Cataract is a clouding of the eye's natural lens, which lies behind the iris and the pupil.

The lens works much

like a camera lens, focusing light onto the retina at the back of the eye. The lens also adjusts the eye's focus, letting
us see things clearly both up close and far away.

The lens is mostly made of water and protein. The protein is arranged in a precise way that keeps the lens clear
and lets light pass through it.

But as we age, some of the protein may clump together and start to cloud a small area of the lens. This is a
cataract, and over time, it may grow larger and cloud more of the lens, making it harder to see.

Cataracts are classified as one of three types:

 A subcapsular cataract begins at the back of the lens. People with diabetes, high farsightedness, retinitis
pigmentosa or those taking high doses of steroids may develop a subcapsular cataract.
 A nuclear cataract is most commonly seen as it forms. This cataract forms in the nucleus, the center of
the lens, and is due to natural aging changes.
 A cortical cataract, which forms in the lens cortex, gradually extends its spokes from the outside of the
lens to the center. Many diabetics develop cortical cataracts.

Cataract Symptoms and Signs

A cataract starts out small and at first has little effect on your vision. You may notice that your vision is blurred a
little, like looking through a cloudy piece of glass or viewing an impressionist painting.

A cataract may make light from the sun or a lamp seem too bright or glaring. Or you may notice when you drive at
night that the oncoming headlights cause more glare than before. Colors may not appear as bright as they once
did.

The type of cataract you have will affect exactly which symptoms you experience and how soon they will occur.
When a nuclear cataract first develops, it can bring about a temporary improvement in your near vision, called
"second sight." Unfortunately, the improved vision is short-lived and will disappear as the cataract worsens. On the
other hand, a subcapsular cataract may not produce any symptoms until it's well-developed.

If you think you have a cataract, see an eye doctor for an exam to find out for sure.

What Causes Cataracts?

No one knows for sure why the eye's lens changes as we age, forming cataracts. Researchers are gradually
identifying factors that may cause cataracts — and information that may help to prevent them.

Many studies suggest that exposure to ultraviolet light is associated with cataract development, so eyecare
practitioners recommend wearing sunglasses and a wide-brimmed hat to lessen your exposure.

Other types of radiation may also be causes. For example, a 2005 study conducted in Iceland suggests that airline
pilots have a higher risk of developing nuclear cataract than non-pilots and that the cause may be exposure to
cosmic radiation. A similar theory suggests that astronauts, too, are at risk from cosmic radiation.

Other studies suggest people with diabetes are at risk for developing a cataract.
The same goes for users of steroids, diuretics and major tranquilizers, but more studies are needed to distinguish
the effect of the disease from the consequences of the drugs themselves.

Some eyecare practitioners believe that a diet high in antioxidants, such as beta-carotene (vitamin A), selenium
and vitamins C and E, may forestall cataract development. Meanwhile, eating a lot of salt may increase your risk.

Other risk factors include cigarette smoke, air pollution and heavy alcohol consumption.

A small study published in 2002 found lead exposure to be a risk factor; another study in December 2004, of 795
men age 60 and older, came to a similar conclusion.

But larger studies are needed to confirm whether lead can definitely put you at risk and, if so, whether the risk is
from a one-time dose at a particular time in life or from chronic exposure over years.*

Cataract Treatment

When symptoms begin to appear, you may be able to improve your vision for a while using new glasses, strong
bifocals, magnification, appropriate lighting or other visual aids.

Think about surgery when your cataracts have progressed enough to seriously impair your vision and affect your
daily life. Many people consider poor vision an inevitable fact of aging, but cataract surgery is a simple, relatively
painless procedure to regain vision.

Cataract surgery is very successful in restoring vision. In fact, it is the most frequently performed surgery in the
United States, with more than 3 million Americans undergoing cataract surgery each year. Nine out of 10 people
who have cataract surgery regain very good vision, somewhere between 20/20 and 20/40.

During surgery, the surgeon will remove your clouded lens and in most cases replace it with a clear, plastic
intraocular lens (IOL).

