovery after surgery
In the absence of complications, the patient can leave the clinic a few hours after the operation. It will take several days for the final restoration of vision.
To prevent the development of complications in the postoperative period, the patient is prescribed antibacterial eye drops and the use of non-steroidal anti-inflammatory drugs.
For a month after the operation, you should limit any physical activity, exclude exposure to the sun, and also do not use makeup and avoid getting soap, shampoo or other substances into the operated eye. You should be especially careful about your own safety and avoid injury to the head and especially the eye. Within a few days after phacoemulsification, the operability of the organ of vision is fully restored, a person can read, watch TV, and, no later than a week later, start work.
Prevention
To prevent congenital cataracts in children, the expectant mother should monitor her health, carry out the prevention of viral diseases and exclude the influence of negative environmental factors on her body. Avoiding acquired cataracts timely treatment of diseases that contribute to their occurrence will help. It is necessary to strictly follow the safety rules at work, at chemical plants and when working with poisons. Prevention of complicated cataracts consists in the timely treatment of inflammation and eye injuries. Senile cataracts are prevented by a healthy lifestyle that slows down the aging of the body.
- It is necessary to exclude bad habits that contribute to the development of cataracts - smoking, drinking alcohol;
- when in the sun, use safety glasses;
- always monitor the side effects of medications taken;
- adequately respond to unfavorable environmental conditions.
Find out what experts think about cataracts from the video.
One of the most common ophthalmic diseases in old age is clouding of the eye lens, which is located between the iris of the eyeball and the vitreous body. Most often, the initial stage of this pathological condition is diagnosed, the treatment of which can be carried out conservatively or surgically. Timely started therapy allows you to avoid other serious complications.
This pathology is considered an age-related disease resulting from the natural aging processes of the body. The disease is diagnosed mainly in people over 60 years of age. The main factor provoking the development of the pathological process is a violation of material metabolism, protein deficiency.
The initial stage of cataracts can also appear at a younger age. The following causes of this disease can be distinguished:
- mechanical damage to the eyeball;
- dysfunction of the thyroid gland;
- long-term use of glucocorticosteroids;
- eye diseases;
- infectious pathologies;
- intoxication of the body;
- exposure to the eyes of radiation, ultraviolet radiation;
- some dermatological diseases (neurodermatitis, eczema);
- alcohol abuse, active smoking.
A complicated form can develop against the background of such pathological conditions:
- anemia;
- Down syndrome;
- rheumatoid arthritis;
- various systemic, autoimmune pathologies.
Ocular cataract can be congenital in nature, resulting from a genetic predisposition, incompatibility of the Rh factors of the mother and the child, infectious diseases or various abnormalities in the development of the embryo.
Most of all, the development of a pathological condition is susceptible to women living in unfavorable environmental conditions or working in production with harmful working conditions.
The first signs of cataracts at an early stage
With the initial cataract, the lens is flooded, as a result of which it increases, the structure of the lens fibers changes, opacities appear, which are initially located only at the equator of the lens, but over time begin to spread along the entire axis. This leads to a gradual deterioration in vision. The peculiarity of the development of the initial stage of cataract is that it is often asymptomatic, which makes it difficult to diagnose the problem at this stage.
Early cataract symptoms in adults:
- flickering of flies, spots and light flashes in front of the eyes;
- increased sensitivity to light;
- split image;
- decreased visual acuity;
- indistinctness of the contours of objects;
- deterioration of vision in the dark;
- tarnishing of flowers;
- Difficulty reading or working at a computer in low light.
Clouding of the lens of the eyeball occurs gradually. At the initial stage of cataract, the accumulation of intraocular fluid is observed only in the peripheral part, which does not affect the quality of vision. Sometimes people who already have vision problems begin to see better at this stage of the disease. But these are only temporary improvements, which, in the absence of timely treatment, quickly turn into myopia or hyperopia.
It is impossible to diagnose pathology on your own, so you need to consult a doctor if you have the slightest vision problems in order to find out how to treat the ailment.
Views
Depending on the nature of the origin, the initial cataract is of 2 types:
- Congenital. Pathology is formed even in the prenatal period or in the first year of a child's life. Due to its genetic nature, the disease is difficult to treat.
