Cataract: symptoms, treatment and prevention, causes

Cataract is a dense turbid region, which is formed in the lens of the eye. It occurs when proteins in the eye formed clumps which impair the clarity of the image projected on the retina.

The retina converts the light passing through the lens into signals. It sends signals to the optic nerve, which carries them to the brain. Cataract leads to the fact that part of the lens of the eye becomes opaque or cloudy. Light is not able to pass easily as before, and vision becomes blurry, blurred as if through a window. The turbid lens, the worse will be the vision.

This disease develops slowly and eventually interferes with your vision. You can develop cataracts in both eyes at once, but it usually affects the eyes at different times. Cataracts are very common among the elderly. According to the National Eye Institute, more than half of people in developed countries have a cataract or have undergone cataract surgery to 80 years of age.

What it is?

Cataracts - a clouding of the eye lens, which is manifested decreased visual acuity, and a sense of the shroud of fog. The human crystalline lens is like a camera lens. In his youth, he is completely transparent and elastic, which allows all the light rays fall into the eye and instantly focus on near and distant objects.

Causes of

Acquired cataracts are age, complications (associated with eye diseases) caused by common diseases, toxic (Effect of certain drugs) and traumatic arising from the action of physical, chemical or thermal and radiation factors.

With age (usually after 50 years), the lens fibers are compacted and possibly its turbidity. Also lead to the development of cataract eye disease such as relapsing iridocyclitis, chorioretinitis, glaucoma, retinal degeneration, high myopia. When all of these conditions occur degenerative changes in the lens.

Quite a lot of common diseases lead to the development of cataracts. For example, diabetes mellitus, emaciation due to starvation, infectious diseases (malaria, typhoid). Toxic effect on the lens have hormones.

Traumatic cataract may occur when blunt and penetrating wounds of the eye. Very often there is a so-called ring Fossiusa (imprint iris pigment ring which dissolves at adequate treatment). When the true vision of cataract development steadfastly declining. Because lens is able to absorb invisible infrared rays, radiation cataract may develop in working shops and hot during irradiation orbit without using protective means (goggles, masks).

Congenital cataracts are associated with impaired differentiation of the lens during embryogenesis and are not amenable to conservative treatment.

senile cataract

This type of eye disease - the natural consequence of the aging of the organism. At the initial stage of the immature cataract objects gradually lose their shape. With the progression of the disease before the eyes swim dark spots, blemishes, image can often look like a double. Near vision becomes problematic. As the pupil of the eye is white maturation. When a nuclear cataract clouding the hearth is formed in the center of the lens, acquiring a brown color. Gradual seal nucleus leads to a high degree of myopia.

Senile cataract progresses faster in the presence of primary ocular diseases provoked its development. It can affect genetic predisposition. Sometimes the cause of cataracts in old age are becoming an eye injury, mechanical or chemical. Great risk of such a disease in diabetics, as well as heavy smokers - there is a cataract is common after age 55.

developmental stage

During senile cataract secrete several stages:

1. Starting cataracts. Clouding occurs in the deep layers of the peripheral part of the lens is gradually spreading to the center (equator) to the axis of the capsule. Stage lasts from a couple of months to decades.
2. The swelling (immature) cataracts. Denoted signs lens hydration, increasing its volume and decrease in the anterior chamber of the eye. the duration of step - up to several years.
3. Mature cataracts. clouding of the lens covers all its layers. Vision appears only at the level of perception of light.
4. Overripe cataracts. Occurs dehydration of the lens, its degeneration and atrophy of the capsule, which leads to total blindness.

The first signs

Insidious disease in the initial phase is that it is difficult to determine. Clouding occurs more often on the edge of the lens without affecting the visual system, so many people either do not feel any changes, or not pay attention to minor deviations. Nevertheless, there are specific signs of cataracts at an early stage.

One suspects the onset of disease if:

• surrounding objects slightly fuzzy, with double loops;
• bright objects surrounded by iridescent glow;
• appear dark "fly";
• it is difficult to thread a needle, read texts in small print.

symptoms of cataract

The most common symptom of cataract is blurred vision (see. Photo). Depending on the location of lens opacities in the center or at the periphery of vision may be reduced or remain high. If the cataract begins to develop in the periphery of the lens, the patient may not experience any change in vision. This cataract is found by chance on the preventive medical examination. The closer to the center is a clouding of the lens, the more serious are the problems with eyesight.