New IOLs are being developed all the time to make the surgery less complicated for surgeons and the lenses more
helpful to patients. Presbyopia-correcting IOLs potentially help you see at all distances, not just one. Another new
type of IOL blocks both ultraviolet and blue light rays, which research indicates may damage the retina (see
illustration).

Read more about what to expect if you have cataract surgery and how to deal with rare cataract surgery
complications. Also, men should be aware that certain prostate drugs can cause intraoperative floppy iris
syndrome (IFIS) during a cataract procedure.
Phacoemulsification refers to modern cataract surgery in which the eye's internal lens is emulsified with
an ultrasonic handpiece, and aspirated from the eye. Aspirated fluids are replaced with irrigation of balanced salt
solution, thus maintaining the anterior chamber, as well as cooling the handpiece.

Preparation and precautions

The eye is a delicate organ, requiring extreme care before, during and after a surgical procedure. An expert
ophthalmologist must identify the need for phacoemulsification and be in charge of conducting the procedure
safely. Many university programs allow patients to specify if they want to be operated upon by the consultant or
the resident / fellow.

Proper anesthesia is a must for any eye surgery. Topical anesthesia is most commonly employed, using tetracaine
eyedrops or lidocaine gel. Alternatively, lidocaine and/or longer-acting marcaine anesthestic may be injected into
the area surrounding (peribulbar block) or behind (retrobulbar block) the eye muscle cone to more fully immobilize
the extraocular muscles and minimize pain sensation. A facial nerve block using Lidocaine and Bupivacaine may
occasionally be performed to reduce lid squeezing. General anesthesia is recommended for children, traumatic eye
injuries with cataract, for very apprehensive or uncooperative patients and animals. Cardiovascular monitoring is
preferable in local anesthesia and is mandatory in general anesthesia. Proper sterile precautions are taken to
prepare the area for surgery, including use of antiseptics like povidone-iodine. Sterile drapes, gowns and gloves are
employed. A plastic sheet with a receptacle helps collect the fluids during phacoemulsification. An eye speculum is
inserted to keep the eyelids open.

Surgical technique

Before the Phacoemulsification can be performed, one or more incisions are made in the eye to allow the
introduction of surgical instruments. The surgeon then removes the anterior face of the capsule that contains the
lens inside the eye. Phacoemulsification surgery involves the use of a machine with microprocessor-controlled fluid
dynamics. These can be based on peristaltic or venturi type of pump.

The phaco probe is an ultrasonic handpiece with a titanium or steel needle. The tip of the needle vibrates at
ultrasonic frequency to sculpt and emulsify the cataract while the pump aspirates particles through the tip. In
some techniques, a second fine steel instrument called a "chopper" is used from a side port to help with chopping
the nucleus into smaller pieces. The cataract is usually broken into two or four pieces and each piece is emulsified
and aspirated out with suction. The nucleus emulsification makes it easier to aspirate the particles. After removing
all hard central lens nucleus with phacoemulsification, the softer outer lens cortex is removed with suction only.

An irrigation-aspiration probe or a bimanual system is used to aspirate out the remaining peripheral cortical
matter, while leaving the posterior capsule intact. As with other extracapsular cataract extraction procedures, an
intraocular lens implant (IOL), is placed into the remaining lens capsule. For implanting a PMMA IOL, the incision
has to be enlarged. For implanting a foldable IOL, the incision does not have to be enlarged. The foldable IOL,
made of silicone or acrylic of appropriate power is folded either using a holder/folder, or a proprietary insertion
device provided along with the IOL.

It is then inserted and placed in the posterior chamber in the capsular bag (in-the-bag implantation). Sometimes, a
sulcus implantation may be required because of posterior capsular tears or because of zonulodialysis. Because a
smaller incision is required, few or no stitches are needed and the patient's recovery time is usually shorter when
using a foldable IOL.
Extracapsular cataract extraction (ECCE) is a category of eye surgery in which the lens of the eye is
removed while the elastic capsule that covers the lens is left partially intact to allow implantation of an intraocular
lens (IOL). This approach is contrasted with intracapsular cataract extraction (ICCE), an older procedure in which
the surgeon removed the complete lens within its capsule and left the eye aphakic (without a lens). The patient's
vision was corrected after intracapsular extraction by extremely thick eyeglasses or by contact lenses.