- Acquired. It manifests itself throughout life.
Taking into account the cause of the development of the disease, acquired cataracts are of several varieties:
- age;
- traumatic;
- beam;
- toxic;
The most common is the initial one. Depending on the area of lens opacity, the following types of disease are distinguished:
- anteropolar;
- posterior polar;
- zonular;
- fusiform;
- cortical;
- nuclear initial cataract;
- total.
The speed of its progression, the peculiarities of its course and treatment depends on the type of pathology.
Treatment of early stage cataracts
What to do at the initial stage of cataract? If your vision deteriorates, you should immediately consult an ophthalmologist who will conduct a detailed examination, diagnose and select the most appropriate treatment. It is impossible to cure the initial cataract with a conservative method even at the initial stage of the development of the disease. But drug treatment can still be prescribed for prophylactic or preparatory purposes. To inhibit the progression of the pathological process, they are prescribed. What drops are better for early stage cataracts? The following remedies are most often recommended:
- Quinax;
- Taufon;
- Catarax;
- Bestoxol.
At the initial stage of cataract, such eye drops contain a large amount of vitamins, antioxidants, amino acids and other useful elements that help slow down lens opacity and improve metabolism. Additionally, vitamin-mineral complexes, preparations for cleansing the body of toxins and normalizing metabolic processes (Fakovit) can be prescribed. Conservative treatment of a complicated form also implies the use of physiotherapy procedures that activate metabolic processes, wearing Sidorenko glasses and adhering to a diet in which you need to consume more foods rich in vitamin C.
Surgical treatment
What to do if you have vision problems? Drug therapy slows down the progression of pathology, but does not restore vision, therefore, in most cases it turns out to be ineffective. The only sure way to treat the initial stage of eye cataracts is surgery. Ultrasonic phacoemulsification is usually performed - a low-traumatic operation performed under local anesthesia. The doctor makes a tiny incision (2-2.5 mm), through which a special probe is inserted, which softens the clouded areas of the lens with ultrasonic waves. The affected area is removed and replaced with a special intraocular lens that restores normal vision to the patient.
Phacoemulsification of cataract
Is surgery necessary for early age-related cataract?
Early age-related cataract is the most common type of disease diagnosed in almost every person aged 65 and over. If there are no contraindications to the operation, then at the request of the patient, the doctor performs a surgical intervention. In the absence of the possibility of surgical treatment, the initial age-related cataract is treated with the help of conservative therapy, which slows down the course of the pathological process.
Folk remedies
Is cataract treated? To slow the progression of the disease, sometimes doctors recommend the use of alternative medicine, which, in combination with conservative therapy, can bring good results. With an initial cataract, you can use the following folk remedies:
- Dissolve a dessert spoon of honey in a glass of boiled warm water, mix well. The resulting product is instilled into the eye 2 drops 4 times a day. You need to carry out this procedure for 14 days, then take a break of 10 days and repeat the course again.
- Mix freshly squeezed onion juice in equal proportions with honey and instill the resulting mixture in the eye 2 drops 2 times a day.
- A dessert spoon of honey is added to a glass of water, after which the mixture is boiled for 5 minutes. In this water, you need to moisten gauze and make a compress on the eyes for 5 minutes.
- Dry potato sprouts (2 tablespoons) should be poured with 200 ml of vodka and left to infuse for 14 days. After that, the mixture must be filtered and drunk 1 teaspoon three times a day before meals for 2-3 months.
- pathology of the refractive structure of the eye - the lens, characterized by its opacity and loss of natural transparency. Cataract is manifested by "blurred" vision, deterioration of night vision, weakening of color perception, sensitivity to bright light, diplopia. Ophthalmological examination for cataract includes visometry, perimetry, ophthalmoscopy, biomicroscopy, tonometry, refractometry, ophthalmometry, ultrasound eye scanning, electrophysiological studies. To slow the progression of cataracts, conservative therapy is performed; cataract removal is performed by microsurgical intervention with the replacement of the lens with an intraocular lens.