With the development of opacity in the central part of the lens (its core) may appear or worsen myopia that exhibit improved near vision, distance vision but deteriorating. This explains the fact that people with cataracts is often necessary to change glasses. Many elderly patients in this situation, note the fact that the lost in the forties Life's ability to read and write without any plus points for a while inexplicably returns. In this case, the objects are seen indistinctly, with blurred outlines. The image can be split in two. The pupil, which normally appears black, may acquire a grayish or yellowish tint. When the swelling pupil cataract becomes white.

People with cataracts may complain of an increase or decrease the sensitivity. For example, some say that the world around became somehow dim. On the other hand, intolerance to bright light, the best sight in cloudy weather or at dusk characteristic opacity of the lens in the central area. Most often, these complaints are observed at t. N. posterior subcapsular cataract. All of these symptoms are an indication for treatment to the doctor.

Congenital cataract, a child may manifest strabismus, the presence of white pupil, decreased vision, which is detected by the absence of reaction to noiseless toys.

complications

If the cataract was not diagnosed in time and not lechena, it can lead to complications such as:

1. Lens luxation. This complication is characterized by the fact that there is its total displacement and separation from holding ligament. Vision at the same time drastically deteriorates, and the lens is subject to mandatory removal.
2. Amblyopia of obscure origin. This complication is often seen in children, and is a consequence of congenital cataract. Characterized in that the retina is not receiving signals from the outside, atrophies and ceases to function, although this was healthy. Treatment of this complication with surgery alone.
3. Total blindness or amaurosis. It cataract ranks first among the diseases that lead to absolute loss of vision. In this blindness does not occur abruptly, it is coming gradually. If you start treatment in time, this complication can be avoided. amaurosis Diagnosis is made when vision is lost completely.
4. Fakogennaya glaucoma is characterized by a secondary increase in pressure inside the eye due to the fact that the lens increases in size. The lens requires removal and the therapy aimed at the reduction of pressure.
5. Fakolitichesky iridocyclitis, which is manifested in inflammation of the iris and ciliary body. A person experiences severe pain in the eyes and head, vascular mesh becomes bluish or red, the pupil bad moves. When the acute process is eliminated, the question of removal of the lens.

To avoid such serious complications, the disease need to be diagnosed and treated in time under the guidance of professional doctors. Should seek help at the first manifestation of symptoms.

cataract treatment

Of great importance in the treatment of cataract is the elimination of risk factors and treatment of diseases, contributing to its development, for example, diabetes, hypoparathyroidism, and others.

No conservative funds are not able to cause resorption of existing lens opacities. If the cataract is already there, it will continue to evolve. Certain pharmacological agents are only able to slow down this process is irreversible. The fact that some areas of the lens material with age-related cataracts are often half-transparent and not subject to further clouding, unlike fully transparent regions. Stage swelling can last for many years.

Conservative method of treatment of cataract is the constant application of eye drops. These components in various ratios are elements the lack of which promotes the development of the disease. These are drugs:

1. Vitayodurol - complex preparation with components such as adenosine, calcium chloride, magnesium chloride, nicotinic acid;
2. Taurine (Taufon) representing an amino acid with sulfur and stimulating energetichesike processes in the lens;
3. Pirenoxine (Katalin - eye drops) - Promotes normalization of glucose metabolism and permeability of the lens capsule, prevents accumulation of sorbitol; used mainly in senile and diabetic cataracts;
4. Oftan-Katahrom, Vitafakol, Cytochrome improving oxidation processes and used primarily in the subcapsular opacity and opacity in the form of a bowl;
5. Vit B2, riboflavin or - intramuscular injection;
6. Kvinaks active substance is azapentatsen, it occupies a special position among drugs for the treatment of cataracts; It is believed that it inhibits the synthesis of the compounds and the oxidative action destroying lenticular proteins, thereby promoting resorption of opacity; however, due to the long development of the disease in old age resolving the action of the drug is subject to serious doubt.

The structure of the complex include conservative therapy and physical therapy techniques, for example, 40 Session electrophoresis solution cysteine ​​- amino acid, which is a part of some proteins and peptides. It helps neutralize certain toxins and protects from harmful effects of radiation.

Eye drops against cataracts

To date, pharmaceutical companies offered a large number of drugs for the treatment of cataract without surgery.

Eye drops cataracts produced by industrial methods differ in price, composition, effectiveness, side effects. The most common eye drops on cataract following: vitayodurol, vitafakol, vitsein drops Smirnov kvinaks, oftan-Katahrom, senkatalin taufon. Such a variety of drugs for medical treatment of cataract is related to the lack of clarity of its causes.

