Cataracts

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | References

Definition

Cataracts are a common eye condition characterised by clouding of the lens, leading to a decrease in vision. They typically develop slowly and can affect one or both eyes.

Aetiology

Cataracts can result from a variety of factors, including:

• Aging (senile cataracts)
• Trauma to the eye
• Radiation exposure
• Genetic factors
• Diabetes mellitus
• Prolonged use of corticosteroids
• Previous eye surgery

Pathophysiology

The lens of the eye is made up of proteins and water. Over time, the proteins can clump together and form cloudy areas in the lens. This clouding scatters light as it passes through the lens, preventing a sharply defined image from reaching the retina, leading to vision impairment.

Risk Factors

• Advanced age
• Family history of cataracts
• Diabetes
• Excessive exposure to sunlight (UV radiation)
• Smoking
• Obesity
• Hypertension
• Prolonged use of corticosteroid medications

Signs and Symptoms

Common signs and symptoms of cataracts include:

• Blurry or cloudy vision
• Difficulty with vision at night
• Sensitivity to light and glare
• Halos around lights
• Frequent changes in eyeglass or contact lens prescription
• Fading or yellowing of colours
• Double vision in a single eye

Investigations

• Comprehensive eye examination including visual acuity test
• Slit-lamp examination to observe the structures at the front of the eye
• Retinal examination to look for changes in the retina and optic nerve
• Tonometry to measure intraocular pressure

Management

Primary Care Management

• Regular monitoring: Regular eye exams to monitor the progression of cataracts
• Eyewear prescription changes: Updating glasses or contact lenses as needed to improve vision
• Use of brighter lighting: To aid vision in dim conditions
• Referral to an ophthalmologist for further evaluation and management

Specialist Management

• Cataract surgery: The most effective treatment, involving removal of the cloudy lens and replacement with an artificial intraocular lens (IOL)
• Preoperative assessment and planning: Comprehensive evaluation to determine the appropriate type of IOL
• Postoperative care: Follow-up visits to monitor healing and manage any complications
• Management of underlying conditions: Such as diabetes, to prevent further eye complications

References

1. NICE. (2024). Cataracts in Adults: Management. Retrieved from NICE
2. NHS. (2023). Cataracts. Retrieved from NHS
3. British Medical Journal (BMJ). (2022). Cataracts: Diagnosis and Management. Retrieved from BMJ
4. American Academy of Ophthalmology (AAO). (2021). Clinical Practice Guidelines: Cataracts. Retrieved from AAO

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