General information
Cataract (from the Greek katarrhaktes - waterfall) is a clouding or discoloration of part or the entire lens, leading to a decrease in its light transmission and a decrease in visual acuity. According to the WHO, half of all blindness cases worldwide are caused by cataracts. In the age group 50-60 years, cataract is detected in 15% of the population, 70-80 years - in 26% -46%, over 80 years - in almost everyone. Among congenital eye diseases, cataract also occupies a leading position. The high prevalence and social consequences of the disease make cataracts one of the most pressing problems of modern ophthalmology.
The lens is part of the diopter (light-conducting and light-refracting) apparatus of the eye, located posterior to the iris, opposite the pupil. Structurally, the lens is formed by a capsule (bag), capsular epithelium and lens substance. The surfaces of the lens (anterior and posterior) have a spherical shape with a different radius of curvature. The lens diameter is 9-10 mm. Lens - avascular epithelial formation; nutrients enter it by diffusion from the surrounding intraocular fluid.
According to its optical properties, the lens is a biological biconvex transparent lens, the function of which is to refract the rays entering it and focus them on the retina. The refractive power of the lens is heterogeneous in thickness and depends on the state of accommodation (at rest - 19.11 diopters; in a state of tension - 33.06 diopters).
Any change in the shape, size, position of the lens leads to significant violations of its functions. Among the abnormalities and pathologies of the lens, there is aphakia (absence of the lens), microfakia (reduction in size), coloboma (the absence of a part of the lens and its deformation), lenticonus (protrusion of the surface in the form of a cone), cataract. Cataract formation can occur in any of the layers of the lens.
Causes of cataracts
The etiology and mechanisms of cataractogenesis - the development of cataracts are explained from the standpoint of several theories, but none of them gives an exhaustive answer to the question of the causes of the disease.
In ophthalmology, the theory of free radical oxidation is the most widespread, which explains the mechanism of cataract formation in terms of the formation of free radicals in the body - unstable organic molecules with an unpaired electron that easily enter into chemical reactions and cause severe oxidative stress. It is believed that lipid peroxidation - the interaction of free radicals with lipids, especially unsaturated fatty acids, leads to the destruction of cell membranes, which causes the development of senile and diabetic cataracts, glaucoma, microcirculation disorders in the brain tissues, hepatitis. The formation of free radicals in the body is primarily promoted by smoking and ultraviolet radiation.
An important role in the mechanism of cataract development is played by an age-related decrease in antioxidant protection and a deficiency of natural antioxidants (vitamins A, E, glutathione, etc.). In addition, with age, the physicochemical properties of the protein fibers of the lens change, which make up over 50% in its structure. Lens metabolism disorders and the development of opacities may be associated with changes in the composition of the intraocular fluid in recurrent inflammatory diseases of the eye (iridocyclitis, chorioretinitis), as well as dysfunction of the ciliary body and iris (Fuchs syndrome), terminal glaucoma, pigmentary degeneration and retinal detachment.
In addition to age-related involution, deep general exhaustion after severe infectious diseases (typhoid, malaria, smallpox, etc.), starvation, anemia, excessive insolation, exposure to radiation, toxic poisoning (mercury, thallium, naphthalene, ergot) predispose to the development of cataracts. Risk factors for the development of cataracts are endocrinopathies (diabetes mellitus, tetany, muscular dystrophy, adiposogenital syndrome), Down's disease, skin diseases (scleroderma, eczema, neurodermatitis, Jacobi poikiloderma). Complicated cataracts can occur with mechanical and contusion eye injuries, eye burns, previous eye surgeries, dysfunctional cataract heredity in the family, high myopia, uveitis.
In most cases, congenital cataracts are caused by toxic effects on the embryo during the period of the lens laying. Among the causes of congenital cataracts, a pregnant woman's infections (influenza, rubella, herpes, measles, toxoplasmosis), hypoparathyroidism, corticosteroid intake, etc. are distinguished. Congenital cataracts can occur in hereditary syndromes and be combined with malformations of other organs.
Cataract classification
In ophthalmology, cataracts are divided into two large groups: congenital and acquired. Congenital cataracts, as a rule, are limited in area and stationary (do not progress); with acquired cataracts, changes in the lens progress.
Among the acquired cataracts, depending on the etiology, there are senile (senile, age-related - about 70%), complicated (with eye diseases - about 20%), traumatic (with eye injuries), radiation (with damage to the lens by X-ray, radiation, infrared radiation ), toxic (with chemical and drug intoxication), cataracts associated with general diseases.