Therefore applies so-called substitution therapies for drug treatment of a disease which lies in the fact that drops from cataracts contain in their composition of matter, a lack of which is linked and progression of the disease. As part of the drops on the progression of cataracts include vitamins (group B, C, PP), potassium iodide, antioxidants (glutathione, cytochrome C), amino acids, ATP, and a number of other substances.

Surgery

Such treatment allows completely rid of human cataract, since during the operation is performed removing the opaque lens mass. But after cataract surgery a person can not see, because the lens would be simply destroyed, so be sure the second part of the surgery is the installation of the prosthesis, which will allow see.

Currently, both stages of operation - the removal of cataracts and installing the intraocular lens (lens prosthesis) are produced during one and the same interference. In other words, in a single operation a person gets rid of the cataract and receives the prosthesis, which allows him to see properly. And artificial intraocular lens, which is often called "artificial lens," will serve as a person indefinitely. So one day cataract surgery with artificial lens set is considered to be a complete cure of eye disease.

It is recommended to refrain from transactions and produce conservative cataract treatment in the following cases:

• Loss of vision - is insignificant and gradually, so that people could easily perform their normal duties at home and work;
• The presence of other eye diseases such as glaucoma and diabetic retinopathy (in this case, the operation for cataract not improve sight);
• Glasses or contact lenses can achieve the level of which suits the person and allows him to perform normal work or home affairs;
• The presence of heavy somatic diseases in which any undesirable stresses and operation.

The surgery for cataract is compulsorily carried out in the following cases:

• Congenital cataract in a child (it is important to remove cataracts as early as possible so that the child could grow and not lose sight);
• Overripe cataracts;
• The swelling immature or mature cataracts for which the lens increases significantly in size and can block the outflow of intraocular fluid by provoking the attack of glaucoma;
• Luxation or subluxation of the lens;
• Secondary glaucoma attack triggered swelling of the lens;
• The need to study the fundus or other diseases for use of laser treatments (e.g., retinal detachment, etc.).

In all other cases, the decision on how to operate a cataract or confine conservative treatment, accepts the man himself.

Cataract surgery

Currently, the following operations can be performed with cataract:

1. Intracapsular extraction lens - performed together with removal of the lens capsule, carried out through a large incision with the help of special devices - cryoextractor. This technique is quite traumatic to the eye, so now almost does not apply. Typically the indication for carrying out such operations are traumatic cataract when fails preserve the integrity of the lens capsule, or dislocated lens, when its hanger threads (chord) damaged.
2. Extracapsular extraction of the lens - in step removes the outer part of the capsule material and all the lens, but the left rear part of the capsule, which allows to keep the barrier between the vitreous body and the cornea. After removal of the lens instead inserted and fixed prosthesis - IOL. This operation is performed relatively infrequently, since it is traumatic because of the large incision in the cornea and suturing. Currently, extracapsular extraction of the lens is replaced with less traumatic phacoemulsification.
3. Femtolazernaya phacoemulsification - removal of the lens via ultrasound. Its advantages are that the operation is performed through a micro-incision of 2.2 to 5.5 mm, depending on the selected IOL. The operation is performed under local anesthesia, it enables the surgeon to be in contact with the patient during the operation. It does not require the imposition of postoperative sutures. Length does not take more than 15 minutes, is painless and safe, the risk of postoperative complications is minimal. The patient quickly rehabilitated, full operation is restored within 10 days.
4. Ultrasonic phacoemulsification - during surgery through a small incision (1.8 - 3 mm) in the anterior chamber administered appliance - phaco whereby destroying the lens material, bringing it to a consistency emulsion. Then, this emulsion was removed through a special tube. That is, during the operation material is removed and the front portion of the lens capsule. The rear of the lens capsule remains and serves as a barrier between the iris and the vitreous body. After removal of the destroyed mass produced lenticular polishing remaining posterior capsule to destroy existing thereon epithelium. Upon completion of polishing in the eye instead of the removal of the lens is inserted intraocular lens, and the incision is sealed without sutures. Ultrasonic phacoemulsification is the "gold standard" in modern cataract surgery, because the technique is simple, widely available, and rarely causes complications.

So, as has become clear, the best options for cataract operations are ultrasonic phacoemulsification and femtolazernaya. Given the chance to make better femtolazernuyu phacoemulsification. But if this is not possible (for example, lack of funds for the operation, or available to visiting health centers do not have the necessary equipment), you can safely produce ultrasound phacoemulsification.

