What is a cataract?

A cataract is an eye disease in which the normally clear lens of the eye becomes cloudy or opaque, causing a decrease in vision. The lens is important for focusing light onto the back of the eye (the retina) so that images appear clear and without distortion, and the clouding of this lens during cataract formation distorts our vision. Cataracts are usually a very gradual process of normal aging but can occasionally develop rapidly. They commonly affect both eyes, but it is not uncommon for a cataract in one eye to advance more rapidly. Cataracts are very common, affecting roughly 60% of people over the age of 60, and over 1.5 million cataract surgeries are performed in the United States each year Precisely why cataracts occur is unknown; however, most cataracts appear to be caused by changes in the protein structures within the lens that occur over many years and cause the lens to become cloudy. Rarely, cataracts can present at birth or in early childhood as a result of hereditary enzyme defects, other genetic disease, or systemic congenital infections. Severe trauma to the eye, eye surgery, or intraocular inflammation can also cause cataracts to develop more rapidly. Other factors that may lead to development of cataracts at an earlier age include excessive ultraviolet light exposure, exposure to ionizing radiation, diabetes, smoking, or the use of certain medications, such as oral, topical, or inhaled steroids. Other medications that are more weakly associated with cataracts include the long-term use ofstatins and phenothiazines.

What are the symptoms and signs of cataracts?

Cataract development is often equated to looking through a dirty windshield of a car or smearing grease over the lens of a camera. Cataracts may cause a variety of complaints and visual changes, including blurred vision, difficulty with glare (often with bright sun or automobile headlights while driving at night), dull color vision, increased nearsightedness accompanied by frequent changes in eyeglass prescription, and occasionally double vision in one eye. A change in glasses may initially help once vision begins to change from a cataract; however, as the cataract continues to become more dense and cloudy, vision also becomes more cloudy, and stronger glasses or contact lenses will no longer improve sight.

How are cataracts diagnosed?

Cataracts are detected by the finding of lens opacification during a medical eye examination by an eye-care professional. The abnormal lens can be seen using a variety of specialized viewing instruments. Using a variety of tests, your doctor is able to tell how much a cataract may be affecting your vision. Usual eye tests include testing visual acuity, glare sensitivity, color vision, contrast sensitivity, and a thorough examination of all other parts of the eye. Your doctor will make sure vision loss is not due to other common eye problems, including diabetes, glaucoma, or macular degeneration.

What should one expect prior to and on the day of cataract surgery?
Prior to the day of surgery, your ophthalmologist will discuss the steps that will occur during surgery. Your ophthalmologist or a staff member will ask you a variety of questions about your medical history and perform a brief physical exam. You should discuss with your ophthalmologist which, if any, of your routine medications you should avoid prior to surgery. Prior to surgery, several calculations will be made to determine the appropriate power of intraocular lens to implant. A specific artificial lens is chosen based on the length of the eye and the curvature of the cornea (the clear portion of the front of the eye).

What are potential complications of cataract surgery?

While cataract surgery is one of the safest procedures available with a high rate of success, rare complications can arise. Your ophthalmologist will discuss the specific potential complications of the procedures that are unique to your eye prior to having you sign a consent form. The most common difficulties arising after surgery are persistent inflammation, changes in eye pressure, infection, or swelling of the retina at the back of the eye (cystoid macular edema), and retinal detachment. If the delicate bag the lens sits in is injured, then the artificial lens may need to be placed in a different location. In some cases, the intraocular lens moves or does not function properly and may need to be repositioned, exchanged, or removed. All of these complications

are rare but can lead to significant visual loss; thus, close follow-up is required after surgery. If you have pre-existing macular degeneration or floaters, these will not be made better by cataract surgery.

Cataract surgery is the removal of the natural lens of the eye (also called "crystalline lens") that has developed an opacification, which is referred to as a cataract. Metabolic changes of the crystalline lens fibers over time lead to the development of the cataract and loss of transparency, causing impairment or loss of vision. Many patients' first symptoms are strong glare from lights and small light sources at night, along with reduced acuity at low light levels. During cataract surgery, a patient's cloudy natural lens is removed and replaced with a synthetic lens to restore the lens's transparency. [1] Following surgical remo val of the natural lens, an artificial intraocular lens implant is inserted (eye surgeons say that the lens is "implanted"). Cataract surgery is generally performed by an ophthalmologist (eye surgeon) in an ambulatory (rather than inpatient) setting, in a surgical center or hospital, using local anesthesia (either topical, peribulbar, or retrobulbar), usually causing little or no discomfort to the patient. Well over 90% of operations are successful in restoring useful vision, with a low complication rate. [2] Day care, high volume, minimally invasive, small incision phacoemulsification with quick post-op recovery has become the standard of care in cataract surgery all over the world.

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Submitted by: Alayon,Jaimiery BSN-IV Fernandez

Submitted to: Prof. Candelaria Talaabucon RN Clinical Instructior