According to the localization of opacities in the lens, they are distinguished:
- anterior polar cataract - located under the capsule in the region of the anterior pole of the lens; turbidity looks like a round spot of whitish and grayish color;
- posterior polar cataract - located under the capsule of the posterior pole of the lens; similar in color and shape to the anterior polar cataract;
- fusiform cataract - located along the anteroposterior axis of the lens; has the shape of a spindle, in appearance it resembles a thin gray ribbon;
- nuclear cataract - located in the center of the lens;
- layered (zonular) cataract - located around the nucleus of the lens, while the cloudy and transparent layers alternate;
- cortical (cortical) cataract - located along the outer edge of the lens shell; looks like whitish wedge-shaped inclusions;
- posterior subcapsular - located under the capsule behind the lens;
- complete (total) cataract is always bilateral, characterized by clouding of the entire substance and the lens capsule.
Overripe cataracts can be complicated by phakogenic (phakolytic) glaucoma associated with clogging of the natural outflow pathways of IHF by macrophages and protein molecules. In some cases, a rupture of the lens capsule and release of protein detritus into the eye cavity may occur, which entails the development of phakolytic iridocyclitis.
Maturation of cataracts can be rapidly progressive, slowly progressive, and moderately progressive. In the first variant, it takes 4-6 years from the initial stage to extensive clouding of the lens. Rapidly progressive cataract develops in about 12% of cases. Slow maturation of cataracts occurs within 10-15 years and occurs in 15% of patients. Moderate progression of cataracts in 70% of cases occurs over a period of 6-10 years.
Cataract symptoms
The severity of clinical manifestations depends on the stage of the cataract. Visual acuity with an initial cataract may not be affected. The early signs of the disease can be double vision of objects (diplopia), flashing "flies" before the eyes, blurred vision ("like a fog"), staining of visible objects in a yellowish tint. Patients with cataracts report difficulties in writing, reading, and working with small details.
For the cataract clinic, increased sensitivity of the eyes to light, deterioration of night vision, weakening of color perception, the need to use bright lighting when reading, and the appearance of a "halo" when looking at any light sources are typical. Vision with cataracts changes towards myopia, so patients with severe hyperopia sometimes suddenly discover that they can see perfectly close up without glasses. The visible image is blurred in front of the eyes, however, it is not possible to correct it with the help of glasses or contact lenses, despite the change in the diopter level.
In the stage of immature and especially mature cataracts, visual acuity sharply decreases, object vision is lost, only light perception is preserved. As the cataract matures, the pupil color becomes milky white instead of black.
Diagnosis of cataracts
Cataract detection is carried out by an ophthalmologist on the basis of a number of standard and additional examinations.
Routine ophthalmologic examinations for suspected cataracts include visometry (visual acuity testing), perimetry (determining visual fields), color testing, tonometry (measuring intraocular pressure), biomicroscopy (examining the eyeball using a slit lamp), ophthalmoscopy (examining the fundus). Taken together, a standard ophthalmological examination reveals such signs of cataracts as decreased visual acuity, impaired color perception; to investigate the structure of the lens, to assess the localization and magnitude of opacity, to detect the dislocation of the lens, etc. If it is impossible to inspect the fundus, with pronounced opacity of the lens, they resort to the study of entopic phenomena (mechanophosphene and the phenomenon of auto-ophthalmoscopy), which make it possible to judge the state of the retina.
Special methods of examination for cataract include refractometry, ophthalmometry, ultrasound scanning of the eye in A- and B-mode, ultrasound biomicroscopy, etc. Additional methods allow the ophthalmologist to calculate the strength of the intraocular lens (artificial lens), to determine the optimal operating technique.
To assess the functional state of the retina, optic nerve and central parts of the visual analyzer in cataract, electrophysiological studies are carried out: electrooculography (EOG), electroretinography (ERG), registration of visual evoked potentials (VEP).
Cataract treatment
In the initial stages of senile cataract, conservative therapy is used, including instillation of eye drops (azapentacene, pyrenoxine, combined drugs with cytochrome C, taurine, etc.). Such measures do not lead to resorption of lens opacities, but only slow down the progression of cataracts.