Currently, the following types of soft lenses to replace the lens:

1. Accommodative lenses - the best lens on the properties closest to the natural lens. Installing this type of lens allows you to find a completely different vision and the near and far, and to renounce the use of additional points even with myopia or hyperopia.
2. Aspheric lenses - corrected spherical irregularities and provide an excellent distance vision in the dark and under normal illumination. However, if a person has myopia, in addition to such a lens needs to use glasses.
3. A lens with a "yellow filter" - protects the human eye from the harmful effects of ultraviolet radiation and provides good distance vision under normal lighting conditions. However, if a person has myopia, in addition to such a lens needs to use glasses.
4. Multifocal lenses - provide excellent vision both near and far in any lighting conditions. Thanks to multifocal lenses in humans, even in the presence of nearsightedness or farsightedness is almost completely eliminates the need to use additional points.
5. Toric lenses - designed for people who suffer from cataract in addition to corneal astigmatism. The lens allows a person not wearing the special cylindrical glasses to correct astigmatism.

The best lens is accommodating. Slightly inferior to her multifocal. But these kinds of lenses are very expensive, so not everyone has the opportunity to purchase and install them exactly. Basically, in terms of price / comfort best aspherical lens is - and it is quite inexpensive, and provides good vision in all light conditions. A need for additional use of glasses is not too burdensome, because people tend to have grown accustomed to the subject.

Complications of cataract surgery

According to the American Society of Cataract and Refractive Surgery, performed annually in the United States about 3 million cataract surgery (IOL) per year (in Russia there is no data). The number of successful operations of more than 98 percent. Complications arising at the moment in the majority of cases treated successfully conservatively or surgically.

The most common complication is the posterior lens capsule opacification or "secondary cataracts." It is found that the frequency of its occurrence depends upon the material from which the lens is made. Thus, for IOLs of polyacrylic it amounts to 10%, while as for silicone - about 40%, and for products made from polymethylmethacrylate (PMMA) - 56%. The true causes leading to it, and effective methods of prevention are not currently installed.

It is believed that this complication could be due to the migration into the space between the lens and the posterior capsule of cells lens epithelium, remaining after the removal, and as a result, formation of deposits degrade the quality Images. The second possible reason is considered fibrosis of the lens capsule. Treatment is carried out using a YAG laser, with which a hole is formed in the central zone of the opaque posterior lens capsule.

In the early postoperative period may increase IOP. The reason for this may be incomplete washout viscoelastic (gel special preparation administered into the anterior chamber structures to protect it from damage), and entering it into the drainage system of the eye, and the development bias at the pupillary block to IOLs iris. In most cases, the application of droplets antiglaucoma for several days.

prevention

If there is a risk of developing cataracts, it is important to use a comprehensive means of prevention. These areas include the use of drops (Kvinaks, Taufon, Vitsetin etc.), After prior consultation with the doctor.

The rest of the preventive measures are as follows:

1. Wearing sunglasses can block UV light from entering the lens of the eye.
2. Obligatory visits to an ophthalmologist at least 2 times a year.
3. Regular measurements of blood sugar levels and timely treatment of diabetes.
4. The use of foods rich in antioxidants, as well as fruits and vegetables.
5. Frequent hand washing, which allows you to protect several organs of sight from the ingress of infection of various origins, which reduces the risk of developing cataracts.
6. Getting rid of bad habits.
7. Safety measures when working with potentially hazardous materials, in hot shops, chemical laboratories and so on.

However, doctors say that the universal methods of prevention of the disease are absent. Therefore, persons older than 65 be sure to regularly visit an ophthalmologist and detection lens opacities in a timely manner to treat this pathology. As for the people, not stepped this age limit, they need to visit a doctor at least once in 4 years, and a balanced diet.

Advice

If you find yourself or your family cataract symptoms that will help you to heed the following advice:

1. Do not allow your eyes to blindness from cataracts;
2. Sign up for a consultation with an ophthalmologist to confirm the diagnosis;
3. Do not self-medicate;
4. For maximum results you need to pick up and precisely calculate the optimal patient for an artificial lens;
5. Advertising promises to cure cataract drops, and tablets - is a way of cheating by unscrupulous employers;
6. A successful result of the operation depends on the 90% of professionalism cataract surgery;
7. Do you have a reasonable opportunity to save on medication by choosing clinics that perform special actions for their patients.

Cataracts - a disease which reduces lens clarity, it becomes cloudy, light that impairs its conductivity. Such a defect may be caused by external damage to the optic sheath (trauma, radiation) and internal pathologies (diabetes). Sometimes cataract it passes without any significant consequences for the person, but in some cases it leads to blindness due to complete loss of the ability to conduct light lens.

The only effective treatment for the disease is a surgical procedure, which It passes in sufficiently coarse form, and with the activation of virtually painless laser methods.