Everything about Cataracts, from Symptoms to Treatment.

Happy friend Hermina,

             Cataract is a clouding of the lens of the eye or its capsule (around the transparent membrane) which can block the passage of light through the lens to the retina of the eye. If the size is large enough or located in the path of light entry, it can reduce visual acuity.

In general, cataracts are related to the aging process which can start at the age of 40 years. The speed of development of cataracts and the extent of cataracts vary greatly from person to person. This disease process develops gradually, so that in the fourth or fifth decade the cataract will finally mature and make the lens completely cloudy, disrupting routine activities. Treatment options including correction with glasses can be done in the early stages of cataract. Meanwhile, in the mature stage of cataract, surgery is the main choice.

             The World Report on Vision in 2019 reported that 2.2 billion people had vision problems. In 2017, the Indonesian Eye Doctors Association (Perdami) stated that 81.2% experienced cataracts, generally occurring at ages over 50 years. Cataracts are the main cause of blindness worldwide.

Several factors influence the occurrence of cataracts:

1. Congenital cataracts: research shows that there is a close relationship between congenital cataracts and maternal nutrition, infections (Rubella and Rubeola), and lack of oxygenation due to placental bleeding.
2. Age-related (senile cataract): the most common type of cataract.
3. Traumatic injury1,2: The most common cause of unilateral cataracts in young adults. Trauma can be: perforation, blunt force, electric shock, ultraviolet radiation, ionizing radiation, chemical trauma.
4. Endocrine Diseases3: Diabetes mellitus, Hypoparathyroidism, Cretinism.
5. Primary Eye Diseases: Chronic anterior uveitis, high myopia, hereditary fundal dystrophy.
6. Medications: Corticosteroids and anticholinesterase inhibitors.
7. Malnutrition4: ​​a diet that lacks antioxidants and vitamins.
8. Alcohol and smoking.

               Cataract patients may complain of any of the following symptoms. Gradual decrease in vision, blurry feeling as if there is smoke blocking it, the patient also complains of shadowy vision as if there are tears. Apart from that, complaints of sensitivity or glare to light, especially when exposed to car headlights or exposed to sunlight during the day. Color vision problems may also be found, such as objects appearing faded or yellow.

Cataracts can be evaluated and diagnosed with the following steps:

1. History: the patient's main complaint is decreased/impaired vision, history of eye conditions in the past, history of systemic diseases that cause or worsen symptoms.
2. Comprehensive eye examination: visual acuity and refraction, slit-lamp examination, pupil response, and eye fundus/nerve examination by dilating the pupil. If there are abnormalities on examination of the posterior segment of the eye, for example age-related macular degeneration or retinopathy in diabetics, it can be an important factor in determining the visual results after surgery.

Treatment options depend on the degree of cloudiness that is affecting important daily activities. If visual acuity is 6/24 or better, treatment with medication or glasses may be considered. Recently there has been research on drops that can dissolve cataracts, but they are still in the trial stage. Cataract surgery can be chosen if visual acuity is worse than 6/24 or there are medical indications (phacolytic glaucoma, phacomorphic glaucoma, retinal detachment) where cataracts have a negative impact on visual conditions. Before surgery is carried out, there are several general conditions that must be evaluated in order to get better surgical results, including diabetes, hypertension, heart disease, nerve disease, and respiratory tract disease.

The prognosis of visual outcomes in cataract surgery depends on several factors such as the level of visual impairment, type of cataract, time and method of intervention, unilateral or bilateral eye involvement, and the presence of other systemic diseases. In the majority of cases, surgery restores vision very effectively. Recent studies reveal that in the majority of cases, the prognosis after surgery is very good, reaching 70-95%, if the patient strictly follows the post-operative instructions and treatment regimen suggested by the ophthalmologist.5 It is recommended to have regular eye examinations, which will detect development of cataracts in the other eye.

There are several things you can do to prevent the occurrence or worsening of cataracts, including:

• Stop smoking and consuming alcohol, which interfere with general health conditions, including the risk of cataracts.
• Maintain a healthy diet and good physical activity, to optimize antioxidant levels in the body to maintain eye health.
• Do regular medical check-ups, cataracts are closely related to diabetes and hypertension.
• Use glasses that protect your eyes from UVB rays when outdoors.
• Consult an ophthalmologist to carry out an eye health test at least once a year.

So Friends of Hermina, if you experience complaints such as the signs and symptoms described above, immediately consult an Eye Specialist so that you can detect further and immediately plan cataract surgery.

Best Regards.