The meaning of the so-called substitution therapy is the introduction of substances, the lack of which leads to the development of cataracts. Therefore, the eye drops contain amino acids, vitamins (riboflavin, nicotinic acid, ascorbic acid), antioxidants, potassium iodide, ATP and other substances. The drug azapentacene has a different mechanism of action - due to the activation of proteolytic enzymes, it to some extent promotes the resorption of the opaque protein structures of the lens.
Conservative treatment of cataracts is ineffective, therefore the only method for eliminating pathology and restoring vision is microsurgical operation - removal of the altered lens and its replacement with an intraocular lens. The possibilities of modern eye microsurgery eliminate the need to wait for the complete maturation of the cataract to remove it.
Medical indications for surgical treatment include: swelling cataract, overripe cataract, subluxation or dislocation of the lens, detection of secondary glaucoma, concomitant fundus pathology requiring treatment (diabetic retinopathy, retinal detachment, etc.). Additional indications for surgical treatment of cataracts are determined by professional and household needs to improve the quality of vision. In case of bilateral cataract, the eye with a lower visual acuity is first operated on.
In modern cataract surgery, several methods are used to remove a clouded lens: extracapsular and intracapsular cataract extraction, ultrasound and laser phacoemulsification.
The most serious prognosis in relation to visual function is associated with congenital cataracts, since in this case, as a rule, there are changes in the neuro-receptor apparatus of the eye. Surgical treatment of acquired cataracts, in most cases, leads to the achievement of acceptable visual acuity, and often - and restoration of the patient's ability to work.
Prevention of congenital cataracts requires the prevention of viral diseases during pregnancy, the elimination of radiation exposure. To prevent the development of acquired cataracts, especially at a young age, antioxidant protection of the body, earlier treatment of concomitant general and ophthalmic pathology, prevention of eye injuries, and annual medical examinations by an ophthalmologist are necessary.
Early age-related cataracts are characterized by rapid progression and a steady decline in visual acuity. This cloudiness does not disappear even with rational drug treatment. But diabetic and some medicinal cataracts can regress or even be completely cured in a conservative way.
Symptoms
As a rule, vision does not decrease at the initial stage of cataract. This explains the untimely appeal of patients to a doctor. Patients go to an ophthalmologist only when the cataract progresses and leads to a pronounced decrease in visual acuity - up to tenths or even hundredths.
Opacities are most often located cortically or subcapsularly (that is, closer to the periphery of the lens); nuclear cataract is less common. Cataract symptoms and their severity directly depend on the location and size of the opacities.
The first signs of an initial cataract:
- double vision in the affected eye;
- the appearance of dots, flies, small spots, circles in front of the eyes;
- the appearance of colored circles when looking at light sources;
- deterioration in color perception and poor tolerance to bright light;
- decreased visual acuity in the dark;
- a temporary improvement in vision in patients with, allowing again to read without glasses, is explained by a slight swelling of the lens, leading to an increase in its refraction.
Deterioration of vision due to clouding and thickening of the lens with a subsequent change in its refractive index is observed in the later stages of cataract.
What causes opacity in the lens?
Most often, opacities are the result of age-related changes. In older people, the lens increases in size, becomes heavier and denser, due to which the nutrition of its tissues is disturbed. Symmetrical or asymmetric cataracts in both eyes often develop with metabolic or endocrine disorders, taking certain medications, and intoxication.
The most common causes of cataracts are:
- age-related changes, the nature of which has not yet been fully understood (senile lens);
- electrical injuries, penetrating wounds, eye contusions;
- exposure to ultraviolet or infrared radiation;
- incomplete removal of lens masses during extracapsular cataract extraction;
- long-term treatment with corticosteroids, phenothiazines, anticholinesterase agents;
- long-term iridocyclitis and peripheral uveitis of various etiologies;
- retrolental fibroplasia - retinal damage that occurs in premature babies;
- various hereditary and congenital diseases and syndromes;
- diabetes mellitus, myotonic dystrophy, hypocalcemia, galactosemia, Wilson-Konovalov disease.
What measures need to be taken at the beginning of the development of the disease
What to do when the initial signs of cataract appear? See an ophthalmologist as soon as possible. Regular use of drugs can significantly slow down the course of the disease and, therefore, postpone.