There are two major types of ECCE: manual expression, in which the lens is removed through an incision made in
the cornea or the sclera of the eye; and phacoemulsification, in which the lens is broken into fragments inside the
capsule by ultrasound energy and removed by aspiration.

Intraocular lens is an implanted lens in the eye, usually replacing the existing crystalline lens because it has
been clouded over by a cataract, or as a form of refractive surgery to change the eye's optical power. It usually
consists of a small plastic lens with plastic side struts, called haptics, to hold the lens in place within the capsular
bag inside the eye. IOLs were traditionally made of an inflexible material (PMMA), although this has largely been
superseded by the use of flexible materials. Most IOLs fitted today are fixed monofocal lenses matched to distance
vision. However, other types are available, such as multifocal IOLs which provide the patient with multiple-focused
vision at far and reading distance, and adaptive IOLs which provide the patient with limited visual accommodation.

Insertion of an intraocular lens for the treatment of cataracts is the most commonly performed eye surgical
procedure. The procedure can be done under local anesthesia with the patient awake throughout the operation.
The use of a flexible IOL enables the lens to be rolled for insertion into the capsule through a very small incision,
thus avoiding the need for stitches, and this procedure usually takes less than 30 minutes in the hands of an
experienced ophthalmologist. The recovery period is about 2–3 weeks. After surgery, patients should avoid
strenuous exercise or anything else that significantly increases blood pressure. They should also visit their
ophthalmologists regularly for several months so as to monitor the implants.

IOL implantation carries several risks associated with eye surgeries, such as infection, loosening of the lens, lens
rotation, inflammation, night time halos. Though IOLs enable many patients to have reduced dependence on
glasses, most patients still rely on glasses for certain activities, such as reading.

Glaucoma refers to a group of diseases that affect the optic nerve and involves a loss of retinal ganglion cells in
a characteristic pattern. It is a type of optic neuropathy. Raised intraocular pressure is a significant risk factor for
developing glaucoma (above 22 mmHg or 2.9 kPa). One person may develop nerve damage at a relatively low
pressure, while another person may have high eye pressure for years and yet never develop damage. Untreated
glaucoma leads to permanent damage of the optic nerve and resultant visual field loss, which can progress to
blindness.

Glaucoma can be divided roughly into two main categories, "open angle" and "closed angle" glaucoma. In closed
angle glaucoma, the canal of Schlemm in the anterior chamber becomes obstructed, preventing the normal
outflow of aqueous humor, which increases the intraocular pressure. All other etiologies comprise open angle
glaucoma. Visual loss can progress quickly but the discomfort often leads patients to seek medical attention before
permanent damage occurs. Open angle, chronic glaucoma tends to progress more slowly and the patient may not
notice that they have lost vision until the disease has progressed significantly.

Glaucoma has been nicknamed the "sneak thief of sight" because the loss of vision normally occurs gradually over
a long period of time and is often only recognized when the disease is quite advanced. Once lost, this damaged
visual field can never be recovered. Worldwide, it is the second leading cause of blindness. [1] Glaucoma affects 1 in
200 people aged fifty and younger, and 1 in 10 over the age of eighty. If the condition is detected early enough it is
possible to arrest the development or slow the progression with medical and surgical means.

Trabeculectomy is a surgical procedure used in the treatment of glaucoma to relieve intraocular pressure by
removing part of the eye's trabecular meshwork and adjacent structures. It is the most common glaucoma surgery
performed and allows drainage of aqueous humor from within the eye to underneath the conjunctiva where it is
absorbed. This outpatient procedure is most commonly performed under monitored anesthesia care in a half
awake state using a retrobulbar block or a combination of topical and subtenon (Tenon's capsule) anesthesia.

Vitrectomy is a surgery to remove some or all of the vitreous humor from the eye. Anterior vitrectomy entails
removing small portions of the vitreous from the front structures of the eye - often because these are tangled in an
intraocular lens or other structures. Pars plana vitrectomy is a general term for a group of operations
accomplished in the deeper part of the eye, all of which involve removing some or all of the vitreous - the eye's
clear internal jelly.