In some cases (with diabetes mellitus, taking certain medications), treatment leads to the disappearance of opacities and restoration of the transparency of the lens. Unfortunately, conservative treatment of the initial senile cataract is impossible.
Phacoemulsification of cataracts is the gold standard today. Surgical treatment allows you to remove opacities, and the implantation of an intraocular lens (artificial lens) makes it possible to return the patient to high visual acuity.
Capillary problems
Deterioration of vision can occur not only due to clouding of the lens, but also when blood circulation in the retina is impaired. As a rule, pathological changes in blood vessels are detected in the fundus.
(this is how this disorder is called) can develop in persons with hypertension, diabetes mellitus, occur as a result of trauma or hypotension. Damage to the capillaries is very dangerous, because if untreated, it often leads to blindness.
Risk factors
Risk factors that contribute to lens clouding include old age, the presence of cataracts in close relatives, and the female gender. It has also been observed that the disease is much more common in people with brown eyes.
Diagnostics of the initial cataract
As a rule, the initial stage of cataract is detected by an ophthalmologist without much difficulty. The diagnosis can be made after examining the patient with a slit lamp. To clarify the cause of the disease, additional research may be conducted.
Treatment
Treatment of an initial cataract is most often conservative. The patient is advised to exclude the action of provoking factors and are prescribed drugs that slow the progression of the disease. A qualified ophthalmologist should be involved in the treatment of cataracts.
Conservative treatment
To combat the initial cataract, a number of biologically active substances are used that can significantly slow down the course of the disease. Some of them are buried in the conjunctival cavity, others are injected intramuscularly.
Especially useful for cataracts are B vitamins, ascorbic and niacin (vitamins C and PP), taurine, cysteine, glutathione, taurine, potassium iodide, some trace elements - zinc, magnesium, potassium, calcium.
Mineral and vitamin complexes
Complexes that improve metabolism in the eyeball are very popular. As a rule, they contain cytochrome C, taurine, adenosine and other substances that have a positive effect on the lens.
Any means of the following can suspend the development of the disease:
- Quinax;
- Oftan-katakhrom;
- Bestoxol;
- Vitafacol;
- Fakovit.
Diet
For people with cataracts, doctors recommend limiting the intake of fatty meats and foods that increase blood cholesterol levels. The diet should include more foods containing omega-3 fatty acids, vitamins C and E (black currants, rose hips, spinach, parsley, vegetable oils, red fish). They are very useful because they inhibit the development of cataracts.
Is the operation performed at the initial stage?
Indications for surgery are determined on a purely individual basis. Usually, surgical treatment is carried out with a pronounced deterioration in vision, which reduces the person's ability to work. It is also indicated if the patient is diagnosed with an initial complicated cataract with glaucoma or other diseases of the visual organ. But with minor opacities that do not cause discomfort, the operation can be postponed.
Which lens should you choose?
After phacoemulsification of the cataract, the patient is implanted with aphakic posterior capsular lenses. The cheapest are monofocal, the most expensive are toric, multifocal and accommodating.
Monofocal lenses provide good distance vision, but they do not accommodate, which is why the operated person requires reading glasses. Toric lenses are mainly used for correction. Multifocal and accommodating IOLs provide good visibility for far and near, but are not suitable for everyone.
Complications
After surgical replacement of the lens, patients may develop iridocyclitis, rise in intraocular pressure, and hemorrhages in the anterior chamber of the eye. Mixing of the implanted lens and retinal detachment is also possible.
Prevention
Preventive measures include limiting eye exposure to ultraviolet radiation, quitting smoking and drinking alcohol. Overweight people should lose weight and exclude unhealthy foods from their diet. With hypertension, regular intake of antihypertensive drugs is required. Diabetes mellitus requires constant monitoring of blood sugar levels.
Timely diagnosis and treatment of inflammatory diseases of the visual organ (iridocyclitis, peripheral uveitis, chorioretinitis) is important. If it requires adequate treatment.
The initial stage of cataract is manifested by double vision, the appearance of various points or flies in the field of vision. Some people notice colored circles when looking at sources of bright color. The disease is treated mainly conservatively. Later, more stages of cataracts usually require surgical treatment.
Useful video about cataracts
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